Diabetes, Hypertension and Systemic Diseases Flashcards
What is the normal size of the kidneys?
10-12cms
What is the most common cause of ESRD?
Diabetic nephropathy
What is normal GFR?
~ 120
How does hyperglycaemia cause glomerula hypertension?
High [glucose] = increase SGLT2 = increased glucose Na/Cl uptake = less Na/Cl to macula densa = activates JGA = AA vasodilation, EA vasoconstriction = glomerular hypertension
Outline the progression of diabetic nephropathy
Hypertrophy = increased GFR
GBM thickening, mesangial expansion
Microalbuminuria = sclerosis, podocyte changes
Overt proteinuria
ESRD
What are the risk factors for diabetic nephropathy?
Genetic susceptibility Race Hypertension Hyperglycaemia High level of hyperfiltration Increasing age Duration of DM Smoking
Outline the primary prevention of diabetic nephropathy
Tight blood glucose control
Tight BP control
Not smoking
Cholesterol control
How are microalbuminuria and proteinuris managed?
Inhibition of RAAS
Tight BP control
Statin therapy
CV risk management = exercise, diet, stop smoking
Moderate protein intake
What effect does AngII have on the kidney?
Increase glomerular permeability to proteins
Mesangial cell proliferation
EA constriction
What is the first sign of renal disease?
Microalbuminuria
What are the key features of hypertensive nephrosclerosis?
Hypertension proceeding proteinuria
Decreased GFR over a long time frame
Pts generally have LV hypertrophy and hypertensive eye disease before kidney disease
Describe renal artery stenosis
Acute hypertension
Rapid GFR decline
Atherosclerosis elsewhere
Acute worsening with RAAS-blockade
How is nephrotic syndrome managed?
Diuretics = oedema
Ace-inhibitors
Hypercholesterolaemia
Treat underlying condition
How is nephritic syndrome managed?
ACEi = BP control
Treat oedema
Disease specific treatment = generally immunosuppressive
CVS risk management = stop smoking, statin
