Case 9 Flashcards
whats the prevalence of people with diabetes will go on to develop diabetic nephropathy? what can you do about this?
20%
if spotted early enough, it can be slowed down with treatment
What causes kidney disease? In diabetic nephropathy
High blood glucose levels damage the small blood vessels and tiny filters in your kidney.
High blood pressure also does this.
This causes the kidney to leak and then abnormal amount of protein can leave the body in your urine.

What are the signs and symptoms of kidney disease ?
what may cause them?
- Swollen ankles, feet and hands
- Hameaturia
- lethargic
- shortness of breath
- feeling sick
this may be because your kidneys are struggling to clear extra fluid and waste from the body. However, it can also be caused by other conditions
Are all symptoms of kidney disease visible ?
No, that’s why you need tests every year so that it cn be spotted early and slowed down with treatment
How can you reduce your risk of kidney disease?
- Keep blood sugar levels within target range
- Keep blood pressure down
- Get support to stop smoking
- eat healthily and keep active
- go to all your medical appointment
What are the 2 tests for kidney disease included in your annual review?
Urine test (ACR)
Blood test (eGFR)
Part of your 15 healthcare essentials you should have both tests for kidney disease every year
What does the urine test (ACR) look for?
Albumin: creatinine ratio looks for signs that protein is leaking into the urine.
This is often an early sign of kidney disease.
Describe the relevant details of the blood test (eGFR)
It tests for the wate product creatinine.
Creatinine levels and other info like age, sex and ethnicity are used to estimate you GFR.
Your GFR is a measure of how well your kidneys are working.
What are the treatments for kidney disease?
It all depends on what stage you are in the kidney disease.
ACE inhibitors and ARBs are used to lower BP, hence can protect the kidney from further damage.
Advice on what food to eat will help a lot. Change in diet is essentiak
If it gets to late stage kidney disease, you may need dialysis or kidney transplant. However theses are rare with new technology and early detection.
Where can you get support and more info for kidney disease as a pt
- Your diabetes team - they’ll answer most of your questions
- A helpline call is available if you just want someone to listen to. They are highly skilled and have an extensive knowledge of diabetes.
- National kidney federation -
- British Kidney patient association- offers telephone counselling
- Kidney research UK - future and current research for kidney disease
What are the 3 compoents of the filtraiton barrier of the glomerurlus
- Endothelial of glomerular capillaries
- Glomerular basement membrane
- Epithelial cells of bowman’s capsule- podocytes
Descirbe the structure of the endothelial cells of glomerulus. Link it to their functions?
Has many 70nm sized fenestrae- they limit filtration of cellular components like RBCs.
It has glycocalyx that surrounds the luminal side of endothelial cells- they hinder diffusion of negatively charged particles.
Glycocalyx is made up of negatively charged GAGs

Describe the structure and function of the glomerular basment membrane
It surrounds the endotheliuem.
It’s made up of type 4 collagen, heparan sulfate proteoglycans and lamina.
The heparan sulfate proteoglycan restrict movement of negatively charged molecules across the basement membrane.
The basement membrane consists of 3 layers

What is the function of the 3 layers of the basment membrane and what are they?
The layers are:
- inner thin layer (lamina rara interna)
- A thick layer (lamina densa)
- an outer dense layer (lamina rara externa)
these layers help to limit filtration of intermediate to large sized solutes
What are podocytes and what features help them in ultrafiltration?
They are speicalised epithelial cells of bowman’s capsule which form the visceral layer of the capsule.
Foot like processes project from these podocytes and interdigitate to form filtration slits.
The filtration slits are bridged by the slit diaphragm.
The slit diaphragm has ver small pores preventing large molecules from crossing.
Podocytes have negatively charged glycoprotein covering it- they restrict filtration of large anions.
Describe the relationship between filtration rate and characteristics of molecules
The filtration rate is inversely proportional to the size of the molecules (molecular weight).
Glcuose (180Da) will easily cross the barrier than albumin (69kDa).
Negatively charged molecules are less easily filtered than positively charged molecules of the same size
What are the signs and symptoms of Alpert syndrome and what mutation causes it ?
Genetic disease that is usually inherited via X-linked.
There are mutations in gene coding fo the a5 chain of type 4 collagen.
This is a chronic kidney disease with symptoms like:
- haematuria
- sensorineural deafness
- ocular abnormalities
Descirbe the effects of the mutation that leads to Alpert syndrome and discuss the management options for this disease
This mutation results in thinning of the lamina densa of GBM with areas of multi-layering producing a basket weave appearance.
There’s no definitive treatment but ACE inhibitors are given to help reduce proteinuria and progression of renal disease.
ACE inhibitors also control hypertension
In later stages of Alport syndrome, what occurs
- Glomerulosclerosis
- Interstitial fibrosis
- Tubular atrophy
What is minimal change glomerulonephtirs
This is resposnible for 10-25% of nephrotic syndrome.
No visible change under rlight microsope but electron microsope shows changes in glomeruli
There’s diffuse effacement of foot process of podocytes - in which there’s widening of filtration slits.
Microvillus change seen on the podocytes.

What is thought to be the cause of minimal change glomerulonephritis ?
Considered idiopathic.
However, it is thought to be due to a T-cell derived factor
Describe the management of minimal change glomerulonephritis and how pts respond to it.
Steroid therapy - Most pts respond well to steroids but symptoms may relapse if they come off steroid therapy.
Some pts become come steroid dependent but most of them do not progress to chronic renal failure.
The steroid dpeepdnent pts that progress to chronic renal failure usually have focal segmental glomeruloscelosis as well .
What are the common symptoms of nephrotic symptoms ?
- Proteinuria
- hypoalbuminaemia
- oedema
What molecule inhibits renin secretion. When and where is the molecule made ?
Atrial natriuretic peptide (ANP).
it is released by stretched atria in response to increased blood pressure

























