Diabetic nephropathy

Question 1

Diabetic nephropathy: pathology and causes

Answer 1

• Kidney damage caused by Type I, Type II diabetes

Question 2

Diabetic nephropathy: causes

Answer 2

Excess glucose in the blood

• glycosuria
• hyaline arteriosclerosis in efferent arteriole ->
• increases pressure in glomerulus → increased glomerular filtration rate (first stage)
• Thickening of basement membrane → glomerulus expands -> increased permeability
• Kimmelstiel–Wilson nodules formation ->
• Damage glomeruli → decreased glomerular filtration rate (second stage)

Question 3

Diabetic nephropathy: RF

Answer 3

• genetics
• ethnic: African, Mexican, native americans
• HT
• poor glycemic control

Question 4

Diabetic nephropathy: symptoms, hallmarks

Answer 4

• can be asymptomatic

Hallmarks:

• HT
• proteinuria: albuminuria
• worsening of kidney function

Question 5

Diabetic nephropathy: progression of the disease

Answer 5

• Microalbuminuria, 5-10 years after DM diagnosis
• Rate of GFR decreases by 7-12 mL per year
• Proteinuria appears 10-20 years after the T1DM diagnosis
• Serum creatinine increases after 15-25 years
• End-stage kidney disease: develops after 20-30 years

Question 6

Diabetic nephropathy: Diagnosis related to the stages

Answer 6

Renal biopsy

• Class I: isolated glomerular basement membrane thickening
• Class II: mesangial expansion
• Class III: at least one kimmelstiel-wilson lesion -> glomerulosclerosis
• Class IV: advanced diabetic sclerosis

Proteinuria

• normoalbuminuria
• Microalbuminuria: 30-300 mg/day
• Microalbuminuria: >300 mg/day

Declined of the GFR

Question 7

Diabetic nephropathy: treatment and prevention

Answer 7

3 things you want to regulate: glycemia, lipid, and the hypertension

• Glycemic control: achieve desirable HbA1c
  Use anti-diabetic meds
• Lipid control: statins etc…
• Dietary protein restriction
• Treat the hypertension
• RAS inhibitors (ACEi + ARBs) -> treat HTN + dilate the efferent arteriole -> less glomerular filtration pressure

Question 8

Diabetic nephropathy: new therapeutic options

Answer 8

Antimeds
SGLT-2 inhibitors: 
- insulin-independent drugs -> less risk of hypoglycemia
- increase urinary glucose excretion
- lower BP and body weight

GLP-1 analogs:
- incretin mimetics