🎧 FREE MSRA PODCAST – Diabetic Nephropathy: Tackle Kidney Complications in Diabetes!
Did you know up to 40% of people with diabetes may develop kidney disease? In this episode, we break down diabetic nephropathy for rapid MSRA revision – what it is, why it happens, how to spot the red flags, and management essentials straight from UK NICE guidelines. Boost your renal and diabetes exam knowledge with confidence!
🧠 Key Learning Points
Definition
• Diabetic nephropathy is progressive kidney damage caused by long-standing diabetes, primarily due to chronic high blood glucose damaging the kidney’s small blood vessels (glomeruli).
Causes & Risk Factors
• Poorly controlled diabetes (type 1 and 2) over many years
• High blood pressure (hypertension)
• Genetic/family history
• Certain ethnicities (African, Hispanic, Native American)
• Smoking and dyslipidaemia
Pathophysiology
• Chronic high blood glucose → formation of AGEs, inflammation, oxidative stress, and overactivation of the renin-angiotensin-aldosterone system (RAAS)
• Leads to endothelial dysfunction, glomerular hypertrophy, thickened basement membrane, and scarring (fibrosis)
Symptoms
• Often asymptomatic in early stages
• Detected by screening for microalbuminuria (tiny protein leaks in urine)
• Later: persistent proteinuria, hypertension, oedema (swelling), fatigue, decreased appetite
Diagnosis
• Urine: Albumin:Creatinine Ratio (ACR):
– Microalbuminuria = ACR ≥2.5mg/mmol (men) or ≥3.5mg/mmol (women)
– Proteinuria = ACR ≥30mg/mmol
• Blood: Creatinine, eGFR
• Imaging: Renal ultrasound
• Biopsy: If diagnosis is uncertain or atypical
Red Flags (Suspect Other Renal Disease)
• No diabetic retinopathy
• Sudden heavy proteinuria
• Rapid decline in kidney function
• Marked haematuria
• Severe or resistant hypertension
• Systemic illness (fever, weight loss, rashes, joint pains)
Management
• Aggressive glucose control: HbA1c target <7% (53 mmol/mol)
• Tight BP control: Target <130/80 mmHg (ACE inhibitors/ARBs preferred)
• Lipid control: Statins
• SGLT2 inhibitors for type 2 diabetes with CKD/proteinuria
• Lifestyle: Stop smoking, reduce salt and protein intake (especially avoid high-protein diet in type 1 nephropathy), healthy weight
• Regular monitoring: urine ACR, eGFR, BP
• Refer to nephrology when eGFR <30
• Dialysis or transplant if ESRD develops
Complications
• End-stage renal disease (ESRD)
• Increased risk of cardiovascular disease (heart attack, stroke)
• Anaemia, bone disease, electrolyte disturbances, infections
📎 More Diabetic Nephropathy Revision Resources:
📝 Revision Notes: https://www.passthemsra.com/topic/diabetic-nephropathy-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/diabetic-nephropathy-flashcards/
🧠 Q&A Notes: https://www.passthemsra.com/topic/diabetic-nephropathy-accordion-qa-notes/
📝 Rapid Quiz: https://www.passthemsra.com/topic/diabetic-nephropathy-rapid-quiz/
🎯 Quiz Portal: https://www.passthemsra.com/quizzes/diabetic-nephropathy/
📚 Renal Course: https://www.passthemsra.com/courses/renal-for-the-msra/
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