Diabetic nephropathy, Glomerulosclerosis, Vascular lesions, Pyelonephritis, Tubular lesions

3. DIABETIC NEPHROPATHY
 Chronic kidney disease with renal failure accounts for
death in more than 10% of all diabetics
 More common in Type 1 than type 2
 Clinical syndromes associated with diabetic nephropathy
• asymptomatic proteinuria
•nephrotic syndrome
•progressive renal failure
•hypertension

4. MORPHOLOGIC FEATURES
4 types of renal lesions
1. DIABETIC GLOMERULOSCLEROSIS
2. VASCULAR LESIONS
3. DIABETIC PYELONEPHRITIS
4. TUBULAR LESIONS

5. DIABETIC GLOMERULOSCLEROSIS
 PATHOGENESIS
Hyperglycemia ➖glomerular hypotension ➖ renal
hyperperfusion ➖ deposition of proteins in the
mesangium➖glomerulosclerosis➖ renal failure
 2 forms: diffuse or nodular lesions

6. Diffuse glomerulosclerosis
 Most common
 Involves all part of the glomeruli
 Thickening of Glomerular basement membrane
 Diffuse increase in mesangial matrix with mild proliferation of
mesangial cell
 Capsular drop: eosinophilic hyaline thickening of parietal layer of
Bowmann’s capsule and bulges into glomerular space
 Fibrin cap: homogenous brightly eosinophilic material appearing
on the wall of peripheral capillary of a lobule

8. Nodular glomerulosclerosis
 Also called Kimmelstiel - Wilson (KW) lesions or intercapillary
glomerulosclerosis.
 Specific for type1
 Consists of one or more nodules in a few or many glomeruli
 Nodule is ovoid or spherical, laminated , hyaline , acellular mass
located within a lobule of the glomerulus
 Nodules are surrounded by glomerular capillary loop
 Nodules: PAS Positive, contain lipid and fibrin

11. VASCULAR LESIONS
 Atheroma
 Hyaline arteriosclerosis – affect the afferent and
efferent arterioles
 These vascular lesions are responsible for renal
ischemia that results in tubular atrophy and
interstitial fibrosis

12. DIABETIC PYELONEPHRITIS
 Poorly controlled diabetics are more susceptible
to bacterial infection
 Papillary necrosis is an important complication
that may result in acute pyelonephritis

13. TUBULAR LESIONS
 Armani-Ebstein lesions
 Seen in untreated diabetics
 Epithelial cells of PCT develop extensive
glycogen deposit appearing as vacoules
 Tubules return to normal on control of
hyperglycemia

14. MANAGEMENT OF DIABETES MELLITUS

15. CURRENT THERAPY

16. NON PHARMACOLOGICAL THERAPY

17. PHARMACOLOGICAL YREATMENT