Diabetes 2 Flashcards
How does diabetes lead to diabetes nephropathy?
- lead to Hypertension
- Progressively increasing proteinuria
- Progressively deteriorating kidney function
- Classic histological features
What are some of the implications for developing diabetes nephropathy?
- CKD
- Dialysis
- Transplant
What are the glomerular histological changes in diabetic nephropathy?
- mesangial expansion
- basement membrane thickening
- glomerulosclerosis
What is the epidemiology of nephorpathy like?
T1DM: 20-40% after 30-40 yrs
T2DM: same but other factors
What other factors are involved in T2DM mellitus developing diabetic nephropathy?
- age at development of disease
- racial factors
- age at presentation
- loss due to cardiovascular morbidity
What are the clinical features of diabetic nephropathy?
- Progressive proteinuria
- Increased BP
- Deranged renal function
What is the normal range for proteinuria?
<30mg/24hr
What is the microalbuminuric range for proteinuria?
30-300mg/24hrs
What is the assymptomatic range for proteinuria?
300-3000mg/24hr
What is the nephrotic range for proteinuria?
> 3000mg/24hr
What are the strategies to control diabetic nephropathy?
- Diabetes control
- BP control
- Inhibition of activity of RAS system
- Stop smoking
What can happen when you give drugs to control BP (esp ACE inhii)?
albuminuria also goes down
What do ACE inihibitors cause?
- cause worsen creatinine within days of starting
- hyperkalaemia
- prevent end stage renal failure
When do you not give ACE inhibitors and why?
renal artery stenosis as pressure already low so GFR can end up as zero and will stop peeing so be careful and check stop ACE inihibtors (reversible)
What treatment do you give for hypothyroid? (hight TSH low FT4)
levothyroxine 100mcg once a day
What treatment do you give for hyperthyroidism? (high FT4, low TSH)
- Beta blocker to control palpitations
T3 is beta receptor sensitiser - Carbimazole (takes a month to work and stay on drug for a year), propylthiouracil or radioiodine - Discuss pros + cons
- Thyroidectomy
What drugs should you give for pituitary failure?
- testosterone
- levothyroxine
- hydrocortisone (3 times daily-15-20mg) or prednisolone (3mg once a day) (gluccocorticosteroid)
What replaces cortisol?
predinosolone
What replaces aldosterone?
fludorocortisone
What is the dose of predinosolone given?
Prednisolone longer half life and more potent that cortisol so 3-4mg once daily (5mg previously was too much) - 5mg can cause LT side effects like weight gain, osteoporosis and adrenal suppression
What is the dose of fludocortisone given?
longer half life 50-100mcg once a day (for renal failure and don’t make aldosterone)
Why do you given predinosolone over hydrocortisone or cortisol?
- Cortisol has diurnal rhythm
- Cortisol has short half life
- Oral hydrocortisone has too short for once daily administration
- Late peaks harmful as leads to insulin resistance
