A 50-YEAR-old male presented with blurring of vision. Urine examination showed proteinuria. fundus examination showed dot n blot hemorrhages, microaneurysm and cotton wool spots. Histopath is given below. What is the most probable diagnosis?

Ans. A. Kimmelstiel-Wilson lesionsa. The given history is suggestive of diabetic retinopathy (dot n blot hemorrhages, microaneurysm and cotton wool spots) along with lesion in the kidney (proteinuria)b. Three lesions are encountered: (1) glomerular lesions; (2) Renal vascular lesions, principally arteriolosclerosis and (3) pyelonephritis, including necrotizing papillitis.c. The most important glomerular lesions are capillary basement membrane thickening, diffuse mesangial sclerosis, and nodular glomerulosclerosis.d. This is also known as inter capillary glomerulosclerosis or Kimmelstiel Wilson disease. The glomerular lesions take the form spherical, often laminated, nodules of matrix situated in the periphery of the glomerulus.e. The nodules are PAS-positive. Usually, not all the lobules in the individual glomerulus are involved by nodular lesions, but even lobules and glomeruli show striking mesangial sclerosis.f. Nodular lesions are frequently accompanied by prominent accumulations of hyaline material in capillary loops ("fibrin caps") or adherent to Bowman's capsules ("capsular drops"). Both afferent and efferent glomerular hilar arterioles show hyalinosis.