Diabetic and Ischaemic Nephropathy Flashcards
what is the cause of diabetic nephropathy?
Type 1 + 2
what are the clinical features of diabetic nephropathy?
- Long history of DM
- Presence of other diabetic complications e.g. retinopathy
- Nocturia
- Tiredness, headaches, nausea, vomiting, frequency, lack of appetite, itchy skin, oedema – renal impairment = late findings
- Microalbuminuria
how is diabetic nephropathy diagnosed?
- microalbuminuria or proteinuria
- Test levels via urinalysis
- Histologically
what is the first stage of diabetic nephropathy?
Glucose sticks to endothelium of efferent arteriole and cause glycation – hyaline arteriosclerosis (narrowing) = obstruction
• Afferent arteriole then dilates allowing more blood flow into glomerulus, increased pressure = increased GFR = hyperfiltration
what is the second stage of diabetic nephropathy?
- In response to high pressure + growth factors – mesangial cells release more structural matrix – this occurs uniformly (diffuse glomerulosclerosis( or as nodules
- Increases permeability of BM allowing proteins to enter, causes damage = reduced GFR
what are the histological features of diabetic nephropathy?
basement membrane thickening, capillary obliteration, mesangial widening. Nodular hyaline areas develop in the glomeruli - Kimmelstiel-Wilson nodules
how is diabetic nephropathy managed?
- Maintain tight glycaemic control
- Antihypertensive therapy - <130/80, ACE, ARBs
- Lipid control
- Renal replacement therapy
what are the causes of ischaemic nephropathy?
- Essential Hypertension
* Secondary Hypertension – renovascular disease – atherosclerotic renal artery sclerosis, fibromuscular dysplasia
what is Ischaemic Nephropathy?
• Refers to reduced GFR associated with reduced renal blood flow beyond the level of autoregulatory compensation
what is the pathophysiology of Ischaemic Nephropathy?
- Over time can lead to renal atrophy and progressive CKD – fibrosis
- Narrowing of renal artery causes BP in kidney to stay low – juxglomeurlar cells release renin – increase BP of body before stenosis whilst kidney BP stays low
what is the cause of renal artery stenosis?
risk factors for generalised
what is the pathophysiology of renal artery stenosis?
mix of fat, calcium + immune cells form a layer inside artery, usually unilateral
what is the cause of Renal Fibromuscular Dysplasia?
genetics, associations with other hereditary conditions, EHD
what is the pathophysiology of Renal Fibromuscular Dysplasia?
fibrosis collagen deposition smooth muscle, leaves bumps (strings of beads)
what are the clinical features of Ischaemic Nephropathy?
renovascular hypertension, AKI after treatment of hypertension, CKD in elderly with diffuse vascular disease, Flash pulmonary oedema, abdominal bruit, atherosclerosis elsewhere, discrepancy in kidney size, headaches + blurry vision
