Diabetic Nephropathy

Question 0

Waxy casts and oval fat bodies in UA?

Answer 0

Hyperlipidemia

Question 1

Best treatment for diabetic nephropathy?

Answer 1

ACE inhibitors

Question 2

Definition of nephrotic syndrome?

Answer 2

1. 3.5+ grams of protein excreted in 24 hours
2. Hypoalbuminemia (<3 g/dL)
3. Edema

Question 3

Effect of nephrosis on the liver? Sign on UA?

Answer 3

Hyperlipidemia. Waxy casts and oval fat bodies

Question 4

Nephropathies?

Answer 4

MCD
Membranous
FSGS
Membranoproliferative

Question 5

Patient with nephrosis. Tests to rule out secondary causes?

Answer 5

1. Serum glucose and A1c (diabetes most common)
2. And ANA
3. SPEP and UPEP (serum/urine Plasma electrophoresis)
4. Viral serologies (HIV and hepatitis)
5. Heavy metals – Mercury

Question 6

Patients with advanced diabetes and proteinuria do not get a biopsy because?

Answer 6

Nephrotic proteinuria from diabetes is irreversible

Question 7

Treatment of edema from nephrosis?

Answer 7

1. Salt restriction
2. diuretics
3. Dietary protein restriction (high-protein increases proteinuria which adversely affects renal function)
4. ACE inhibitors or ARBs to reduce proteinuria and slow progression

Question 8

Dosages of diuretics in nephrosis?

Answer 8

Very large. thiazides and loop diuretics are highly protein-bound and there is decreased renal delivery if low-protein

Question 9

Non-renal consequences of nephrosis?

Answer 9

1. Hypercoagulable because loss of anti-thrombin III and protein C and S (increased thromboembolic risk)
2. Hypogammaglobulinemia (increased infection risk - esp strep)
3. Hypotransferrinemia (iron deficiency anemia)
4. Loss of vitamin D binding proteins (vitamin D deficiency)

Question 10

Relative GFR during progression of diabetic nephropathy?

Answer 10

Elevated then declines

Question 11

Early stages of diabetic nephropathy can be detected with?

Answer 11

Microalbuminuria (3 to 300 total excretion)

Question 12

Overt nephropathy?

Answer 12

Albuminuria exceeds 300

Question 13

Natural history of diabetic nephropathy?

Answer 13

Microalbuminuria

5 to 10 years later: overt nephropathy, Development of edema hypertension
5-15 years later: progression to end-stage regional disease
2 years later: death

Question 14

Most common cause of death for patients with diabetes and end stage renal disease? (Mech?) goal of tx?

Answer 14

Cardiovascular disease due to increased atherosclerosis. LDL-cholesterol <100.

Question 15

Drug that can slow progression of renal disease? Must be given in what stage?

Answer 15

ACE inhibitors. Must be given before overt proteinuria

Question 16

Intervention that prevents progression of microvascular complications (retinopathy and nephropathy)?

Answer 16

Tight glycemic control with A-1 C less than 7

Question 17

Intervention to slow progression after overt nephropathy begins?

Answer 17

Blood pressure control with goal less than 130/80

Question 18

Treatment for diabetic gastroparesis?

Answer 18

Erythromycin and metoclopramide