DPD: Diabetic nephropathy

Question 1

Describe 4 pathophysiolical features of diabetic nephropathy

Answer 1

Progressive proteinuria
HTN
Deranged renal function
Classic histological features

Question 2

List 3 histological glomerular changes

Answer 2

Mesangial expansion
Basement membrane thickening
Glomerulosclerosis

Question 3

List 4 strategies to minimise damage to the kidneys in diabetes

Answer 3

Diabetic control
BP control
Inhibition of the activity of RAS system
Stopping Smoking

Question 4

What effect do ACEi have within days of starting in diabetics with microalbuminuria? How does this benefit the patient?

Answer 4

Increase (worsening) of creatinine

Despite initial worsening, rate of worsening then plateaux’s

Question 5

Why do we not give ACEi to patients with renal artery stenosis?

Answer 5

Renal artery already has reduced BP
JGA sees low pressure, pushes out lots of renin + A2 to maintain GFR. Flow is not good as artery is partly blocked
If given an ACEi, A2 level falls a lot, pressure falls a lot + so GFR falls A LOT
Will stop peeing