Renal - Diabetes Flashcards
Why would severe hyperglycemia lead to dehydration and polydipsia (extreme thirst)?
Kidneys are attempting to pressure natriurese due to the high effective osmolality of the plasma glucose. This results in high fluid loss and hyponatremia that encourages thirst.
Name at least 3 symptoms that are part of the downward spiral for someone with diabetes Insipidis.
Polydipsia (extreme thirst); Polyuria (high urine output); Hyperglycemia/ Hyperlipidemia (damaging glomerular integrity)
What is the leading cause of End-Stage Renal Disease in the US?
Diabetes mellitus is the #1 cause of kidney failure in the US. Which is why it’s an important learning point for pathological conditions of the renal system.
List 3 pathological steps in the temporal progression of the diabetic kidney.
- Rising BP (HTN maybe due to water retention)
- Glomerular Hyperfiltration leads to traces of albumin in urine (micro-albuminuria)
- Proteinuria (>500 mg/24 h, high protein in urine) can progress into ESRD overtime, if not treated.
Name at least 3 pathologic conditions associated with Diabetes Mellitus (DM).
Microvascular disease (reduced blood supply to key organs) can result in Adult blindness, Limb amputation, Kidney failure
Describe the progression of insulin resistance in DM II.
Blood sugar picks up and the pancreas keeps up with the increased glucose for a while. As the condition is prolonged, the pancreas no longer keeps up with the insulin-resistant stop and blood sugar sky rockets. This condition can be somewhat resolved at early stages through diet and exercise.
Explain why metabolic obesity, linked to DM II, can be so deadly.
Visceral abdominal fat as indicated by an elevated waist-to-hip ratio can result in HTN, hyperlipidemia and insulin resistance. This fat can suppress leptin hormone and stimulate appetite, making a bad situation worse, assuming no changes in high-carb diet.
Why don’t Sumo wrestlers and NFL linemen have a high incidence of CV disease? They’re hefty too!
These athletes consume diets that lend to the build up of subcutaneous fat, not visceral fat. This coupled with regular exercise, results in a lower incidence of DM and CV diseases, despite their BMI.
What 3 molecules can the kidneys contribute to maintain euglycemia in the context of gluconeogenesis?
Lactate, glutamine and glycerol are contributed by the kidneys if prolonged fasting and acidosis occurs.
How do the kidneys use glucose?
The kidneys use it for fuel since they have a high energy demand having to manage numerous active transporters and ion pumps.
Explain how hyperfiltration in the glomeruli of the diabetic kidney can be associated to hypertension.
Hyperfiltration (increased GFR) can be detected downstream by the macula densa in the DCT as low pressure. This stimulates Na+ reabsorption which raises ECV and BP accordingly.
Name at least 3 factors that can ruin the integrity of the glomerulus in the pathogenesis of DM II.
Hyperlipidemia, Hyperglycemia and Hypertension can increase hyperfiltration and ruin the integrity of the glomerulus.
What ketone bodies are produced during lipolysis of someone with Diabetic Ketoacidosis?
2 Ketoacids: Beta-hydroxybutyrate and Acetoacetate, as well as Acetone
Name at least 5 symptoms that a person with Type 1 DM can experience?
Hypoinsulinemia, Hyperglycemia, Polydipsia (thirst), polyuria (diuresis due to XS ketones), Polyphagia, (relentless appetite); weight loss, infection and blurred vision
Describe what condition makes Type II DM, so deadly?
The onset of a Hyperosmolar Hyperglycemic State (HHS). Insulin resistance is associated with hyperglycemia and dehydration. This can further spike up blood sugar and lead to hyperosmolality. There is no significant ketoacidosis.
