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Dr. Carlos Azañero Inope
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
Dr. Carlos Azañero Inope
TheThe basementbasement membranesmembranes ofof thethe glomerularglomerularcapillariescapillaries thickenthicken andand can can obliterateobliterate thethebloodblood vesselsvessels..
HistologicalHistological changeschanges in in diabeticdiabetic nefropatnefropatííaa: basal : basal membranemembrane thickeningthickening..
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
TheThe diabeticdiabetic nephropathynephropathy takestakesplace by place by alterationalteration in in thethe functionfunction totoglomerularglomerular..
HistologicalHistological changeschanges in in diabeticdiabetic nefropatnefropatííaa: basal : basal membranemembrane thickeningthickening..
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
TheThe cellscells mesangicalmesangical thatthatsurroundssurrounds toto glomerularglomerularvesselsvessels increasesincreases as a as a resultresultofof thethe depotdepot similar material similar material toto thethe basementbasement membranemembrane..
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
TheThe glomerulosclerosisglomerulosclerosis isis diffusediffuse, , butbut in 50% in 50% ofof thethe cases cases itit isisaccompaniedaccompanied withwith nodularnodular sclerosissclerosis. . ThisThis nodularnodular componentcomponent, , denominateddenominated KIMMELSTIELKIMMELSTIEL--WILSON NODULESWILSON NODULES, , isis pathognomonicpathognomonicofof thethe Diabetes. Diabetes.
Un glomérulo con lesiones lesiones nodularesnodulares de de KimmelstielKimmelstiel--Wilson.Wilson. Los nódulos más pequeños pueden ser más celulares y los más grandes tienden a ser acelulares en el centro y rodeados por zonas más celulares. Alrededor de estos nódulos se ven capilares, a veces adoptando un aspecto en guirnalda (como en los tres nódulos señalados con flechas); en algunos casos vemos microaneurismasalrededor de nódulos. Note la variabilidad de tamaño de los nódulos (H&E, X400).
Dr. Carlos Azañero Inope
TYPE 1 DIABETES :TYPE 1 DIABETES :
HYPERFILTRATIONHYPERFILTRATION
AFFERENT AND EFFERENT ARTERIOLES AFFERENT AND EFFERENT ARTERIOLES GLOMERULARGLOMERULAR VASODILATATIONVASODILATATION
GLUCAGONGLUCAGONGROWTH GROWTH
HORMONEHORMONE
GLOMERULUS CHANGESGLOMERULUS CHANGES
ItIt isis notnot clearclear ifif thisthis phasephase ofof earlyearly hyperfiltrationhyperfiltration occursoccurs in in thethe diabetes diabetes typetype 2.2.
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
MICROALBUMINURIAMICROALBUMINURIA
MICROALBUMINURIAMICROALBUMINURIA
DIMINUTION OF HEPARAN SULFHATE IN DIMINUTION OF HEPARAN SULFHATE IN THE BASEMENT MEMBRANETHE BASEMENT MEMBRANE
ALBUMIN ALBUMIN
((NegativeNegative ChargeCharge))
NORMAL CONTENT OF HEPARAN SULFHATE ( NORMAL CONTENT OF HEPARAN SULFHATE ( ProteoglycanProteoglycan withwithNegativeNegative ChargeCharge) IN THE GLOMERULAR BASEMENT MEMBRANE ) IN THE GLOMERULAR BASEMENT MEMBRANE
THEREFORE, THE LOSS OF SULPHATE ALLOWS THE INCREASE IN THE FILTRATION OF ALBUMIN
DiabetesDiabetes
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
FILTRATION OF FILTRATION OF PROTEINSPROTEINS
INCREASE OF INJURY INCREASE OF INJURY GLOMERULARGLOMERULAR
DiabeticDiabetic NephropathyNephropathy:: PresencePresence ofof 300 300 -- 500 500 mgmg urinaryurinary proteinprotein perper dayday (in (in thethe normal normal urianurianáálisislisis))
DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
GLOMERULUS CHANGESGLOMERULUS CHANGES
Dr. Carlos Azañero Inope
PROTEINURIA : PROTEINURIA : NEPHROTIC (> 4 g/NEPHROTIC (> 4 g/dayday))
INCREASE OFINCREASE OFPROTEINURIA PROTEINURIA
DIMINUTION OF THE RENAL FUNCTIONDIMINUTION OF THE RENAL FUNCTION
HYPERTENSIONHYPERTENSION
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
TYPO 1 DIABETESTYPO 1 DIABETES TYPO 2 DIABETESTYPO 2 DIABETES
HYPERTENSIONHYPERTENSIONDIABETICDIABETIC NEPHROPATHYNEPHROPATHY
HYPERTENSIONHYPERTENSION
IN BOTH CASES, THE HTA GETS WORSE AS IN BOTH CASES, THE HTA GETS WORSE AS DETERIORATES THE RENAL FUNCTIONDETERIORATES THE RENAL FUNCTION
PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
DIABETICDIABETIC NEPHROPATHYNEPHROPATHY
Dr. Carlos Azañero Inope
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