Diabetic Nephropathy

Question 1

How does diabetes cause kidney damage

Answer 1

• Excess glucose in the blood leads to glycation to proteins, and resultant thickening of GBM as glucose passes through.
• As a result, we get sclerosis affecting the efferent arteriole and thus glomerular hypertension due to obstruction
• This causes afferent arteriole dilation to increase GFR and produce hyper filtration
• In response to high GFR, mesangial expand ECM and form Kimmelstiel-Wilson nodules
• Podocytes are stretched out and lose their function giving albuminuria and eventually this fall in function leads to a fall in GFR and resultant CKD

Question 2

How does diabetic nephropathy present

Answer 2

• High BP
• Peripheral oedema
• Muscle atrophy
• Pallor

Question 3

What is needed for diagnosis of diabetic nephropathy

Answer 3

• ACR through urinalysis: >2.5 = microalbuminuria. >3 = macroalbuminuria

Extra tests:
- eGFR: will be low
- Imaging: doppler USS can show renal artery stenosis
- Biopsy: will show mesangial expansion and nodular glomeruloscleorsis

Question 4

How do we manage diabetic nephropathy

Answer 4

• BP control: aim for <130/80mmHg
• Diet: low sodium and fat
• Tight glycemic control
• Lipid control: statin