Diabetic Nephropathy

Question 1

What is the commonest cause of end-stage renal failure?

Answer 1

• Diabetic Nephropathy

Question 2

What is the Px of DM N?

Answer 2

1. Hyperglycaemia causes
   
   • RAAS activation
   • glycoylation of proteins in GBM
   • oxidative stress
2. Inc. Glomerular capillary pressure
   
   • podocyte damage
   • endothelial dysfunction
3. Scarring

Question 3

How does DM Nephropathy progress?

Answer 3

1. Hyperfiltration
2. Albuminuria (first clinical sign)
3. Decrease filtration
4. Renal failure

Question 4

How would you diagnose DM N?

Answer 4

• Bedside
  
  • microalbumin urine test
• Histology
  
  • Thickening GBM
  • Disruption of podocytes
  • Mesangial expansion
  • Sclerosis
  • Kimmelstiel-Wilson lesion

Question 5

How would you tx DM N?

Answer 5

• Strict DM control
  
  • prevent progression to macroalbuminuria
• BP control
  
  • ACEi/ARB
• Sodium restriction
  
  • <2g/day
• Statin
  
  • reduce CVS risk

Question 6

What should DM pt be screened annually for?

Answer 6

• albumin:creatinine ratio
• U&E