Kidney damage in diabetes mellitus

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Last update: Thursday, 30 Mar 2023 at 7.30 pm.

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Macroangiopathy[edit | edit source]

Affection of large arteries (a. renalis and its branches up to aa. arcuatae) -Atherosclerosis.

Microangiopathy[edit | edit source]

These are diabetické nefropatie –damage to arterioles (hyalinization of vas afferens and efferens) and glomerular capillaries ( diabetic glomerulosclerosis ).

Diabetic glomerulosclerosis[edit | edit source]

In 50% of DM type I, in 15–30% of DM II. type.

Kimmelstiel-Wilson nodular glomerulosclerosis

Microscopic

Thickening of the basal membranes of the glomerular capillaries (more kolagenu, less GAG- increased permeability) and enlargement of the glomeruli;
proliferation of the mesangial matrix between the glomerular capillaries, the matrix has the form of an eosinophilic mass similar to hyaline, it is PAS+, initially it is diffuse, later it forms nodes in part of the glomeruli (nodular diabetic glomerulosclerosis of Kimmelstiel-Wilson )
in more advanced stages, so-called insudative lesions (drop-shaped deposits of plasma proteins with lipids) appear under the parietal sheet of Bowman's capsule and under the glomerular capillaries .

Makroskopicky

At first Hyperemia of the kidney is visible , later fine granulation of the surface and a slight reduction in size, terminally the picture of the so-called end-stage kidney occurs - a non-functional, strongly Atrophic kidney with a coarsely granulated surface, a hard-to-peel capsule and a faded pattern without discernible cortex and medulla.

Tubulointerstitial disorders[edit | edit source]

Inflammatory – more common pyelonephritis up to purulent Necrosis of papillae;
dystrophic - accumulation of glycogen in cells of the proximal tubule (bulky, bright cytoplasm - the so-called Armani zone ), Steatosis of cells and thickening of tubular basement membranes, fibrosis of the interstitium, or the presence of lipophages in the interstitium;
the functional consequences are the development of renal hypertension (overproduction of renin with reduced renal perfusion) and Proteinuria (up to the development of Nephrotic syndrome with Renal failure).

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