Diabetic Nephropathy

Question 0

Clinical features

Answer 0

Microalbuminaemia
Nephropathy usu 10-15yrs after diagnosis
Hypertension
Glomerular and retinal vascular changes

Question 1

Effects of hyperglycaemia

Answer 1

Predisposes to nephropathy
Hyperfiltration leads to increased GFR, related to nephropathy but mech not known
Non-enzymatic glycosylation of proteins eg HbA1c, AGEs

Question 2

Glomerular changes

Answer 2

Hypertrophic
Nodular intercapillary glomerulosclerosis (Kimmelsteil-Wilson nodules) +ve on PAS and laminated on silver, in mesangial/intercap regions of glom
Diffuse intercapillary glomerulosclerosis - expansion of mesangium, stains similarly. GBM thickened
Capsular drop- hyaline mass in Bowman’s capsule, trichrome +ve
Fibrin cap-btw glom cap endo cells and GBM.
Microaneurysms
Thickened capillary walls

Question 3

Tubules

Answer 3

Protein droplets
Atrophic tubules
Thickened BM
Neuts suggest superimposed infection

Question 4

Interstitium

Answer 4

Fibrosis

Question 5

Vessels

Answer 5

Intimal hyaline thickening (hyaline arteriosclerosis)

If affects aff and eff arteriole, very suggestive of DN

Question 6

IF

Answer 6

IgG linear staining of GBM (non-specific)

Albumin costaining

Question 7

Differentials

Answer 7

Any cause if advanced glomerulosclerosis
Hypertensive renal disease
Light chain deposition disease (k or l restricted)
Amyloidosis
Advanced MPGN

Question 8

Other associated conditions

Answer 8

Coexisting membranous glomerulonephropathy

Papillary necrosis