BIO 12 Lecture Notes - Lecture 32: Histopathology, Renal Replacement Therapy, Hyperglycemia
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Jeff Koo
Bio 12
Human Physiology
Spring 2020
4 Units
Diabetic Nephropathy
● epidemiology of diabetic kidney disease.
○ Diabetes (especially type 2) is becoming a major issue.
■ In 1995, only 3 states had a prevalence over 6%; today 6% is the lowest.
■ Prevalence in higher in Hispanics and African Americans but hovers
around 10% across the board.
■ Diabetes is the #1 cause of end-stage renal disease, blindness, and
lower extremity amputations
● It also raises the risk of CV events by 2-4 fold
○ About ⅓ of patients with diabetes will develop nephropathy
● histopathologic manifestations of diabetic nephropathy.
○ Might try and just weave this into 3. Stay tuned.
○ Yup, gonna just weave it in. Makes more sense as a structure/function thing
● natural history and clinical stages of diabetic nephropathy.
○ Hyperfiltration (silent phase)
■ Functional Changes:
● Increase in GFR (unclear why. Somehow related to
hyperglycemia and RAAS activation)
● May also show an increase in overall kidney size
■ Structural Changes:
● Glomerular hypertrophy (without proliferation of cells)
● Basement membrane thickening
■ Time course:
● 5 to 10 years
● Microalbuminuria (incipient nephropathy)
○ Functional Changes:
■ Development of microalbuminuria (30-300mg of albumin daily)
● In order to find this, we need to check a urinary albumin to
creatinine ratio
● Needs to be followed closely because GFR and creatinine will
often still be normal
■ Tends to be associated with other microvascular complications. If you
know someone has retinopathy, you might be able to say they have
nephropathy without getting a biopsy.
○ Structural Changes: