Kikuta Tomohiro, Inoue Tsutomu, Watanabe Yusuke, Sato Takahiko, Tsudai Masahiro, Uchida Kousuke, Sueyoshi Keita, Kojima Eriko, Sakurai Takaki, Okada Hirokazu, Takenaka Tsuneo, Suzuki Hiromichi
Department of Nephrology, Saitama Medical University, Japan.
Nihon Jinzo Gakkai Shi. 2010;52(7):959-65.
Diabetic nodular glomerulosclerosis, also known as Kimmelstiel-Wilson syndrome, is a specific pathological variant of diabetic nephropathy ; however, histological findings similar to diabetic nephropathy are observed occasionally without glucose intolerance. Therefore, such nodular glomerulosclerosis is called idiopathic nodular glomerulosclerosis. Several case reports that have been published recently indicate that smoking and hypertension, which are classical renal risk factors, may be attributed to this form of glomerular degeneration. Accordingly smoking- and hypertension-associated nodular glomerulosclerosis has been considered to be different from the idiopathic form. This novel form of nodular glomerulosclerosis is associated with a history of long-term smoking and hypertension, and the age of onset of this disease is more than 60 years. We present the case of a 27-year-old Japanese male who was admitted to our hospital with nephrotic syndrome, hypertension, and renal impairment. He had a smoking history of at least 13 years, and had been exposed to passive smoking for several years because his parents were smokers. Renal biopsy revealed diffuse and global nodular glomerulosclerosis, although the patient did not have any primary diseases such as diabetes mellitus or paraproteinemia, that can cause this condition. We diagnosed smoking- and hypertension-associated nodular glomerulosclerosis. Cessation of smoking and the administration of an angiotensin II receptor blocker decreased his proteinuria and showed recovery of kidney function. This case report suggests that long-term smoking is closely associated with nodular glomerulosclerosis. Further, in our case, the age of the patient was lower than that of patients with the same disease among cases that have been reported previously.
糖尿病结节性肾小球硬化症，也称为金梅尔施泰因-威尔逊综合征，是糖尿病肾病的一种特定病理变体；然而，偶尔会观察到组织学表现与糖尿病肾病相似但不存在葡萄糖不耐受的情况。因此，这种结节性肾小球硬化症被称为特发性结节性肾小球硬化症。最近发表的几例病例报告表明，作为经典肾脏危险因素的吸烟和高血压，可能是这种肾小球变性形式的病因。相应地，与吸烟和高血压相关的结节性肾小球硬化症被认为与特发性形式不同。这种新型结节性肾小球硬化症与长期吸烟和高血压病史相关，且该病的发病年龄超过60岁。我们报告一例27岁日本男性病例，该患者因肾病综合征、高血压和肾功能损害入院。他有至少13年的吸烟史，并且由于其父母吸烟，他曾有几年被动吸烟接触史。肾活检显示弥漫性和全球性结节性肾小球硬化，尽管该患者没有任何可导致这种情况的原发性疾病，如糖尿病或副蛋白血症。我们诊断为与吸烟和高血压相关的结节性肾小球硬化症。戒烟和给予血管紧张素II受体阻滞剂可减少其蛋白尿并显示肾功能恢复。该病例报告表明长期吸烟与结节性肾小球硬化症密切相关。此外，在我们的病例中，患者年龄低于先前报道的同病患者。
