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