Diabetic nephropathy

Diabetic nephropathy

1. Anatomy of the kidney

   • Blood supply

2. Histology of the kidney

3. Physiology of glomerular filtration

   • Clearance
     • Volume of plasma cleared of the substance by the kidney in one minute
     • C ml/min (Clearance) = U x V / P
   • Glomerular filtration rate
     • the clearance of a substance freely filtered at the glomerulus but not reabsorbed or secreted in the tubules

4. Pathological features and types of glomerular diseases

   • Nephritic syndrome
     • Post streptococcal GN
     • Rapidly progressive GN (crescentic)
     • IgA nephropathy
     • SLE
     • Alport syndrome
   • Nephrotic syndrome
     • Primary
     • Secondary
       • SLE
       • Diabetes
         • Pathogenesis
           • 1. High serum glucose levels lead to hyaline arteriolosclerosis in efferent arteriole
             • 2. high GFR and microalbuminuria
               • 3. progress to sclerosis of the mesangium of the glomerulus and nephrotic syndrome
       • Amyloidosis

5. Complications

   • hypertention
   • Acute kidney failure
   • Chronic kidney failure

6. Renal function tests

   • Serum Blood Urea Nitrogen (BUN) – 7-18 mg/dL
   • Serum Creatinine – 0.6-1.2 mg/dL
   • Serum BUN/Creatinine ratio - 15
   • Creatinine Clearance (CCr) – 97-137 mL/minute
   • Urinalysis

7. Treatment

   • Diuretics
     • Thiazide diuretics
     • Loop diuretics
     • Potassium sparing diuretics
     • carbonic anhydrase inhibitors
     • Osmotic diuretics
   • Kidney transplantation

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