USMLE/COMLEX - Step 2 - Diabetic Nephropathy

USMLE/COMLEX - Step 2 - Diabetic Nephropathy Diabetic nephropathy is a multifactorial disease process involving hyperglycemia-induced damage to the glomerular filtration barrier, inflammation, activation of the renin-angiotensin-aldosterone system, and genetic factors. These mechanisms lead to structural changes in the GFB, recruitment of inflammatory cells, and the production of pro-inflammatory mediators. In addition, RAAS activation exacerbates kidney damage. Proteinuria Edema Hypertension Fatigue Loss of appetite Insomnia Itchy skin Increased urine albumin Decreased glomerular filtration rate Elevated serum creatinine Anemia Hypertension Fluid retention and edema Abnormal electrolyte levels Urine R/E Blood urea nitrogen Serum creatinine Glomerular filtration rate Ultrasound KUB The primary goal of treatment is to slow the progression of the disease and prevent or delay the onset of kidney failure. Some treatment options for diabetic nephropathy are: 1. Blood sugar control: The essential step in treating diabetic nephropathy is to control blood sugar levels. It is usually achieved through lifestyle changes and medication. 2. Blood pressure control: High blood pressure is a common complication of diabetic nephropathy and can further damage the kidneys. Blood pressure control is essential to slow the progression of the disease. 3. Medications: ACE inhibitors or ARBs are commonly used to treat diabetic nephropathy. These drugs lower blood pressure and protect the kidneys by reducing proteinuria (the presence of protein in the urine). 4. Dietary changes: A diet low in protein and sodium may be recommended to help reduce the burden on the kidneys. 5. Exercise: Regular exercise can help control blood sugar, lower blood pressure, and improve overall health. 6. Kidney replacement therapy: In severe cases, kidney replacement therapy may be necessary, such as dialysis or a kidney transplant.