Diabetes nefropati - Amboss

Question 1

Hvordan er epidemiologien til diabetes nefropati?

Amerikansk data

Answer 1

Question 2

Hvilke risikofaktorer predisponerer for diabetes nefropati?

Answer 2

Question 3

Hvordan er patofysiologien til diabetes nefropati?

Answer 3

The mechanism behind hyperfiltration is not fully understood; dilation of the afferent arterioles plays an important role. A variety of hormones and the tubuloglomerular feedback system may be involved.

Question 4

Tegn opp RAAS systemet?

Answer 4

Renin-angiotensin-aldosterone system. Flowchart summarizing the biochemical and physiological effects of the renin-angiotensin-aldosterone system.

Question 5

Hvilke patologiske forandringer fører diabetes nefropati til?

Answer 5

Chronic hyperglycemia, hyperlipidemia, elevated levels of growth hormones, and intraglomerular hypertension are responsible for these changes.

Question 6

Hva viser bildet?

Answer 6

Diabetic nephropathy; Photomicrograph of a kidney autopsy specimen (H&E stain; 400x magnification). Nodular glomerulosclerosis in diabetic nephropathy (Kimmelstiel-Wilson syndrome) displays with mesangial thickening due to nodular, hyaline deposits (Kimmelstiel-Wilson lesions; yellow overlay) within the glomerulus (blue overlay). Further findings include thickening of the tubular basement membranes, tubular atrophy, and an increase of interstitial connective tissue between renal tubules (interstitial fibrosis). Nodular glomerulosclerosis takes a decade or longer to develop in diabetes mellitus.

Question 7

Hva viser pilen til?

Answer 7

Question 8

Hva viser pilen til?

Answer 8

Question 9

Hva viser dette snittet?

Answer 9

Question 10

Hva ser vi i dette snittet?

Answer 10

Question 11

Hva viser pilen til?

Answer 11

Question 12

Hva viser pilen til?

Answer 12

Question 13

Hva viser pilen til?

Answer 13

Question 14

Hvilke symptomer har pas. med diabetes nefropati?

Answer 14

Question 15

Hvordan går man frem med diagnostisering hos en pas. med diabetes nefropati?

Answer 15

Question 16

Hvilke lab.prøver tar man ved diabetes nefropati?

Answer 16

24-hour urine collection is generally not necessary.

Question 17

Hvordan starter man behandlingen for diabetes nefropati?

Answer 17

E.g., nephrologist, endocrinologist, dietitian, exercise specialists.

Question 18

Hvilken målsetning har man for blodsukkerverdien ved diabetes nefropati?

Answer 18

More frequent monitoring is recommended if glycemic targets are not met. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend a target of < 6.5–8%, while the American Diabetes Association (ADA) recommends a target of < 7% for most patients. Consider the potential benefits (e.g., reduction in the rate of CKD progression) and risks (e.g., hypoglycemia) when selecting a target.

Question 19

Hvilken type farmakoterapi må man justere hos DM1 med diabetes nefropati?

Answer 19

Because of the increased half-life of the drug.

Question 20

Hva slags farmakoterapi er akt. til pas. med DM2 og diabetes nefropati?

Answer 20

This benefit occurs independent of their effect on glycemia.

Question 21

Hvordan behandler man pas. med DM2 med KNS med eGFR ≥ 30 mL/min/1.73 m^2?

Answer 21

SGLT-2 inhibitors can be used alone for patients who do not require metformin for glycemic control or who cannot tolerate metformin.

Question 22

Hvordan behandler man pas. med DM2 med KNS med eGFR < 30 mL/min/1.73 m^2?

Answer 22

Adjust the dosing of antihyperglycemic medications in patients with reduced eGFR as needed. Metformin is contraindicated in patients with an eGFR < 30 mL/min/1.73 m2.

Question 23

Hvordan behandler man diabetikere med en transplantert nyre?

Answer 23

Studies on the management of diabetes in patients with CKD after kidney transplant are limited; coordinate care with specialists as needed. There is currently no recommendation for or against their use in patients who have received a kidney transplant.

Question 24

Hvordan behandler man risikoen for kardiovaskulære hendelser hos pas. med diabetesrelatert nyresykdom?

Answer 24

Blood pressure goals differ between guidelines. The KDIGO recommends systolic blood pressure < 120 mm Hg for all patients, while the American Diabetes Association recommends < 130/80 mm Hg. Patients should have an eGFR ≥ 25 mL/min/1.73 m2 and normal potassium levels before initiation.

Question 25

Hvordan behandler man pas. med diabetes som har KNS?

Answer 25

E.g., RAS inhibitors, SLGT2 inhibitors. A protein intake of approx. 0.8 g/kg/day is recommended for patients who are not on dialysis; however, some guidelines may recommend a lower protein target of 0.6–0.8 g/kg/day. Patients on dialysis may be malnourished and require a higher protein intake of 1–1.2 g/kg/day. The American Diabetes Association suggests restricting sodium to < 2.3 g/day, while the KDIGO guidelines recommend < 2 g/day. Sodium restriction may also be used in the management of hypertension. Patients with hyperkalemia may need to reduce their dietary potassium intake. Hepatitis B vaccination is recommended for patients at risk of developing ESRD.

Question 26

Hvordan følger man opp pas. med diabetesrelatert nyresykdom?

Answer 26

E.g., serum calcium, phosphate, parathyroid hormone, and vitamin D.

Question 27

Hvilke preventive tiltak har man for å hindre utvikling av diabetes nefropati?

Answer 27

RAS inhibitors, however, should not be avoided as their use in diabetes slows the progression of kidney disease.

Question 28

Hvem, og når bør man screene for diabetesrelatert nyresykdom?

Answer 28