Diabetic nephropathy pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Overview

Thickening of glomerular basement membrane, accumulation of eosinophilic material in the mesangium and intraglomerular hypertension are the major pathophysiologic changes taking place in the nephrons in long standing diabetes mellitus.

Pathophysiology

Gross Pathology

Microscopic Pathology

  • Earliest microscopic change seen in renal biopsy are thickening of glomerular basement membrane and accumulation of glycosylated proteins and eosinophilic material in the mesangium.
  • With progression, the accumulation of extracellular matrix becomes more diffuse and nodular, called Kimmelstein-Wilson lesions.
  • The renal arterioles shows thickening secondary to hypertensive arteriosclerosis and hyperlipidemia.
  • On immunoflorescent microscopy, the GBM shows deposition of non-immunogenic IgG in a linear pattern.

References

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