Diabetic nephropathy
Description
- The single commonest cause of ESKD in Australia (~35-40% of incident dialysis)
- Classically defined by persistent albuminuria + declining eGFR + diabetic retinopathy in someone with long-standing diabetes
- *Diabetic kidney disease' is now preferred - because a large and growing proportion progress with normoalbuminuric eGFR decline*, particularly in type 2 diabetes on RAS blockade
Histology
- Mesangial expansion -> nodular glomerulosclerosis (Kimmelstiel-Wilson nodules)
- GBM thickening (the earliest structural change), hyaline arteriolosclerosis of BOTH afferent and efferent arterioles (the efferent involvement is specific to diabetes)
- Capsular drop and fibrin cap lesions; large kidneys, even when function is poor
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