title: Smoking-related glomerulopathy: expanding the morphologic spectrum.
abstract: BACKGROUND
  Chronic smoking and hypertension may lead to smoking-related nodular glomerulopathy (SRNG), a well-recognized entity that clinically and pathologically mimics nodular diabetic nephropathy (DN). However, like DN, diffuse mesangial sclerosis may occur in this setting without nodules.
  
  
  METHODS
  The clinicopathologic features of 10 non-diabetic patients with a long smoking history diagnosed from 2003-2012 showing diffuse mesangial glomerulosclerosis (6) or SRNG (4) were analyzed.
  
  
  RESULTS
  Nine of 10 patients were men, aged 58-80 with a 20-58 pack-year smoking history. None of the patients manifested diabetes, but all of them had hypertension. Numerous other cardiovascular comorbidities were present. At biopsy, the mean creatinine was 1.9 mg/dl (range 1.4-3) and the mean proteinuria was 3.9 g/24 h. The renal pathologic findings were similar in all patients except mesangial nodules in SRNG. Global glomerulosclerosis was seen in 6-72% of glomeruli (mean 31%), glomerulomegaly in all cases, and a range of interstitial fibrosis in 10-70% (mean 43%). Moderate (40%) and severe (50%) arteriosclerosis and arteriolar hyalinosis (80%) were also observed. Glomerular hilar or mesangial neovascularization was prominent. Endothelial swelling, subendothelial widening, and new basement membrane formation suggesting chronic healing thrombotic microangiopathy (TMA) was noted in 80%. No immune complexes were localized.
  
  
  CONCLUSIONS
  Kidney biopsies from patients with proteinuria and chronic renal insufficiency in the setting of prolonged smoking and hypertension show either diffuse or nodular mesangial glomerulosclerosis. Chronic glomerular mesangial and endothelial injury associated with smoking leads to a chronic TMA appearance in the appropriate setting, even in the absence of mesangial nodule formation.
authors: Weill Cornell Medical College, New York, N.Y., USA.
authors: Steven P
authors: SP
authors: Salvatore
authors: Megan L
authors: ML
authors: Troxell
authors: Douglas
authors: D
authors: Hecox
authors: Kevin R
authors: KR
authors: Sperling
authors: Surya V
authors: SV
authors: Seshan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001160:Arterioles; D001161:Arteriosclerosis / Q000473:pathology; D003404:Creatinine / Q000097:blood; D003967:Diarrhea / Q000473:pathology; D015785:Eye Diseases, Hereditary / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000473:pathology; D050533:Glomerular Basement Membrane / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007410:Intestinal Diseases / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology; D009404:Nephrotic Syndrome / Q000209:etiology* / Q000473:pathology*; D011507:Proteinuria / Q000652:urine; D012598:Sclerosis / Q000209:etiology* / Q000473:pathology*; D012868:Skin Abnormalities / Q000473:pathology; D012907:Smoking / Q000009:adverse effects*; D057049:Thrombotic Microangiopathies / Q000473:pathology; D014652:Vascular Diseases / Q000473:pathology
chemical_list: D003404:Creatinine