[Association between long-term smoking and hypertension and early-onset nodular glomerulosclerosis].

Abstract

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.

• Authors: Tomohiro Kikuta, Tsutomu Inoue, Yusuke Watanabe, Takahiko Sato, Masahiro Tsudai, Kousuke Uchida, Keita Sueyoshi, Eriko Kojima, Takaki Sakurai, Hirokazu Okada, Tsuneo Takenaka, Hiromichi Suzuki
• Journal: Nihon Jinzo Gakkai shi (Nihon Jinzo Gakkai Shi) Vol. 52 Issue 7 Pg. 959-65 ( 2010) ISSN: 0385-2385 [Print] Japan
• PMID: 21077348 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Antihypertensive Agents

Topics

• Adult
• Age Factors
• Antihypertensive Agents (administration & dosage)
• Diabetic Nephropathies (diagnosis, etiology, pathology, therapy)
• Diet, Sodium-Restricted
• Humans
• Hypertension (complications)
• Kidney (pathology)
• Male
• Smoking (adverse effects)
• Smoking Cessation
• Time Factors
• Treatment Outcome