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Diabetic Nephropathy 2

Diabetic nephropathy
histology

Question

Vignette: A 25-year-old female presents to her primary care physician for a routine check-up. She has no complaints and her physical examination is within normal limits. She has a history of Type 1 Diabetes Mellitus and controls her condition with daily insulin injections. The physician decides to assess her kidney function and orders a renal biopsy. The biopsy slide shows an increase in mesangial matrix and thickening of the glomerular basement membrane on light microscopy. Electron microscopy shows diffuse effacement of foot processes. What is the most likely diagnosis?

Choices

A) Minimal change disease

B) Focal segmental glomerulosclerosis

C) Diabetic nephropathy

D) Poststreptococcal glomerulonephritis

E) Membranous nephropathy

Answer

C) Diabetic nephropathy

Explanation

Diabetic nephropathy is a complication of diabetes and is the leading cause of end-stage renal disease. It is characterized histologically by thickening of the glomerular basement membrane, mesangial expansion, and nodular glomerulosclerosis (Kimmelstiel-Wilson nodules). The effacement of foot processes seen on electron microscopy shows the progression to nephrotic syndrome. Because the patient in this vignette has a long-standing history of Type 1 diabetes mellitus and the biopsy shows these characteristic findings, the most likely diagnosis is diabetic nephropathy.

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