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. 2018 Mar 20;8:4909. doi: 10.1038/s41598-018-23244-2

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© The Author(s) 2018

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Glomerular histologic and ultrastructural findings in advanced DKD. Patient 2. (A) A light microscopy image shows an hypertrophic glomerulus with prominent nodular expansion of the mesangium due primarily to increased matrix (Kimmelstiel-Wilson nodules). Other features of these nodules are mesangiolysis and initial microaneurysm formation. The surrounding tubular parenchyma reveals somewhat diffuse mild interstitial fibrosis, associated with focal tubular atrophy (periodic acid-Schiff). (B) A transmission electron micrograph documents dramatic denudation of GBM (arrow). C, capillary lumen; GBM, glomerular basement membrane, US, urinary space. (C) Glomerular scanning electron micrographs, with the corresponding high magnification insets (D and E). A large, mostly acellular glomerulus, protrudes from the renal cortex surface. (D, arrow) Fragments of foot processes remained in very few areas. (E, asterisk) A lonely podocyte, with a vague bottle-shaped cellular body, appears to be almost nearly completely detached from the underlying GBM surface. (F) The surface of a sclerotic glomerulus with an extensively shattered and fragmented GBM. (F, inset) A tangle of elongated collagen fibrils has replaced the typical glomerular structures.