Diabetic nephropathy

Question 1

How common is diabetic nephropathy?

Answer 1

-Most common cause of end-stage renal failure

Question 2

What causes diabetic nephropathy?

Answer 2

-Hyperglycaemia causes:
1. increase in growth factors
2. RAAS activation
3. Production of advanced glyclosylation end-products
4. Oxidative stress
-Leading to increased glomerular capillary pressure, podocyte damage and endothelial dysfunction

Question 3

How signs might the patient have on examination?

Answer 3

-Microaulbuminuria (ACR >3mg/mmol)
NB not detected on urine dip - must do ACR
-Screen annually

Question 4

What features does diabetic nephropathy have?

Answer 4

-HTN causes accelerated disease
-Progressive loss of renal function

Question 5

What treatment would you consider for a patient with diabetic nephropathy?

Answer 5

-DM control reduced risk of progression
-Aim for BP <130/80 (ACEi or ARB)
-Salt restriction
-Statins to reduce CV risk
-Spironolactone may help