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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 5. (A) A light microscopy image shows a glomerulus with frequently nodular mesangial expansion, due primarily to increased matrix (Kimmelstiel-Wilson nodules), microaneurysm formation and obstruction of the glomerular outflow tract by segmental sclerosis at the glomerulo-tubular junction (periodic acid-Schiff). (B) A transmission electron micrograph documents extensively denuded GBM accompanied by degenerated podocyte bodies (asterisk) with isolated secondary processes detectable (arrowhead). (C) Glomerular scanning electron micrographs, with the corresponding high magnification insets (D,E and F). A mostly acellular glomerulus, partially visible from the Bowman’s capsule, displays naked subepithelial surface with a smooth appearance (C and D). (D, arrow) A blood cell protrudes through an accidentally broken glomerular capillary wall. (E, asterisk) A podocyte clearly shows a severe alteration of its structure and microvillous transformation. Sparse and damaged foot processes are detected in focal areas (F, arrows).