diabetic nephrotpathy

Question 1

diabetic nephropathy is present w persistent …… and decline in …..?

Answer 1

albuminuria and decline in GFR

Question 2

what are the causes that might lead to DN?

Answer 2

hyperglycemia(type 2 DM)
genetics
autoimmune process
insulin resistance(type 1 DM)

Question 3

what is the hallmark of DN?

Answer 3

reduction of kidney functions, which is preceded by hypertension, proteinuria

Question 4

what is the pathophysiology of diabetic nephropathy?

Answer 4

1-hyperglycemia–>leads to non-enzymatic glycosylation of the BM which destroys mesangial -ve charged cells.

2-inrtaglomerular hypertension and glomerular hyperfiltration

3-impaired insulin signaling in podocytes

Question 5

what is the histopathology of DN?

Answer 5

1-kimmelsteil-wilson nodules
2-GBM thickening
3-Glomerular sclerosis
4-inflammation

Question 6

what are the stages of diabetic nephrotpathy?

Answer 6

stage 1: GFR is high, renal hypertrophy

stage 2: hyperfiltration, non-specific inc in mesangial thickness

stage 3: microalbuminuria, mesangial exapnsion, GBM thickening, arteriole hyalinosis

stage 4: Nephropathy(proteinuria, nephrotic syndrome), GFR decline and hypertension

stage5: end stage renal disease

Question 7

what are the risk factors of DN?

Answer 7

-HT
-persistent hyperglycemia
-genetics
-family history of HT
-obesity, smoking, hyperlipidemia
-males
-inc duration of DM

Question 8

how to diagnose DN?

Answer 8

on urinalysis:
1-persistent albuminuria: 3grams per day on 2 or more occasions separated by 3 months
2-moderate albuminuria: 0.3-3 grams per day

Question 9

what are the signs that nephropathy had set in?

Answer 9

-fatigue
-foamy urine (proteinuria >3.5g/day)
-pedal edema due to hypoalbuminemia and nephrotic syndrome
-Diabetic nephropathy
-HT

Question 10

what is an indication of diabetic nephropathy in type 1 DM?

Answer 10

retinopathy/neuropathy

Question 11

what is a crucial step in diagnosing DN in T2DM?

Answer 11

history and physical exam(neurologic exam)

Question 12

what is the criteria for diagnosing DN?

Answer 12

-high BP
-progressive decline in GFR
-persistent albumniuria
-urine analysis

Question 13

how often should patients with type 2 DB screen for DN

Answer 13

yearly

Question 14

proteinuria ass can be deferred for the first … yrs in pts with type1 DM?

Answer 14

5yrs

Question 15

what does the tx for DN target?

Answer 15

-cardiovascular risk reduction
-glycemic control
-control of BP
-inhibition of Renin angiotensin system

Question 16

which new drugs are shown to reduce albuminuria

Answer 16

-third gen mineralocorticosteroid receptor antagonist: Finerenone

-SGLT2(Na-glucose co-transporter) inhibitor: prevents reabsorption of glucose

Question 17

management for DN?

Answer 17

-ACE inhibitors or ARB’s
-limit protein intake to 0.8g/kg(not less than what u need)
-monitor serum Cr and BUN
-monitor urine albumin-Creatinine ratio
-make sure GFR doesnt go below 60

Question 18

…………is a risk factor for cardiovascular mortality?

Answer 18

microalbuminuria