To the Editor.—
The article entitled, "Acute Glomerulonephritis Complicating Diabetic Nephropathy," by Drs Olivero and Suki (Arch Intern Med 137:732-734, 1977) reminded me of three nearly consecutive biopsies in diabetics that proved puzzling to Dr Paul Kimmelstiel and myself when we encountered them in 1968 (see Table).
Report of Cases.—Case 1.—
Patient 1 had a ten-day history of nausea and vomiting, and a three-day history of edema and dyspnea. Dr Kimmelstiel's biopsy interpretation was:The differential diagnosis lies between a diffuse diabetic glomerulosclerosis and lobular glomerulonephritis. In favor of the latter is the marked degree of cellularity, including polymorphonuclear leukocytes; against it are a clearly delineated basement membrane of peripheral capillaries. The possibility of a glomerulonephritis superimposed upon diabetic glomerulosclerosis must be considered.
Patient 2 delivered a normal infant complicated by "toxemia of pregnancy." Three months later, a biopsy was performed because of nausea, vomiting, persistent