Nodular glomerulosclerosis: not always diabetic nephropathy.

Nodular glomerulosclerosis -as it was originally described by Kimmelstiel and Wilson- is the main pathognomonic lesion of diabetic nephropathy. However, this particular pattern can also be seen in other conditions such as membranoproliferative glomerulonephritis, light or heavy chain deposition disease, amyloidosis, fibrillary and immunotactoid glomerulonephritis and Takayasu's arteritis. History of diabetes as well as other clinical and pathological features are of crucial importance in order to determine the precise cause of nodular glomerulosclerosis. The term of "idiopathic" nodular glomerulosclerosis (ING) is applied in cases that precise etiology cannot be established, so it is a diagnosis of exclusion. Almost one hundred cases of ING have been published in literature. The majority of these patients are old with long history of hypertension and heavy smoking. Hyperlipidemia and obesity are common too. Patients usually present with proteinuria and renal failure.