Renal complications of diabetes mellitus

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

1. 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

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

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

4. 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

5. 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

6. 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

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

8. 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

9. MANAGEMENT OF DIABETES MELLITUS

10. CURRENT THERAPY

11. NON PHARMACOLOGICAL THERAPY

12. PHARMACOLOGICAL YREATMENT