The Glomerular Lesions of Diabetes mellitus

Abstract

The reports of Kimmelstiel and Wilson 1 and Murakami,2 in 1936, established the identity of special glomerular lesions in association with diabetes mellitus. Since then considerable interest has centered about the location, composition, and pathogenesis of glomerular changes in diabetes. In this communication we wish to record the results of the application of a series of histochemical procedures to the kidneys from six diabetic subjects. Sections from these kidneys, prepared by the usual techniques, demonstrated the glomerular lesions of diabetes as described in the literature.*The findings presented herein serve to add emphasis to the presence of a multiplicity of ingredients within certain of the diabetic glomerular lesions. The observations reflect on the general problem of vascular hyalin by distinguishing further between "cellular hyaline lesions" and "acellular hyaline lesions" within the glomeruli. Also, additional support for the smooth-muscle origin of certain forms of vascular hyalin is presented.Review of Literature Different points of view have evolved since the discussions of 1936.\s=d\ In order to attempt to establish the relationship of the present findings to various avail¬ able descriptions and interpretations, a general review of the literature appears appropriate at this time. Composition and Location of Glomerular Lesions of DiabetesKimmelstiel and Wilson (1936) desig¬ nated the spherical hyaline lesions which they observed in the kidneys from eight diabetics as "intercapillary glomerulosclerosis" because they interpreted the source of the lesion as sclerosis and hyalinization of the "intercapillary connective tissue" of the glomerulus. Allen3 (1941) demonstrated the presence of an endothelial-lined lumen within the lesion by means of serial sections and interpreted the evolution of the nodule as due to a progressive thickening of the capillary wall. Allen3 also reemphasized certain features of the lesion and added to an understanding of its make-up. These as¬ pects may be summarized as follows: (1) The lesions are cellular, but the cellularity varies, consisting mainly of two or three concentric layers of flattened cells at the periphery and an occasional nucleus within the core. (2) A concentric fibrillar structure can be demonstrated by silver stains. (3) The nodular lesion is essen¬ tially collagenous but during its development it may contain ingredients possessing staining properties of noncollagenous type. (4) The nodule resists tryptic digestion in contradistinction to

Exudative lesions in diabetes mellitus

“…Other authors have incorporated the term 'fibrinoid' in their descriptive titles, e.g., 'fibrinoid crescents' (Spuihler and Zollinger, 1943), 'hyaline-fibrinoid lesion' (Koss, 1952), whilst Muirhead, Montgomery, and Booth (1956) described the lesion as the 'acellular hyaline lesion'. Barrie, Askanazy, and Smith (1952) distinguished two types, one affecting the glomerular loops which they called the 'fibrin cap', and one affecting the parietal layer of Bowman's capsule which they called the 'capsular drop'.…”

Diseases of the Kidney (Medical)

“…Renal involvement in periarteritis nodosa was reported by Backman (77) and Suchenwirth (78). Muirhead et al (79) prefer the term "cellular hyaline lesion" for the nodules in diabetic glomerulosclerosis and "acellular hyaline lesion" for the crescentic, globular, oval, or elongated lesions; the cellula � lesion stains like collagen, while the acellular lesion is histochemically similar to the hyaline in hyaline arteriosclerosis. Sommers & Haley (SO) found a muco polysaccharide-like material in glomeruli and arterioles of nondiabetics treated with cortisone which had ultraviolet absorptive qualities indis tinguishable from those of the nodules of diabetic glomerulosclerosis.…”