Diabetic nephropathy (also covered in Endo) Flashcards
What is the commonest cause of end-stage renal disease (ESRD) in the western world?
Diabetic nephropathy
What percentage of patients with type 1 diabetes mellitus have diabetic nephropathy by the age of 40?
33%
What percentage of patients with type 1 diabetes mellitus develop ESRD?
Approximately 5-10%
What is thought to be key in the pathophysiology of diabetic nephropathy?
Changes to the haemodynamics of the glomerulus leading to increased glomerular capillary pressure
What role does non-enzymatic glycosylation of the basement membrane play in diabetic nephropathy?
It is thought to play a key role in the disease process.
What are the histological changes seen in diabetic nephropathy?
Basement membrane thickening, capillary obliteration, mesangial widening, and Kimmelstiel-Wilson nodules.
What are Kimmelstiel-Wilson nodules?
Nodulular hyaline areas that develop in the glomuli.
What are some modifiable risk factors for developing diabetic nephropathy?
Hypertension, hyperlipidaemia, smoking, poor glycaemic control, and raised dietary protein.
What are some non-modifiable risk factors for developing diabetic nephropathy?
Male sex, duration of diabetes, and genetic predisposition (e.g. ACE gene polymorphisms).
What is the recommended screening frequency for diabetic nephropathy?
All patients should be screened annually using urinary albumin:creatinine ratio (ACR).
What type of specimen should be used for ACR screening?
Should be an early morning specimen.
What ACR value indicates microalbuminuria?
ACR > 2.5.
What dietary management is recommended for diabetic nephropathy?
Dietary protein restriction.
What is the target for tight glycaemic control in diabetic nephropathy management?
Tight glycaemic control.
What is the target blood pressure for diabetic nephropathy management?
Aim for < 130/80 mmHg.
When should ACE inhibitors or angiotensin-II receptor antagonists be started?
Should be started if urinary ACR of 3 mg/mmol or more.
Should dual therapy with ACE inhibitors and angiotensin-II receptor antagonists be initiated?
Dual therapy should not be started.
How should dyslipidaemia be controlled in diabetic nephropathy management?
Control dyslipidaemia e.g. Statins.
What are the five stages of diabetic nephropathy?
Diabetic nephropathy may be classified as occurring in five stages.
What characterizes Stage 1 of diabetic nephropathy?
Stage 1 involves hyperfiltration and an increase in GFR, which may be reversible.
What occurs during Stage 2 of diabetic nephropathy?
Stage 2 is the silent or latent phase where most patients do not develop microalbuminuria for 10 years, and GFR remains elevated.
What defines Stage 3 of diabetic nephropathy?
Stage 3 is known as incipient nephropathy, characterized by microalbuminuria (albumin excretion of 30 - 300 mg/day, dipstick negative).
What are the key features of Stage 4 diabetic nephropathy?
Stage 4 is overt nephropathy with persistent proteinuria (albumin excretion > 300 mg/day, dipstick positive), hypertension in most patients, and histology showing diffuse and focal glomerulosclerosis (Kimmelstiel-Wilson nodules).
What occurs in Stage 5 of diabetic nephropathy?
Stage 5 is end-stage renal disease, with GFR typically < 10ml/min, requiring renal replacement therapy.
How does the progression of diabetic nephropathy differ between type 1 and type 2 diabetes?
The timeline for type 1 diabetics is different from type 2 diabetes mellitus (T2DM), where some T2DM patients may progress quickly to the later stages.
diabetic nephropathy - Thickening of the basement membrane is seen alongside multiple Kimmelstiel-Wilson nodules
Severe arteriolosclerosis is seen in the afferent arteriole on the left of the slide. Multiple, smaller acellular nodules are seen in the glomerulus - Kimmelstiel-Wilson nodules. The tubular basement membrane is also thickened
