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THE DIABETIC KIDNEY IN THE TROPICS

This study describes the diabetic kidney in a tropical country. The incidence of severe grades of nodular glomerulosclerosis was strikingly low while varying degrees of diffuse glomerulosclerosis were frequently observed. Nodular lesions occurred only in the glomeruli, which showed severe grades of the diffuse changes. It would thus appear that these two types of lesions are closely related in respect to pathogenesis and that the nodule may represent a variation in the pattern of development of glomerulosclerosis which is most often diffuse. At least in this geographical location it would appear that the typical natural history of diabetic glomerulosclerosis is for the diffuse changes to become increasingly severe until hyalinization and obliteration of the glomerulus occur without the formation of Kimmelstiel‐Wilson nodules. Further, it appears that in the tropics it is the diffuse changes that are of clinical importance, in the majority of cases it being the pathological basis of renal insufficiency and the diabetic nephrotic syndrome. Satisfactory tubular function in the presence of a declining glomerular filtration rate is a distinct functional pattern occurring in the diabetic kidney as a whole.