Nodular glomerulosclerosis is associated with: September 2009 and 2011, September 2012

Ans. D: Diabetes Mellitus Nodular glomerulosclerosis refers to a histologic pattern of nodular mesangial sclerosis with accentuated, lobular-appearing glomeruli on renal biopsy. Although nodular glomerulosclerosis is classically described in association with diabetes (the so-called "KimmelstielWilson lesion"), the lesion is not pathognomonic for diabetic nephropathy. In fact, a number of renal conditions have been seen in association with this distinctive, histologic pattern. The differential diagnosis of non-diabetic, nodular glomerulosclerosis includes, but is not limited to: Immunotactoid glomerulosnephritis Fibrillary glomerulosnephritis Fibronectin glomerulosnephritis Cryoglobulinemic glomerulosnephritis Amyloidosis Light Chain Deposition Disease (LCDD) Heavy Chain Deposition Disease (HCDD) Idiopathic Nodular Glomerulosclerosis In order to determine the specific disease responsible for nodular glomerulosclerosis, a deliberate inspection of the renal biopsy (paicularly, Congo red staining) is required. The diagnosis of "idiopathic" nodular glomerulosclerosis remains one of exclusion.