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How many nephrons are within each kidney?
1 million
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Which kidney structure is fenestrated and lines glomerular capillaries?
Capillary endothelium
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What kidney structure is an acellular substance that is gel like?
basement membrane
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What is the role of the basement membrane?
- To form a boundary between blood and urine
- to control permeability
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What supports the basement membrane?
Podocytes (epithelium)
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What is the final stage of protein filtration?
Podocytes
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What is the mesangium?
- Lies between the vessels
- Offers mechanical support to the glomerular capillaries
- Maintains filtration membrane
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What three conditions characterize diabetic nephropathy?
- Persistent macroalbuminuria
- Decline in GFR
- Elevated arterial blood pressure
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What is the most common cause of ESRD in the US?
Diabetic nephropathy
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What is the primary cause of dialysis in the US?
Diabetic nephropathy
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What % of T1DM pts will develop frank nephropathy?
30-40%
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What % of T2DM will develop diabetic nephropathy?
15-20%
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Which HL drugs are renal protective?
statins
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What are the earliest demonstratable abnormalities in diabetic nephropathy?
- Glomerular HTN
- Hyperfiltration
- Microalbuminuria
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How does sugar affect the kidneys?
- It causes the afferent vessels to dilate, and the efferent vessels to constrict, causing:
- glomerular HTN,
- hyperfiltration,
- disruption of the membrane
- Decline in GFR as kidneys become so damaged
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What is the earliest structural change of diabetic nephropathy?
thickening of GBM and expansion of the mesangium
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What is the most common lesion in diabetic nephropathy?
Glomerulosclerosis
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What lesion is pathonogmonic for diabetic nephropathy?
Kimmelstiel-Wilson nodules
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Ball like deposits in the mesangium, pushing capillaries out and forming a halo around the nodules
Kimmelstiel-Wilson nodules
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When does kidney function start to decline in diabetic nephropathy?
After 5 years
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When does protein leakage peak in diabetic nephropathy?
Around 15 years
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What causes fatigue in a pt with diabetic nephropathy?
hypoalbuminemia
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When does foot edema occur in a pt with diabetic nephropathy?
When nephrotic syndrome is present
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How do you screen a pt with T1DM?
Urine test every year after you have had DM for 5 years
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How do you screen a pt with T2DM?
Start yearling testing at the time of dx
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When is the best time to do spot urine screening?
early morning
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What is THE accepted measure for urine screening?
- 24 hour urine collection
- Checks volume, Cr, and protein
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At what GFR do you see an elevation of BUN and Cr?
When GFR is <60% of nl
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What needs to happen in order to use urine screening to dx someone with diabetic nephropathy?
2 out of 3 positive urines within 3-6 mo
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What does a kidney bx show in someone with diabetic nephropathy?
- Glomerulosclerosis
- BM thickening
- Mesangial expansion
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What are your tx goals with diabetic nephropathy?
control blood sugar, BP, and glomerular capillary pressure
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What analgesics do you avoid with diabetic nephropathy?
NSAIDs, as they can be nephrotoxic and cause an increase in GFR of someone with DN
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How do you tx diabetic nephropathy?
- ACE-Is/ARBs (ACEs prevent conversion, ARBs block receptors and vasodilate)
- Monitor BP, Cr, and K
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When is dialysis indicated in diabetic nephropathy?
- GFR <15 ml/min OR
- Cr > 6mg/dl
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How does dialysis work for a pt with diabetic nephropathy?
2x/week for 3.5-4 hours each session
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What should you consider when thinking about a renal transplant in a pt with T1DM?
doing a combined pancrease transplant as well
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Progression of diabetic nephropathy often leads to what?
nephrotic syndrome
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