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Abstract: FR-PO653

Presence of Kimmelstiel-Wilson Nodules in Diabetic Nephropathy Correlates with Duration of Diabetes and Poor Glycemic Control

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical


  • Sircar, Monica, MGH, Boston, Massachusetts, United States
  • Rosales, Ivy A., MGH, Boston, Massachusetts, United States
  • Xu, Dihua, MGH, Boston, Massachusetts, United States
  • Kalim, Sahir, MGH, Boston, Massachusetts, United States
  • Thadhani, Ravi I., MGH, Boston, Massachusetts, United States

Mesangial nodules are regarded as a major histologic correlate of diabetic nephropathy. However, whether there is an association between the presence of nodules with various stages of diabetic chronic kidney disease (CKD) is not known. Here we report clinicopathologic association between the presence of nodules in diabetic patients with varying stages of CKD.


All seventy-five available autopsy records and charts from 2013 to 2016 of type 1 and 2 diabetics were examined. Twenty-six patients had all necessary demographic data in their records, including age, sex, race, hemoglobin A1c level, duration of diabetes, hypertension status, at least 2 creatinine levels within the last six months prior to death, and treatment information. Archived autopsy kidney sections were reviewed by a pathologist blind to clinical data. Nineteen kidneys free of autolysis were systematically assessed for (i) percent global glomerulosclerosis, (ii) mesangial hypercellularity, (iii) percent glomeruli with nodules, and (iv) percent interstitial fibrosis.


Mesangial nodules were present in diabetic patients with CKD II (50%, n=4), III (86%, n=7), IV (86%, n=7), and V (100%, n=1). Poor glycemic control, defined as HgbA1c >7.5% (Welch’s t test p = 0.035), and duration of diabetes >10 years (p=0.036) showed strong associations with higher percent of nodules. Although a linear trend was evident, the correlation between percent of nodules and CKD stage was not statistically significant. The extent of glomerulosclerosis did not correlate with clinical factors such as age, sex, hypertension, treatment with RAAS blockade or longstanding diabetes.


The presence of nodules in diabetic kidneys showed significant associations with duration of diabetes >10 years and poor glycemic control. Mesangial nodules were present in kidneys of diabetic patients at all stages of CKD, with apparently more nodule formation in the later stages of the disease. These preliminary findings suggest a trend towards increased nodule formation as chronic kidney disease progresses. Together, our study suggests that diabetic nephropathy is associated with significant nodule formation, and the percentage of glomeruli with nodules may be a more definitive readout of CKD progression than determining just the presence or absence of nodules in glomeruli.


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