Wk 8 Diabetic Nephropathy Quick review

Question 1

Microvascular complications:

Answer 1

diabetic nephropathy, neuropathy, retinopathy

Question 2

Pathophysiology:

Answer 2

Chronic hyperglycemia, AGE => deposit in mesangial cells, glomerular capillary damage, AGE antibodies. All of this will cause glomerular sclerosis, protein leakage, blood sludging leading to tubular destruction, loss of charge barrier, increased capillary pressure

Question 3

Diagnosis:

Answer 3

1. Urine albumin >300 mg/d 2. Start screening 5 years after DM1 diagnosis; *DM2 at diagnosis; yearly thereafter

Question 4

Risk factors:

Answer 4

Chronic dysglycemia, HTN, smoking, Vitamin D deficiency

Question 5

Clinical Presentation:

Answer 5

Early: isolate proteinuria Later: CKD

Question 6

Prevention/early treatment:

Answer 6

1. Glucose control, nephroprotective herbs, ACEi, ARBs, stop smoking, BP <130/80
2. Protein 0.9 g/kg/d
3. Arctium lappa fruit: repair basement membrane & podocytes
4. Glycosaminoglycans: lower albumin
5. Silymarin: lower albumin
6. Thiamine, benfotiamine: lower urine protein by inhibiting AGEs
7. Turmeric: lower proteinuria