Diabetes and the Kidney Flashcards
1
Q
What is Diabetic Nephropathy?
A
Kidney damage caused by diabetes
2
Q
What region of the nephron does Diabetic Nephropathy affect?
A
Glomerulus
3
Q
What are the 3 layers of the glomerulus?
A
- Vascular endothelium
- Basement membrane
- Podocyte filtration slits
4
Q
What are the risk factors of Diabetic Nephropathy?
A
- Hyperglycemia
- Smoking
- Obesity
- Hypertension
- Physical inactivity
- Genetic susceptibility
5
Q
What are the clinical features of Diabetic Nephropathy?
A
- Albuminuria is the first clinical sign
- Glomeruscelrosis
- Nodule formation (Kimmelstiel-Wlson lesions)
- Fibrosis
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
7
Q
What are the investigations in suspected Diabetic Nephropathy?
A
- ACR ratio regularly screened
- ACR > 2.5 indicates microalbuminuria
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