The basement membranes of the glomerular capillaries thicken in diabetic nephropathy, which can obliterate the blood vessels. The mesangial cells that surround the glomerular vessels increase due to deposits of similar material to the basement membrane. This results in diffuse glomerulosclerosis in 50% of cases, accompanied by nodular sclerosis known as Kimmelstiel-Wilson nodules, which are pathognomonic of diabetes. The loss of heparan sulfate in the basement membrane allows increased filtration of albumin, leading to microalbuminuria and diabetic nephropathy.

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

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Dr. Carlos Azañero Inope