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Abstract
In order to elucidate a participation of the mesangiolysis in the formation of diabetic
nodular lesions, 355 kidney specimens obtained from 327 patients with primary diabetes
mellitus were studied. Mesangiolyses begun by focal and segmental disintegration of
the pivotal structure of the mesangium ("torn off phase"), resulting in cystic or
aneurysmal dilatation of the involved tuft, were found in 56 specimens (16%). The
dilated tufts were filled with lysed mesangial matrix, which showed a reticular or
fibrillar arrangement ("structureless phase"), being followed by a concentrical re-arrangement
("reconstructive phase") and by the ultimate formation of diabetic nodules. The mesangiolysis
of various phases was frequently found concomitant with severe diabetic arteriolosclerosis
and, in the reconstructive phase, the lysed mesangial matrix near the recanalized
capillary along the inner aspect of glomerular basement membrane was observed to be
rearranged in a layered structure. These results suggest the hypothesis that: 1) the
mesangiolysis is the initial lesion occurring in glomeruli in the process of diabetic
nodule formation, and disturbed blood flow into glomeruli, caused by diabetic arteriolosclerosis,
may be implicated in the development of the mesangiolysis; and 2) concentric compression
of the lysed mesangial matrix by recanalized capillaries forms layered structures
and ultimate completed diabetic nodules.