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PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY
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PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY

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  • 1. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY Dr. Carlos Azañero Inope Dr. Carlos Azañero Inope
  • 2. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY The basement membranes of the glomerular capillaries thicken and can obliterate the blood vessels. Histological changes in diabetic nefropatía: basal membrane thickening. Dr. Carlos Azañero Inope
  • 3. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY The diabetic nephropathy takes place by alteration in the function to glomerular. Histological changes in diabetic nefropatía: basal membrane thickening. Dr. Carlos Azañero Inope
  • 4. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY The cells mesangical that surrounds to glomerular vessels increases as a result of the depot similar material to the basement membrane. Dr. Carlos Azañero Inope
  • 5. The glomerulosclerosis is diffuse, but in 50% of the cases it is accompanied with nodular sclerosis. This nodular component, denominated KIMMELSTIEL-WILSON NODULES, is pathognomonic of the Diabetes. Un glomérulo con lesiones nodulares de Kimmelstiel- Wilson. Los nódulos más pequeños pueden ser más celulares y los más grandes tienden a ser acelulares en el centro y rodeados por zonas más celulares. Alrededor de estos nódulos se ven capilares, a veces adoptando un aspecto en guirnalda (como en los tres nódulos señalados con flechas); en algunos casos vemos microaneurismas alrededor de nódulos. Note la variabilidad de tamaño de los nódulos (H&E, Dr. Carlos Azañero Inope X400).
  • 6. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY TYPE 1 DIABETES : GROWTH GLUCAGON HORMONE AFFERENT AND EFFERENT ARTERIOLES GLOMERULAR VASODILATATION HYPERFILTRATION GLOMERULUS CHANGES Dr. Carlos Azañero Inope It is not clear if this phase of early hyperfiltration occurs in the diabetes type 2.
  • 7. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY MICROALBUMINURIA NORMAL CONTENT OF HEPARAN SULFHATE ( Proteoglycan with Negative Charge) IN THE GLOMERULAR BASEMENT MEMBRANE Diabetes DIMINUTION OF HEPARAN SULFHATE IN THE BASEMENT MEMBRANE ALBUMIN (Negative Charge) MICROALBUMINURIA THEREFORE, THE LOSS OF SULPHATE ALLOWS THE INCREASE IN THE FILTRATION OF ALBUMIN Dr. Carlos Azañero Inope
  • 8. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY GLOMERULUS CHANGES INCREASE OF INJURY GLOMERULAR FILTRATION OF PROTEINS DIABETIC NEPHROPATHY Dr. Carlos Azañero Inope Diabetic Nephropathy: Presence of 300 - 500 mg urinary protein per day (in the normal
  • 9. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY DIABETIC NEPHROPATHY HYPERTENSION INCREASE OF PROTEINURIA PROTEINURIA : NEPHROTIC (> 4 g/day) DIMINUTION OF THE RENAL FUNCTION Dr. Carlos Azañero Inope
  • 10. PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY TYPO 1 DIABETES TYPO 2 DIABETES DIABETIC NEPHROPATHY HYPERTENSION HYPERTENSION DIABETIC NEPHROPATHY IN BOTH CASES, THE HTA GETS WORSE AS DETERIORATES THE RENAL FUNCTION Dr. Carlos Azañero Inope
  • 11. www.carlosvirtual.wordpress.com Dr. Carlos Azañero Inope