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Nodular glomerulosclerosis in a kidney transplant recipient with impaired glucose tolerance: diabetic or idiopathic? A case report and literature review

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Abstract

Nodular glomerulosclerosis, typically diagnosed in patients with diabetes mellitus, has been reported in native kidneys of pre-diabetic patients but similar cases in kidney transplant recipients are lacking. We describe a case of nodular glomerulosclerosis in a kidney transplant recipient who had not been found to be diabetic despite regular screening and discuss the implications for the pathogenesis and diagnosis of nodular glomerulosclerosis and screening of post-transplant diabetes mellitus.

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Abbreviations

AGE:

Advanced glycation end product

CKD:

Chronic kidney disease

CNI:

Calcineurin inhibitors

DM:

Diabetes mellitus

DN:

Diabetic nephropathy

EM:

Electron microscopy

HbA1c:

Glycated hemoglobin

HLA:

Human leukocyte antigen

KTR:

Kidney transplant recipient

IFG:

Impaired fasting glucose

IGT:

Impaired glucose tolerance

IMF:

Immunofluorescence

OGTT:

Oral glucose tolerance test

PTDM:

Post-transplant diabetes mellitus

References

  1. American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. Diabetes Care. 2019;42(Suppl 1):S13–28. https://doi.org/10.2337/dc19-S002.

    Article  Google Scholar 

  2. Sharif A, Ravindran VMR. Insulin resistance indexes in renal transplant recipients maintained on tacrolimus immunosuppression. Transplantation. 2010;89(3):327–33. https://doi.org/10.1097/TP.0b013e3181bbf2c4.

    Article  CAS  PubMed  Google Scholar 

  3. Venkataraman K, Khoo CMLM. New measure of insulin sensitivity predicts cardiovascular disease better than HOMA estimated insulin resistance. PLoS ONE. 2013;8(9):e74410. https://doi.org/10.1371/journal.pone.0074410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jia T, Huang XQA. Validation of insulin sensitivity surrogate indices and prediction of clinical outcomes in individuals with and without impaired renal function. Kidney Int. 2014;86(2):383–91. https://doi.org/10.1038/ki.2014.1.

    Article  CAS  PubMed  Google Scholar 

  5. Paul Kimmelstiel CW. Intercapillary lesions in the glomeruli of the kidney. Am J Pathol. 1936;12(1):83–98.

    Google Scholar 

  6. K O Alsaad AMH. Distinguishing diabetic nephropathy from other causes of glomerulosclerosis: an update. J Clin Pathol. 2007;60(1):18–26. https://doi.org/10.1136/jcp.2005.035592.

    Article  Google Scholar 

  7. Baradhi KM, Gary Abuelo JSI. The case: diabetic nephropathy in a nondiabetic smoker? Kidney Int. 2012;82(10):1141–2. https://doi.org/10.1038/ki.2012.333.

    Article  PubMed  Google Scholar 

  8. Markowitz GS, Lin J, Valeri AM, Avila C, Nasr SHDVD. Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. Hum Pathol. 2001;33(8):826–35. https://doi.org/10.1053/hupa.2002.126189.

    Article  Google Scholar 

  9. Qian Y, Feldman E, Pennathur S, Matthias Kretzler FCBI. From fibrosis to sclerosis: mechanisms of glomerulosclerosis in diabetic nephropathy. Diabetes. 2008;57(6):1439–45. https://doi.org/10.2337/db08-0061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Mise K, Ueno THJ. Nodular lesions in diabetic nephropathy: collagen staining and renal prognosis. Diabetes Res Clin Pr. 2017;127:187–97. https://doi.org/10.1016/j.diabres.2017.03.006.

    Article  Google Scholar 

  11. Wada T, Shimizu MYH. Nodular lesions and mesangiolysis in diabetic nephropathy. Clin Exp Nephrol. 2013;17(1):3–9. https://doi.org/10.1007/s10157-012-0711-6.

    Article  PubMed  Google Scholar 

  12. Jonatan Barrera-Chimal FJ. Pathophysiologic mechanisms in diabetic kidney disease: a focus on current and future therapeutic targets. Diabetes Obes Metab. 2020;22(Suppl 1):16–31. https://doi.org/10.1111/dom.13969.

    Article  CAS  PubMed  Google Scholar 

  13. Nyumura I, Honda K, Babazono T, et al. Recurrence of diabetic kidney disease in a type 1 diabetic patient after kidney transplantation. Nephrol (Carlton). 2015;20(Suppl 2):90–2. https://doi.org/10.1111/nep.12454.

    Article  Google Scholar 

  14. Rodriguez Cubillo B, Rodriguez B, Calvo M, de la Manzanara V, Bautista J, Perez-Flores I, Calvo N, Moreno A, Shabaka A, Delgado JS-FA. Risk factors of recurrence of diabetic nephropathy in renal transplants. Transpl Proc. 2016;48(9):2956–8. https://doi.org/10.1016/j.transproceed.2016.07.045.

    Article  CAS  Google Scholar 

  15. Coemans M, Van Loon E, Lerut E, Gillard P, Sprangers B, Senev A, Emonds M-P, Van Keer J, Callemeyn J, Daniëls L, Sichien J, Verbeke G, Kuypers D, Chantal Mathieu MN. Occurrence of diabetic nephropathy after renal transplantation despite intensive glycemic control: an observational cohort study. Diabetes Care. 2019;42(4):625–34. https://doi.org/10.2337/dc18-1936.

    Article  PubMed  Google Scholar 

  16. Nishihama K, Nakai T, Kanai K, Sugiyama T. A Case of “Hidden” Diabetic nephropathy diagnosed by a combination of renal biopsy findings and continuous glucose monitoring system. CEN Case Rep. 2015;4(1):101–5. https://doi.org/10.1007/s13730-014-0150-1.

    Article  PubMed  Google Scholar 

  17. Bhatt AP, Gupta A, Vibha D, Sharma A, Mahajan S. Florid diabetic complications in impaired glucose tolerance. Saudi J Kidney Dis Transpl. 2013;24(1):86–8.

    Article  Google Scholar 

  18. Kinoshita C, Inoue Y. A case of idiopathic nodular glomerulosclerosis with fibrin caps. Clin Exp Nephrol. 2011;15(6):937–41. https://doi.org/10.1007/s10157-011-0513-2.

    Article  PubMed  Google Scholar 

  19. Sanai T, Okuda S, Yoshimitsu T, et al. Nodular Glomerulosclerosis in patients without any manifestation of diabetes mellitus. Nephrol. 2007;12(1):69–73. https://doi.org/10.1111/j.1440-1797.2006.00743.x.

    Article  CAS  Google Scholar 

  20. Chang CS, Yang CHC AH. Nodular glomerulosclerosis mimicking diabetic nephropathy without overt diabetes mellitus. Clin Nephrol. 2005;64(4):300–4.

    Article  CAS  Google Scholar 

  21. Altiparmak MR, Pamuk ON, Pamuk GE, Apaydin GO S. Diffuse diabetic glomerulosclerosis in a patient with impaired glucose tolerance: report on a patient who later develops diabetes mellitus. Neth J Med. 2002;60(6):260–2.

    CAS  PubMed  Google Scholar 

  22. Karalliedde JGL. Diabetes mellitus, a complex and heterogeneous disease, and the role of insulin resistance as a determinant of diabetic kidney disease. Nephrol Dial Transpl. 2016;31(2):206–13. https://doi.org/10.1093/ndt/gfu405.

    Article  CAS  Google Scholar 

  23. Sharif ACS. Post-transplantation diabetes-state of the art. Lancet Diabetes Endocrinol. 2016;4(4):337–49. https://doi.org/10.1016/S2213-8587(15)00387-3.

    Article  PubMed  Google Scholar 

  24. Nasr SHDVD. Nodular glomerulosclerosis in the nondiabetic smoker. J Am Soc Nephrol. 2007;18(7):2032–6. https://doi.org/10.1681/ASN.2006121328.

    Article  PubMed  Google Scholar 

  25. Nakamura N, Taguchi KMY. AGEs-RAGE overexpression in a patient with smoking-related idiopathic nodular glomerulosclerosis. CEN Case Rep. 2018;7(1):48–54. https://doi.org/10.1007/s13730-017-0290-1.

    Article  PubMed  Google Scholar 

  26. Whaley-Connell A, Sowers JR. Insulin resistance in kidney disease: is there a distinct role separate from that of diabetes or obesity? Cardiorenal Med. 2018;8(1):41–9. https://doi.org/10.1159/000479801.

    Article  CAS  Google Scholar 

  27. Wu J, Yu S, Tejwani V, Mao M. Idiopathic nodular glomerulosclerosis in Chinese patients: a clinicopathologic study of 20 cases. Clin Exp Nephrol. 2014;18(6):865–75. https://doi.org/10.1007/s10157-013-0929-y.

    Article  PubMed  Google Scholar 

  28. Choung HG, Bomback ASSM. The spectrum of kidney biopsy findings in patients with morbid obesity. Kidney Int. 2019;95(3):647–54. https://doi.org/10.1016/j.kint.2018.11.026.

    Article  PubMed  Google Scholar 

  29. Shivaswamy V, Boerner B, Larsen J. Post-transplant diabetes mellitus: causes, treatment, and impact on outcomes. Endocr Rev. 2016;37(1):37–61. https://doi.org/10.1210/er.2015-1084.

    Article  CAS  PubMed  Google Scholar 

  30. Naesens M, Kuypers DRSM. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol. 2009;4(2):481–508. https://doi.org/10.2215/CJN.04800908.

    Article  CAS  PubMed  Google Scholar 

  31. Sharif A, Hecking M, de Vries APJ, Porrini E, Hornum M, Rasoul-Rockenschaub S, Berlakovich G, Krebs M, Kautzky-Willer A, Schernthaner G, Marchetti P, Pacini G, Ojo A, Takahara S, Larsen JL, Budde K, Eller K, Pascual J, Jardine A, Bakker SJL, Vald MDS TG. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transpl. 2004;14(9):1992–2000. https://doi.org/10.1111/ajt.12850.

    Article  Google Scholar 

  32. Valderhaug TG, Jenssen T, Hartmann A, Midtvedt K, Holdaas H. Fasting plasma glucose and glycosylated hemoglobin in the screening for diabetes mellitus after renal transplantation. Transplantation. 2009;88(3):429–34. https://doi.org/10.1097/TP.0b013e3181af1f53.

    Article  PubMed  Google Scholar 

  33. Bergrem HA, Valderhaug TGHA. Undiagnosed diabetes in kidney transplant candidates: a case-finding strategy. Clin J Am Soc Nephrol. 2010;5(4):616–22. https://doi.org/10.2215/CJN.07501009.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Jung M, Warren BGM. Performance of non-traditional hyperglycemia biomarkers by chronic kidney disease status in older adults with diabetes: results from the atherosclerosis risk in communities study. J Diabetes. 2018;10(4):276–85. https://doi.org/10.1111/1753-0407.12618.

    Article  CAS  PubMed  Google Scholar 

  35. Galindo RJ, Beck RW, Scioscia MF, Umpierrez GETK. Glycemic monitoring and management in advanced chronic kidney disease. Endocr Rev. 2020;41(5):bnaa017. https://doi.org/10.1210/endrev/bnaa017.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Renal Medicine, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore

    Zhong Hong Liew, Marjorie Foo, Terence Kee & Quan Yao Ho

  2. Division of Pathology, Singapore General Hospital, Singapore, Singapore

    Puay Hoon Tan

  3. SingHealth-Duke NUS Transplant Centre, SingHealth, Singapore, Singapore

    Terence Kee & Quan Yao Ho

Authors
  1. Zhong Hong Liew
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  2. Puay Hoon Tan
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  4. Terence Kee
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All authors participated in the care of the patient and the writing of the paper.

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Correspondence to Quan Yao Ho.

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Liew, Z.H., Tan, P.H., Foo, M. et al. Nodular glomerulosclerosis in a kidney transplant recipient with impaired glucose tolerance: diabetic or idiopathic? A case report and literature review. CEN Case Rep 10, 273–280 (2021). https://doi.org/10.1007/s13730-020-00546-x

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  • DOI: https://doi.org/10.1007/s13730-020-00546-x

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