Nephropathy Flashcards
what is diabetic nephropathy?
Kimmelsteil- wilson syndrome/ nodular glomerulosclerosis
progressive kidney disease caused by damage to the capillaries in the glomeruli in the kidneys, characterised by proteinuria and diffuse scarring of the glomeruli
what is the most common cause of kidney failure/dialysis in the UK?
diabetes
what are the consequences of diabetic nephropathy?
development of hypertension
decline in renal function (reduction in GFR of 1ml/min/month if untreated)
accelerated vascular disease
if chronic kidney disease secondary to diabetes the risk of dying is greatly increased
what is nephropathy defined by?
The basis of urine protein, neuropathy can be divided into insipient nephropathy and overt neuropathy
what is ACR?
albumin creatinine ration (units = mg alb/mmol creat)
what is PCR?
protein to creatinine ratio
which is smaller ACR or PCR
albumin is a component of total protein therefore ACR smaller than PCR (ACR is a fraction of PCR)
when to test for ACR and PCR?
if urine dipstick +ve for glucose and protein
normal ACR
<3.5 in females
<2.5 in males
microalbuminuria
ACR <30
PCR <50
repeat twice if 2/3 +ve then confirmed (incipitent neuropathy)
proteinuria
ACR >30
PCR>50
repeat on EMU - early morning urine
overt nephropathy
what causes the urinary albumin excretion rate to vary?
dat/night
exercise
protein load
fluid load
what can cause a false +ve for microalbuminuria?
menstruation vaginal discharge UTI pregnancy other illness non-diabetic renal disease
how do you interpret urine protein measures?
measure PCR and multiple by 10 (assuming daily creatinine excretion is 10mmol)
how is nephropathy screened for?
all patients with diabetes should have urinary albumin conc. (using a random urine sample) and serum creatinine measured at diagnosis and at regular intervals (usually annually)
ACR should be measured using a laboratory method or near-patient test specific for albumin at low conc.
an abnormal result should be confirmed by a further 1st pass (first morning urine) sample without delay