Diabetic kidney disease
How high blood glucose makes the kidneys over-filter, how years of raised glomerular pressure and glycation thicken and scar the filters so albumin leaks into the urine, and why this is a leading cause of kidney failure worldwide.
By the end, you can
- Describe the glomerular filtration barrier and how the afferent and efferent arterioles set glomerular pressure.
- Explain how hyperglycaemia causes hyperfiltration through tubuloglomerular feedback and angiotensin II.
- Describe the structural changes: basement membrane thickening, mesangial expansion and podocyte loss.
- Relate albuminuria and falling filtration rate to the structural damage.
- Explain why blood pressure and treatments that lower glomerular pressure matter for progression.
- Recognise the classic biopsy appearances, classification, thresholds and tests of diabetic kidney disease, and explain how each main treatment acts on its mechanism.
What it is
Diabetic kidney disease is chronic kidney disease caused by diabetes, with persistent albuminuria (albumin leaking into the urine), a falling estimated filtration rate, or both. It develops after years of diabetes, affects a large proportion of people with type 1 and type 2 diabetes, and is a leading cause of kidney failure worldwide.
2 types to tell apart
- Albuminuric
- The classic course: hyperfiltration, then rising albuminuria, then falling filtration.
- Non-albuminuric
- Filtration falls without much albuminuria, increasingly common in type 2 diabetes, often with vascular disease.
Normal function
A filter with two adjustable valves
Each is a tuft of capillaries inside the . Its wall is a three-layer filter: fenestrated endothelium, the glomerular basement membrane and the foot processes of podocytes. It lets water and small solutes through but holds back albumin.
Uniquely, the glomerular capillaries sit between two arterioles. Tone in the (in) and the (out) sets the pressure in the glomerulus and so the filtration rate: dilating the afferent or constricting the efferent raises it.
The , part of the distal tubule touching its own glomerulus, senses salt delivery and adjusts the afferent arteriole (tubuloglomerular feedback), while the release renin.
Underlying change · Step 1 of 3
High glucose makes the kidneys over-filter
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 3
The filter thickens and scars
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 3 of 3
From albuminuria to kidney failure
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 3 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .