Nodular glomerulosclerosis in a patient showing impaired glucose tolerance

We report a case showing typical diabetic nodular glomerulosclerosis without retinopathy or other apparent clinical findings of DM except for impaired glucose tolerance. The 57-year-old man had a family history but no personal history of DM. In an extensive examination for DM, the results of funduscopy, daily profile of serum glucose and hemoglobin Alc were entirely within normal limits. However, the oral glucose tolerance test was abnormal. A renal biopsy showed typical nodular lesions (Kimmelstiel-Wilson's lesions). Previously, the interesting feature of transient proteinuria had been recognized. Although hypocellular nodular lesions by light microscopy are characteristic of diabetic nephropathy, renal amyloidosis, carbon disulfide intoxication, multiple myeloma and light chain disease, we concluded that the present lesions had resulted from diabetic nephropathy based on the family history, patient history, impaired glucose tolerance, immunofluorescent findings and electron microscopic observations.