Nephropathy Flashcards
What pathological changes happen in hypertension
Renal vessels (small): Hypertrophy: lumen shrinks Protein deposition Glomerular sclerosis Tubular atrophy Interstitial fibrosis
What are signs of small vessel ischemic nephropathy?
Decrease GFR
Bland urine (glomeruli gets shut down)
Slow progression
Normal imaging
Treatment for small vessel ischemic nephropathy
Blood pressure control: can use ace but could use others
Control lipids
Control sugars
Lifestyle
Risk factors for large vessel ischemic nephropathy
Atherosclerosis
Fibromuscular dysplasia
Signs of large vessel ischemic nephropathy
Bilateral: flash pulmonary edema with HTN
Decrease in GFR greater than 30% with ACEi
Unilateral: HTN
Investigations showing large vessel ischemic nephropathy
Abdominal Bruits
Imaging
Renal angiogram etc
Ultrasound etc
Treatment large vessel nephropathy
Lifestyle mod
Aspirin, statins
If unilateral: ace
If bilateral: avoid ace
Consider stenting
Natural history of diabetic nephropathy?
Initial increase in GFR: hyper filtration (micro albumin)
Followed by decline in GFR and proteinuria
Eventually a cause of nephrotic syndrome
Treatment of diabetic nephropathy
Glycemic control (legacy effect in DM1) ACEi very effective in preventing ESRD BP control (more impactful in DM1)
Characteristics of diabetic nephropathy
Persistent albuminuria Bland urine sediment Slow progression of disease Low GFR with overt proteinuria Other diabetic complications Known duration of diabetes greater than 5 years
When does risk of nephropathy occur?
At 10 years
Micro albuminuria
150-300mg/day proteinuria
30-300mg/day albuminuria
Overt proteinuria
> 300mg/ day proteinuria or albuminuria
Normal albumin:creatinine ratios
General: less than 3 mg/mmol
Diabetes: less than 2 mg/mmol
Normal albumin:creatinine ratios
General: less than 3 mg/mmol
Diabetes: less than 2 mg/mmol
