diabetic kidney disease Flashcards
what is the definition of diabetic kidney disease?
albuminuria (uACR >3.4mg/mmol)
progressive reduction in eGFR
typically associated with retinopathy
what are the symptoms of DKD?
may be absent until the disease is advanced
fatigue
anorexia
swelling of the extremities
hypertension
oedema
associated microvascular complications
what factors increase the likleyhood of DKD?
the extent and duration of hyperglycaemia and HTN
glomerular hyperfiltration
smoking
obesity
physical inactivity
dyslipidaemia
proteinuria
what is the impact of DKD?
thickening of the glomerular basement membrane and fusion of foot processes
what is the natural progression of kidney disease?
- hyperfiltration (raised eGFR, low serum creatinine)
- proteinuria
- proteinuria rises, eGFR falls
- ESRD
what is the consequence of raised albuminuria?
increased kidney and CVD risk
how is DKD treated in patients with albuminuria?
ACEi or ARB
what is the impact of an ACEi?
reduce arterial BP and dilate arterioles, leading to a reduced risk of glomerular injury
reduce hyperfiltration leading to lower microalbuminuria and a reduced mesangial cell growth
this prevents/delays progression of renal disease
what is the target BP in a diabetic patient with proteinuria?
<130/80
when should an ACEi/ARB be reduced/stopped?
in hyperkalaemia or a >30% increase in creatinine
can SGLT-2i reduce kidney decline?
yes
what affect do SGLT-2i have on kidney function?
they increase sodium delivery to maculae densa
activates tubuloglomerular feedback
afferent arteriolar vasoconstriction
decreases intraglomerular pressure
reduces CKD progression and albuminuria
when are SGLT-2i prescribed in DKD?
T2DM and eGFR>25mls/min/1.73m2
without T2DM, eGFR >25 and uACR>25 mg/mmol
when is an SGLT-2i not used for T2DM and CKD?
if eGFR< 20
if patient on dialysis
when is metformin discontinued in T2DM and CKD?
if eGFR<30
if patient on dialysis
reduce dose if eGFR<45
