Diabetes Complications: Nephropathy Flashcards
describe what diabetic nephropathy is
a progressive kidney disease caused by damage to the capillaries in the kidney’s glomeruli
what is diabetic nephropathy characterised by
characterised by proteinuria and diffuse scarring of the glomeruli
what is diabetic nephropathy also known as
Kimmelsteil-Wilson syndrome or Nodular Glomerulosclerosis
what microvascular changes are seen in diabetic nephropathy
angiopathy of capillaries
how does diabetes relate to kidney failure and dialysis
diabetes is commonest cause of kidney failure/dialysis in the UK
what are the consequences of diabetic nephropathy
development of hypertension, relentless decline in renal function, accelerated vascular disease
describe the decline in renal function if diabetic nephropathy is left untreated
relentless decline, reduction in GFR(glomerular filtration rate) of 1ml/min/month if untreated
what investigation is used to screen for renal dysfunction and protein in the urine
urine dipstick, tests for protein, creatinine and eGFR(renal function)
what do ACR and PCR stand for
ACR= albumin:creatinine ratio PCR = protein:creatinine ratio
what tests are done if urine dipstick is ++glucose and +++protein
nitrites/leucocytes/bloods
and sample sent to lab for ACR and PCR
what is the normal range for ACR and PCR
ACR = <3.5female, <2.5males PCR = <15`
what are the ACR and PCR ranges that define microalbuminuria
ACR = >3.5female/2.5male to <30
PCR = >15 to <50
(if +ve repeat twice, established microalbuminuria if 2 out of 3 +ve)
what are the ACR and PCR ranges for proteinuria(overt nephropathy)
ACR = >30
PCR = >50
(if +ve repeat on early morning urine)
what does the urine albumin excretion rate(UAER) vary with
day : night, exercise, protein load, urine load
what are some situations that can result in a false positive microalbuminuria
menstruation, vaginal discharge, UTI, pregnancy,
how is nephropathy defined
on the basis of urine protein
if low then incipient nephropathy, if high then overt nephropathy
when should diabetes patients have their urinary albumin conc. and serum creatinine measured
at diagnosis and at regular intervals, usually annually
what should be screened for/investigated in a patient with microalbuminuria
check for retinopathy, hypertension, peripheral vascular disease, ischaemic heart disease
what is the first line treatment for nephropathy
ACEi, or ARB
what should all microalbuminuria or proteinuria patients be commenced on and be considered for
start ACEi or ARB
consider angiotensin II antagonist therapy
what are the benefits of ACEi or ARB in nephropathy
dilatation of renal arterioles, decrease filtration pressure, decrease proteinuria, decrease GFR
(allow up to 20% decrease in eGFR)
what is eGFR
estimated glomerular filtration rate
