Recent issue of JASN talks about this interesting topic.
Alas, more classifications to add to our terminology. This one might be useful. The Renal Pathology Society made a system for DM Nephropathy now. They divided diabetic nephropathy into four hierarchical glomerular lesions with a separate evaluation for degrees of interstitial and vascular involvement. Biopsies diagnosed as diabetic nephropathy were classified as follows:
Class I, glomerular basement membrane thickening: isolated glomerular basement membrane thickening.
Class II, mesangial expansion, mild (IIa) or severe (IIb): glomeruli classified as mild or severe mesangial expansion but without nodular sclerosis (Kimmelstiel-Wilson lesions) or global glomerulosclerosis in more than 50% of glomeruli.
Class III, nodular sclerosis (Kimmelstiel-Wilson lesions): at least one glomerulus with nodular increase in mesangial matrix (Kimmelstiel-Wilson) without changes described in class IV.
Class IV, advanced diabetic glomerulosclerosis: more than 50% global glomerulosclerosis with other clinical or pathologic evidence that sclerosis is attributable to diabetic nephropathy.
How useful is this going to be clinically? How many diabetic patients do we biopsy nowadays? This might be useful for prognosticating if we had a biopsy specimen in a patient
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