Diabetes 2

Question 1

How does diabetes lead to diabetes nephropathy?

Answer 1

1. lead to Hypertension
2. Progressively increasing proteinuria
3. Progressively deteriorating kidney function
4. Classic histological features

Question 2

What are some of the implications for developing diabetes nephropathy?

Answer 2

1. CKD
2. Dialysis
3. Transplant

Question 3

What are the glomerular histological changes in diabetic nephropathy?

Answer 3

1. mesangial expansion
2. basement membrane thickening
3. glomerulosclerosis

Question 4

What is the epidemiology of nephorpathy like?

Answer 4

T1DM: 20-40% after 30-40 yrs
T2DM: same but other factors

Question 5

What other factors are involved in T2DM mellitus developing diabetic nephropathy?

Answer 5

• age at development of disease
• racial factors
• age at presentation
• loss due to cardiovascular morbidity

Question 6

What are the clinical features of diabetic nephropathy?

Answer 6

1. Progressive proteinuria
2. Increased BP
3. Deranged renal function

Question 7

What is the normal range for proteinuria?

Answer 7

<30mg/24hr

Question 8

What is the microalbuminuric range for proteinuria?

Answer 8

30-300mg/24hrs

Question 9

What is the assymptomatic range for proteinuria?

Answer 9

300-3000mg/24hr

Question 10

What is the nephrotic range for proteinuria?

Answer 10

> 3000mg/24hr

Question 11

What are the strategies to control diabetic nephropathy?

Answer 11

1. Diabetes control
2. BP control
3. Inhibition of activity of RAS system
4. Stop smoking

Question 12

What can happen when you give drugs to control BP (esp ACE inhii)?

Answer 12

albuminuria also goes down

Question 13

What do ACE inihibitors cause?

Answer 13

1. cause worsen creatinine within days of starting
2. hyperkalaemia
3. prevent end stage renal failure

Question 14

When do you not give ACE inhibitors and why?

Answer 14

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)

Question 15

What treatment do you give for hypothyroid? (hight TSH low FT4)

Answer 15

levothyroxine 100mcg once a day

Question 16

What treatment do you give for hyperthyroidism? (high FT4, low TSH)

Answer 16

1. Beta blocker to control palpitations
   T3 is beta receptor sensitiser
2. Carbimazole (takes a month to work and stay on drug for a year), propylthiouracil or radioiodine - Discuss pros + cons
3. Thyroidectomy

Question 17

What drugs should you give for pituitary failure?

Answer 17

1. testosterone
2. levothyroxine
3. hydrocortisone (3 times daily-15-20mg) or prednisolone (3mg once a day) (gluccocorticosteroid)

Question 18

What replaces cortisol?

Answer 18

predinosolone

Question 19

What replaces aldosterone?

Answer 19

fludorocortisone

Question 20

What is the dose of predinosolone given?

Answer 20

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

Question 21

What is the dose of fludocortisone given?

Answer 21

longer half life 50-100mcg once a day (for renal failure and don’t make aldosterone)

Question 22

Why do you given predinosolone over hydrocortisone or cortisol?

Answer 22

1. Cortisol has diurnal rhythm
2. Cortisol has short half life
3. Oral hydrocortisone has too short for once daily administration
4. Late peaks harmful as leads to insulin resistance