DIABETIC NEPHROPATHY

DIABETIC NEPHROPATHY

• DIABETIC NEPHROPATHY refers to chronic loss of kidney function occurring in those with diabeic nephropathy

• DIABETIC MELLITUS →→ Nephropathy (if HbA2C > 7% develop nephropathy)

Type - 1 → 5 years

Type - 2 → 20 years

- bilateral enlarged kidney

SCREENING:

1. Albumin Excretion rate
2. Urine Albumin creatinine ratio

SPOT URINE SAMPLE:

1. Urinary Albumin creatinine ratio
2. albumin(mg)/urinary creatinine(gm)

- 30 - 300mg/gm (moderately increased albuminuria

- serum creatinine may be normal (rises later after 60% kidney damage)

- most specific test - kidney function test

KIDNEY BIOPSY:

1. Nodular glomerulosclerosis - kimmelstiel wilson change(most specific)
2. Diffuse glomerulosclerosis - most common kidney biopsy finding
3. Armani ebstein changes: PCT
4. Damage to DCT leads to development of Type 4 renal tubular acidosis 

- thus ENaC( epithelial sodium channel) become defective

- resulting in aldosterone resistance

- impaired excretion of K+/H+

- use ACEI cautiously

- increase K+ can results in cardiac arrest

• GFR in Diabetic Nephropathy

- initial 0 - 5 years: GFR increases

- glomerular hyperfiltration

glomerular hypertrophy

- 5 - 10 years → albuminuria → irreversible damage

CO - existing complication in DM at onset of albuminuria

1. hypertension
2. non healing ulcer
3. peripheral vaso occlusive disease
4. retinopathy(blindness)

TREATMENT:

• STOP METFORMIN / SULFONYLUREA

Glipizide / linagliptin - can be given in kidney disease as they are metabolized by liver

• initiate insulin : 80% of calculated dose
• Target BP < 130/80 mm  Hg if tolerated
• ACE inhibitor /ARB 
• treatment of hyperkalemia - sodium polystyrene sulfate , patiromer
• 
  
  

TRANSPLANT INDICATION

IF GFR - < 20 ML /MIN/1.73 BODY SURFACE AREA