A 64-year-old woman with type 2 diabetes for 10 years now develops increasing fatigue, dyspnea, and pedal edema. On examination, her blood pressure is 165/90 mmHg, pulse 90/min, JVP is 4 cm, heart sounds are normal, lungs are clear, and there is 3+ pedal edema.Her urinalysis is positive for 3 gm/L of protein and no casts or red blood cells. An abdominal ultrasound reveals normal size kidneys and no hydronephrosis. Which of the following renal diseases is the most likely diagnosis in this patient?: (A) acute glomerulonephritis (GN), (B) obstructive uropathy, (C) glomerulosclerosis with mesangial thickening, (D) renal infarction
Answer is C. The patient is most likely to develop glomerulosclerosis. This can be diffuse or nodular (Kimmelstiel-Wilson nodules). Poor metabolic control is probably a major factor in the progression of diabetic nephropathy. Acute GN is unlikely given the lack of casts or red cells in the urine, and patients with renal infarction usually provide a history of flank pain and/or hematuria. The ultrasound results argue against obstructive uropathy and PCKD.