Diabetic glomerulosclerosis Flashcards
What is the most common cause of chronic renal failure?
Diabetes
Diabetes is the leading cause of chronic kidney disease.
What does renal failure indicate in terms of glomerular filtration rate (GFR)?
¯ glomerular filtration rate
A decrease in GFR signifies renal impairment.
What is the first change that occurs in the kidney due to diabetes?
Hyperfiltration
Hyperfiltration is characterized by increased glucose crossing the glomerular basement, pulling water with it, leading to polyuria.
What is the second change that occurs in the kidney due to diabetes?
Thickening of the glomerular basement membrane
This thickening results from non-enzymatic glycosylation, causing loss of size and charge barrier.
What are Kimmelstiel-Wilson nodules composed of?
Hyaline
Kimmelstiel-Wilson nodules appear as pink circles on light microscopy.
True or False: Hyperfiltration leads to a decrease in glomerular filtration rate over time.
True
Initially, GFR increases due to hyperfiltration, but it eventually decreases as kidney function declines.
Fill in the blank: The initial renal change in diabetes is _____ due to increased glucose in the glomerular filtration.
Hyperfiltration
Hyperfiltration is the body’s attempt to handle increased glucose levels.
What does the thickening of the glomerular basement membrane lead to?
Loss of size and charge barrier
This alteration can affect the kidney’s filtering ability.
What is hyaline arteriolosclerosis?
Deposition of hyaline (protein) in the walls of the renal vasculature
This condition is often associated with diabetes.
What are the first drugs used in diabetes for HTN, proteinuria, or elevated creatinine or renin?
ACE inhibitors (e.g., lisinopril) or ARBs (e.g., valsartan)
These are indicated when blood pressure exceeds >130/80 in diabetic patients.
What effect does AT-II have on efferent arterioles in the kidney?
Constricts efferent arterioles, causing a backup of pressure at the glomerulus
This helps maintain GFR when renal blood flow decreases.
How do ACEi and ARBs affect efferent arterioles?
They decrease constriction of efferent arterioles
This reduces filtration fraction and GFR.
True or False: Reducing GFR in diabetes is always harmful.
False
A slight reduction in GFR early on decreases the rate of excess glucose filtration.
What long-term effect do ACEi/ARBs have on the glomerular basement membrane?
They slow the process of non-enzymatic glycosylation and thickening
This is important for preventing a massive decrease in GFR later.
Fill in the blank: ACE inhibitors and ARBs help maintain GFR during decreased renal blood flow by reducing _______.
constriction of efferent arterioles
