Diabetic Nephropathy Wall

Question 1

whats the most common cause of kidney failure?

Answer 1

Diabetes

Question 2

The first clinical abnormailty in DN is what?

Answer 2

microaluminuria

Question 3

ACR stands for?

Answer 3

Albumin creatinine ratio

Question 4

what is macroalbuminuria?

Answer 4

ACR over 300….30-300 is miro

Question 5

stage one kidney disease?

Answer 5

Hyperfiltration, inc in GFR

Question 6

Stage 2

Answer 6

glomerular damage, microalbuminuria

Question 7

stage 3?

Answer 7

albumin excretion rate over 200 micrograms per minute. blood creatinine and urea rise

Question 8

stage 4?

Answer 8

GFR less than 75 ml/min, high bp,

Question 9

stage 5?

Answer 9

kidney failure

Question 10

what distinguishes DN from other chronic kidney diseases?

Answer 10

glomeruli increase in size first

Question 11

describe glomerular hyperfiltration?

Answer 11

glucose provides an osmotic diuretic effect (draws water out), increases glomerular filtration and leads to glomerular hypertrophy, glomerular presure increases, kidney responds with hypertrophy of the epithelium and endothelium, accelerates glomerular failure, results in premature glomerular sclerosis

Question 12

How is glomerular hypertension harmful?

Answer 12

Too much pressure can cause damage to the basement membrane, causing it to leak plasma proteins into the urine, the proximal tubules then attempt to reabsorb this plasma protein and it causes injury to the endothelial cells which activates inflammation. THe injury to the tubules and the and mocrovasculature activates pathways that lead to fibrosis and scarring of both glomerular and tubular nephron segments.

Question 13

How is renin involved in the promotion of glomerular hypertension during DN?

Answer 13

For some reason, there is increased intra-renal activation of the renin-angiotensin system. Ang II is increased which constricts the efferent arteriole, single nephron glomerular filtration rate increases and intraglomerular pressure increases. This causes glomerular hypertension. sustained intraglomerular pressure can lead to GBm damage, glomerular dysfunction, and protein in bowmans capsule

Question 14

Does angio II inc TGF Beta?

Answer 14

yes

Question 15

What does TGF beta lead to>

Answer 15

Proliferation of fibroblasts and tubuloepithelial cells. Leads to thickiening and scarring of matrix

Question 16

TGF beta both stimulates ECM synthesis and inhibits matrix degradation

Answer 16

true

Question 17

Collagen type IV deposition is stimulated by what?

Answer 17

hyperglycemia

Question 18

WHat does AGE stand for and what is its significance?

Answer 18

Stands for advenced glycosylation end products. Glycosylation of capilary basement membrane due to long term hyperglycemia

Question 19

What is significant about ACEi and ARBs that make them good treamtment for DN?

Answer 19

Lower glomerular capillary pressure and blood pressure in general

Question 20

What is the goal of hypertension control in DN?

Answer 20

lower bp to 130/80

Question 21

ACEi best for what type of pts

Answer 21

Type 1 pts who present with microalbuminuria

Question 22

ACEi + ARB best for who

Answer 22

Type 2 who present with microalb and HTN.

Question 23

ARB alone best for who?

Answer 23

T2D with macroalb, htn, and renal insufficiency. prevents progression to ESRD

Question 24

Other renal complications of Diabetes besides DN?

Answer 24

Increased risk of pyelonephritis, Emphasematous pyelonephrits,
Papillary necrosis,
Increased risk for nephrotoxic agents (NSAIDS and Radiocontrast media)
Neurogenic bladder
T4 RTA

Question 25

3 Major types of nephropathy>

Answer 25

Glomerular, Papillary, Tubulo-interstitial

Question 26

What is most common

Answer 26

Diffuse Diabetic glomerlopathy- earlier, less severe, most common
Consists of capillary basement membrane thickening

Question 27

Nodular type diabetic glomeruopathy characterized by what?

Answer 27

more than 10 years of diabetes

Question 28

Nodular glomerulosclerosis shows kimmelstiel wilson nodules which look like what?

Answer 28

oval, hyaline, sometimes laminated deposits of mucopolysacharides, lipids and fibrillary proteins within mesangium. squeeze capillary shut

Question 29

What are exudative lesions

Answer 29

can be fibrin caps or capsular drops, they occur in non-diabetic disease and it is important to differentiate them from nodular glomerulopathy b/c kimmelstiel wilson nodules will eventually lead to ESRD and dialysis. Exudative lesions will not.