Idiopathic nodular glomerulosclerosis

Idiopathic nodular glomerulosclerosis is an unusual entity with light micro scopic and ultrastructural features similar to those of nodular diabetic gl omerulosclerosis but without evidence of abnormal glucose metabolism. We re port 2 patients whose renal biopsies showed nodular glomerulosclerosis with afferent and efferent arteriolosclerosis, glomerular basement membrane thi ckening, focal mesangiolysis and capillary microaneurysm formation, and who had no evidence of abnormal glucose metabolism or other features of diabet es mellitus. Review of the literature shows that, of the 27 reported cases of idiopathic nodular glomerulosclerosis (not including the 2 cases reporte d herein), 11 showed evidence of abnormal glucose metabolism or were frankl y diabetic. Of the remaining 16 cases with normal serum blood glucose measu rements, 3 had diabetic retinopathy and 1 had a delayed insulin response cu rve. The cause and pathogenesis of the glomerular nodules are discussed, an d it is suggested that arteriolar stenosis and glomerular ischemia may be i nvolved in the development these lesions. (C) 1999 by the National Kidney F oundation, Inc.