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Hanna R, Zuckerman JE, Ferrey A, Torres EA, Tonthat S, Barsoum M, Ghobry L, Wassef O, Kalantarzadeh K. Finding of pathological thrombomodulin gene variant in a patient with idiopathic nodular glomerulosclerosis and chronic thrombotic microangiopathy-like changes. SAGE Open Med Case Rep 2020; 8:2050313X20940510. [PMID: 32699635 PMCID: PMC7357015 DOI: 10.1177/2050313x20940510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022] Open
Abstract
Idiopathic nodular glomerulosclerosis is an unusual histopathological finding that has commonly been observed in male smokers with hypertension. It has remained an enigmatic condition and is best described as a diabetic pattern of glomerular injury seen in non-diabetic patients. It is also one of the few nicotine (smoking)-associated/smoking-associated patterns of renal injury. We present an even more unusual manifestation of this pathological finding in a 59-year-old Hispanic female who presented with chronic kidney disease approaching need for renal replacement therapy. The patient had idiopathic nodular glomerulosclerosis on kidney biopsy, despite no prior history of diabetes, nor smoking history, including no secondhand smoking exposure. The patient did have hypertension. The renal biopsy also showed evidence of chronic thrombotic-microangiopathic changes within arteries and arterioles. Genetic testing of the alternative pathway revealed an unusual and likely pathological variant of thrombomodulin supporting complement dysfunction as having a role in the presentation.
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Affiliation(s)
- Ramy Hanna
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Irvine, CA, USA
| | - Jonathan E Zuckerman
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Antoney Ferrey
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Irvine, CA, USA
| | | | - Sam Tonthat
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Irvine, CA, USA
| | - Marina Barsoum
- School of Pharmaceutical Sciences, Chapman University, Orange, CA, USA
| | - Lena Ghobry
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Olivia Wassef
- Division of Nephrology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kamyar Kalantarzadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Irvine, CA, USA
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