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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.