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Updated: Jul 29, 2025

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Diabetic nephropathy with marked extra-capillary cell proliferation: a case report.

Madoka Morimoto1, Tomoko Namba-Hamano2, Shoki Notsu3

  • 1Department of Nephrology, Sakai City Medical Center, 1-1-1 Ebaraji-Cho, Nishi-Ku, Sakai City, Osaka, Japan. m_i_morimoto@sakai-hospital.jp.

BMC Nephrology
|May 22, 2023
PubMed
Summary

Extra-capillary hypercellularity is a rare finding in diabetic nephropathy (DN). This case study identified epithelial cell proliferation as the origin of this atypical lesion in DN, aiding diagnosis.

Keywords:
Crescentic glomerulonephritisDiabetic nephropathyExtra-capillary cell proliferationFocal segmental glomerulosclerosisParietal epithelial cellPodocyte

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Area of Science:

  • Nephrology
  • Pathology
  • Immunohistochemistry

Background:

  • Extra-capillary hypercellularity is common in crescentic glomerulonephritis (GN) and focal segmental glomerulosclerosis (FSGS).
  • In diabetic nephropathy (DN), it often indicates superimposed conditions like IgA nephropathy or microscopic polyangiitis.
  • Rarely, epithelial cell proliferation can occur directly within DN.

Observation:

  • A patient with nephrotic syndrome presented with nodular diabetic glomerulosclerosis and significant extra-capillary hypercellularity.
  • Serological and immunofluorescence results did not suggest other forms of crescentic GN.
  • Immunostaining for claudin-1 and nephrin was used to investigate the source of the extra-capillary lesions.

Findings:

  • The study identified epithelial cell proliferation as the cause of extra-capillary hypercellularity in a case of nodular diabetic glomerulosclerosis.
  • Immunostaining for claudin-1 and nephrin proved crucial in determining the origin of these atypical lesions.
  • The findings support a diagnosis of DN-associated extra-capillary cell proliferation.

Implications:

  • Extra-capillary hypercellularity in diabetic nephropathy is a rare but significant finding that requires careful consideration.
  • Co-staining for claudin-1 and nephrin can aid in diagnosing this specific manifestation of diabetic nephropathy.
  • This approach helps differentiate DN-associated proliferation from other forms of GN.