The KIDNEY: Understanding Diabetic Nephropathy
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Dr. Roopam Jain, Professor & Head, Dept. of Pathology & Blood Bank
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The KIDNEY: Understanding Diabetic Nephropathy
- 1. The KIDNEY Diabetic Nephropathy DR. ROOPAM JAIN PROFESSOR & HEAD, PATHOLOGY
- 3. Diabetic Nephropathy • Renal involvement is an important complication of diabetes mellitus. • Chronic kidney disease with renal failure accounts for deaths in more than 10% of all diabetics. • Renal complications are more severe, develop early and more frequently in type 1 DM (30-40% cases) than in type 2 diabetics (about 20% cases). • Asymptomatic proteinuria, • Nephrotic syndrome, • Progressive renal failure and • Hypertension. • Cardiovascular disease is 40 times more common in patients of chronic kidney disease in diabetes mellitus than in non-diabetics
- 4. Diabetic Nephropathy MORPHOLOGIC FEATURES • Diabetic nephropathy encompasses 4 types of renal lesions in DM: • Diabetic glomerulosclerosis, (diffuse or nodular lesions) • Vascular lesions, • Diabetic pyelonephritis and • Tubular lesions (Armanni-Ebstein lesions).
- 5. Diabetic Nephropathy MORPHOLOGIC FEATURES 1. DIABETIC GLOMERULOSCLEROSIS sequential changes: • Hyper-glycaemia • glomerular hypertension • renal hyperperfusion • deposition of proteins in the mesangium • Glomerulosclerosis • renal failure.
- 6. Diabetic Nephropathy MORPHOLOGIC FEATURES 1. DIABETIC GLOMERULOSCLEROSIS Glomerulosclerosis in diabetes may take one of the 2 forms: diffuse or nodular lesions: i) Diffuse glomerulosclerosis ii) Nodular glomerulosclerosis
- 7. Diabetic Nephropathy A, Diffuse lesions. The characteristic features are diffuse involvement of the glomeruli showing thickening of the GBM & diffuse increase in the mesangial matrix with mild proliferation of mesangial cells and exudative lesions (fibrin caps & capsular drops).
- 8. Diabetic Nephropathy B, Nodular lesion (Kimmelstiel-Wilson Lesion). There are one or more hyaline nodules within the lobules of glomeruli, surrounded peripherally by glomerular capillaries with thickened walls.
- 9. Diabetic Nephropathy Diabetic nephropathy—nodular (Kimmelstiel-Wilson or KW) lesions