Diabetes Complications

Question 1

What are the changes/ lesions seen on rebal biopsy for long term diabetic ptn?

Answer 1

1- Kimmelstiel-Wilson nodule: is the most specific lesion of diabetic glomerulosclerosis ( these are ovoid, hyaline, PAS positive structures found in the mesangial core at the edge of the glomerulus ) this lesion is pathognomonic in diabetic ptn but not seen in all of them

2- glomerular cappillary basement ( membrane thickening )

3- diffuse glomerulosclerosis

4- hyaline thickening of arteriolar walls

5- tubular atrophy

6- interstitial fibrosis

7- PAS-positive capsular drops in parietal layer of Bowman capsule

Question 2

A- if you take a biopsy of diabetic nephropathy ptn, what do you expect to find?

Answer 2

Mesangial proliferation
Nodular deposits of Mesangial matrix &
thickened basement membranes

Question 3

What are the recommendations for ptn with diabetic nephropathy who has proteinuria?

Answer 3

1- tight control of glucose

2-low protein diet

3- control of BP

4- ACE Inhibitors : as captopril to ⬇️ hyperfiltiration & BP

Question 4

Name renal diseases that require steroids In ttt plan?

Answer 4

Glomerulonephritis ass. With lupus or Wegener’s diseases