Nondiabetic nodular glomerulosclerosis: A case-anchored approach to a morphologic convergence pattern

Nodular glomerulosclerosis is most readily associated with diabetic nephropathy, yet a similar morphologic pattern may arise from deposition, organized, metabolic, and vasculopathic disorders. Light-microscopic findings alone may provide little etiologic specificity, particularly when the clinical and exclusionary evaluation is incomplete. We describe a patient without known diabetes in whom matrix-dominant nodular glomerulosclerosis was identified during an undiagnosed multisystem illness with bilateral panuveitis and occlusive retinal vasculitis. The renal lesion had substantial chronic features, but neither a shared mechanism nor complete exclusion of alternative causes could be established. Using this case to illustrate the limits of etiologic attribution, we synthesize an established, practical diagnostic approach integrating light microscopy, immunofluorescence, electron microscopy, targeted ancillary studies, and clinical findings. The biopsy findings favor a deposit-free, matrix-dominant pattern; because the serum free light-chain ratio, antiphospholipid testing, and selected complement studies were not performed and electron microscopy sampled one glomerulus, the index case is designated nondiabetic nodular glomerulosclerosis, etiology undetermined. A descriptive diagnosis is preferable to an idiopathic label when clinically relevant exclusions remain incomplete.