Nodular Glomerulosclerosis: Renal Lesions in Chronic Smokers Mimic Chronic Thrombotic Microangiopathy and Hypertensive Lesions

Cigarette smoking is associated with vascular lesions and chronic renal failure. In this report, we describe clinical and kidney biopsy findings for a 66-year-old woman with a history of long-term heavy cigarette smoking who developed proteinuria and decreasing renal function. This study also describes clinical and kidney biopsy findings for 9 patients with a history of smoking. None of these patients had hypertension, diabetes mellitus, or other risk factors that might result in vascular injury. Renal biopsy specimens showed a range of long-term changes with varying degrees of focal segmental or focal global glomerulosclerosis, nodular glomerulosclerosis, ischemic glomeruli, interstitial fibrosis and tubular atrophy, and mild to moderate arterial sclerosis and arteriolar hyalinosis. Electron microscopy often showed glomerular capillary wall thickening caused by subendothelial expansion by cellular elements and new basement formation resulting in segments of double contours. These changes indicate endothelial injury and glomerular capillary wall remodeling; the lesions mimic those seen in patients with chronic hypertension and chronic or healed thrombotic microangiopathies.