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Urinary & Renal > DN > Flashcards

DN Flashcards

1
Q

classic stages of diabetic nephropathy

A
  1. hyperperfusion/hyperfiltration, 2. microalbuminuria, 3. deterioration of GFR
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2
Q

morphologic changes associated with early stage diabetic nephropathy

A

glomerular hypertrophy, thickening of GBM, mesangial expansion

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3
Q

microalbuminuria is defined as?

A

persistent urinary losses between 20-200 micrograms/min (timed urine), 30-300 mg/d (24hr urine), or 30-300 micrograms/mg (urine albumin:creatinine ratio), measured on 2/3 collections within 6 months

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4
Q

ESKD is reached within ____ years of overt nephropathy in diabetics

A

7-10 years

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5
Q

normoalbuminuric DKD have a ____ rate of GFR deterioration and a ___ disease course

A

slower; similar

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6
Q

histopathologic progression of type 1 DKD

A
  1. GBM thickening (first 2 years), 2. efferent/afferent arteriolar hyalinosis (few years), 3. mesangial expansion (5-7 yrs), 4. atubular glomerula (very late)
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7
Q

arteriolar hyalinosis

A

amorphic, eosinophilic material within vessel wall

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8
Q

Kimmelstiel-Wilson nodules

A

nodular mesangial expansion seen in late-stage DKD

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9
Q

there is a correlation between the degree of mesangial expansion and?

A

deterioration of GFR (due to decreased capillary filtration surface area)

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10
Q

histopathologic progression of type 2 DKD

A

more heterogeneous; may include interstitial fibrosis, tubular atrophy, tubular BM thickening, global glomerular sclerosis, etc. but highly variable

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11
Q

downstream mediators of DKD

A

RAAS, fibrinolytic system, growth hormones, reactive oxygen species

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12
Q

growth factors present in DKD

A

TGF-beta, connective-tissue growth factor, VEGF, PDGF, IGF-1

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13
Q

diabetes and HTN

A

additive in terms of disease progression; more labile BP, postural hypoTN, loss of nocturnal dip in BP due to baroreflex sensitivity and autonomic dysfunction

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14
Q

risk factors in progression to diabetic kidney disease

A

poor control of glycemia, HTN, lipids, genetics

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15
Q

what is the heritability of diabetic nephropathy?

A

35-55% (genes include ACE I/D, ELMO-1, and CNDP1)

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16
Q

evidence for the protective effect of tight glycemic control is greater in patients with (T1D/T2D)

A

type 1 diabetes

17
Q

BP control recommendation for patients with diabetes and HTN

A

SBP less than 140mmHg

18
Q

dietary protein restriction to ____ resulted in a significant decrease in the rate of decline of GFR among patients with DN

A

0.8 g/kg/d (low end of recommended range for all individuals)

19
Q

this is first line therapy in patients with diabetes and HTN, especially if they have albuminuria

A

ACE inhibitors or ARBs (not combined though)

Urinary & Renal (22 decks)

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