Diabetes and the Kidney Flashcards

1
Q

What is Diabetic Nephropathy?

A

Kidney damage caused by diabetes

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2
Q

What region of the nephron does Diabetic Nephropathy affect?

A

Glomerulus

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3
Q

What are the 3 layers of the glomerulus?

A
  • Vascular endothelium
  • Basement membrane
  • Podocyte filtration slits
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4
Q

What are the risk factors of Diabetic Nephropathy?

A
  • Hyperglycemia
  • Smoking
  • Obesity
  • Hypertension
  • Physical inactivity
  • Genetic susceptibility
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5
Q

What are the clinical features of Diabetic Nephropathy?

A
  • Albuminuria is the first clinical sign
  • Glomeruscelrosis
  • Nodule formation (Kimmelstiel-Wlson lesions)
  • Fibrosis
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6
Q

What is the pathophysiology of Diabetic Nephorpathy?

A
  • 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
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7
Q

What are the investigations in suspected Diabetic Nephropathy?

A
  • ACR ratio regularly screened

- ACR > 2.5 indicates microalbuminuria

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8
Q

What is the management of Diabetic Nephropathy?

A
  • 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
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