Diabetes nephropathy

Diabetic nephropathy 

Updated: 01/21/2021

© Jun Wang, MD, PhD

General features

• Leading cause of end stage renal disease
• Associated with increased extracellular matrix
• Associated with long standing hyperglycemia
  
• Renal disease reduced by tight diabetic control
• Severity associated with diabetes duration, glycemic control, and genetic background
• Earliest sign: moderately increased albuminuria (30-300 mg/d)
• Annual glomerular filtration and urine ablumin level tests in diabetic patients for early detection
• Diagnosis based on renal biopsy
  

Clinical features

• Albuminuria
• Moderately increased albuminuria (microalbuminuria): 30-300 mg/d
• Severely increased albuminuria (macroalbuminuria): > 300 mg/d
  
• Decreasing glomerular filtration rate
• Hypertension
• Hypoalbuminemia and associated presentations, such as edema
  
• Less common, hematuria
• Other diabetic complications: diabetic retinopathy, diabetic neuropathy, etc
  

Key pathogenesis

• Excess extracellular matrix
• Resulted from stromal cell proliferation caused by advanced glycation end products, etc
  

Pathological features

• Glomerular abnormalities: Most common

Nodular glomerulosclerosis

Diffuse capillary basement membrane thickening

Diffuse and nodular glomerulosclerosis

Diffuse mesangial sclerosis

• Macrovascular abnormalities: Atherosclerosis and ateriolosclerosis
• Pyelonephritis: Tubular atrophy, interstitial fibrosis and inflammation

Back to diabetes

Back to pathology of endocrine pancreas

Back to pathology of endocrine system

Back to contents