Topic: ischemic heart disease and diabetes mellitus
Question: Discuss the renal lesions in Diabetes Mellitus
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Glomerular Lesions:
– Diffuse glomerulosclerosis – Diffuse increase in mesangial matrix and thickening of glomerular capillary walls due to accumulation of PAS-positive hyaline material. Leads to proteinuria.
– Nodular glomerulosclerosis (Kimmelstiel-Wilson lesions) – Spherical nodules of hyaline material cause diffuse or nodular glomerular basement membrane thickening. diagnostic of diabetes.
– Hyalinosis of afferent and efferent arterioles – Homogeneous, pink hyaline thickening of arteriolar wall. Causes ischemia.
Tubulointerstitial Lesions:
– Tubular basement membrane thickening – Due to accumulation of PAS-positive material in membrane.
– Tubular atrophy and interstitial fibrosis – Loss of tubular cells, thickening of tubular basement membrane and collagen deposition in interstitium.
– Armanni-Ebstein lesions – Tubular epithelial cells filled with detached Tamm-Horsfall protein casts.
– Interstitial inflammation – Mononuclear leukocytic infiltration between tubules.
Vascular Lesions:
– Arteriolar hyalinosis – Affects afferent arterioles initially, later efferent arterioles.
– Arteriosclerosis – Intimal proliferation, lipid deposition and hyalinization of larger renal arterioles.
– Atherosclerosis – Affects large renal arteries as in systemic atherosclerosis.
In summary, diabetes causes widespread damage to all compartments of the kidney leading to nephropathy
