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Diabetic Nephropathy
Diabetic nephropathy
- Characterized as abnormal levels of albumin in the urine, glomerular lesions, and reduced GFR.
- Results from metabolic and vascular abnormalities caused by diabetes mellitus.
- Risk factors include high blood pressure, dyslipidemia, smoking, genetic mutations that lead to a lower number of glomeruli in the kidney.
- Thus, treatment requires blood pressure, lipid, and glucose control.
- Screen diabetic patients annually.
- May be associated with other renal/urinary tract disorders (papillary necrosis, renal tubular acidosis, infections) that promote renal decline.
Pathophysiology: Glomerular sclerosis and fibrosis
- Microvascular disease with thickened glomerular basement membrane and mesangial expansion.
- Kimmelstiel-Wilson lesions: areas of nodular glomerulosclerosis, areas of hyalinosis and atherosclerosis of the arterioles.
- Early hyperfiltration with microalbuminuria; over time, GFR decreases and albuminuria increases.
- Leads to nephrotic syndrome, end-stage renal disease with high rate of renal failure in patients with Type 1 and Type 2 diabetes.
- Asymptomatic in early stages. In later stages, patients experience signs and symptoms of uremia - nausea, vomiting, loss of appetite.