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In order to clarify the mode of development of the diabetic nodular glomerulosclerosis, 38 kidney specimens of autopsied and biopsied diabetic cases were studied light and electron microscopically including serial sections. Disorganization process occurred chiefly at the capillary region of glomeruli. Early change of this process was proliferation of intramembranous cells following histolysis in the glomerular loop and it was characterized by transformation of the glomerular loop into enmeshed or reticular structure, that is, disorganization of the glomerular architecture. In the subsequent stage intercellular matrix production and hyalinization accompanied by axial crowding of proliferated intramembranous cells and peripheral recanalization of blood spaces were clarified. And in the later stage axially crowded intramembranous cells decreased in number and the matrix was increased and hyalinized, resulting in the formation of the axial hyaline nodule. The distribution of this process was focal and segmental, lesions of various stages coexisted, and it was suggested that glomerular lesions may spread all over the kidney by recurrence of this process. This process was quite similar to those seen in disorganization process of glomerulonephritis. But another characteristic changes were the presence of foam cells, intra- and intercellular deposition of lipid droplets, and increased matrix formation.

Disorganization process in the development of diabetic nodular glomerulosclerosis.