A Case of Idiopathic Nodular Glomerulosclerosis Related to Hypertension and Smoking

Korean Journal of Nephrology 2007;26(4):480-484.

Geun Ho Park, M.D.1, Woong Gil Choi, M.D.1, Wook Hyun Um, M.D.1, Su Hyun Kwon, M.D.1, Seung Won Lee, M.D.1, Joon Ho Song, M.D.1, 2, Seoung Woo Lee, M.D.1, Ji Young Han, M.D.3 and Moon Jae Kim, M.D.1

Department of Internal Medicine¹
Center for Advanced Medical Education by BK21 Project2; Department of Pathology³
Inha University College of Medicine, Incheon, Korea

고혈압 및 흡연과 연관된 특발성 결절성 사구체경화증

박근호1

인하대학교 의과대학 내과학교실1, BK 21사업단2, 병리학교실3

Abstract

A 39-year-old man with a history of hypertension for 10 years and 10 pack-years smoking, was admitted with dyspnea and generalized edema. On admission, renal insufficiency accompanied with nephrotic syndrome was diagnosed. Even on careful examination including history, blood chemistry test, and fundoscopic examination, no clinical evidence of diabetes was found. Renal biopsy findings, which strongly resembled that of diabetic nodular glomerulosclerosis in microscopic features, showed glomerular hypertrophy and nodular mesangeal sclerosis. Additional immunohistochemistry and ultrastructural investigations excluded other possible diseases that should be differentiated; membranoproliferative glomerulonephritis, thrombotic microangiopathy, amyloidosis, monoclonal immunoglobulin deposition disease, fibrillary glomerulonephritis, and immunotactoid glomerulopathy. Idiopathic nodular glomerulosclerosis is histopathologically similar to nodular diabetic glomerulosclerosis but is unusually developed in persons with hypertension and smoking history. Though there were three reports about cases of nodular glomerulosclerosis in the Korean literature, the cases were related to hepatitis B virus or diabetic retinopathy without overt diabetes. We report a rare case of idiopathic nodular glomerulosclerosis that was related to hypertension and smoking without other medical history.

Key Words: Nodular glomerulosclerosis, Hypertension, Smoking