Renal Digest
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    Diffuse and nodular diabetic glomerulosclerosis


Differential diagnosis:
Amyloidosis
Monoclonal immunoglobulin deposition disease (MIDD)
Membranoproliferative glomerulonephritis (MPGN), idiopathic, type I
Thrombotic microangiopathy, chronic (CTMA)

Immunofluorescence:   

      Mild linear reactivity for albumin and IgG along the capillary loops; no immune deposits
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Kimmelstiel-Wilson nodules; note nodular accumulation of acellular matrix in the mesangium of a patient with long-standing diabetes mellitus; HandE, 400x
Kimmelstiel-Wilson nodules in diffuse nodular diabetic glomerulosclerosis; PAS, 200x
Large, sclerotic, argyrophilic mesangial nodules and capillary loop mycroaneurisms.
Nodular mesangial sclerosis
Advanced diffuse and nodular diabetic glomerulosclerosis
Thickened capillary loops and nodular mesangial expansion in diabetic glomerulosclerosis, EM 2,200x
Thickened capillary loops and nodular mesangial expansion in diabetic glomerulosclerosis, EM 2,200x
Diabetic glomerulosclerosis, EM 2,200x
Nodular mesangial expansion by matrix, thickened basement membranes; EM, 2,200x
Diffuse and nodular diabetic glomerulosclerosis, EM 1,400x
Nodular mesangial expansion by matrix, hyaline entrapement, foam cell infiltration; EM, 2,200x
Increase in mesangial matrix in the absence of electron-dense deposits. Capillary loops are irregularly thickened.
Nodular accumulation of mesangial matrix, in the absence of electron-dense deposits. Mesangial cells are aggregated at the periphery of the nodule; EM, 2,200x
Nodular expansion of mesangial matrix in diabetic glomerulosclerosis; EM, 3,500x
Mild linear reactivity for IgG is seen in glomerular and tubular basement membranes. Nodular mesangial expansion can also be appreciated; IF, 200x
Linear reactivity for IgG along the capillary loops. Nodular mesangial expansion; IF, 400x
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