糖尿病肾病6 幻灯片课件.pptVIP

Diabetic Nephropathy Diabetic nephropathy is the leading cause of chronic renal failure in the industrialised world. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. Although both type 1 diabetes mellitus (insulin-dependent diabetes mellitus [IDDM]) and type 2 diabetes mellitus (non–insulin-dependent diabetes mellitus [NIDDM]) lead to ESRD, the great majority of patients are those with NIDDM. The glomeruli and kidneys are typically normal or increased in size initially, thus distinguishing diabetic nephropathy from most other forms of chronic renal insufficiency, wherein renal size is reduced (except renal amyloidosis and polycystic kidney disease). Signs and Symptoms Approximately 25% to 40% of patients with DM 1 ultimately develop diabetic nephropathy (DN), which progresses through five predictable stages. Stage 1 (very early diabetes) Increased demand upon the kidneys is indicated by an above-normal glomerular filtration rate (GFR). Hyperglycemia leads to increased kidney filtration (see later) This is due to osmotic load and to toxic effects of high sugar levels on kidney cells Increased Glomerular Filtration Rate (GFR) with enlarged kidneys Stage 4 (late-stage diabetes) Glomerular damage continues, with increasing amounts of protein albumin in the urine. The kidneys’ filtering ability has begun to decline steadily, and blood urea nitrogen (BUN) and creatinine (Cr) has begun to increase. The glomerular filtration rate (GFR) decreases about 10% annually. Almost all patients have hypertension at stage 4. Stage 5 (end-stage renal disease, ESRD) GFR has fallen to 10 ml/min and renal replacement therapy (i.e., haemodialysis, peritoneal dialysis, kidney transplantation) is needed. CAPILLARY ENDOTHELIUM BASEMENT MEMBRANE FOOT PROCESSES OF PODOCYTES FIL