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: Albumin Excretion rate Urine Albumin creatinine ratio SPOT URINE SAMPLE: Urinary Albumin creatinine ratio 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: Nodular glomerulosclerosis - kimmelstiel wilson change(most specific) Diffuse glomerulosclerosis - most common kidney biopsy finding Armani ebstein changes: PCT Damage to DCT leads to development of Type 4 renal tubular acidosis - thus ENaC( epithelial sodium channel) become defective - resulting in aldosterone resistance - impai...