Diabetes and the Kidney

Question 1

What is Diabetic Nephropathy?

Answer 1

Kidney damage caused by diabetes

Question 2

What region of the nephron does Diabetic Nephropathy affect?

Answer 2

Glomerulus

Question 3

What are the 3 layers of the glomerulus?

Answer 3

• Vascular endothelium
• Basement membrane
• Podocyte filtration slits

Question 4

What are the risk factors of Diabetic Nephropathy?

Answer 4

• Hyperglycemia
• Smoking
• Obesity
• Hypertension
• Physical inactivity
• Genetic susceptibility

Question 5

What are the clinical features of Diabetic Nephropathy?

Answer 5

• Albuminuria is the first clinical sign
• Glomeruscelrosis
• Nodule formation (Kimmelstiel-Wlson lesions)
• Fibrosis

Question 6

What is the pathophysiology of Diabetic Nephorpathy?

Answer 6

• Glycosylation of the basement membrane results in hyaline arteriosclerosis
• Obstruction of the renal artery increases pressure and causes arteriole dilatation
• This leads to increase in GFR, hyperfiltration
• As the disease progresses, the GFR eventually decreases

Question 7

What are the investigations in suspected Diabetic Nephropathy?

Answer 7

• ACR ratio regularly screened

- ACR > 2.5 indicates microalbuminuria

Question 8

What is the management of Diabetic Nephropathy?

Answer 8

• Tight glycaemic control reduces risk of progression to microalbuminuria
• BP target 130/80. Use ACE-i or ARBs as these are reno-protective and cardio-protective. Switch from ACEi to ARBs if cough develops
• Sodium restriction
• Statins to prevent dyslipidemia