• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/24

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

24 Cards in this Set

  • Front
  • Back
What is the main cause of ESRD in the US?
Diabetes
What racial groups are susceptible to ESRD?
African americans

Native americans
Where is ESRD more severe? Why?
Places where there's obesity

More diabetes in these places
What is the prognosis for someone with ESRD?
Terrible

Just as bad as small cell lung cancer
What kills people with CKD, ESRD?
CV complications

Co-morbid issues
If you're a diabetic, what are your chances of having renal disease?
25%
Is there any difference in the progression towards neuropathy in type 1 vs. 2 DM?
Essentially the same

Slight difference is that type 2 has a more compressed timeline
What are the risk factors for renal disease in DMII?
Genetic factors
Hyperglycemia
HTN
Glomerular hyperfiltration/HTN
Smoking
Race (AA, NA)
How should you screen for diabetic nephropathy?
1. Microalbumineria
2. Estimate GFR
How often should you screen type I DM px for microalbuminuria? Type II DM px?
Type I: after 5 years, every year thereafter

Type II: every year
If someone has a positive microalbumin test, what should you do? What's necessary for a positive dx?
Rule out transient causes

Repeat the test 2x within 3-6 months

If you've got 2/3 positive tests, you've got microalbuminuria
What's the problem with microalbuminuria as a test to estimate nephropathy in DM patients?
Not everyone who has kidney disease has microalbuminuria
Should you take creatine levels in patients with DM?
YES!
What physical changes happen tot he glomeruli in DM nephropathy?
Glomeruli are enlarged

Thickening of the basement membrane

Expansion of the mesangium

Loss of podocytes
What is the first step in the pathogenesis of DM nephropathy?
Renal preglomerular vasodilation

We don't know what causes this, but systemic hypertension can contribute
What is the mechanism for increased matrix production during hyperglycemia?
Increased glucose and pressure cause an increase in fibronectin, collagen IV
Does inflammation play a role in DM nephropathy?
Yes, but not large amounts of it (don't think glomerulonephritis, here)

Small bits of inflammation can cause damage
What is the pathogenesis of DM nephropathy?
What is the effect of controlling glucose on the development of DM nephropathy?
Reversing vasodilation

Reversing the causes of ROS species leading to glomerular sclerosis
When in the course of DM should you aggressively control glucose? Why?
AS EARLY AS POSSIBLE!

Substantial long term benefits to survival, development of ESRD
What three variables should you seek to control in DM nephropathy?
Sugar level
Systemic HTN via ACEIs, ARBs
Diet: don't let them have high protein in their diet
What is the effect of tx of HTN, controlling of hyperglycemia in px. at risk of DM nephropathy?
Remission of microalbuminuria--> less CV, kidney problems

You're able to stabilize them!
What's the target blood pressure for a person with diabetes?
<130/80
What is azotemia? If someone with DM has this, what should you do?
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!