A Study of Nodular Glomerulopathy – A Single-center Experience and Review

Abstract

ABSTRACT Background: Mesangial expansion is a histopathological manifestation characterized by abnormal proliferation of mesangial cells and accumulation of matrix proteins within the central region of the glomerulus. While diabetes is a well-known cause of mesangial expansion, several rare diseases can also present with this pathology. This study aimed to estimate the prevalence of lesions exhibiting mesangial expansion in a tertiary care center in Tirunelveli, India, and elucidate the spectrum of disorders contributing to mesangial expansion lesions in renal biopsies. Methodology: A retrospective analysis of renal biopsies conducted at Tirunelveli Medical College and Hospital from 2016 to 2022 was performed. Kidney tissue samples were subjected to light microscopy and immunofluorescence studies using appropriate stains. Patients with isolated mesangial expansion were identified. Demographic details, clinical indications for biopsy, and pathological findings were recorded and analyzed. Results: Out of 616 kidney biopsies, mesangial expansion was present in 39 patients (6.33%). Notably, nodular mesangial expansion was observed in 33 patients (5.3%), with diabetes being the most prevalent associated condition (74.19%). Amyloidosis, heavy chain deposition disease, fibrillary glomerulonephritis, collagen fibrotic glomerulopathy, and idiopathic nodular glomerulosclerosis were identified as other contributors to mesangial expansion. Glomerular filtration rate and interstitial fibrosis and tubular atrophy were worse in the diabetic population. Conclusions: This study sheds light on the varied etiologies contributing to mesangial expansion beyond diabetes, emphasizing the importance of specialized staining methods for precise diagnosis.