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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 1. (A) A light microscopy image shows an hypertrophic glomerulus with segmentally nodular mesangial expansion, due primarily to increased matrix (Kimmelstiel-Wilson nodules) and features of mesangiolysis. The surrounding tubular parenchyma reveals somewhat diffuse interstitial fibrosis associated with focal tubular atrophy (periodic acid-Schiff). (B) A Transmission electron image demonstrates podocyte microvillous transformation (asterisk). C, capillary lumen; GBM, glomerular basement membrane; US, urinary space. (C) Glomerular scanning electron micrographs, with the corresponding high magnification insets (D,E and F). (C and D) A large, mostly acellular glomerulus, exhibits “cauliflower-like” lobulations with loss of the typical cylindrical shape of glomerular capillaries. (E, asterisk) A lonely podocyte shows loss of most of its primary and secondary processes, severe degeneration of its cellular cytoarchitecture and microvillous transformation. (F, arrow) Higher magnification of the GBM surface reveals occasional cavities and tunnels.