Diabetes Complications: Nephropathy

Question 1

describe what diabetic nephropathy is

Answer 1

a progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli

Question 2

what is diabetic nephropathy characterised by

Answer 2

characterised by proteinuria and diffuse scarring of the glomeruli

Question 3

what is diabetic nephropathy also known as

Answer 3

Kimmelsteil-Wilson syndrome or Nodular Glomerulosclerosis

Question 4

what microvascular changes are seen in diabetic nephropathy

Answer 4

angiopathy of capillaries

Question 5

how does diabetes relate to kidney failure and dialysis

Answer 5

diabetes is commonest cause of kidney failure/dialysis in the UK

Question 6

what are the consequences of diabetic nephropathy

Answer 6

development of hypertension, relentless decline in renal function, accelerated vascular disease

Question 7

describe the decline in renal function if diabetic nephropathy is left untreated

Answer 7

relentless decline, reduction in GFR(glomerular filtration rate) of 1ml/min/month if untreated

Question 8

what investigation is used to screen for renal dysfunction and protein in the urine

Answer 8

urine dipstick, tests for protein, creatinine and eGFR(renal function)

Question 9

what do ACR and PCR stand for

Answer 9

ACR= albumin:creatinine ratio
PCR = protein:creatinine ratio

Question 10

what tests are done if urine dipstick is ++glucose and +++protein

Answer 10

nitrites/leucocytes/bloods

and sample sent to lab for ACR and PCR

Question 11

what is the normal range for ACR and PCR

Answer 11

ACR = <3.5female, <2.5males
PCR = <15`

Question 12

what are the ACR and PCR ranges that define microalbuminuria

Answer 12

ACR = >3.5female/2.5male to <30
PCR = >15 to <50
(if +ve repeat twice, established microalbuminuria if 2 out of 3 +ve)

Question 13

what are the ACR and PCR ranges for proteinuria(overt nephropathy)

Answer 13

ACR = >30
PCR = >50
(if +ve repeat on early morning urine)

Question 14

what does the urine albumin excretion rate(UAER) vary with

Answer 14

day : night, exercise, protein load, urine load

Question 15

what are some situations that can result in a false positive microalbuminuria

Answer 15

menstruation, vaginal discharge, UTI, pregnancy,

Question 16

how is nephropathy defined

Answer 16

on the basis of urine protein

if low then incipient nephropathy, if high then overt nephropathy

Question 17

when should diabetes patients have their urinary albumin conc. and serum creatinine measured

Answer 17

at diagnosis and at regular intervals, usually annually

Question 18

what should be screened for/investigated in a patient with microalbuminuria

Answer 18

check for retinopathy, hypertension, peripheral vascular disease, ischaemic heart disease

Question 19

what is the first line treatment for nephropathy

Answer 19

ACEi, or ARB

Question 20

what should all microalbuminuria or proteinuria patients be commenced on and be considered for

Answer 20

start ACEi or ARB

consider angiotensin II antagonist therapy

Question 21

what are the benefits of ACEi or ARB in nephropathy

Answer 21

dilatation of renal arterioles, decrease filtration pressure, decrease proteinuria, decrease GFR
(allow up to 20% decrease in eGFR)

Question 22

what is eGFR

Answer 22

estimated glomerular filtration rate