Nodular glomerulosclerosis in patients without any manifestation of diabetes mellitus

SUMMARY: Aim/Methods:  Diabetic nodular glomerulosclerosis is considered to be the specific renal lesion of diabetes mellitus (DM). However, some cases, in which nodular glomerulosclerosis was found without any manifestation of DM, have also occasionally been reported. We clinicopathologically examined seven cases without a prior history of DM. They consisted of six men and one woman with a mean age of 57 years, and included three cases with family history of DM and six cases with hypertension. Results:  Mean body mass index was 26.2 ± 5.9 (means ± SD) kg/m2 and haemoglobin A1c 5.3 ± 1.1% or haemoglobin A1 7.0 ± 0.6%. Mean plasma glucose levels were 5.3 ± 0.7 mmol/L at fasting and 10.1 ± 1.9 mmol/L at 2 h of 75 g OGTT (normal: 1 patient; impaired glucose tolerance: 4 patients; DM: 2 patients). None of them showed diabetic retinopathy in fundoscopic ophthalmoscopy. Mean serum creatinine was 268 ± 215 μmol/L, urinary protein 5.2 ± 4.0 g/day, and three patients had mild haematuria. Renal biopsy revealed typical nodular glomerulosclerosis, a negative deposition based on an immunofluorescence study, and neither any significant electron dense deposits nor fibrils on electron microscopy. Conclusion:  These patients at presentation had no overt clinical manifestations of glucose intolerance. Diabetic nodular glomerulosclerosis can occur in patients without overt DM, suggesting the role of factors additional to prolonged hyperglycaemia in the pathogenesis of this disorder.