[1] Diabetic Nephropathy Flashcards
What is diabetic nephropathy?
Chronic loss of kidney function occuring in those with diabetes mellitus
What renal diseases are people with diabetes at increased risk of?
- Renal atherosclerosis
- Urinary tract infections
- Papillary necrosis
- Glomerular lesions
Is diabetic nephropathy diffuse or nodular?
Can be either
What happens in the early stages of diabetic nephropathy?
There is an elevated glomerular filtration rate with enlarged kidneys
What is the principle feature of diabetic nephropathy?
Proteinuria
Describe the development of proteinuria in diabetic nephropathy?
It develops insidiously, starting as intermittent microalbuminaemia before progressing to constant proteinuria and occassionally nephrotic syndrome
How does diabetes cause albuminuria?
Diabetes causes a number of changes to the body’s metabolism and blood circulation, which combines to produce excess ROS. These changes damage the kidneys glomeruli, which leads to the hallmark features of albuminuria
What happens as diabetic nephropathy progresses?
The glomerular filtration barrier is increasingly damaged
What is the result of the increasing damage to the glomerular filtration barrier in diabetic nephropathy?
The kidney cannot perform its function of selective filtration of the blood entering the kidneys glomeruli, allowing proteins to leak through, causing proteinuria
What are the risk factors for diabetic nephropathy?
- Poor control of blood glucose
- Uncontrolled hypertension
- Type 1 diabetes mellitus, with onset before age 20
- Past or current cigarette use
- Family history of diabetic nephropathy
When do clinical features appear in diabetic nephropathy?
They are usually absent until advanced CKD develops, 5-10 years after the disease began
What is usually the first symptom of diabetic nephropathy?
Nocturia
What are the other symptoms of diabetic nephropathy?
- Tiredness
- Headache
- Malaise
- Nausea
- Vomiting
- Polyuria
- Lack of appetite
- Itchy legs
- Leg swelling
How is diabetic nephropathy detected?
Usually on routine screening
Who gets routine screening for diabetic nephropathy?
All people with type 1 and 2 diabetes
How often should people with diabetes have screening for diabetic nephropathy?
Annually
What is involved in routine screening for diabetic nephropathy?
- Measuring urinary ACT or albumin concentration
- Measure serum creatinine and eGFR
What initial investigations can be performed to find the cause of proteinuria?
- Urinalysis
- Urine culture and microscopy
- Renal ultrasound
- Renal biopsy may occassionally be required
What is raised albumin excretion in type 2 diabetes often a sign of?
General vascular damage, rather than specific renal damage
What is abnormal serum creatinine in type 2 diabetes often due to?
Renal artery disease, and/or diuretic therapy for cardiac failure
When should non-diabetes causes of renal disease be considered?
- No progressive retinopathy
- Blood pressure is particularly high, or resistant to treatment
- If proteinuria develops suddenly
- If significant haematuria is present
- Absence of systemic ill health
What is the goal of treatment of diabetic nephropathy?
To slow progression of kidney damage, and control related complications
What is the goal of treatment of diabetic nephropathy?
To slow progression of kidney damage and control related complications
What is involved in primary prevention of diabetic nephropathy?
- Optimal control of blood glucose and blood pressure
- Early diagnosis and management of nephropathy
- Smoking cessation
How is established microalbuminaemia and proteinuria in diabetic nephropathy managed?
- ACE inhibitors should be started and titrated to full dose in all adults with confirmed nephropathy and type 1 diabetes. If ACE inhibitors are not tolerated, angiotension II antagonists should be substituted
- Blood pressure should be maintained below 130/80mmHg by addition of other antihypertensive drugs
- Measure urine albumin and serum creatinine levels more frequently, with frequency depending on individual situation for patient
At what eGFR should patients with diabetic nephropathy be referred to a specialist?
Below 30
