Nodular glomerulosclerosis in a patient with metabolic syndrome without diabetes.

BACKGROUND: A 56-year-old man with previously treated hepatitis C presented to a nephrology clinic with hypertension, proteinuria and declining renal function. His medical history included previous smoking, prior hip replacements with prolonged osteomyelitis, and left renal artery stenosis. Diabetes mellitus was ruled out by a 2 h oral glucose tolerance test and two glycated hemoglobin (HbA 1c) measurements. A renal biopsy showed evidence of nodular glomerulosclerosis. INVESTIGATIONS: Physical examination, renal biopsy, and urine and blood analyses including an oral glucose tolerance test. DIAGNOSIS: Nodular glomerulosclerosis and metabolic syndrome. MANAGEMENT: Patients with metabolic syndrome should be screened for evidence of renal injury since clinical and histological nodular glomerulosclerosis identical to diabetic nephropathy can occur in this setting. Early diagnosis and treatment of albuminuria could alter the course of disease progression.