1: Diabetes and the Kidney Flashcards
What is diabetic nephropathy
Kidney disease due to diabetes mellitus
What fulfils criteria for diabetic nephropathy
Diabetes and microalbuminuria (A:Cr >3)
What is the leading cause of ESRD worldwide
Diaebtic nephropathy
Is diabetic neprhopathy a microvascular or microvascular complication of diabetes mellitus
Macrovascular
What are two risk factors for diabetic neprhopathy
- Poor Glycaemic Control
- HTN
Explain symptoms of diabetic nephropathy
Asymptomatic. Then GFR will drop significantly
Explain pathophysiology of diabetic nephropathy
- In diabetes there is glycosuria
- Glucose causes glycation of basement membrane causing thickening
- It causes thickening of efferent arteriole called hyaline arteriosclerosis
- This increases pressure which leads to obstruction
- The afferent arteriole dilates to increase flow to the glomerulus, however this increases pressure more
- Increase pressure leads to increase GFR (stage I hyper filtration)
- In response to increase pressure mesangial cells release more matrix, expanding the glomerulus = this is called kimmelsteil wilson nodules
- Thickening means podocytes are further apart increasing permeability of the glomerulus
What should diabetics be screened for and how often
Diabetic neprhopathy - annually
When should A:Cr be measured
In the morning
What is microalbuminaemia
A:Cr >3
What is macroalbuminaemia
A:Cr >30
What should also be measured
Creatinine - to estimate GFR
What defines proteinuria
A:Cr >30mg/mmol
What defines nephrotic syndrome
Loss of 3g protein in 24h
A:Cr >250
Explain principles of management of diabetic nephropathy
Diabetic nephropathy is a progressive condition - progress can be slowed but not stopped
