Idiopathic Nodular Glomerulosclerosis: A Case Report

Nodular glomerulosclerosis, although once identified as a histopathological diagnosis identical with diabetes mellitus (DM), can be seen in many diseases like membranoproliferative glomerulonephritis, amyloidosis, fibrillary and immunotactoid glomerulopathy. Idiopathic nodular glomerulosclerosis (ING) can be diagnosed by exclusion of these diseases. Medical history, serology and immunohistochemical and electron microscopical examination of renal biopsy are helpful also. ING has been related with smoking and hypertension in recent studies. Herein, we present a case of ING who is smoker and had hypertension for seven years.

A 43 year-old man with swollen ankles had laboratory examinations showing creatinine:2.1mg/ dl, albumin:2.9g/l and daily proteinuria:4380mg. Hepatitis B surface antigen was positive. DM was excluded. Renal size was normal by ultrasound. Renal biopsy contained 30 glomeruli, 18 of which were globally sclerotic. Mesangial nodular lesions were striking in the others. With these findings we diagnosed ING.

As a result, relation of ING with smoking and hypertension has been highlighted by recent studies. ING should be considered if nodular glomerulosclerosis is identified in renal biopsy of a smoker nondiabetic with hypertension. Although hepatitis B infection is among the classical secondary reasons of nodular glomerulosclerosis; co-existing serum hepatitis B surface antigen positivity has been reported in a few case reports.