Structure and Function in Diabetic Nephropathy: The Importance of Diffuse Glomerulosclerosis

Structural-functional relationships in diabetic nephropathy.

“…Thus, these findings strengthen the light microscope studies of Gellman et al (9). Conversely, these results support the thesis that mesangial EM measurements, based upon a relatively small glomerular sample and perhaps subject to sectioning vagaries (25), accurately represents the general glomerular population.…”

“…Quantitative studies of structural-functional relationships in human diabetic nephropathy are rare. However, in 1959 Gellman et al (9) reported their observations in 53 patients with diabetes of 8 to 24 yr duration and an age of onset of 5 to 70 yr. Despite this obviously mixed group of diabetic patients and the use of only semiquantitative light microscopic observations, these workers were able to correlate hypertension, proteinuria, and renal failure with the severity of diffuse glomerulosclerosis but were unable to define the importance of other structural changes such as glomerular basement membrane (GBM) thickening or to explain how diffuse glomerulosclerosis caused renal failure.…”

Effect of Insulin Therapy on Renal Changes in Spontaneously Diabetic Torii Rats

“…Diabetic nephropathy is usually asymptomatic in its early stages but can have a profound impact on patients who later develop renal failure. The underlying pathogenesis in diabetic nephropathy is mainly related to glomerulosclerosis [4,5], but in human diabetes, extraglomerular lesions such as arteriolar sclerosis and tubulointerstitial degeneration and fibrosis can exacerbate glomerular injury [1,2,4,5,19].…”

“…It is caused by glomerulosclerosis, the pathogenesis of which is related to chronic hyperglycemia [1,4,5]. Patients with advanced diabetic nephropathy have few treatment options and often have a poor prognosis [19,20].…”

The “Kimmelstiel-Wilson Lesion”

“…A "diffuse" glomerular lesion, sometimes associated with, and possibly preceding the nodular, has been described by Bell 4 and has been given increasing recognition in recent years. However, although recent studies 5 suggest that the diffuse lesion may be more closely related to clinical symptoms than the nodular, it must be emphasized that the term "Kimmelstiel-Wilson lesion" is properly applied only to the classical nodular lesion described by the original authors.…”