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Diabetic Nephropathy Histology — RACP Adult Medicine MCQ

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EasyNephrologyDiabetic Nephropathy HistologyRACP Adult Medicine

A 55-year-old man presents with bilateral lower limb oedema and proteinuria. He has a history of longstanding poorly controlled type 2 diabetes (20 years). His urine ACR is 350 mg/mmol. Renal biopsy shows nodular glomerulosclerosis (Kimmelstiel-Wilson nodules) with diffuse GBM thickening. What is the diagnosis?

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Correct answer: C — Diabetic nephropathy

Kimmelstiel-Wilson nodules (nodular glomerulosclerosis) with diffuse GBM thickening are pathognomonic for diabetic nephropathy. While most diabetic nephropathy is diagnosed clinically (proteinuria progressing from microalbuminuria to macroalbuminuria in a patient with long-standing diabetes and retinopathy), biopsy is performed when atypical features are present (acute onset, no retinopathy, active sediment, rapid decline). Management includes intensive glycaemic control, RAS blockade, SGLT2 inhibitor, and finerenone for residual albuminuria.

Reference: KHA-CARI – 2024 – Diabetic Nephropathy; KDIGO – 2024 – DM-CKD Guidelines