Diabetic Nephropathy Flashcards Preview

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Flashcards in Diabetic Nephropathy Deck (19)
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0
Q

Waxy casts and oval fat bodies in UA?

A

Hyperlipidemia

1
Q

Best treatment for diabetic nephropathy?

A

ACE inhibitors

2
Q

Definition of nephrotic syndrome?

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

Effect of nephrosis on the liver? Sign on UA?

A

Hyperlipidemia. Waxy casts and oval fat bodies

4
Q

Nephropathies?

A

MCD
Membranous
FSGS
Membranoproliferative

5
Q

Patient with nephrosis. Tests to rule out secondary causes?

A
  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
Q

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

A

Nephrotic proteinuria from diabetes is irreversible

7
Q

Treatment of edema from nephrosis?

A
  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
Q

Dosages of diuretics in nephrosis?

A

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

9
Q

Non-renal consequences of nephrosis?

A
  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
Q

Relative GFR during progression of diabetic nephropathy?

A

Elevated then declines

11
Q

Early stages of diabetic nephropathy can be detected with?

A

Microalbuminuria (3 to 300 total excretion)

12
Q

Overt nephropathy?

A

Albuminuria exceeds 300

13
Q

Natural history of diabetic nephropathy?

A

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
Q

Most common cause of death for patients with diabetes and end stage renal disease? (Mech?) goal of tx?

A

Cardiovascular disease due to increased atherosclerosis. LDL-cholesterol <100.

15
Q

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

A

ACE inhibitors. Must be given before overt proteinuria

16
Q

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

A

Tight glycemic control with A-1 C less than 7

17
Q

Intervention to slow progression after overt nephropathy begins?

A

Blood pressure control with goal less than 130/80

18
Q

Treatment for diabetic gastroparesis?

A

Erythromycin and metoclopramide

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