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24 Cards in this Set
- Front
- Back
What is the main cause of ESRD in the US?
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Diabetes
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What racial groups are susceptible to ESRD?
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African americans
Native americans |
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Where is ESRD more severe? Why?
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Places where there's obesity
More diabetes in these places |
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What is the prognosis for someone with ESRD?
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Terrible
Just as bad as small cell lung cancer |
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What kills people with CKD, ESRD?
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CV complications
Co-morbid issues |
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If you're a diabetic, what are your chances of having renal disease?
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25%
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Is there any difference in the progression towards neuropathy in type 1 vs. 2 DM?
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Essentially the same
Slight difference is that type 2 has a more compressed timeline |
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What are the risk factors for renal disease in DMII?
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Genetic factors
Hyperglycemia HTN Glomerular hyperfiltration/HTN Smoking Race (AA, NA) |
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How should you screen for diabetic nephropathy?
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1. Microalbumineria
2. Estimate GFR |
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How often should you screen type I DM px for microalbuminuria? Type II DM px?
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Type I: after 5 years, every year thereafter
Type II: every year |
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If someone has a positive microalbumin test, what should you do? What's necessary for a positive dx?
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Rule out transient causes
Repeat the test 2x within 3-6 months If you've got 2/3 positive tests, you've got microalbuminuria |
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What's the problem with microalbuminuria as a test to estimate nephropathy in DM patients?
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Not everyone who has kidney disease has microalbuminuria
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Should you take creatine levels in patients with DM?
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YES!
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What physical changes happen tot he glomeruli in DM nephropathy?
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Glomeruli are enlarged
Thickening of the basement membrane Expansion of the mesangium Loss of podocytes |
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What is the first step in the pathogenesis of DM nephropathy?
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Renal preglomerular vasodilation
We don't know what causes this, but systemic hypertension can contribute |
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What is the mechanism for increased matrix production during hyperglycemia?
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Increased glucose and pressure cause an increase in fibronectin, collagen IV
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Does inflammation play a role in DM nephropathy?
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Yes, but not large amounts of it (don't think glomerulonephritis, here)
Small bits of inflammation can cause damage |
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What is the pathogenesis of DM nephropathy?
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|
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What is the effect of controlling glucose on the development of DM nephropathy?
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Reversing vasodilation
Reversing the causes of ROS species leading to glomerular sclerosis |
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When in the course of DM should you aggressively control glucose? Why?
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AS EARLY AS POSSIBLE!
Substantial long term benefits to survival, development of ESRD |
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What three variables should you seek to control in DM nephropathy?
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Sugar level
Systemic HTN via ACEIs, ARBs Diet: don't let them have high protein in their diet |
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What is the effect of tx of HTN, controlling of hyperglycemia in px. at risk of DM nephropathy?
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Remission of microalbuminuria--> less CV, kidney problems
You're able to stabilize them! |
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What's the target blood pressure for a person with diabetes?
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<130/80
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What is azotemia? If someone with DM has this, what should you do?
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by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood
Refer to a nephrologist! |