BIO 12 Study Guide - Quiz Guide: Diabetic Nephropathy, Albuminuria, Glycated Hemoglobin
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1. historical features, clinical symptoms, and laboratory findings one would expect in a
patient with diabetic nephropathy.
a. Did this with 3.
2. key factors thought to be involved in pathogenesis of diabetic nephropathy.
i. NO ONE really knows
1. Thought to be a mix of three things
a. Glomerular hypertrophy (increase capillary surface area)
b. Afferent arteriolar vasodilation
c. Efferent arteriolar vasoconstriction (Angiotensin II)
i. Reasons the barrier might be leaky
1. GBM composition
a. So it does become thicker, but it also gets partially
2. Podocyte abnormalities
a. Become damaged. Either fuse or detach from the GBM and
undergo apoptosis. Basically become less effective
3. Hemodynamic effects
a. Hypertension worsens albuminuria
c. Loss of GFR
i. Thought to be almost entirely related to mesangial matrix expansion
(which correlates inversely with GFR)
ii. Expanding matrix impinges on capillary loops and fucks up the surface
area available for filtration
iii. Tubulointerstitial fibrosis also occurs later in the disease process
3. Understand the key components of treatment of diabetic nephropathy.
a. Intensive glycemic control (HbA1C under 7%) has been shown to slow disease
progression in multiple large trials.
i. Especially apparent in microvascular complications. Less exciting in
macrovascular (heart and brain)
b. Treat hypertension aggressively.
i. There’s a lot of debate. Take home point, aim for 140/90