Journal of Diabetes Research / 2017 / Article / Tab 3

Review Article

Classification and Differential Diagnosis of Diabetic Nephropathy

Table 3

Differential diagnosis of DN with another nodular glomerulopathy.

DiseaseClinical manifestationsLight microscopyImmunofluorescence microscopyElectron microscopy

Diabetic nephropathyLong duration of diabetesMesangial nodular sclerosis; PAS (+); silver (+)Linear deposition of immunoglobulin (Ig) G, with or without IgM and C3 in sclerotic nodulesMesangial expansion; diffuse GBM thickening; nonspecific fibrillar deposition

Membranoproliferative glomerulonephritisChronic nephritis, nephrotic syndrome, hypertension, hypocomplementemiaMesangial nodular sclerosis; mesangial insertion; double contouring; PAS (+); silver (+)Granular deposition of multiple immunoglobulin
deposition and complement components
Subendothelial (type I), intramembranous, often ribbon-like or nodular (type II), subepithelial (type III) electron-dense deposits

Renal amyloidosisChronic infection, systemic amyloidosis, lymphoproliferative disease, long-term dialysis, family inheritanceMesangial nodular sclerosis; Congo red (+)Light chain (+) in the mesangium, GBM, tubulointerstitium, and blood vessel wallAmyloid fibrils (randomly oriented, nonbranching, 9−11 nm in diameter)

Monoclonal immunoglobulin/light chain deposition diseaseAgeing, plasma cell dyscrasia, idiopathicMesangial nodular sclerosis; PAS (+); silver (−)Monoclonal light chain (+) in the GBM, TBM, and vascular wall basement membranesGranular, powdery deposits

Type III collagen glomerulopathyPersistent proteinuria, nephrotic syndromeMesangial nodular sclerosis; PAS (weak +)Collagen III (+)Parallel collagen fibers (100 nm in diameter)

Fibronectin nephropathyA rare autosomal dominant disease, nephrotic syndromeMesangial nodular sclerosis; PAS (+); Congo red (−)Fibronectin (+)Granular deposits with short fibers (10−14 nm in diameter)

Cryoglobulinemia glomerulosclerosisProteinuria, nephrotic syndrome, high serum cryoglobulins, lymphoproliferative disordersIntracapillary proliferation and inflammatory cell infiltrates, intracapillary thrombi, nodular glomerulosclerosis; double contouring; PAS (+)Monoclonal or polyclonal immunoglobulin (IgM, IgG and C3), rheumatoid factorOrganized electron-dense deposits (microtubular, 30 nm in diameter)

Idiopathic nodular glomerulosclerosisSmoking, long-standing hypertension; normal glucose metabolismSimilar to those of nodular diabetic glomerulosclerosis,IgG and albuminNo electron-dense or fibrillar deposits

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