Diabetic Nephropathology
Definition
Microvascular complication
Stage 1 (Very early diabetes): High eGFR
Stage 2 (Developing diabetes): 30 to 300mg albumin per day
Stage 3 (overt/ dipstick +ve diabetes): >300mg albumin per day + HTN usually
Stage 4 (late-stage): ++Cr
Stage 5 (ESRD): ESRD, need dialysis
Epidemiology
Not many diabetics detected
With T1DM with retinopathy, 90% has nephropathy
40% 5yr mortality
Screening
Using ACR, eGFR
T1DM: after 5y,, then annually
T2DM: @ dx, then annually
Pathogenesis
++ glucose --> ++osmotic diuresis --> increased renal filtration --> hypertrophy of epi/endothelim --> accelerated glomerular cell failure --> premature glomerulosclerosis
++ glucose --> schiff bases --> AGEP --> deposition in glomerulus --> damage
Clinical Features
Symptoms
Vision (retinopathy)
T1DM - Long standing diabetes (onset not immediately)
T2DM - Onset possible with dx of diagnosis
Investigations
Bedside: HTN
Bloods: ACR, UEC (eGFR)
Management
Source
Dr Rajesh Raj 2014
Microvascular complication
- Presence of albuminuria
- Elevated blood pressure
- Gradual declining glomerular function (if rapid decline, not diabetic)
Stage 1 (Very early diabetes): High eGFR
Stage 2 (Developing diabetes): 30 to 300mg albumin per day
Stage 3 (overt/ dipstick +ve diabetes): >300mg albumin per day + HTN usually
Stage 4 (late-stage): ++Cr
Stage 5 (ESRD): ESRD, need dialysis
Epidemiology
Not many diabetics detected
With T1DM with retinopathy, 90% has nephropathy
40% 5yr mortality
Screening
Using ACR, eGFR
T1DM: after 5y,, then annually
T2DM: @ dx, then annually
Pathogenesis
- Mesangial expansion
- Thickening of GBM
- Glomerular sclerosis
++ glucose --> ++osmotic diuresis --> increased renal filtration --> hypertrophy of epi/endothelim --> accelerated glomerular cell failure --> premature glomerulosclerosis
++ glucose --> schiff bases --> AGEP --> deposition in glomerulus --> damage
Clinical Features
Symptoms
Vision (retinopathy)
T1DM - Long standing diabetes (onset not immediately)
T2DM - Onset possible with dx of diagnosis
Investigations
Bedside: HTN
Bloods: ACR, UEC (eGFR)
Management
- Diet + exercise
- ACEi (anti TGF-b)/ ARB/ Direct Renin Inhibitors (DRI)
Source
Dr Rajesh Raj 2014