Idiopathic nodular glomerulosclerosis (ING) in an African American (AA) man with hepatitis C

Abstract

Idiopathic nodular glomerulosclerosis (ING) in a non-diabetic patient is uncommon. Nodular glomerulosclerosis is hallmark sign of diabetic nephropathy. ING is a very rare clinicopathological disease associated with smoking, obesity and hypertension, chronic obstructive pulmonary disease and metabolic syndrome. A 68-year-old non-obese African American man with hypertension, smoking and history of hepatitis C presented to the clinic with progressive worsening of lower extremity oedema and declining renal function over few months. Renal biopsy demonstrated nodular glomerulosclerosis. In this case, ING is hypothesised to be associated with hepatitis C along with smoking and hypertension (HTN). We present this case to speculate the existence of yet unknown aetiologies of ING.

Finding of pathological thrombomodulin gene variant in a patient with idiopathic nodular glomerulosclerosis and chronic thrombotic microangiopathy-like changes

“…The finding of a TMA and a thrombomodulin mutation in this report may be a fortuitous discovery that sheds light on a possible connection between the alternative pathway of complement and ING. 1 – 10 , 15 – 27 The connections of ING to hyperlipidemia, obesity, and atherosclerosis are also interesting since they all represent inflammatory states, and this could be suggestive of a role for complement as well. 2 Studies of the coagulation cascade may be useful in ING and TMA presentations given that the coagulation cascade and the complement system interact.…”