<prompt> Diabetic glomerulosclerosis is characterized by all EXCEPTDiffuse glomerulosclerosisFibrin capFibrin clotKimmelstiel-Wilson lesions  <response>: Fibrin clot 677-78-Harsh. Mohan 6th ,1141- Robbiins - Basis of disease 8thDIABETIC NEPHROPATHYFour types renal lesions1. Diabetic glomerulosclerosis2. Vascular lesions - Atheroma, Hyaline arteriolosclerosis3. Diabetic pyelonephritis Papillary necrosis necrotizingpapillitis4. Tubular lesions Armanni- Ebstein lesions Earliest manifestation of diabetic nephropathy is microalbuminuria 30mgday, but 300mgdayDIABETIC GLOMERULOSCLEROSISi Diffuse glomerulo sclerosis - Most common lesions thickening of the GBM and diffuse increase in mesangial matrix with mild proliferation of mesangial cells Capsular hyaline drop is an eosinophilic hyaline thickening of the parietal layer of Bowmans capsule and bulges into the glomerular space Fibrin cap is a homogenous, brightly eosinophilic material appearing on the wall of a peripheral capillary of lobuleii Nodular glomerulo sclerosis Kimmelstiel - Wilson K. W lesions or intercapillaiy glomerulosclerosis - specific for type I-DMThe nodules are PAS positive and contain lipid and fibrinAs a result of glomerular and arteriolar involvement renal ischaemia occurs leading to tubular atrophy and interstitial fibrosis and grossly small contracted kidney Important Points Nephrocalcinosis is seen in - Hyperparathyroidism, Hypercalcemia, Hyperphosphatemia, RTA. Hyper vitaminosis D, Excessive bone destruction. In metastatic malignancy, Hyperthyroidism. Milk-alkali syndrome and Sarcoidosis Medullary sponge kidney Papillary- nephrocalcinosis Low and fixed specific gravity of urine is seen in CRF Most of the infectious causes lead to membranous GN like Hepatitis B C,syphilis, malaria, leprosy, filariasis schistosomiasis, carcinoma of lung and melanomaGeneChromosomeProteinLocationDiseaseNPHS-119q 13NephrinSlipt diaphragmNephrotic syndrome of finish typeNPH-21 q25-31PodocinSlipt diaphragmSteroid resistant nephritic syndrome Fibrinogen level is increased in Nephrotic syndrome due to increased hepatic synthesis of fibrinogen The classic and most common HIV associated glomerulopathy is an aggressive form of focal segmental glomerulosclerosis, an entity that is termed HIV associated nephropathy It was earlier called collapsing glomerulopathy shows degeneration of visceral epithelium Focal segmental GN - seen in SLE, H.S purpura, SABE, wegners granulomatosis, PAN, Goodpasteurs syndrome Low C3 complex GN - Post infections GN, lupus nephritis cryoglobulinemia, Bacterial endocarditis shunt nephritis, membrano proliferative GN, Cresenteric GN, Idiopathic proliferative GN Most specific and sensitive marker of ANCA is seen in idiopathic cresenteric GN Hereditary Nepritls occursin - Alports syndrome, Fabrys disease, Nail patella syndrome 