Diabetic Nephropathy Flashcards
What is Type 2 DM?
- inadequate response to insulin
What is Type 1 DM?
- inability to produce insulin
How long after developing DM is the peak onset of diabetic nephropathy?
- 10-15 years
Why have rates of ESRD in patients with T1DM dropped?
- better glycemic control
- better BP control
- ACE inhibitors
What are the pathological abnormalities of diabetic nephropathy?
- mesangial expansion
- glomerular basement membrane thickening
- glomerular sclerosis
- renal arteriolosclerosis
What is the natural progression of diabetic nephropathy?
- hyperfiltration
- increase BP
- microalbuminuria
- proteinuria
- elevated serum creatinine
- ESRD
What is the pathogenesis of diabetic nephropathy?
- intraglomerular hypertension
- glucose and cytokines cause renal vasodilation
What is microalbuminuria?
- albumin excretion of 30-300mg/day
What tests can be ordered to detect microalbuminuria?
- 24 hour urine collection
- dipstick
- urine albumin:creatinine ratio
What percentage of T1DM patients with microalbuminuria will progress to proteinuria?
- 50%
What is the treatment and prevention of diabetic nephropathy?
- tight glycemic control (glyHb < 7%)
- tight BP control (< 130/80) with ACE inhibitors/ARBs
- tight lipid control (< 2 mmol/L)
When do you start screening T1DM for nephropathy?
- 5 years after DM diagnosis
- if microalbuminuria present, then give ACE inhibitors/ARBs along with tight glycemic and BP control
When do you start screening T2DM for nephropathy?
- right away
- if microalbuminuria present, give ACE inhibitors/ARBs
