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Urinary > 7. Diabetic Nephropathy > Flashcards

7. Diabetic Nephropathy Flashcards

1
Q

What is the most common cause of end stage renal disease?

A

Diabetic nephropathy

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2
Q

What are the pathological changes in diabetic nephropathy?

A
  1. Hyperfiltration/capillary hypertension
  2. Glomerular basement membrane thickening
  3. Mesangial expansion
  4. Podocyte injury
  5. Glomerular sclerosis/arteriosclerosis
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3
Q

What is hyperfiltration and hypertrophy related to?

A

Hyperglycaemia

Results in increased GFR

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4
Q

What happens in the nephron in diabetes?

A

Afferent vasodilation - hyperglycaemia, high blood amino levels, low NaCl delivery to macula densa
Lots of Na reabsorbed as glucose is reabsorbed
Glucose reabsorbed until all GLUT transporters saturated
Efferent vasoconstriction
RAAS pathway stimulated

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5
Q

What causes the hyperfiltration in diabetics nephrons?

A

Higher pressure in glomerulus as vasodilated afferent and vasocontricted efferent

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6
Q

What are the clinical signs and symptoms in diabetic nephropathy in the first stage?

A

Hyperfiltration and hypertrophy

- increased GFR

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7
Q

What are the clinal signs and symptoms in diabetic nephropathy in the second stage?

A

Normal albuminuria

GBM thickening and mesangial expansion

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8
Q

What are the clinal signs and symptoms in diabetic nephropathy in the third stage?

A 
Microalbuminuria
Variable mesangial expansion/sclerosis
Increased GBM thickening
Podocyte changes
GFR normal
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9
Q

What are the clinal signs and symptoms in diabetic nephropathy in the fourth stage?

A

Overt proteinuria
Diffuse glomerular histopathological changes
Systemic hypertension
Falling GFR

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10
Q

What happens in the fifth stage of diabetic nephropathy?

A

End stage renal disease

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11
Q

What happens in the overt proteinuria stage?

A

GFR normal initially then generally drops
Mesangial expansion/sclerosis - reduced surface area for filtration
Frequently increases to nephrotic range proteinuria
Worsening systemic hypertension
Microvascular changes - causes tissue ischaemia

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12
Q

What are the risk factors for diabetic nephropathy?

A 
Genetic susceptibility
Race
Hypertension
Hyperglycaemia
High level of hyperfiltration
Increasing age
Duration of diabetes 
Smoking
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13
Q

What is the primary prevention of diabetic nephropathy?

A

Tight blood glucose control

Tight BP control

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14
Q

How is tight glycaemic control reached?

A

Multiple injections or insulin pump

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15
Q

What can keeping tight glycaemic control do?

A

Can reverse initial hyperfiltration and delay microalbuminuria
Can reduce microalbuminuria over 2 years treatment period

Doesn’t slow GFR loss once overt proteinuria develops

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16
Q

What is the management of microalbuminuria and proteinuria?

A 
Inhibition of RAAS
Tight BP control
Statin therapy
CV risk management
Moderate protein intake
Tight blood glucose control

Urinary (30 decks)

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