A study was made of the renal pathology of 43
consecutive diabetic autopsies, and the pathology
grouped under five headings, separating those cases
who showed Kimmelstiel Wilson lesions (11) from the
other groups, the Arteriosclerotic (4), Arteriolosclerotic (3), Pyelonephritis (4) and "other
diabetic" group (21) .
A comparison of the clinical syndrome revealed
that the Kimmelstiel Wilson lesions occur principally
in elderly females, who show albuminuria and often
renal infection. The lesion was characterised by
the presence of
Hypertension with heart failure,
Oedema at least of the dependent parts,
Peripheral neuropathy,
Diabetic retinopathy where the fundus is not
obscured by cataract.
This syndrome was not found togther in any of the other
groups. The literature was discussed on these
points.
A further series of observations were then made
on 9 patients who exhibited the syndrome outlined.
They showed that while the syndrome could be discovered for the first time in its fully developed
state (3 cases) that the march of progress shown by
the other six cases showed that, while eye changes,
oedema and peripheral neuropathy were early signs,
hypertension developed later and progressed to
failure if the disease was not terminated by one of
the other hazards. Two cases coming to post mortem
confirmed the clinical diagnosis.
A study of ancillary methods of diagnosis showed
that the presence of doubly refractile bodies in the
urine was a useful point of differential diagnosis
from all but the nepbr oti c stage of chronic glomerulonephritis, whilst that condition might be distinguished by repeated Addis counts. The massive
degree of albuminaria was found to be a useful point
in the fully developed syndromes, but not of clear
differential diagnostic value, and liable to extra-renal variations.
A study of renal clearances was made on normal
diabetics (13) , advanced art eri o s cl er oti cs (5) , those with Kimmelstiel Wilson syndromes (7), and 1
case of chronic glomerulonephritis. The technique
developed is described.
These studies showed that the normal diabetic
had no demonstrable alteration in renal function.
The Kimmelstiel Wilson cases bad a considerably
reduced function, the glomerular filtration rate
being more reduced than the tubular maximum
capacity for reabsorption of glucose, with the
result that the renal thresholds tended to be
high. The advanced arteriosclerotic cases
had a more severe and more generalised disturbance of function with the result that their
thresholds were low. The suggestion is made
that the raised thresholds in Kimmelstiel
Wilson syndromes may explain the delay in
diagnosing the diabetes which is encountered,
or even some of the cases which show the
lesions at autopsy but were not known to be
diabetic in life. The suggestion is also
made that the high thresholds may lead to
inadequate control if urine estimations only
are used, and that this may be at least an
aggravating factor in the production of the
full degenerative picture of the Kimmelstiel
Wilson Syndrome.
