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Renal > 05.20 - Diabetic Renal Disease (Wall, Nichols) - PP > Flashcards

05.20 - Diabetic Renal Disease (Wall, Nichols) - PP Flashcards

1
Q

Stage 2 of DN

A

Clinically evident: Micro-albuminuria, BP rises, glomeruli show damage

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1
Q

Which is specific for diabetic glomerulopathy: Capsular Drops, Fibrin Caps

A

Capsular Drops

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1
Q

Globally sclerotic glomeruli, dilated tubules resembling thyroid follicles, interstial fibrosis

A

Microscopic appearance of end stage kidney in DN

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2
Q

Stage 4 of DN

A

GFR < 75mL/min - HTN ubiquitous

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3
Q

Stage 3 of DN

A

Macro-Albuminuria, Creatinine and BUN levels rise, BP rises

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3
Q

Development of ___ heralds rapdid decline in GFR in Type2 DM

A

Macroalbuminuria

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3
Q

Condition that will cause Hyaline Sclerosis in both efferent and afferent arterioles

A

DM

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4
Q

% of diabetics who develop nephropathy

A

30-40%

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5
Q

By the time of Macroalbuminuria (over nephropathy), over 90% of patients have

A

HTN

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5
Q

Features of Nodular Type Diabetic Glomerulopathy

A

Kimmelstiel Wilson nodules and Hyaline sclerosis of both arterioles

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6
Q

Macroalbuminuria is defined as

A

random urine albumin/creatinine over 300 mg/g

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6
Q

Patients taking ACEi’s or ARB’s should be monitored for

A

Hyperkalemia

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7
Q

End Stage kidney from Diabetic Nephropathy looks just like

A

HTN Nephropathy

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8
Q

Nodular Glomerulosclerosis (Kimmelstiel Wilson Disease) correlates with

A

Renal failure eventually requiring dialysis

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9
Q

How do you distinguish diabetic nephropathy from most other forms of CKD

A

Glomeruli and kidneys are typically normal or larger in DN; in others, renal size is usually reduced

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10
Q

How does Glucose lead to Glomerular Pressure increase

A

Glucose provides osmotic diuretic effect –> Incr renal filtration –> Glomerular hypertophy –> Glomerular pressure incr

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10
Q

Diffuse type Diabetic Glomerulopathy consists of

A

Capillary BM thickening; Increased MM

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12
Q

Macroalbuminuria is aka

A

Overt Nephropathy

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14
Q

Micro-Albuminuria is defined as

A

> 30 mg/g loss

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15
Q

How does glucose lead to Premature Glomerulosclerosis

A

Osmotic Diuretic Effect –> Incr filtration –> G pressure incr –> Hypertrophy –> G cell failure –> Premature Glomerulosclerosis

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15
Q

Most common type of Diabetic Glomerulopathy

A

Diffuse

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16
Q

What causes injury to tubular cells in Glomerular HTN

A

G HTN –> Injury to GBM –> Leaks plasma proteins –> Attempts to reabsorb these proteins injures tubular cells

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16
Q

What causes fibrosis and scarring in Glomerular HTN

A

Tubular inflammation and renal microvascular injury from protein leakage

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16
Q

Reduction in proteinuria is associated with

A

Reduced risk for ESRD

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17
Q

Where do fibrosis and scarring occur in Glomerular HTN

A

Both glomerular and tubular elements of nephron

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18
Q

Kimmelstiel Wilson nodules and Hyaline sclerosis of both arterioles

A

Features of Nodular Type Diabetic Glomerulopathy

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20
Q

Which drug has been shown to slow rate of diabetic nephropathy more than others

A

ACEi

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22
Q

Fibrin caps

A

Crescentic deposits of condensed leaked plasma proteins

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23
Q

Avg time to progression from stage 1 to stage 4 in DM1

A

17 years

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24
Q

Higher baseline Albuminuria =

A

Faster rate of progression

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24
Q

Microscopic appearance of end stage kidney in DN

A

Globally sclerotic glomeruli, dilated tubules resembling thyroid follicles, interstial fibrosis

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25
Q

At what stage of DN is the condition essentially irreversible?

26
Q

Stage 5 of DN

A

GFR less than 10 (ESRD)

27
Q

___ is marker for increased CV risk in DN

A

Microalbuminuria

29
Q

Fasting blood glucose criteria for DM

30
Q

Anti-hypertensives to use in diabetics

A

ACEi’s and ARB’s

31
Q

TGF-beta has been implicated in many ___ diseases

A

Chronic, Scarring

32
Q

T/F: Patients with macroalbuminuria are more likely to die than develop ESRD

33
Q

Diffuse type Diabetic Glomerulopathy is identical to that which occurs in

A

HTN and aging

33
Q

What condition has Kimmelstiel Wilson nodules

A

Nodular Type Diabetic Glomerulopathy

34
Q

Hyaline Sclerosis of Afferent and Efferent Arterioles in DM vs HTN

A

HTN causes hyaline sclerosis of afferent, whereas DM will affect both

36
Q

Microalbuminuria in DN over time leads to

A

Overt Proteinuria, Reduced GFR, HTN

37
Q

What starts the clinical phase of DN

A

Overt Proteinuria

38
Q

Tubular inflammation and injury from Glomerular HTN activates pathways that lead to

A

Fibrosis and Scarring

39
Q

At what stage of DN do patients require dialysis or transplantation

39
Q

Where in glomerulus do Kimmelstiel Wilson nodules occur

A

Periphery of Glomerular Tuft

40
Q

For almost all kidney disease, including DN, likelihood of dying from what is higher than reaching ESRD

A

CV disease

41
Q

Top 2 causes of ESRD

A

Diabetes (43%), HTN (23%)

42
Q

Which type of Diabetic Glomerulopathy is characteristic (specific) for DM

A

Nodular Type

42
Q

Where in glomerulus do Fibrin Caps occur?

A

Overlying peripheral capillaries

43
Q

Classic symptoms of hyperglycemia

A

Thirst, Polyuria, Poldipsia, Visual Blurring

45
Q

What occurs earlier than microalbuminuria in DN

A

Changes to GBM structure (collagen IV deposition)

46
Q

Why does RAAS play a role in diabetic nephropathy

A

Inefficient at shutting down RAAS production

48
Q

How is Albuminuria calculated

A

Albumin / Creatinine to correct for diffs in urine concentration

49
Q

At what stage of DN does kidney demonstrate an inability to adequately filter wastes

A

Stage 3 - Creatinine and BUN rise

50
Q

Stage 1 of DN

A

Hyperfiltration - Kidney incr in size

52
Q

___ lower both arterial BP and glomerular capillary pressures

A

ACEi’s and ARBs

54
Q

What causes inflammation in tubular cells in Glomerular HTN

A

G HTN –> Injury to GBM –> Leaks plasma proteins –> Attempts to reabsorb these proteins injures tubular cells –> Inflammation

55
Q

Nodular Type Diabetic Glomerulopathy occurs after how many years

56
Q

Kimmelstiel Wilson nodules eventually

A

squeeze capillaries shut

57
Q

Where in glomerulus do Capsular drops occur

A

Parietal layer of Bowman’s Capsule protruding into urinoferous space

59
Q

Once in ____, patient is unlikely to regress

A

Overt Proteinuria (macroalbuminuria)

60
Q

2 types of Exudative lesions

A

Fibrin Caps, Capsular Drops

62
Q

Most common cause of kidney failure

63
Q

ACEi’s have been show to lower BP and also reduce ___

A

Microalbuminuria (lower glomerular capillary pressure)

65
Q

Avg time to progression from stage 1 to stage 5 in DM1

66
Q

Capsular Drops

A

Deposits of partly plasma proteins, and partly basment membrane

67
Q

On which arteriole does Ang2 selectively act?

A

Efferent –> Incr intraglomerular pressure

68
Q

Deposits of partly plasma proteins, and partly basment membrane

A

Capsular Drops

69
Q

Diabetics Microvascular Complications are eliminated if patient obtains optimal management of glucose, BP, and lipid levels

70
Q

Effects of Glomerular HTN

A

Injury of GMB –> Leak proteins –> Injury to tubular cells and inflammation

71
Q

First clinically detectable abnormality of DN

A

Microalbuminuria

72
Q

Outcome of increased glomerular pressure and subsequent hypertrophy

A

Premature Glomerulosclerosis

74
Q

How does TGF-beta get activated? What is consequence?

A

Ang2 –> TGF-beta –> Proliferation of fibroblasts and tubuloepithelial cells –> Hypertrophy, BM thickening, MM expansion

75
Q

Gross appearance of End stage kidney in Diabetic Neprhopathy

A

Diffuse fine granularity of cortical surface = Nephrosclerosis

76
Q

Crescentic deposits of condensed leaked plasma proteins

A

Fibrin caps

77
Q

3 histological features of DN

A

Incr MM, Glomerular Collapse, Glomerulosclerosis

78
Q

___ reduction determines CV outcome

A

Proteinuria

79
Q

Effect of Ang2 in DN

A

Selective constriction of efferent>afferent –> Incr SNGFR –> Incr intraglomerular pressure –> Glomerular HTN

Renal (31 decks)

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