Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking

Glen S. Markowitz, Julie Lin, Anthony M. Valeri, Cecilia Avila, Samih H. Nasr, Vivette D. D'Agati

Research output: Contribution to journalArticle

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Abstract

Idiopathic nodular glomerulosclerosis (ING) is an enigmatic condition that resembles nodular diabetic glomerulosclerosis but occurs in nondiabetic patients. We reviewed clinicopathologic features, immunohistochemical profiles, and outcomes in 23 patients with ING diagnosed from among 5,073 native renal biopsy samples (0.45%) at Columbia University from January 1996 to March 2001. This cohort, in which diabetes mellitus was excluded, consisted predominantly of older (mean age, 68.2 years) white (73.9%) men (78.3%). Clinical findings at presentation included renal insufficiency in 82.6% (mean serum creatinine = 2.4 mg/dL), proteinuria (> 3 g/d in 69.6%; mean 24-hour urine protein = 4.7 g/d), and - less frequently - full nephrotic syndrome (21.7%). There was a high prevalence of hypertension (95.7%; mean = 15.1 ± 3.4 years), smoking (91.3%; mean = 52.9 ± 6.9 pack-years), hypercholesterolemia (90%), and extrarenal vascular disease (43.5%). All 23 patients had prominent diffuse and nodular mesangial sclerosis, glomerular basement membrane thickening, arteriosclerosis, and arteriolosclerosis. Immunohistochemical staining for CD34, a marker of endothelial cells, showed an increased number of vascular channels within ING glomeruli compared with normal controls. Follow-up data were available for 17 patients, 6 of whom reached end-stage renal disease (ESRD) (35.3%). By Kaplan-Meier estimates, the median time after biopsy to ESRD was 26 months. Predictors of progression to ESRD included continuation of smoking (P = .0165), lack of angiotensin II blockade (P = .0007), degree of tubular atrophy and interstitial fibrosis (P = .0517), and degree of arteriosclerosis (P = .0096). In conclusion, ING is a progressive vasculopathic lesion linked to hypertension and cigarette smoking.

Original languageEnglish (US)
Pages (from-to)826-835
Number of pages10
JournalHuman Pathology
Volume33
Issue number8
DOIs
StatePublished - Aug 2002
Externally publishedYes

Fingerprint

Diabetic Nephropathies
Smoking
Hypertension
Chronic Kidney Failure
Arteriosclerosis
Arteriolosclerosis
Biopsy
Glomerular Basement Membrane
Kaplan-Meier Estimate
Nephrotic Syndrome
Hypercholesterolemia
Vascular Diseases
Proteinuria
Angiotensin II
Atrophy
Renal Insufficiency
Blood Vessels
Creatinine
Diabetes Mellitus
Fibrosis

Keywords

  • Hypertension
  • Idiopathic nodular glomerulosclerosis
  • Mesangial sclerosis
  • Smoking

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Markowitz, G. S., Lin, J., Valeri, A. M., Avila, C., Nasr, S. H., & D'Agati, V. D. (2002). Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. Human Pathology, 33(8), 826-835. https://doi.org/10.1053/hupa.2002.126189

Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. / Markowitz, Glen S.; Lin, Julie; Valeri, Anthony M.; Avila, Cecilia; Nasr, Samih H.; D'Agati, Vivette D.

In: Human Pathology, Vol. 33, No. 8, 08.2002, p. 826-835.

Research output: Contribution to journalArticle

Markowitz, GS, Lin, J, Valeri, AM, Avila, C, Nasr, SH & D'Agati, VD 2002, 'Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking', Human Pathology, vol. 33, no. 8, pp. 826-835. https://doi.org/10.1053/hupa.2002.126189
Markowitz, Glen S. ; Lin, Julie ; Valeri, Anthony M. ; Avila, Cecilia ; Nasr, Samih H. ; D'Agati, Vivette D. / Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. In: Human Pathology. 2002 ; Vol. 33, No. 8. pp. 826-835.
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abstract = "Idiopathic nodular glomerulosclerosis (ING) is an enigmatic condition that resembles nodular diabetic glomerulosclerosis but occurs in nondiabetic patients. We reviewed clinicopathologic features, immunohistochemical profiles, and outcomes in 23 patients with ING diagnosed from among 5,073 native renal biopsy samples (0.45{\%}) at Columbia University from January 1996 to March 2001. This cohort, in which diabetes mellitus was excluded, consisted predominantly of older (mean age, 68.2 years) white (73.9{\%}) men (78.3{\%}). Clinical findings at presentation included renal insufficiency in 82.6{\%} (mean serum creatinine = 2.4 mg/dL), proteinuria (> 3 g/d in 69.6{\%}; mean 24-hour urine protein = 4.7 g/d), and - less frequently - full nephrotic syndrome (21.7{\%}). There was a high prevalence of hypertension (95.7{\%}; mean = 15.1 ± 3.4 years), smoking (91.3{\%}; mean = 52.9 ± 6.9 pack-years), hypercholesterolemia (90{\%}), and extrarenal vascular disease (43.5{\%}). All 23 patients had prominent diffuse and nodular mesangial sclerosis, glomerular basement membrane thickening, arteriosclerosis, and arteriolosclerosis. Immunohistochemical staining for CD34, a marker of endothelial cells, showed an increased number of vascular channels within ING glomeruli compared with normal controls. Follow-up data were available for 17 patients, 6 of whom reached end-stage renal disease (ESRD) (35.3{\%}). By Kaplan-Meier estimates, the median time after biopsy to ESRD was 26 months. Predictors of progression to ESRD included continuation of smoking (P = .0165), lack of angiotensin II blockade (P = .0007), degree of tubular atrophy and interstitial fibrosis (P = .0517), and degree of arteriosclerosis (P = .0096). In conclusion, ING is a progressive vasculopathic lesion linked to hypertension and cigarette smoking.",
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AB - Idiopathic nodular glomerulosclerosis (ING) is an enigmatic condition that resembles nodular diabetic glomerulosclerosis but occurs in nondiabetic patients. We reviewed clinicopathologic features, immunohistochemical profiles, and outcomes in 23 patients with ING diagnosed from among 5,073 native renal biopsy samples (0.45%) at Columbia University from January 1996 to March 2001. This cohort, in which diabetes mellitus was excluded, consisted predominantly of older (mean age, 68.2 years) white (73.9%) men (78.3%). Clinical findings at presentation included renal insufficiency in 82.6% (mean serum creatinine = 2.4 mg/dL), proteinuria (> 3 g/d in 69.6%; mean 24-hour urine protein = 4.7 g/d), and - less frequently - full nephrotic syndrome (21.7%). There was a high prevalence of hypertension (95.7%; mean = 15.1 ± 3.4 years), smoking (91.3%; mean = 52.9 ± 6.9 pack-years), hypercholesterolemia (90%), and extrarenal vascular disease (43.5%). All 23 patients had prominent diffuse and nodular mesangial sclerosis, glomerular basement membrane thickening, arteriosclerosis, and arteriolosclerosis. Immunohistochemical staining for CD34, a marker of endothelial cells, showed an increased number of vascular channels within ING glomeruli compared with normal controls. Follow-up data were available for 17 patients, 6 of whom reached end-stage renal disease (ESRD) (35.3%). By Kaplan-Meier estimates, the median time after biopsy to ESRD was 26 months. Predictors of progression to ESRD included continuation of smoking (P = .0165), lack of angiotensin II blockade (P = .0007), degree of tubular atrophy and interstitial fibrosis (P = .0517), and degree of arteriosclerosis (P = .0096). In conclusion, ING is a progressive vasculopathic lesion linked to hypertension and cigarette smoking.

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