A 64-year woman with Type II diabetes for 10 years now develops increasing fatigue, dyspnea, and pedal edema. On examination, her blood pressure is 165/90 mm Hg, pulse 90/min, JVP is 4 cm, heart sounds are normal, lungs are clear, and there is 3+ pedal edema. Her urinalysis is positive for 3 gm/L of protein and no casts. Which of the following renal diseases is the most likely diagnosis in this patient?
High-Yield Explanation
The patient is most likely to develop glomerulosclerosis. This can be diffuse or nodular (Kimmelstiel-Wilson nodules). Poor metabolic control is probably a major factor in the progression of diabetic nephropathy.