Diabetic nephropathy Flashcards
Progression of diabetic nephropathy
Pre: (stage 1+2) Renal hypertrophy and hyperfiltration, basement membrance changes
Incipient: (stage 3) Microalbuminaemia, hypertension. Mesangial expansion, thickening of the basement membrane
Overt: (stage 4) Proteinuria, nephrotic syndrome, low GFR. Tubulointerstitial fibrosis and mesangial nodules.
What is seen in a diffuse glomerular lesion?
Increase in the mesangial matrix that expands into the capillaries
Capillary wall thickening
Mesangial expansion that leads to capillary narrowing and glomerular fibrosis
Nodular glomerular lesion
Nodular lesions in the mesangium due to dilation of the glomerular capillaries (aneurysm) and lysis of the mesansium
Glomerular syndromes associated with diabetic nephropathy
non-nephrotic proteinuria
nephrotic synfrome
CKD
What is the effect of diabetes on the renal vasculature?
Causes hyalinizing arteriolar sclerosis.
Hyaline material replaces the entire wall of the afferent and efferent arterioles at the hilum.
Increases susceptibility to pyelonephritis, papillary necrosis and tubular lesions.
Morphological changes that occur in glomeruli in diabetic nephropathy
Capillary basement membrane thickening
Diffuse mesangial sclerosis
Nodular glomerularsclerosis
Describe the pathogensis of diabetic nephropathy
Glomerulosclerosis is caused by insulin deficiency>hyperglycaemia.
Hyperglycaemia has a toxic effect on glomerular endothelial cells. Metabolic defects in the glomerular basement membrane increases the production of collagen and damages the glomerulus.
Haemodynamic changes cause an increase in GFR and glomerular hypertrophy which leads to increased vascular permeability and proteinuria (hyperfiltration)
Clinical presentation of diabetic nephropahy
Earliest manifestation is microalbuminaemia >30mg day
Requires monitoring and intensive glucose management to prevent overt proteinuria.
Treatment of diabetic nephropathy
ACEi reduce proteinuria
Good glycaemic control
BP control
