DIABETIC NEPHROPATHY for MBBS STUDENT.pptx

Pathology point of view

1. DIABETIC NEPHROPATHY Reena 2415

2. Renal complications are more severe,develop early and more frequently in type 1 Diabetes mellitus (30-40%)than in type 2 DM( about 20%). Variety of clinical syndromes are associated with diabetic nephropathy like asymptomatic proteinuria, nephrotic syndrome, progressive renal failure and hypertension

3. Pathology Diabetic nephropathy includes 4 types of renal leasions in DM Diabetic glomerulosclerosis Vascular lesions Diabetic pyelonephritis Tubular lesion

4. Diabetic glomerulosclerosis:- Hyperglycemia Non enzymatic glycosylation of glomerular matrix Advance glycation end product(AGEs) Increased resistance to filtration Glomerular hypertension

5. Renal hyper perfusion against a pressure gradient Isudation of plasma proteins into mesangial areas and glomerular basement membrane Thickening of hyperoerfused area Glomerulosclerosis

6. Glomerulosclerosis in diabetes may take one of two forms::- Diffuse glomerulosclerosis Nodular glomerulosclerosis

7. Diffuse glomerulosclerosis Involvement of all part of glomeruli Pathologic changes consist of Thickening of the GBM and diffuse increase in mesangial matrix with mild proliferation of mesangial cell Various insudate lesions like capsular hyaline drops & fibrin caps may be also present

8. Capsular drop is an eosinophilic hyaline thickening of parietal layer of Bowman capsule and bulges into the glomerular space Fibrin cap is homogeneous, brightly eosinophilic material appearing on wall of peripheral capillary of the lobule

9. 2) Nodular glomerulosclerosis Also known as Kimmelstiel- Wilson lesion or intercapillary glomerulosclerosis Pathologic changes include one or more nodule in a few or more glomeruli Nodule is an ovoid or spherical, laminated, hyaline, acellular mass located within a lobule of glomerulus. Nodules are surrounded by glomerular capillary loops which may have normalmor thickened basement membrane

10. The nodules are PAS positive and contain lipid & fibrin As the nodules enlarges, they compress glomerular capillary and obliterate glomerular tuft

11. Vascular lesions Atheroma of renal arteries Hyaline arteriosclerosis of afferent and efferent arteroles These lesions are responsible for renal ischaemia results in tubular atrophy and interstitial fibrosis

12. Diabetic pyelonephritis Uncontrolled diabetes are more susceptible to bacterial infection leading to inflammation of kidney Papillary necrosis is an important complication of diabetic pyelonephritis

13. Tubular lesions ( Armanni- Ebstein lesion) The epithelial cells of PCT develops extensive glycogen deposits appearing as vacuoles These are called Armanni- Ebstein lesion Tubules return to normal on controlling hyperglycaemic state

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