Diabetic Nephropathy Flashcards Preview

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Flashcards in Diabetic Nephropathy Deck (19):
0

Best treatment for diabetic nephropathy?

ACE inhibitors

1

Waxy casts and oval fat bodies in UA?

Hyperlipidemia

2

Definition of nephrotic syndrome?

1. 3.5+ grams of protein excreted in 24 hours
2. Hypoalbuminemia (<3 g/dL)
3. Edema

3

Effect of nephrosis on the liver? Sign on UA?

Hyperlipidemia. Waxy casts and oval fat bodies

4

Nephropathies?

MCD
Membranous
FSGS
Membranoproliferative

5

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

6

Patients with advanced diabetes and proteinuria do not get a biopsy because?

Nephrotic proteinuria from diabetes is irreversible

7

Treatment of edema from nephrosis?

1. Salt restriction
2. diuretics
3. Dietary protein restriction (high-protein increases proteinuria which adversely affects renal function)
4. ACE inhibitors or ARBs to reduce proteinuria and slow progression

8

Dosages of diuretics in nephrosis?

Very large. thiazides and loop diuretics are highly protein-bound and there is decreased renal delivery if low-protein

9

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)

10

Relative GFR during progression of diabetic nephropathy?

Elevated then declines

11

Early stages of diabetic nephropathy can be detected with?

Microalbuminuria (3 to 300 total excretion)

12

Overt nephropathy?

Albuminuria exceeds 300

13

Natural history of diabetic nephropathy?

Microalbuminuria

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

14

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.

15

Drug that can slow progression of renal disease? Must be given in what stage?

ACE inhibitors. Must be given before overt proteinuria

16

Intervention that prevents progression of microvascular complications (retinopathy and nephropathy)?

Tight glycemic control with A-1 C less than 7

17

Intervention to slow progression after overt nephropathy begins?

Blood pressure control with goal less than 130/80

18

Treatment for diabetic gastroparesis?

Erythromycin and metoclopramide

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