Nephrology · NEET PG Preparation Medicine
A 60-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus is evaluated for progressive proteinuria. His urine protein-to…
Practice question from Nephrology (NEET PG Preparation Medicine), with the correct answer and a step-by-step solution.
medium · MCQ · Q-732EAE
A 60-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus is evaluated for progressive proteinuria. His urine protein-to-creatinine ratio is 3.5 g/g, serum creatinine is 1.4 mg/dL, and blood pressure is 150/95 mmHg. Renal ultrasound shows normal-sized, highly echogenic kidneys. Which of the following is the earliest histological glomerular lesion seen in diabetic nephropathy?
- A.Kimmelstiel-Wilson nodules
- B.Thickening of the glomerular basement membraneCorrect answer
- C.Mesangial cell proliferation
- D.Fibrinoid necrosis of afferent arterioles
Solution
The earliest ultrastructural and histological abnormality in diabetic nephropathy is the thickening of the glomerular basement membrane (GBM), followed by mesangial expansion. Kimmelstiel-Wilson nodules (nodular glomerulosclerosis) are pathognomonic but represent a later, advanced stage of diabetic nephropathy.
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