Diabetic Nephropathy Wall Flashcards
whats the most common cause of kidney failure?
Diabetes
The first clinical abnormailty in DN is what?
microaluminuria
ACR stands for?
Albumin creatinine ratio
what is macroalbuminuria?
ACR over 300….30-300 is miro
stage one kidney disease?
Hyperfiltration, inc in GFR
Stage 2
glomerular damage, microalbuminuria
stage 3?
albumin excretion rate over 200 micrograms per minute. blood creatinine and urea rise
stage 4?
GFR less than 75 ml/min, high bp,
stage 5?
kidney failure
what distinguishes DN from other chronic kidney diseases?
glomeruli increase in size first
describe glomerular hyperfiltration?
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
How is glomerular hypertension harmful?
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.
How is renin involved in the promotion of glomerular hypertension during DN?
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
Does angio II inc TGF Beta?
yes
What does TGF beta lead to>
Proliferation of fibroblasts and tubuloepithelial cells. Leads to thickiening and scarring of matrix
TGF beta both stimulates ECM synthesis and inhibits matrix degradation
true
Collagen type IV deposition is stimulated by what?
hyperglycemia
WHat does AGE stand for and what is its significance?
Stands for advenced glycosylation end products. Glycosylation of capilary basement membrane due to long term hyperglycemia
What is significant about ACEi and ARBs that make them good treamtment for DN?
Lower glomerular capillary pressure and blood pressure in general
What is the goal of hypertension control in DN?
lower bp to 130/80
ACEi best for what type of pts
Type 1 pts who present with microalbuminuria
ACEi + ARB best for who
Type 2 who present with microalb and HTN.
ARB alone best for who?
T2D with macroalb, htn, and renal insufficiency. prevents progression to ESRD
Other renal complications of Diabetes besides DN?
Increased risk of pyelonephritis, Emphasematous pyelonephrits,
Papillary necrosis,
Increased risk for nephrotoxic agents (NSAIDS and Radiocontrast media)
Neurogenic bladder
T4 RTA
3 Major types of nephropathy>
Glomerular, Papillary, Tubulo-interstitial
What is most common
Diffuse Diabetic glomerlopathy- earlier, less severe, most common
Consists of capillary basement membrane thickening
Nodular type diabetic glomeruopathy characterized by what?
more than 10 years of diabetes
Nodular glomerulosclerosis shows kimmelstiel wilson nodules which look like what?
oval, hyaline, sometimes laminated deposits of mucopolysacharides, lipids and fibrillary proteins within mesangium. squeeze capillary shut
What are exudative lesions
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.
