Idiopathic nodular glomerulosclerosis

Nodular glomerulosclerosis can be seen in diabetic nephropathy
and idiopathic nodular glomerulosclerosis

Idiopathic nodular glomerulosclerosis (ING) is a recently recognized entity in renal Nasr and D'Agati described pathogenesis of the disease. ING is found mainly in elderly with a long history of smoking and/or hypertension. Their predominant clinical presentation is renal failure.
pathology.
The central player in the pathogenesis is advanced glycation end product (AGE) which is increased in smokers in similar way to hyperglycemia in diabetic patients. Other participating factors include oxidative stress, sympathetic activation, hypoxia and nicotine. The later two involve angiogenesis while AGE and oxidative stress involve increased extracellular matrix production. ING can also be found in non-smoking, hypertensive patients.
The main concern for renal pathologists is that ING has a morphology of nodular glomerulosclerosis identical to diabetic nephropathy. This is not surprising because AGE involves in the pathogenesis of both. Clinical history of diabetes must be established in order for pathologist to call the lesion diabetic nephropathy.