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Flashcards in Diabetes Nephropathy Deck (24):
1

T or F: DN is the most common cause of ESRD

T

2

T or F: Development is strongly genetic

T: only 17 % risk if no family history

3

Describe the early changes assc with DN (pathogenesis, clinical, histo)

hyperfiltraion resulting in glomerular hypertrophy

clinically manifests as microalbuminemia

histo: inc mesangial matrix, glomerular collapse, glomerularsclerosis

4

Describe the progression of DN.

microalbuminemia --> proteinuria --> inc Sr Cr --> ESRD

5

What is the clinical defn of DN?

long standing DM (+/-retinopathy)
Macroalbuminemia
HTN

6

What usually develops at the same time as DN?

retinopathy

7

What are the 5 stages of DN kidney disease?

1. hyperfiltration (inc GFR)
2. microalbuminemia
3. more proteinuria, more Sr Cr, inc BUN, +/- HTN
4. GFR <10 ml/min

8

How long can it take to get to ESRD?

long time (avg 23 yrs)

9

What causes the damage in DN?

inc blood glc, inc Ang II causes hyperfiltration --> inc glomerular pressure --> hypertrophy of epithelium and endothelium --> accerlation of cell failure and premature glomerulosclerosis

10

Is there inflammation assc with progression of DN?

no, TGF-B secreted by the tubuloepithelial cells causes thickening of GBM, hypertrophy, mesangial matrix expansion

11

What are AGEs? What is their role in DN? How are they formed?

advanced glycosylation products --> accelerates cell injury

*long term hyperglycemia forms them from non-enzymatic glycosylation of capillary BM

12

Are AGEs normal?

yes, there are just more of them in DN pts

13

What is the tx for DN? Why?

CONTROL DM!! (slows progression)

ARBs and ACE-Is (only drugs that dec glomerular pressure = relax both aff and eff tone)

14

What is a good marker for the progression of DN towards ESRD?

degree of proteinuria

15

What are some complications of DN?

pyelonephritis
papillary necrosis
RTA type 4
neurogenic bladder

16

What are the 3 main types of DN? (and their subtypes)

1. glomerular: diffuse and nodular
2. papillary: pyelonephritis and papillary necrosis
3. tubulointersitial: tubular BM thickening and intersitial fibrosis

17

What is the most common type of DN?

diffuse
**earlier and less severe

18

Describe the appearance of diffuse DN histologically

thickening of GBM and mesangial matrix expansion

19

When does nodular type appear?

> 10 yrs of DM
= correlates with ESRD/need for dialysis

20

What are the histological features of nodular DN

kimmelsteil wilson nodules and hyaline sclerosis od afferent and efferent arterioles

21

What are kimmelstiel wilson nodules?

spherical hyaline deposits of mucopolysacchairdes, lipids, and fibrillary proteins within the mesangium or glomerular tuft

*they eventually squeeze capillaries shut

22

What are the 2 types of exudative lesions and which one occurs only in DN?

fibrin caps
capsular drops (only DN)

23

What are fibrin caps and capsular drops?

firbin caps: crescentric deposits of condened leaked plasma proteins overlying the peripheral capillaires (can be subspi or sub endo)

Capsular drops: deposits of partly plasma proteins and BM in parietal later of Bowman's capsule (protrudes into urinary space)

24

The end stage of DN looks just like __disease_ (describe gross and microscopic appearance too)

hypertensive nephropathy

*gross, diffuse fine granularity of cortical surface
**microscpoic: fibrosis and sclerosis --> globally sclerotic glomeruli, dilated tubules, tubules resembling thyroid follicles and interstitial fibrosis