Diabetic Nephropathy Flashcards
Describe the natural history of diabetic nephropathy
Glomerular hyperperfusion
increased glomerular filtration and increased kidney size
What is the earliest clinical finding of diabetic neuropathy
microalbuminuria
What is microalbuminuria
persistent excretion of small amounts of albumin into he urine
What is microalbuminuria an important predictor of
progression to proteinuria
What are patients with microalbuminuria or reduced Glomerular filtrate rate at risk of
end stage renal disease and premature cardiovascular morbidity and mortality
What are the major histological changes in the glomeruli in diabetic nepthropathy
expansion of the mesangium
glomerular basement membrane thickening
glomerular sclerosis
T1DM Patients with nephropathy almost always have what
retinopathy
Describe how diabetic nephropathy results
hyperglycaemia results in increased reactive species and AGEs by non enzymatic combination
These in turn activate a number of signalling pathways involving protein kinase C, mitogen-activated protein kinase and transforming growth factor-beta, resulting in the accumulation of extracellular matrix proteins in the mingle space and glomerulosclerosis
What might endothelial dysfunction and podocyte damage result in
diabetic glomerulosclerosis
How is microalbyminuria diagnosed
a spot urine sample must be sent to the lab for measurement of urine albumin and creatinine concentrations
What are some transient causes of microalbuminuria
UTI fever exercise menstruation semen cardiac failure poor glcaemic control
What may reduce the risk of progression of diabetic nephropathy
ACE inhibitors and ARBs
Blood pressure control
Control of glycaemia
Diet: protein restriction
What are side effects of ACE inhibitors
hyperkalaemia or cough
Where is the site of insulin degradation
Kidney
What is microalbuminuria define as
ACR above 2.5g/ mol in men or above 3.5g/mol in women
