Diabetic Nephropathy Flashcards
What are the 3 main microvascular complications that occur in diabetes. Which of the following is NOT one of these?
1 - Retinopathy
2 - Nephropathy
3 - Neuropathy
4 - Hepatopathy
4 - Hepatopathy
How common is diabetic nephropathy in T1DM and T2DM following 10 years since diagnosis?
- T1DM = 20-30% will have microalbuminuria and 1% renal failure
- T2DM = 25% will have microalbuminuria
In T2DM diabetic nephropathy patients, which ethnicities are at a greater risk of developing diabetic neuropathy?
- African-Caribbean, Mexican and Pima Indians
Which of the following is NOT a common risk factors for developing diabetic nephropathy?
1 - baseline albumin excretion
2 - age of diabetes diagnosis
3 - glycemic control – ‘legacy affect’
4 - liver damage
5 - blood pressure
6 - lipid profile
4 - liver damage
Diabetic nephropathy relates to kidney damage due to diabetes, and is the leading cause of CKD in developed countries. Diabetes increases glucose content in the blood, causing the glucose to bind with lipids and proteins. What is this process called?
1 - catalysation
2 - non-enzymatic glycation
3 - oxidative stress
4 - aponeurosis
2 - non-enzymatic glycation
Excess glucose can spill into the urine, called glycosuria
These non-enzymatic glycated molecules are pro-inflammatory
In diabetic nephropathy, damage is caused by the pro-inflammatory glycalated molecules that move through the capillary endothelium of the blood vessels of the nephron. This can lead to thickening and narrowing of the blood vessels. Which blood vessel is specifically affected?
1 - afferent arteriole
2 - efferent arteriole
3 - arcuate artery
4 - renal artery
2 - efferent arteriole
Process is called hyaline arteriosclerosis
- deposits of hyaline on basement membrane
- occurs in glomerulus and efferent (leaving nephron) nephrons
- causes stiffness, thickening and vasoconstriction and increases glomerulus pressure
In diabetic nephropathy (DM), the efferent arteriole becomes narrow, limit outflow, and the afferent vasodilates, increasing inflow, thus increasing glomerular pressure. What affect does this have on the eGFR in the glomerulus?
- Increased filtration and eGFR
STAGE 1 DN = Hyperfiltration
In diabetic nephropathy, in response to thickening and narrowing of the blood vessels (hyaline arteriosclerosis) that causes the following:
1st - narrowing of efferent arterioles
2nd - dilation of afferent arterioles and increased eGFR (hyperfiltration)
What affect does this have on the glomerulus?
1 - mesangial cells atrophy and die
2 - mesangial cells being secreting excessive renin
3 - mesangial cells secrete structural matrix
4 - all of the above
3 - mesangial cells secrete structural matrix
Mesangial cells are specialised cells in kidney making up the mesangium of the glomerulus
- they remove trapped residues and aggregated protein from the basement membrane thus keeping the filter free of debris
Aim is to increase the size of the glomerulus to assist with filtration
- matrix deposition can be general or nodular forming kimmelstiel wilson nodules
In diabetic nephropathy mesangial cells are stimulated and secrete matrix, which increases the size of the glomerulus, which aims is to increase the size of the glomerulus to assist with filtration. Instead of assisting with filtration, does this increase or decrease the basement membrane?
- increases the basement membrane
Thickens the basement membrane, leading to:
- podocyte foot processes spread-out
- permeability increases allowing proteins and glucose to pass through
In diabetic nephropathy, does the damage to the glomerulus ultimately increase or decreases the eGFR?
- reduces it
In diabetic nephropathy, does the damage to the glomerulus occur rapidly or slowly?
the damage to the glomerulus ultimately leads to reduces eGFR. How can this present clinically?
- occurs slowly over time with no symptoms
Diabetic nephropathy causes slow damage to the glomerulus, typically with no symptoms. However, if enough nephrons are affected, does this causes a gradual or rapid decline in eGFR?
Rapid decline in eGFR
- micro (30-60mg/day) and macroalbuminaemia (>300mg/day)
If kidneys cannot filter blood, the patient enters end stage renal disease
As diabetic nephropathy does not present with any clear symptoms, it is important that diabetic patients have their urine screened regularly. What is the diagnosis of microalbuminuria?
1 - <30mg/day
2 - 30-300mg/day
3 - 100-300mg/day
4 - >300mg/day
2 - 30-300mg/day
Gives a good first clue that there is damage to the kidneys due to diabetes
As diabetic nephropathy does not present with any clear symptoms, it is important that diabetic patients have their urine screened regularly. What is the diagnosis of macroalbuminuria?
1 - <30mg/day
2 - 30-300mg/day
3 - 100-300mg/day
4 - >300mg/day
4 - >300mg/day
Also called proteinuria
We cannot reverse diabetic nephropathy, but we can slow it down. which of the following treatment options is NOT effective for reducing the pressure in the kidneys?
1 - angiotensin-converting enzyme inhibitors (ACEi)
2 - angiotensin receptor blockers (ARBs)
3 - NSAIDs
4 - optimised BP, glucose and lipids
5 - protein restricted diet
3 - NSAIDs
ACE-I and ARBs induce efferent arteriole dilation, thus reducing pressure on the glomerulus
