Flashcards in Diabetic Nephropathy Deck (19):
Best treatment for diabetic nephropathy?
Waxy casts and oval fat bodies in UA?
Definition of nephrotic syndrome?
1. 3.5+ grams of protein excreted in 24 hours
2. Hypoalbuminemia (<3 g/dL)
Effect of nephrosis on the liver? Sign on UA?
Hyperlipidemia. Waxy casts and oval fat bodies
Patient with nephrosis. Tests to rule out secondary causes?
1. Serum glucose and A1c (diabetes most common)
2. And ANA
3. SPEP and UPEP (serum/urine Plasma electrophoresis)
4. Viral serologies (HIV and hepatitis)
5. Heavy metals – Mercury
Patients with advanced diabetes and proteinuria do not get a biopsy because?
Nephrotic proteinuria from diabetes is irreversible
Treatment of edema from nephrosis?
1. Salt restriction
3. Dietary protein restriction (high-protein increases proteinuria which adversely affects renal function)
4. ACE inhibitors or ARBs to reduce proteinuria and slow progression
Dosages of diuretics in nephrosis?
Very large. thiazides and loop diuretics are highly protein-bound and there is decreased renal delivery if low-protein
Non-renal consequences of nephrosis?
1. Hypercoagulable because loss of anti-thrombin III and protein C and S (increased thromboembolic risk)
2. Hypogammaglobulinemia (increased infection risk - esp strep)
3. Hypotransferrinemia (iron deficiency anemia)
4. Loss of vitamin D binding proteins (vitamin D deficiency)
Relative GFR during progression of diabetic nephropathy?
Elevated then declines
Early stages of diabetic nephropathy can be detected with?
Microalbuminuria (3 to 300 total excretion)
Albuminuria exceeds 300
Natural history of diabetic nephropathy?
5 to 10 years later: overt nephropathy, Development of edema hypertension
5-15 years later: progression to end-stage regional disease
2 years later: death
Most common cause of death for patients with diabetes and end stage renal disease? (Mech?) goal of tx?
Cardiovascular disease due to increased atherosclerosis. LDL-cholesterol <100.
Drug that can slow progression of renal disease? Must be given in what stage?
ACE inhibitors. Must be given before overt proteinuria
Intervention that prevents progression of microvascular complications (retinopathy and nephropathy)?
Tight glycemic control with A-1 C less than 7
Intervention to slow progression after overt nephropathy begins?
Blood pressure control with goal less than 130/80