Diabetes Nephropathy Flashcards
T or F: DN is the most common cause of ESRD
T
T or F: Development is strongly genetic
T: only 17 % risk if no family history
Describe the early changes assc with DN (pathogenesis, clinical, histo)
hyperfiltraion resulting in glomerular hypertrophy
clinically manifests as microalbuminemia
histo: inc mesangial matrix, glomerular collapse, glomerularsclerosis
Describe the progression of DN.
microalbuminemia –> proteinuria –> inc Sr Cr –> ESRD
What is the clinical defn of DN?
long standing DM (+/-retinopathy)
Macroalbuminemia
HTN
What usually develops at the same time as DN?
retinopathy
What are the 5 stages of DN kidney disease?
- hyperfiltration (inc GFR)
- microalbuminemia
- more proteinuria, more Sr Cr, inc BUN, +/- HTN
- GFR <10 ml/min
How long can it take to get to ESRD?
long time (avg 23 yrs)
What causes the damage in DN?
inc blood glc, inc Ang II causes hyperfiltration –> inc glomerular pressure –> hypertrophy of epithelium and endothelium –> accerlation of cell failure and premature glomerulosclerosis
Is there inflammation assc with progression of DN?
no, TGF-B secreted by the tubuloepithelial cells causes thickening of GBM, hypertrophy, mesangial matrix expansion
What are AGEs? What is their role in DN? How are they formed?
advanced glycosylation products –> accelerates cell injury
*long term hyperglycemia forms them from non-enzymatic glycosylation of capillary BM
Are AGEs normal?
yes, there are just more of them in DN pts
What is the tx for DN? Why?
CONTROL DM!! (slows progression)
ARBs and ACE-Is (only drugs that dec glomerular pressure = relax both aff and eff tone)
What is a good marker for the progression of DN towards ESRD?
degree of proteinuria
What are some complications of DN?
pyelonephritis
papillary necrosis
RTA type 4
neurogenic bladder
What are the 3 main types of DN? (and their subtypes)
- glomerular: diffuse and nodular
- papillary: pyelonephritis and papillary necrosis
- tubulointersitial: tubular BM thickening and intersitial fibrosis
What is the most common type of DN?
diffuse
**earlier and less severe
Describe the appearance of diffuse DN histologically
thickening of GBM and mesangial matrix expansion
When does nodular type appear?
> 10 yrs of DM
= correlates with ESRD/need for dialysis
What are the histological features of nodular DN
kimmelsteil wilson nodules and hyaline sclerosis od afferent and efferent arterioles
What are kimmelstiel wilson nodules?
spherical hyaline deposits of mucopolysacchairdes, lipids, and fibrillary proteins within the mesangium or glomerular tuft
*they eventually squeeze capillaries shut
What are the 2 types of exudative lesions and which one occurs only in DN?
fibrin caps capsular drops (only DN)
What are fibrin caps and capsular drops?
firbin caps: crescentric deposits of condened leaked plasma proteins overlying the peripheral capillaires (can be subspi or sub endo)
Capsular drops: deposits of partly plasma proteins and BM in parietal later of Bowman’s capsule (protrudes into urinary space)
The end stage of DN looks just like __disease_ (describe gross and microscopic appearance too)
hypertensive nephropathy
- gross, diffuse fine granularity of cortical surface
- *microscpoic: fibrosis and sclerosis –> globally sclerotic glomeruli, dilated tubules, tubules resembling thyroid follicles and interstitial fibrosis
