Diabetic Nephropathy

Question 1

four main consequences of diabetes

Answer 1

ESRD, CV, Blindness, Amputation

Question 2

what fraction of diabetics develop nephropathy

Answer 2

1/3, #1 cause of ESRD

Question 3

Stage 1 (silent)

Answer 3

hyperfiltration and hypertrophy

Question 4

stage 2 (Incipient)

Answer 4

normal GFR, microalbuminuria. MM expansion

Question 5

Stage 3 (overt nephropathy)

Answer 5

macroalbuminuria (>300mg/day), renal insufficiency (HTN)

Question 6

stage 4 (advanced nephropathy)

Answer 6

renal failure. possible nephrotic syndrome but declines as GFR falls very low (Scr >6, GFR<15ml/min).

Question 7

cause of early hyperfiltration and later renal failure.

Answer 7

glomerular hypertrophy, afferent dilation, efferent constriction. Loss of functioning nephrons due to MM fibrosis

Question 8

two main factors involved in nephropathy

Answer 8

VEGF: altered hemodynamics and barrier leads to albuminuria, TGF-beta: matrix proliferation leads to sclerosis and hypertrophy

Question 9

Two main treatments

Answer 9

Tight glucose control (HbA1c<130/80

Question 10

What is the renin state of diabetics

Answer 10

low systemic but high local. Block the RAS path but dont combine ACEI and ARB