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Nodular Glomerulosclerosis


Presentation

  • Here, we present three patients with edema, heavy proteinuria, chronic renal failure, in whom no past or present symptomatic glucose intolerance or diabetic retinopathy were found.[ncbi.nlm.nih.gov]
  • Fourteen patients (93%) presented with renal insufficiency with mean serum creatinine level of 2.8 mg/dL. All 15 patients presented with proteinuria (mean urinary protein excretion, 5.6 g/24 h).[ncbi.nlm.nih.gov]
  • We present this case to speculate the existence of yet unknown aetiologies of ING.[ncbi.nlm.nih.gov]
  • In this paper, we present the case of a non-diabetic male patient referred to our Department for advanced chronic kidney disease and nephrotic syndrome. After excluding different causes of secondary nephrotic syndrome, a kidney biopsy was performed.[ncbi.nlm.nih.gov]
  • We investigated the nature of Ig deposits in a patient who presented with rapidly progressive renal failure secondary to crescentic nodular glomerulosclerosis.[ncbi.nlm.nih.gov]
Hypertension
  • ING is a very rare clinicopathological disease associated with smoking, obesity and hypertension, chronic obstructive pulmonary disease and metabolic syndrome.[ncbi.nlm.nih.gov]
  • The patients were 75-, 48- and 84-year-old males with a history of long-term hypertension. Laboratory examination revealed moderate proteinuria and mild renal dysfunction.[ncbi.nlm.nih.gov]
  • Recent evidence points to the role of hyperglycemia, hyperlipidemia, hypertension and smoking in the mechanisms of this uncommon condition.[ncbi.nlm.nih.gov]
  • A very rare association among smoking, hypertension and nodular mesangial glomerulosclerosis has been recently described.[ncbi.nlm.nih.gov]
  • Patients with type 2 diabetes and hypertension have characteristic renin-angiotensin system (RAS) gene polymorphisms.[ncbi.nlm.nih.gov]
Suggestibility
  • When the glomerular filtration rate fell to 30 ml/min, the syndrome of mild renal failure, decreased potassium excretion, and hyporeninemic hypoaldosteronism developed, suggesting that kappa light chain nephropathy is a cause of this syndrome.[ncbi.nlm.nih.gov]
  • Light, electron, and immunofluorescence microscopic findings were highly suggestive of diabetic glomerulosclerosis. Interestingly, this patient had no history of diabetes mellitus or diabetic retinopathy.[ncbi.nlm.nih.gov]
  • The cause and pathogenesis of the glomerular nodules are discussed, and it is suggested that arteriolar stenosis and glomerular ischemia may be involved in the development these lesions.[ncbi.nlm.nih.gov]
  • The distribution of this process was focal and segmental, lesions of various stages coexisted, and it was suggested that glomerular lesions may spread all over the kidney by recurrence of this process.[ncbi.nlm.nih.gov]
  • It has recently been suggested that immunotactoid glomerulopathy be separated from much more common fibrillary glomerulonephritis by ultrastructural features of highly organized immune deposits containing tubules of more than 30 nm in diameter.[ncbi.nlm.nih.gov]
Nocturia
  • […] associated with an increased risk of death in general, particularly from cardiovascular disease. [11] [14] Signs and symptoms [ edit ] The onset of symptoms is 5 to 10 years after the disease begins. [1] A usual first symptom is frequent urination at night: nocturia[en.wikipedia.org]

Workup

Small Kidney
  • kidney size Patients are tested for proteinuria by routine urinalysis; if proteinuria is present, testing for microalbuminuria is unnecessary because the patient already has macroalbuminuria suggestive of diabetic renal disease.[merckmanuals.com]
Glucose Tolerance Test Abnormal
  • Only after cortisone stress was the glucose tolerance test abnormal.[annals.org]
Creatinine Increased
  • However, over a 9-month period, serum creatinine increased gradually from 2.4 to 6.3 mg/dL. Proteinuria never fell below 5 g/day; maintenance hemodialysis was initiated due to the development of pericardial effusion, considered a uremic symptom.[ekjm.org]
  • Dose should be decreased if symptoms of orthostatic hypotension develop or serum creatinine increases by more than 30%.[merckmanuals.com]

Treatment

  • For this reason, we urge caution in the empiric cytotoxic treatment of p-ANCA-associated renal disease in stable patients. When possible, a tissue diagnosis should be made.[ncbi.nlm.nih.gov]
  • Early diagnosis and treatment of albuminuria could alter the course of disease progression.[ncbi.nlm.nih.gov]
  • A low protein and low salt diet was started, accompanied by smoking cessation, the administration of diuretics, of antiproteinuric treatment with angiotensin receptor blocker and antihypertensive therapy.[ncbi.nlm.nih.gov]
  • A low-protein diet and potent anti-hypertensive treatment using angiotensin-converting enzyme inhibitors were initiated in all patients and urinary protein excretion significantly reduced without the progression of renal dysfunction.[ncbi.nlm.nih.gov]
  • […] differ in the groups (age, body mass index, duration of diabetes mellitus, HbA1c, prevalence of hypertension, duration of hypertension, serum cholesterol, triglyceride, estimated glomerular filtration rate, and renin-angiotensin-aldosteron system-blocker treatment[ncbi.nlm.nih.gov]

Prognosis

  • SLE Nephropathy Degree of kidney involvement correlates with prognosis in SLE. Anti ds-DNA antibodies. WHO I: Normal WHO II: Increased mesangial matrix WHO III: Focal proliferation WHO IV: Diffuse proliferation, worst.[kumc.edu]
  • Prognosis is good for patients who are meticulously treated and monitored.[merckmanuals.com]
  • […] progression of diabetic nephropathy. [3] Other issues that are important in the management of this condition include control of high blood pressure and blood sugar levels (see diabetes management ), as well as the reduction of dietary salt intake. [24] Prognosis[en.wikipedia.org]

Etiology

  • We speculate that long exposure to smoking may be the etiologic factor for nodular glomerulosclerosis in the kidney graft of our patient.[ncbi.nlm.nih.gov]
  • Exact etiology for the development of non-diabetic glomerulosclerosis is unclear.[ncbi.nlm.nih.gov]
  • Smoking is an important risk factor not only for cardiovascular and pulmonary diseases, but also for the progression of chronic kidney disease of different etiologies.[ncbi.nlm.nih.gov]
  • Molecular genetic approaches for studying the etiology of diabetic nephropathy. Curr Mol Med. 2005 Aug;5(5):509-25. PMID: 16101480[humpath.com]

Epidemiology

  • […] nephropathy is the most common cause of end-stage kidney disease, [11] [12] which may require hemodialysis or even kidney transplantation. [13] It is associated with an increased risk of death in general, particularly from cardiovascular disease. [11] [14] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Each disease-oriented section begins with an up-to-date review of pathophysiology and then focuses on specific diseases.[books.google.de]
  • Written by leading pathologists, this second edition presents an up-to-date, concise presentation of major pathological, clinical, pathophysiological, and genetic information for over 240 diagnoses.[books.google.de]
  • This review will shed light on the pathophysiology, screening, and diagnosis of DKD.[jrenhep.com]
  • "Diabetic Nephropathy: Background, Pathophysiology, Etiology". 2015-06-20. a b Blázquez-Medela AM, López-Novoa JM, Martínez-Salgado C (March 2010). "Mechanisms involved in the genesis of diabetic nephropathy".[en.wikipedia.org]
  • This type of approach may facilitate progress in understanding the pathophysiology of rapidly progressive subtypes of diabetic nephropathy and in formulating prognoses. REFERENCES 1. Tervaert TW, Mooyaart AL, Amann K, et al.[ekjm.org]

Prevention

  • The ability of MSCs to repair damaged mesangium represents a novel therapeutic intervention to reverse mesangial injury and is potentially a powerful and unique approach to prevent progression ending in end-stage renal disease (ESRD).[ncbi.nlm.nih.gov]
  • The lack of animal models has prevented the development of further therapeutic approaches to be tested in platforms such as ex-vivo and in-vivo preparing the way for human studies.[ncbi.nlm.nih.gov]
  • Screening for microalbuminuria and controlling hyperglycemia remain the pillars for the prevention of diabetic nephropathy. However, evidence from multiple studies suggests that controlling DKD is more challenging.[jrenhep.com]
  • Both type I and type II diabetes prevent the body from turning sugar into energy. Normally, eating sugar causes an organ called the pancreas to release the hormone insulin. This insulin turns the sugar into energy.[unckidneycenter.org]
  • Prevention Edit Low protein diet helps in preventing or delaying the onset of kidney disease. High blood pressure requires proper treatment as continued high blood pressure accelerates the onset of kidney disease.[diabetes.wikia.com]

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