title: [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.affiliation: Department of Nephrology, Saitama Medical University, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kikuta
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inoue
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Takahiko
authors.initials: T
authors.lastname: Sato
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsudai
authors.forename: Kousuke
authors.initials: K
authors.lastname: Uchida
authors.forename: Keita
authors.initials: K
authors.lastname: Sueyoshi
authors.forename: Eriko
authors.initials: E
authors.lastname: Kojima
authors.forename: Takaki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okada
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Takenaka
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000008:administration & dosage; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D004039:Diet, Sodium-Restricted; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007668:Kidney / Q000473:pathology; D008297:Male; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents