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Renal > 05.20 - Diabetic Renal Disease (Wall, Nichols) - PP > Flashcards

05.20 - Diabetic Renal Disease (Wall, Nichols) - PP Flashcards

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1
Q

Stage 2 of DN

A

Clinically evident: Micro-albuminuria, BP rises, glomeruli show damage

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1
Q

Which is specific for diabetic glomerulopathy: Capsular Drops, Fibrin Caps

A

Capsular Drops

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1
Q

Globally sclerotic glomeruli, dilated tubules resembling thyroid follicles, interstial fibrosis

A

Microscopic appearance of end stage kidney in DN

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2
Q

Stage 4 of DN

A

GFR < 75mL/min - HTN ubiquitous

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3
Q

Stage 3 of DN

A

Macro-Albuminuria, Creatinine and BUN levels rise, BP rises

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3
Q

Development of ___ heralds rapdid decline in GFR in Type2 DM

A

Macroalbuminuria

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3
Q

Condition that will cause Hyaline Sclerosis in both efferent and afferent arterioles

A

DM

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4
Q

% of diabetics who develop nephropathy

A

30-40%

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5
Q

By the time of Macroalbuminuria (over nephropathy), over 90% of patients have

A

HTN

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5
Q

Features of Nodular Type Diabetic Glomerulopathy

A

Kimmelstiel Wilson nodules and Hyaline sclerosis of both arterioles

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6
Q

Macroalbuminuria is defined as

A

random urine albumin/creatinine over 300 mg/g

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6
Q

Patients taking ACEi’s or ARB’s should be monitored for

A

Hyperkalemia

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7
Q

End Stage kidney from Diabetic Nephropathy looks just like

A

HTN Nephropathy

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8
Q

Nodular Glomerulosclerosis (Kimmelstiel Wilson Disease) correlates with

A

Renal failure eventually requiring dialysis

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9
Q

How do you distinguish diabetic nephropathy from most other forms of CKD

A

Glomeruli and kidneys are typically normal or larger in DN; in others, renal size is usually reduced

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10
Q

How does Glucose lead to Glomerular Pressure increase

A

Glucose provides osmotic diuretic effect –> Incr renal filtration –> Glomerular hypertophy –> Glomerular pressure incr

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10
Q

Diffuse type Diabetic Glomerulopathy consists of

A

Capillary BM thickening; Increased MM

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12
Q

Macroalbuminuria is aka

A

Overt Nephropathy

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14
Q

Micro-Albuminuria is defined as

A

> 30 mg/g loss

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15
Q

How does glucose lead to Premature Glomerulosclerosis

A

Osmotic Diuretic Effect –> Incr filtration –> G pressure incr –> Hypertrophy –> G cell failure –> Premature Glomerulosclerosis

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15
Q

Most common type of Diabetic Glomerulopathy

A

Diffuse

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16
Q

What causes injury to tubular cells in Glomerular HTN

A

G HTN –> Injury to GBM –> Leaks plasma proteins –> Attempts to reabsorb these proteins injures tubular cells

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16
Q

What causes fibrosis and scarring in Glomerular HTN

A

Tubular inflammation and renal microvascular injury from protein leakage

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16
Q

Reduction in proteinuria is associated with

A

Reduced risk for ESRD

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17
Where do fibrosis and scarring occur in Glomerular HTN
Both glomerular and tubular elements of nephron
18
Kimmelstiel Wilson nodules and Hyaline sclerosis of both arterioles
Features of Nodular Type Diabetic Glomerulopathy
20
Which drug has been shown to slow rate of diabetic nephropathy more than others
ACEi
22
Fibrin caps
Crescentic deposits of condensed leaked plasma proteins
23
Avg time to progression from stage 1 to stage 4 in DM1
17 years
24
Higher baseline Albuminuria =
Faster rate of progression
24
Microscopic appearance of end stage kidney in DN
Globally sclerotic glomeruli, dilated tubules resembling thyroid follicles, interstial fibrosis
25
At what stage of DN is the condition essentially irreversible?
Stage 4
26
Stage 5 of DN
GFR less than 10 (ESRD)
27
\_\_\_ is marker for increased CV risk in DN
Microalbuminuria
29
Fasting blood glucose criteria for DM
126 mg/dL
30
Anti-hypertensives to use in diabetics
ACEi's and ARB's
31
TGF-beta has been implicated in many ___ diseases
Chronic, Scarring
32
T/F: Patients with macroalbuminuria are more likely to die than develop ESRD
TRUE
33
Diffuse type Diabetic Glomerulopathy is identical to that which occurs in
HTN and aging
33
What condition has Kimmelstiel Wilson nodules
Nodular Type Diabetic Glomerulopathy
34
Hyaline Sclerosis of Afferent and Efferent Arterioles in DM vs HTN
HTN causes hyaline sclerosis of afferent, whereas DM will affect both
36
Microalbuminuria in DN over time leads to
Overt Proteinuria, Reduced GFR, HTN
37
What starts the clinical phase of DN
Overt Proteinuria
38
Tubular inflammation and injury from Glomerular HTN activates pathways that lead to
Fibrosis and Scarring
39
At what stage of DN do patients require dialysis or transplantation
Stage 5
39
Where in glomerulus do Kimmelstiel Wilson nodules occur
Periphery of Glomerular Tuft
40
For almost all kidney disease, including DN, likelihood of dying from what is higher than reaching ESRD
CV disease
41
Top 2 causes of ESRD
Diabetes (43%), HTN (23%)
42
Which type of Diabetic Glomerulopathy is characteristic (specific) for DM
Nodular Type
42
Where in glomerulus do Fibrin Caps occur?
Overlying peripheral capillaries
43
Classic symptoms of hyperglycemia
Thirst, Polyuria, Poldipsia, Visual Blurring
45
What occurs earlier than microalbuminuria in DN
Changes to GBM structure (collagen IV deposition)
46
Why does RAAS play a role in diabetic nephropathy
Inefficient at shutting down RAAS production
48
How is Albuminuria calculated
Albumin / Creatinine to correct for diffs in urine concentration
49
At what stage of DN does kidney demonstrate an inability to adequately filter wastes
Stage 3 - Creatinine and BUN rise
50
Stage 1 of DN
Hyperfiltration - Kidney incr in size
52
\_\_\_ lower both arterial BP and glomerular capillary pressures
ACEi's and ARBs
54
What causes inflammation in tubular cells in Glomerular HTN
G HTN --\> Injury to GBM --\> Leaks plasma proteins --\> Attempts to reabsorb these proteins injures tubular cells --\> Inflammation
55
Nodular Type Diabetic Glomerulopathy occurs after how many years
10
56
Kimmelstiel Wilson nodules eventually
squeeze capillaries shut
57
Where in glomerulus do Capsular drops occur
Parietal layer of Bowman's Capsule protruding into urinoferous space
59
Once in \_\_\_\_, patient is unlikely to regress
Overt Proteinuria (macroalbuminuria)
60
2 types of Exudative lesions
Fibrin Caps, Capsular Drops
62
Most common cause of kidney failure
DM
63
ACEi's have been show to lower BP and also reduce \_\_\_
Microalbuminuria (lower glomerular capillary pressure)
65
Avg time to progression from stage 1 to stage 5 in DM1
23 years
66
Capsular Drops
Deposits of partly plasma proteins, and partly basment membrane
67
On which arteriole does Ang2 selectively act?
Efferent --\> Incr intraglomerular pressure
68
Deposits of partly plasma proteins, and partly basment membrane
Capsular Drops
69
Diabetics Microvascular Complications are eliminated if patient obtains optimal management of glucose, BP, and lipid levels
FALSE
70
Effects of Glomerular HTN
Injury of GMB --\> Leak proteins --\> Injury to tubular cells and inflammation
71
First clinically detectable abnormality of DN
Microalbuminuria
72
Outcome of increased glomerular pressure and subsequent hypertrophy
Premature Glomerulosclerosis
74
How does TGF-beta get activated? What is consequence?
Ang2 --\> TGF-beta --\> Proliferation of fibroblasts and tubuloepithelial cells --\> Hypertrophy, BM thickening, MM expansion
75
Gross appearance of End stage kidney in Diabetic Neprhopathy
Diffuse fine granularity of cortical surface = Nephrosclerosis
76
Crescentic deposits of condensed leaked plasma proteins
Fibrin caps
77
3 histological features of DN
Incr MM, Glomerular Collapse, Glomerulosclerosis
78
\_\_\_ reduction determines CV outcome
Proteinuria
79
Effect of Ang2 in DN
Selective constriction of efferent\>afferent --\> Incr SNGFR --\> Incr intraglomerular pressure --\> Glomerular HTN

Renal (31 decks)

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