Diabetic Nephropathy

Pathophysiology

  • Glomerular hyperfiltration and initial enlargement of kidney volume occur as local vasoactive factors increase flow
  • The GBM thickens and the mesangium expands
  • Progressive depletion of podocytes from the filtration barrier results in podocyturia early in the disease
  • Proteinuria evolves as filtration pressure rises and and the filter is compromised
  • Later, glomerulosclerosis develops in the nodules (Kimmel Steil Wilson Lesions) and hyaline deposites in the glomerular arterioles

Management

  • Good glycaemic control
  • Control dyslipidaemia and BP