Lecture 14-Diabetes, Hypertension and Systemic Disease

Question 1

What are the pathological changes that take place in diabetic nephropathy?

Answer 1

• hyperfiltration/capillary hypertension
• GBM thickening
• mesangial expansion
• podocyte injury
• glomerular sclerosis/arteriosclerosis

Question 2

How does diabetic nephropathy cause hypertension?

Answer 2

Extra glucose upregulates SGLT2 receptor to try and reabsorb excess -> not much glucose or Na+ in urine as more is reabsorbed -> afferent vasodilation and efferent vasoconstriction in response to less Na+ detected at macula densa -> hypertension

Question 3

What are the clinical signs and symptoms in diabetic nephropathy?

Answer 3

• latent stage: GBM thickening and mesangial expansion
• microalbuminuria
• overt proteinuria
• end stage renal disease

Question 4

What are the risk factors of diabetic nephropathy?

Answer 4

• genetics
• race
• hyperglycaemia
• increased age
• smoking
• duration of diabetes

Question 5

What are the primary prevention methods of diabetic nephropathy?

Answer 5

• tight blood glucose control (injections or insulin pump)

- tight BP control

Question 6

How can microalbuminuria and proteinuria be managed?

Answer 6

• tight BP control
• statins
• CV risk management
• moderate protein intake
• block RAAS

Question 7

What are the vascular changes that occur in hypertensive renal disease to the renal arteries/arterioles?

Answer 7

• fibroelastic intimal thickening -> narrow lumen

- hyalinosis of afferent arteriolar walls

Question 8

What are the glomerular changes that occur in hypertensive kidney disease?

Answer 8

• wrinkling of glomerular tuft

- glomerulosclerosis

Question 9

What is systemic lupus erythematosus?

Answer 9

Autoimmune systemic disease, can cause nephrotic or nephritic syndrome