PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHY

PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYDr. Carlos Azañero InopeDr. Carlos Azañero InopePATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYThe basement membranes of the glomerularcapillaries thicken and can obliterate theblood vessels.Histological changes in diabetic nefropatía: basal membrane thickening.Dr. Carlos Azañero InopePATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYThediabeticnephropathytakesplace by alteration in the function toglomerular.Histological changes in diabetic nefropatía: basal membrane thickening.Dr. Carlos Azañero InopePATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYThe cells mesangical thatsurroundstoglomerularvessels increases as a resultof the depot similar material to the basement membrane.Dr. Carlos Azañero InopeThe glomerulosclerosis is diffuse, but in 50% of the cases it isaccompanied with nodular sclerosis. This nodular component, denominated KIMMELSTIEL-WILSON NODULES, is pathognomonicof 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 microaneurismasalrededor de nódulos. Note la variabilidad de tamaño de los nódulos (H&E, Dr. Carlos Azañero InopeX400).PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYTYPE 1 DIABETES :GROWTH GLUCAGONHORMONEAFFERENT AND EFFERENT ARTERIOLES GLOMERULAR VASODILATATIONHYPERFILTRATIONGLOMERULUS CHANGESDr. Carlos Azañero InopeIt is not clear if this phase of early hyperfiltration occurs in the diabetes type 2.PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYMICROALBUMINURIANORMAL CONTENT OF HEPARAN SULFHATE ( Proteoglycan withNegative Charge) IN THE GLOMERULAR BASEMENT MEMBRANE DiabetesDIMINUTION OF HEPARAN SULFHATE IN THE BASEMENT MEMBRANEALBUMIN (Negative Charge)MICROALBUMINURIATHEREFORE, THE LOSS OF SULPHATE ALLOWS THE INCREASE IN THE FILTRATION OF ALBUMINDr. Carlos Azañero InopePATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYGLOMERULUS CHANGESINCREASE OF INJURY GLOMERULARFILTRATION OF PROTEINSDIABETIC NEPHROPATHYDr. Carlos Azañero InopeDiabetic Nephropathy: Presence of 300 - 500 mg urinary protein per day (in the normal mal urianálisis)PATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYDIABETIC NEPHROPATHYHYPERTENSIONINCREASE OFPROTEINURIA PROTEINURIA : NEPHROTIC (> 4 g/day)DIMINUTION OF THE RENAL FUNCTIONDr. Carlos Azañero InopePATHOPHYSIOLOGY OF DIABETIC NEPHROPATHYTYPO 1 DIABETESTYPO 2 DIABETESDIABETIC NEPHROPATHYHYPERTENSIONHYPERTENSIONDIABETIC NEPHROPATHYIN BOTH CASES, THE HTA GETS WORSE AS DETERIORATES THE RENAL FUNCTIONDr. Carlos Azañero Inope