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Diabetic Nephropathy
Allan B. Schwartz, MD, is professor of medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine. He opens his lecture with slides showing the dramatic increase in the incidence of diabetes mellitus, and the prevalence of the disease by race and ethnicity. The lecture is built around a total of 69 slides. This lecture and the post-test is worth 1.5 credit hours. The author discusses proteinuria in diabetes mellitus, noting that it is a warning sign for progressive chronic renal failure. He describes the slide on the natural history of diabetic nephropathy as the most important in his presentation because it traces the functional and structural changes through hypertension and microalbuminuria to proteinuria. He next presents a biopsy of a patient with progressive diabetic nephropathy that shows the classic lamellated appearance of the Kimmelstiel and Wilson nodules. The American Diabetes Association recommends screening for microalbuminuria at the time of diagnosis of diabetes, and annually thereafter, and the author goes on to present a schematic of events with microalbuminuria and proteinuria. The author points out that antihypertension therapy slows the progression of diabetic nephropathy and shows how intensive ACE inhibitor therapy correlates with renal function preservation. The lecture continues with slides showing treatment strategies for preventing type 2 diabetes progressive nephropathy including blockade of the renin angiotensin system. The lecture concludes with slides that show several studies, including the Irbesartan Diabetic Nephropathy Trial, the RENAAL trial and the CALM study. |
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