A 61-year-old man comes to the physician because of progressively worsening swelling of his ankles. He says he has felt exhausted lately. Over the past 3 months, he has gained 5 kg (11 lb). He has smoked one pack of cigarettes daily for 30 years. His pulse is 75/min and his blood pressure is 140/90 mm Hg. Examination shows 2+ pitting edema in the lower extremities. Neurologic examination shows diminished two-point discrimination over the fingers and toes. Laboratory studies show a serum creatinine concentration of 1.9 mg/dL. A urine sample is noted to be foamy. A kidney biopsy is performed; light microscopic findings following staining with hematoxylin and eosin are shown in the image below: Which of the following is the most likely explanation for this patient's biopsy findings?

Question

A 61-year-old man comes to the physician because of progressively worsening swelling of his ankles. He says he has felt exhausted lately. Over the past 3 months, he has gained 5 kg (11 lb). He has smoked one pack of cigarettes daily for 30 years. His pulse is 75/min and his blood pressure is 140/90 mm Hg. Examination shows 2+ pitting edema in the lower extremities. Neurologic examination shows diminished two-point discrimination over the fingers and toes. Laboratory studies show a serum creatinine concentration of 1.9 mg/dL. A urine sample is noted to be foamy. A kidney biopsy is performed; light microscopic findings following staining with hematoxylin and eosin are shown in the image below:  Which of the following is the most likely explanation for this patient's biopsy findings?

Quizplus · Accepted Answer

Eductional Objective: Nodular glomerulosclerosis is characterized by increased mesangial matrix deposition, forming Kimmelstiel-Wilson nodules.  It is most commonly caused by diabetic nephropathy and indicates irreversible glomerular damage with a rapid decline in kidney function.

A 61-Year-Old Man Comes to the Physician Because of Progressively