Diabetic Nephropathy

Question 1

dx of diabetic nephropathy

Answer 1

in pt w/ diabetes, presence of persistent albuminuria (>300mg per 24 hr) and diabetic retinopathy + absence of other kidney disease

Question 2

what is the most common cause of ESRD

Answer 2

diabetes

Question 3

microalbuminuria

Answer 3

best predictor of diabetic nephropathy - stage lasts 5-20 yrs. reversible in early stages.
kidneys: renal enlargement, hyperfiltration
other systems: retinopathy, neuropathy, CV events, HTN

Question 4

proteinuria

Answer 4

stage lasts 20-30 yrs
decreased GFR, HTN
renal or cardiac death

Question 5

tx for diabetic nephropathy

Answer 5

improve glucose control
improve BP - ACE inhibitors/ARBS
decrease proteinuria ???
exercise/weight loss

Question 6

how do ACE inhibitors/ARBS protect kidneys? comes with what risk?

Answer 6

decrease perfusion pressure by blocking constriction of efferent arteriole by ATII
risk: ischemic AKI - renal hypoperfusion b/c lack of efferent arteriole resistance - if you stop ACE/ARB in late stage ESRD, may have temporary GFR improvement

Question 7

current BP goal for pts w/ diabetic nephropathy

Answer 7

<140/90

Question 8

when to tx diabetic w/ ACE/ARB?

Answer 8

suggested for microalbuminuria, definitely for albuminuria