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

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Flashcards in 05.20 - Diabetic Renal Disease (Wall, Nichols) - PP Deck (79):
1

Stage 2 of DN

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

1

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

Capsular Drops

1

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

Microscopic appearance of end stage kidney in DN

2

Stage 4 of DN

GFR < 75mL/min - HTN ubiquitous

3

Stage 3 of DN

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

3

Development of ___ heralds rapdid decline in GFR in Type2 DM

Macroalbuminuria

3

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

DM

4

% of diabetics who develop nephropathy

30-40%

5

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

HTN

5

Features of Nodular Type Diabetic Glomerulopathy

Kimmelstiel Wilson nodules and Hyaline sclerosis of both arterioles

6

Macroalbuminuria is defined as

random urine albumin/creatinine over 300 mg/g

6

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

Hyperkalemia

7

End Stage kidney from Diabetic Nephropathy looks just like

HTN Nephropathy

8

Nodular Glomerulosclerosis (Kimmelstiel Wilson Disease) correlates with

Renal failure eventually requiring dialysis

9

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

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

10

How does Glucose lead to Glomerular Pressure increase

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

10

Diffuse type Diabetic Glomerulopathy consists of

Capillary BM thickening; Increased MM

12

Macroalbuminuria is aka

Overt Nephropathy

14

Micro-Albuminuria is defined as

> 30 mg/g loss

15

How does glucose lead to Premature Glomerulosclerosis

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

15

Most common type of Diabetic Glomerulopathy

Diffuse

16

What causes injury to tubular cells in Glomerular HTN

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

16

What causes fibrosis and scarring in Glomerular HTN

Tubular inflammation and renal microvascular injury from protein leakage

16

Reduction in proteinuria is associated with

Reduced risk for ESRD

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