Diabetic
nodular glomerulosclerosis, also known as
Kimmelstiel-Wilson syndrome, is a specific pathological variant of
diabetic nephropathy ; however, histological findings similar to
diabetic nephropathy are observed occasionally without
glucose intolerance. Therefore, such
nodular glomerulosclerosis is called idiopathic
nodular glomerulosclerosis. Several case reports that have been published recently indicate that smoking and
hypertension, which are classical renal risk factors, may be attributed to this form of glomerular degeneration. Accordingly smoking- and
hypertension-associated
nodular glomerulosclerosis has been considered to be different from the idiopathic form. This novel form of
nodular glomerulosclerosis is associated with a history of long-term smoking and
hypertension, and the age of onset of this disease is more than 60 years. We present the case of a 27-year-old Japanese male who was admitted to our hospital with
nephrotic syndrome,
hypertension, and renal impairment. He had a smoking history of at least 13 years, and had been exposed to
passive smoking for several years because his parents were smokers. Renal biopsy revealed diffuse and global
nodular glomerulosclerosis, although the patient did not have any primary diseases such as
diabetes mellitus or
paraproteinemia, that can cause this condition. We diagnosed smoking- and
hypertension-associated
nodular glomerulosclerosis. Cessation of smoking and the administration of an
angiotensin II receptor blocker decreased his
proteinuria and showed recovery of kidney function. This case report suggests that long-term smoking is closely associated with
nodular glomerulosclerosis. Further, in our case, the age of the patient was lower than that of patients with the same disease among cases that have been reported previously.