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Diagnosis: Diabetic nephropathy
The pathohnomonic lesion: arteriolar hyalinosis with involvement of afferent and efferent arterioles.
Although...

Dr. Markowitz et al state that in a non diabetic glomerulopathy: Idiopathic nodular glomerulosclerosis, may be "in some cases, hyalinosis within Bowman’s capsule (“capsular drop” lesion) and combined afferent and efferent arteriolar hyalinosis, lesions once thought to be pathognomonic for diabetic glomerulosclerosis" (Markowitz GS, et al. Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. Hum Pathol. 2002 Aug;33(8):826-35. [PubMed link]); in this paper the authors do not inform how many cases had aferent arteriolar hyalinosis or capsular drop.

The capsular drop, although tipically is found in diabethic nephropathy, has been described also in other non-diabetic conditions (Stout LC, et al. Insudative lesions--their pathogenesis and association with glomerular obsolescence in diabetes: a dynamic hypothesis based on single views of advancing human diabetic nephropathy. Hum Pathol. 1994 Nov;25(11):1213-27. [PubMed link]); these authors found that capsular drops and hyalinized afferent arterioles were not specific for diabetes, being present in 15% of controls in their study.

Insudative lesions in Bowman's capsule are called capsular drop lesions, in glomerular capillaries they are called fibrin cap lesions, and in afferent and efferent arterioles they are called hyalinized afferent and hyalinized efferent arterioles, respectively. If a combination of these lesions are found in a renal biopsy, the diagnosis of diabethic nephropathy is "almost" certain. Although my experience as nephropatholosts is not very longer, I have never seen in my cases or in archives capsular drops or hyalinized efferent arterioles in other conditions.

In conclusion, we can not say that combined afferent and efferent arteriolar hyalinosis is pathognomonic of diabetic nephropathy, but it is very, very suggestive of the disease.

See the chapter Renal involvement in diabetes mellitus and other metabolic diseases, with atlas and text in our Tutorial.

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Bibliography

• Alsaad KO, Herzenberg AM. Distinguishing diabetic nephropathy from other causes of glomerulosclerosis: an update. J Clin Pathol. 2007 Jan;60(1):18-26. [PubMed link]
• Markowitz GS, Lin J, Valeri AM, Avila C, Nasr SH, D'Agati VD. Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity linked to hypertension and smoking. Hum Pathol. 2002 Aug;33(8):826-35. [PubMed link]
• Stout LC, Kumar S, Whorton EB. Insudative lesions--their pathogenesis and association with glomerular obsolescence in diabetes: a dynamic hypothesis based on single views of advancing human diabetic nephropathy. Hum Pathol. 1994 Nov;25(11):1213-27. [PubMed link]
  

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