Focal mesangiolysis and the pathogenesis of the Kimmelstiel-Wilson nodule

L. Clarke Stout, Shimareet Kumar, Elbert B. Whorton

Research output: Contribution to journalArticle

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Abstract

Kidneys from 74 consecutively autopsied primarily non-insulin-dependent diabetes cases and 59 age-, sex-, and ethnic group-matched controls were examined qualitatively and semiquantitatively to determine whether focal mesangiolyses (FMs), Kimmelstiel-Wilson (KW) nodules, and glomerular capillary microaneurysms (GCMs) were related lesions, to determine their extent and pathogenic sequence, and to look for associations with structural and functional factors. Light microscopic examination of serial sections, immunohistochemical stains, image analysis, and electron microscopy were used. Focal mesangiolyses, KW nodules, and GCMs occurred in 31 of the 74 diabetes cases (27 had FMs, 29 had KW nodules, and nine had GCMs) and were positively correlated with each other semiquantitatively (r = .71, .70, and .68, respectively). Numerous FMs were found, involving 62% and 78% of the glomeruli in the two most severely affected cases. Most FMs were located at the periphery of KW nodules, but de novo FMs were documented in six cases. Glomerular capillary microaneurysms were deemed occasional complications of FMs because they were much less common, and 25 of the 27 GCMs identified were contiguous with FMs. Focal mesangiolyses and GCMs were deemed transient lesions, being absent in end-stage kidneys. Both FMs and KW nodules consisted of a spectrum of lesions. For the sake of clarity they were arbitrarily divided into two types: edematous and proliferative FMs and simple and complicated KW nodules. Their characteristics suggested the following pathogenic sequence: edematous FM → proliferative FM → focal nodular mesangial expansion → simple KW nodule → recurrent FM → complicated KW nodule. Complicated nodules were associated with marked alterations in the lobular capillary. The number of mesangial cells was increased in FMs and they were thought to be responsible for increased matrix production. Focal mesangiolyses and KW nodules were positively associated with diabetes, proteinuria, and hyalinization of afferent and efferent arterioles, but were weakly or not associated with hypertension, arcuate and interlobular artery stenosis, hydronephrosis, acute pyelonephritis, renal arterial atheromatous emboli, glomerular platelet-fibrin thromboemboli, and congestive heart failure.

Original languageEnglish (US)
Pages (from-to)77-89
Number of pages13
JournalHuman Pathology
Volume24
Issue number1
DOIs
StatePublished - 1993

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Kidney
Mesangial Cells
Hydronephrosis
Pyelonephritis
Arterioles
Embolism
Fibrin
Proteinuria
Ethnic Groups
Microaneurysm
Electron Microscopy
Pathologic Constriction
Coloring Agents
Blood Platelets
Heart Failure
Arteries
Age Groups
Hypertension
Light

Keywords

  • diabetes
  • diabetic nephropathy
  • focal mesangiolysis
  • Kimmelstiel-Wilson nodule

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Focal mesangiolysis and the pathogenesis of the Kimmelstiel-Wilson nodule. / Clarke Stout, L.; Kumar, Shimareet; Whorton, Elbert B.

In: Human Pathology, Vol. 24, No. 1, 1993, p. 77-89.

Research output: Contribution to journalArticle

Clarke Stout, L. ; Kumar, Shimareet ; Whorton, Elbert B. / Focal mesangiolysis and the pathogenesis of the Kimmelstiel-Wilson nodule. In: Human Pathology. 1993 ; Vol. 24, No. 1. pp. 77-89.
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