Which one of the listed findings is more characteristic of juvenile diabetes mellitus (type 1 diabetes mellitus) than of adult onset diabetes mellitus (type 2 diabetes mellitus)?
A. Amyloid deposition occurs in islets of LangerhansB. It is associated with HLA-DR3 and HLA-DR4
C. Numbers of insulin receptors on adipocytes are decreased
D. There is insulin resistance that results from marked obesity
The answer is D.
Diabetes may
produce abnormalities that affect any part of the kidney, such as the
glomerulus,the blood vessels (benign nephrosclerosis), the tubules
(Armanni-Ebstein lesions, which refers to vacuolization of the cells of the
proximal convoluted tubules), the interstitium, and the pelvis (infection leads
to pyelonephritis and acute papillary necrosis). Diabetic lesions of the
glomerulus include capillary basement thickening, diffuse glomerulosclerosis
(increase in mesangium and mesangial cells), and nodular glomerulosclerosis.
The latter refers to oval hyaline masses at the periphery of the glomerulus and
is also called Kimmelstiel-Wilson disease. Nodular glomeruloscleroses may
resemble amyloid, and, if they are present, amyloid staining should be done. Other
characteristic lesions found in the glomerulus include “capsular drops”(round
nodules found between Bowman’s capsule and the parietal epithelium) and “fibrin
caps” (subendothelial accumulations along capillary loops).
