title: Smoking as the potential link between Kimmelstiel-Wilson lesion and non-diabetic nodular glomerulosclerosis in male patients - a single center retrospective study.
abstract: BACKGROUND
  The histological pattern of nodular glomerulosclerosis (NGS) can be found both in diabetic nephropathy (Kimmelstiel-Wilson (KW) lesion) and non-diabetic nodular glomerulosclerosis (non-diab NGS). Chronic smoking is considered to be a potential cause of non-diab NGS, but the prevalence of smokers in KW is unknown.
  
  
  METHODS
  In a retrospective analysis, native renal biopsy specimens (n = 644, 2001 - 2011) were evaluated and male patients' characteristics, including smoking habits, were assessed within three groups: diabetic patients with KW (n = 15), diabetic patients with other classes of diabetic nephropathy (non-KW; n = 46), and patients with non-diab NGS (n = 7).
  
  
  RESULTS
  The majority of patients in the KW and non-diab NGS groups (13/15 = 87%, 7/7 = 100%, respectively; p = 1.0 vs. KW) were smokers, unlike the non-KW group (16/46 = 35%; p = 0.001 vs. KW). Cigarette pack-years showed a similar pattern (KW: 15 (6 - 30), non-KW: 0 (0 - 21), non-diab NGS: 30 (16 - 33); p = 0.010 non-KW vs. KW, p = 0.008 non-KW vs. non-diab NGS). Other known factors responsible for the worsening of non-KW or the development of non-diab NGS did not differ in the groups (age, body mass index, duration of diabetes mellitus, HbA1c, prevalence of hypertension, duration of hypertension, serum cholesterol, triglyceride, estimated glomerular filtration rate, and renin-angiotensin-aldosteron system-blocker treatment).
  
  
  CONCLUSIONS
  We propose that chronic cigarette smoking could play a pivotal role in the development of KW lesions.
authors: 2nd Department of Internal Medicine and Nephrological Center, University of Pecs, Pecs, Hungary.
authors: Richárd
authors: R
authors: Halmai
authors: Péter
authors: P
authors: Degrell
authors: István András
authors: IA
authors: Szijártó
authors: Viktória
authors: V
authors: Mátyás
authors: Gergå Attila
authors: GA
authors: Molnár
authors: Tibor
authors: T
authors: Kovács
authors: István
authors: I
authors: Wittmann
mesh_terms: D000704:Analysis of Variance; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000209:etiology; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D018709:Statistics, Nonparametric