Diabetic Nephropathy

Question 1

What are the stages of diabetic nephropathy

Answer 1

1. Hyperfiltration
2. Microalbuminuria
3. Macroalbuminuria
4. End stage renal failure

Question 2

Features of diabetic nephropathy

Answer 2

Hypertension
Progressively increasing proteinuria
Progressively deteriorating kidney function

Question 3

Likelihood of developing diabetic nephropathy

Answer 3

Type 1 DM: 20-40% after 30-40 years

Question 4

Investigations for diabetic nephropathy

Answer 4

Screened annually using urinary albumin:creatinine ratio (ACR)
- should be an early morning specimen
- First past sample or spot sample
- Microalbuminuria is confirmed if, in the absence of infection or overt proteinuria, two out of three specimens have an elevated ACR*.
- ACR > 2.5 = microalbuminuria
Biopsy → microscopy:
- Kimmelstein-Wilson nodules: cellular nodules in the mesangium of the glomerulus
- Thickening of the basement membrane of the tubules and peritubular capillaries.

Question 5

Management for diabetic nephropathy

Answer 5

Good glycaemic control
Dietary protein restriction
BP control: aim <130/80mmHg
ACEi/ARB: may slow progression to end stage renal failure
- Start if urinary ACR >3mg/mmol
- Do NOT start dual therapy
Control dyslipidaemia: statins
Dialysis and transplant may be options later down the line.