Is there a link between diabetic glomerular injury and crescent formation? A case report and literature review

Naoko Otani,Shigeaki Muto,Wako Yumura,Noriyoshi Fukushima,Eiji Kusano,Takuya Miki,Fumi Takemoto,Yoshitaka Iwazu,Daisuke Matsubara,Akihiko Numata,Tetsu Akimoto

doi:10.1186/1746-1596-7-46

Abstract

Glomerular crescents are most commonly associated with rapidly progressive crescentic glomerulonephritis; however, they also develop in response to a wide range of primary and secondary glomerular injuries. Since various kind of glomerulopathies occasionally overlay diabetic glomerular injuries, the presence of crescents in renal biopsy specimens of diabetics may have stimulated a search for etiologies other than diabetes. In this report, we describe an unusual case of diabetic glomerulosclerosis with peculiar extracapillary proliferation. Although such a relationship has so far been ignored in most of the literature, the etiological linkage between diabetic glomerulosclerosis and the development of crescents may not be exceptional. We have reviewed the previous literature and herein discuss the pathological implications of the development of crescents in patients with diabetic glomerulosclerosis.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3950457896920255.

Highlights

Glomerular crescents, which are formed by the accumulation of cells in Bowmans space that surround and compress the glomerulus, are most commonly associated with rapidly progressive crescentic glomerulonephritis (RPGN); they develop in response to a wide range of primary and secondary glomerular injuries, including lupus nephritis, purpura nephritis, IgA nephropathy, post-infectious glomerulonephritis, and membranoproliferative glomerulonephritis (MPGN) [1,2,3]
We describe an unusual case of diabetic glomerulosclerosis with peculiar extracapillary proliferation
Nodular glomerulosclerosis, which is one of the major pathological findings of diabetic glomerulosclerosis, is a glomerular change characterized by nodular mesangial sclerosis and accentuated glomerular lobularity [9,10]

Summary

Introduction

Glomerular crescents, which are formed by the accumulation of cells in Bowmans space that surround and compress the glomerulus, are most commonly associated with rapidly progressive crescentic glomerulonephritis (RPGN); they develop in response to a wide range of primary and secondary glomerular injuries, including lupus nephritis, purpura nephritis, IgA nephropathy, post-infectious glomerulonephritis, and membranoproliferative glomerulonephritis (MPGN) [1,2,3]. Eleven years prior to admission, he was found to have type 2 diabetes with a fasting blood glucose (FBS) of 200 mg/dl and HbA1c of 8.2, for which he had received sporadic medical care. He gradually developed a loss of appetite for psychosomatic reasons, making the use of hyperglycemia controlling agents unnecessary in the beginning of January 2010 (HbA1c 4.9). The patient’s urine protein settled around 1.5 g/gÁCr to 2.0 g/ gÁCr with a slightly elevated serum level of creatinine of 1.7 to 1.9 mg/dl at follow up without any exacerbation of the blood pressure control

Discussion

Conclusion

Mathieson PW

18. Tóth T