DIABETIC NEPHROPATHY

SUMMARY

1. May be associated with hyporeninemic hypoaldosteronism and Type 4 RTA.

2. The risk of nephropathy is the same, regardless of whether patients have Type 1 or 2 diabetes, in most cases, retinopathy precedes nephropathy.

3. Risk factors - age, race, genetics, obesity, smoking, BP, GFR, glycemic control, OCP use.

4. Renal biopsy classically shows expansion of the mesangium, thickening of the GBM, and sclerosis of the glomeruli (termed the Kimmelstiei-Wilson lesion).

5. 2 phases - preclinical phase with microalbuminuria, can be detected by measuring random urine albumin:creatinine ratio. Clinical phase with nephrotic syndrome.

6. Control of HTN (to < 140/90 with an ACEI/ARB), glycemia (HbA1c < 7), weight reduction & treatment of hyperlipidemia slows the rate of progression.

7. As renal function decreases, insulin requirements decrease (2° to decreased metabolism by the kidneys).

Reference(s)

Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].