diabetic kidney disease

Question 1

how is diabetic kidney disease defined?

Answer 1

albuminuria >3.4mg/mmol
progressive reduction in eGFR
seen after long duration of diabetes - although may not seem like it if diabetes was diagnosed late

Question 2

what factors increase the risk of DKD?

Answer 2

long duration of hyperglycaemia
glomerular hyperfiltration
smoking
obesity + physical inactivity
dyslipidaemia
proteinuria

Question 3

how does DKD occur?

Answer 3

Renal hypertrophy, hyperfiltration and intrarenal hypertension cause mesangial expansion, glomerulosclerosis and tubulointerstitial fibrosis

Question 4

what is the factor associated with the highest risk of cardiovascular mortality in T2DM patients without pre-exisitng CVD?

Answer 4

declining eGFR

Question 5

what is the treatment of DKD?

Answer 5

lifestyle changes
RAS inhibition with ACEIs and ARBs
SGLT2 inhibitors

Question 6

what are the sick day rules for RAS inhibition in DKD?

Answer 6

pause medication if unwell

Question 7

how do SGLT2is cause renal protection?

Answer 7

• Increase sodium delivery to macula densa
• Activates tubuloglomerular feedback
• Afferent arteriolar vasoconstriction
• Decreases intra-glomerular pressure
• Reduces CKD progression and albuminuria

Question 8

when would you prescribe an SGLT2i?

Answer 8

T2DM & eGFR ≥ 25 mls/min/1.73m2
Without T2DM, eGFR ≥ 25 & uACR ≥ 25 mg/mmol

cant give in PKD or those on immunological therapy for renal disease