S8.2 DM, BP & Systemic Disease Flashcards
What is the commonest cause of ESRD?
Diabetic nephropathy
What pathological changes occur in diabetic nephropathy?
Microalbuminuria (first sign)
GBM thickening, Mesangial expansion, Podocyte damage
Hyperfiltration, Increased GFR
How are the clinical signs and symptoms staged in diabetic nephropathy?
Microalbuminuria Hyperfiltration and hypertrophy Latent stage Overt proteinuria ESRD
In diabetes, Diffuse nodular glomerulosclerosis is shown by what on histology?
Kimmelstiel-Wilson nodules
What are the risk factors and prevention methods for diabetic nephropathy?
Risk factors – genetics, race, hypertension, high hyperfiltration.
Primary prevention is via blood glucose control
What is the management for overt proteinuria and mesangial expansion?
Inhibition of RAAS, BP control, reduce protein intake.
Why does RAAS blockade help treat proteinuria and microalbuminuria? (Talk about the effects of angiotensin 2 first)
Angiotensin 2 causes increased glomerular permeability to proteins, and increased glomerular pressure.
Therefore RAAS blockade reduces glomerular hyperfiltration and proteinuria
What occurs in hypertensive renal disease?
Microalbuminuria first renal sign.
Diagnosis – hypertension should come before proteinuria.
In comparison to renal artery stenosis Hypertension, hypertension is often more acute and refractory to treatment, decline in GFR often more rapid.
What histological changes occurs in hypertensive renal disease?
Hylanosis of arterioles
Glomerulosclerosis
What is Lupus?
Auto-immune systemic disease that can cause nephritic or nephrotic syndrome.
Prognosis depends on type of lesion, activity and amount of kidney involved.
What is a myeloma?
Where there is a malignant clone of plasma cells, so the kidney can no longer filter and re-absorb the increased number of proteins, so they remain in the kidney and cause damage.
