Diabetic Nephropathy

Diabetic Nephropathy is a subtype of nephrotic syndrome.

It’s a 2ry glomerulopathy which mean that the patient had DM then he developed Diabetic nephropathy
therefore we understand that there is 1ry glomerulopathy which mean that kidney is the 1st affected
organ in cases like minimal change disease focal segmental glomerulosclerosis and membranous
nephropathy.

There are many systemic diseases that can lead to nephrotic syndrome:

1. Diabetes
2. SLE
3. Amyloidosis
4. Multiple Myeloma
5. HCP

Cause: The patient has DM for 10 years or more poorly controlled and HTN as risk factor

 Other risk factors: Smoking.High blood cholesterol.Obesity and family history of

diabetes and kidney disease

It’s a chronic disease so it starts with microalbuminuria then proteinuria.

Causes of hypoproteinemia:

1. decrease intake.
2. Decrease synthesis.
3. Increase loss: malabsorption syndrome in gut and protein losing nephropathy in kidney.
Which can lead to edema in return

Pathogenesis:

Diabetes, which is hyperglycemia, too much glucose can destroy cells in the body proteins and fat by
non-enzymatic glycosylation (glycation) damaging vessels causing retinopathy neuropathy nephropathy.
Diabetes damages the kidney vessels and renal glomeruli and renal pelvis.

When diabetes damage renal vessels cause:

1. Macrovascular disease: hyaline arteriosclerosis

2. Microvascular disease: thickening of capillary basemen membrane
In return it increases the permeability of vessels and tubular cells to the proteins

When diabetes damage glomeruli it can cause:

1. Osmotic damage to the glomerular capillary endothelium as the glucose turned to

sorbitol by aldose reductase and sorbitol attracts water which causes oncotic damage.
2. Thickening of capillary basement membrane by deposition of type IV collagen
 3. Hyperfiltration which causes diffuse mesangial sclerosis.
4. Nodular Glomerulosclerosis.

When diabetes damage renal pelvis it can cause pyelonephritis

Diagnosis:

The patient may be present with hematuria, edema, anemia.

Labs: Microalbuminuria, defined as albuminuria in the range of 30–300 mg/24 h, is an important

marker. It typically appears 5–10 years after the onset of diabetes.

Microalbuminuria classically progresses over 5–10 years to proteinuria and declining GFR.

In LM: Diffuse thickening of capillary wall, Diffuse mesangial sclerosis and papillary necrosis

In EM: Podocyte Fusion

Management: Blood Sugar and Blood Pressure Control

1. Treatment: Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS):

 Drugs that inhibit the RAAS, such as ACE inhibitors and angiotensin receptor blockers
(ARBs), have been shown in large clinical trials to slow the progression of diabetic
nephropathy at early (microalbuminuria) and late (proteinuria with reduced glomerular
filtration) stages.

2. SGLT2 Inhibitors:

 Inhibitors of sodium-glucose cotransporter 2 (SGLT2) have demonstrated benefits in

patients with type 2 diabetes and kidney disease with albuminuria, reducing the risk of
kidney failure and cardiovascular events.