DIABETIC NEPHROPATHY

• Diabetic nephropathy also called diabetic kidney disease, is a serious

kidney related complication of type 1 diabetes and type 2 diabetes

• When advanced it leads to end-stage kidney with kidney failure which

accounts for deaths in more than 10% of all diabetics.

• Renal complications are more severe, earlier and frequently in type 1

diabetes mellitus.
• Some clinical syndromes associates with diabetic nephropathy
include:
-asymptomatic proteinuria
-nephrotic syndrome
-progressive renal failure
-hypertension
• Morphologically, diabetic nephropathy shows 4 types of renal lesions
include diabetic glomerulosclerosis, vascular lesions, diabetic
pyelonephritis and tubular lesions( Armanni-Ebstein lesions).

• Glomerulosclerosis is the scarring in the glomeruli and it can be

diffused or nodular i.e Kimmelstiel-Wilson lesions or intercapillary
glomerulosclerosis.
• Vascular lesions include atheroma of renal arteries are common.

• Also hyaline arteriosclerosis affecting both afferent and efferent

arterioles is common with characteristic deposits of hyaline materials
composed of plasma proteins.
• They lead to renal ischemia>>>>tubular atrophy and interstitial
fibrosis
• Also poorly-controlled diabetes can lead to pyelonephritis result from
bacterial infection.
• Symptoms include frequent urination and pain in the back and groin.

• Armanni-Ebstein lesions are characterized by extensive glycogen

deposits in the epithelial cells of PCT which appear as vacuoles.
• Major cause of diabetic nephropathy is diabetes mellitus which when
uncontrolled damages blood vessels and other cells in the kidneys.
• Risk factors:
 hyperglycemia
Hypertension
Smoking
High blood cholesterol
Family history i.e diabetes and kidney disease
Genetic factors i.e carnosinase-1 (18q) and adiponectin gene(3q)
Clinical features:
• Early stages are asymptomatic but advanced stages have symptoms
include:
 proteinuria
 Increased frequency of urination
 Swelling of feet , ankles, hands or eyes
 Worsening hypertension and renal failure
 Persistent itching
Epidemiology:
• DN is currently the leading cause of end stage renal disease globally
• It affects one third of patients with type 1 and type 2 DM
• Women with diabetes are more affected with complications of DN
compared to men with diabetes.
• According to race, north Americans >African Americans >Asians
• In Tanzania prevalence of kidney diseases is high among adult diabetic
outpatients attending clinic but usually undiagnosed.
Diagnosis:
• Imaging tests: X-rays and Ultrasound for kidney structure and size,
CT-scan and MRI to determine how well is blood circulation.
• Immunofluorescence: detection of advanced glycation end-
products(AGEs) by antibodies
• ANCA screening test: negative
• Kidney biopsy
Management:
• Management of hyperglycemia
• Control high blood pressure by medications e.g ACE inhibitors like
benazepril and captopril.
• Lowering cholesterol level i.e use of statins.
• Managing proteinuria by treating underlying causes example diabetes
and hypertension.
REFERENCES:
• Harsh mohan textbook of pathology
• Muir’s textbook of pathology 14th edition