What is the Renal Pathology Society histologic classification system for diabetic nephropathy?

Updated: Oct 09, 2019
  • Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The Renal Pathology Society proposed a histologic classification system for diabetic nephropathy in 2010, which can be used for both type 1 and type 2 DM. Based on the presence and severity of glomerular lesions, four classes are proposed [21] :

  • Class I, glomerular basement membrane thickening - Isolated glomerular basement membrane thickening exists, with light microscopy revealing only mild, nonspecific changes
  • Class II, mesangial expansion, mild (IIa) or severe (IIb) - Mild or severe mesangial expansion in the glomeruli but without Kimmelstiel-Wilson lesions (nodular sclerosis) and with no more than 50% of glomeruli demonstrating global glomerulosclerosis
  • Class III, nodular sclerosis (Kimmelstiel–Wilson lesions) - At least one Kimmelstiel-Wilson lesion and none of the changes described in class IV, with no more than 50% global glomerulosclerosis present on biopsy
  • Class IV, advanced diabetic glomerulosclerosis - More than 50% global glomerulosclerosis on biopsy, with clinical or pathologic evidence indicating that the sclerosis stems from diabetic nephropathy.

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