A re-evaluation of diabetic glomerulosclerosis 50 years after the discovery of insulin.

Diabetic glomerulosclerosis is a degenerative-proliferative lesion involving most glomeruli in the kidneys of all individuals with hereditary, pancreatic, or experimental diabetes mellitus. The exact nature of the lesion and its etiology remain unknown. Morphologically there appear to be two courses this disease may follow. There is a benign course, which occurred in 89 per cent of our series of adult diabetic patients, consisting of concurrent thickening of the capillary basement membranes and diffuse glomerulosclerosis. The benign course is slowly progressive over many years, and rarely leads to renal failure. The accelerated course, in our experience is always superimposed on the changes of the benign course, and consists of a more rapid progression with the development of glomerulocapillary microaneurysms. Kimmelstiel-Wilson nodules, exudative-deposit lesions, and glomerulocapsular adhesions leading to glomerular obliteration and renal failure. Data are presented to support the concept that large Kimmelstiel-Wilson nodules are formed by the organization of the glomerulocapillary microaneurysms.