Diabetic Nephropathy

Diabetic Nephropathy

Write in short about diabetic nephropathy.
Answer:

Diabetic nephropathy means renal involvement in diabetes Mellitus, which is a complication of diabetes mellitus.

Diabetic nephropathy constitutes four types of renal lesions:

• Diabetic glomerulosclerosis
  • Diffuse glomerulosclerosis
  • Nodular glomerulosclerosis.
• Vascular lesions
• Diabetic pyelonephritis
• Tubular lesions.

Diabetic nephropathy

Diabetic Glomerulosclerosis

Glomerular lesions in diabetes mellitus are common and account for the majority of abnormal findings referable to the kidney. Pathogenesis of these lesions in diabetes mellitus is explained by following sequential changes, i.,e. glomerular hypertension → Renal hyperperfusion → Deposition of proteins in the mesangium → Glomerulosclerosis → Renal failure.

• Diffuse glomerulosclerosis:
  • Diffuse glomerular lesions are the most common.
  • There is the involvement of all parts of the glomeruli.
  • Pathologic changes consist of thickening of the GBM and diffuse increase in the mesangial matrix with the mild proliferation of mesangial cells. Various exudative lesis, such as capsular hyaline drops and firing caps, may also be present.
• Nodular glomerulosclerosis:
  • Nodular lesions of diabetic glomerulosclerosis are also called Kimmezlstiel-Wilson (KW) lesions or intercapillary glomerulosclerosis.
  • These lesions are specific for juvenile-onset diabetes or islet cell antibody-positive diabetes mellitus.
  • The pathologic changes consist of one or more nodules in a few or many glomeruli. A nodule is an ovoid or spherical, laminated, hyaline, acellular mass located within a lobule of the glomerulus.

Diabetic nephropathy stages

Diabetic nephropathy Vascular Lesions

Atheroma of renal arteries is very common and severe in diabetes mellitus. Hyaline arteriolosclerosis affecting the afferent and efferent arterioles of the glomeruli is also often severe in diabetes.

These vascular lesions are responsible for renal ischemia that results in tubular atrophy and interstitial fibrosis.

Diabetic Pyelonephritis

Poorly controlled diabetics are particularly susceptible to bacterial infections. Papillary necrosis (necrotizing papillitis) is an important complication of diabetes that may result in acute pyelonephritis.

Diabetic nephropathy treatment

Tubular Lesions (Armani-Ebstein Lesions)

In untreated diabetics who have extremely high blood sugar levels, the epithelial cells of proximal convoluted tubules develop extensive glycogen deposits appearing as vacuoles.

These are called Armanni-Ebstein lesions. The tubules return to normal on control of the hyperglycemic state.