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A - MSRA Renal and Urinary [17] > [1] Diabetic Nephropathy > Flashcards

[1] Diabetic Nephropathy Flashcards

1
Q

What is diabetic nephropathy?

A

Chronic loss of kidney function occuring in those with diabetes mellitus

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2
Q

What renal diseases are people with diabetes at increased risk of?

A
  • Renal atherosclerosis
  • Urinary tract infections
  • Papillary necrosis
  • Glomerular lesions
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3
Q

Is diabetic nephropathy diffuse or nodular?

A

Can be either

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4
Q

What happens in the early stages of diabetic nephropathy?

A

There is an elevated glomerular filtration rate with enlarged kidneys

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5
Q

What is the principle feature of diabetic nephropathy?

A

Proteinuria

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6
Q

Describe the development of proteinuria in diabetic nephropathy?

A

It develops insidiously, starting as intermittent microalbuminaemia before progressing to constant proteinuria and occassionally nephrotic syndrome

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7
Q

How does diabetes cause albuminuria?

A

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

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8
Q

What happens as diabetic nephropathy progresses?

A

The glomerular filtration barrier is increasingly damaged

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9
Q

What is the result of the increasing damage to the glomerular filtration barrier in diabetic nephropathy?

A

The kidney cannot perform its function of selective filtration of the blood entering the kidneys glomeruli, allowing proteins to leak through, causing proteinuria

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10
Q

What are the risk factors for diabetic nephropathy?

A
  • 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
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11
Q

When do clinical features appear in diabetic nephropathy?

A

They are usually absent until advanced CKD develops, 5-10 years after the disease began

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12
Q

What is usually the first symptom of diabetic nephropathy?

A

Nocturia

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13
Q

What are the other symptoms of diabetic nephropathy?

A
  • Tiredness
  • Headache
  • Malaise
  • Nausea
  • Vomiting
  • Polyuria
  • Lack of appetite
  • Itchy legs
  • Leg swelling
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14
Q

How is diabetic nephropathy detected?

A

Usually on routine screening

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15
Q

Who gets routine screening for diabetic nephropathy?

A

All people with type 1 and 2 diabetes

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16
Q

How often should people with diabetes have screening for diabetic nephropathy?

A

Annually

17
Q

What is involved in routine screening for diabetic nephropathy?

A
  • Measuring urinary ACT or albumin concentration
  • Measure serum creatinine and eGFR
18
Q

What initial investigations can be performed to find the cause of proteinuria?

A
  • Urinalysis
  • Urine culture and microscopy
  • Renal ultrasound
  • Renal biopsy may occassionally be required
19
Q

What is raised albumin excretion in type 2 diabetes often a sign of?

A

General vascular damage, rather than specific renal damage

20
Q

What is abnormal serum creatinine in type 2 diabetes often due to?

A

Renal artery disease, and/or diuretic therapy for cardiac failure

21
Q

When should non-diabetes causes of renal disease be considered?

A
  • 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
22
Q

What is the goal of treatment of diabetic nephropathy?

A

To slow progression of kidney damage, and control related complications

23
Q

What is the goal of treatment of diabetic nephropathy?

A

To slow progression of kidney damage and control related complications

24
Q

What is involved in primary prevention of diabetic nephropathy?

A
  • Optimal control of blood glucose and blood pressure
  • Early diagnosis and management of nephropathy
  • Smoking cessation
25
Q

How is established microalbuminaemia and proteinuria in diabetic nephropathy managed?

A
  • 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
26
Q

At what eGFR should patients with diabetic nephropathy be referred to a specialist?

A

Below 30

A - MSRA Renal and Urinary [17] (17 decks)

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