Nefropatía Diabetica

Jorge Arturo Bustos MartinezResidente de primer año medicina

interna UN

Contenido

• Epidemiologia• Definición• Fisiopatologia• Historia Natural• Clasificación• Screening y tratamiento

Epidemiologia

Principal causa de IR en los adultos en

EEUU

43% de diabéticos

microalbuminuria

8% macroalbumin

uria

45% de las IR son de origen

diabetico

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Definición

• Lesiones microangiopaticas renales• Complicación vascular crónica especifica de la

diabetes• Alteraciones funcionales y estructurales.• Proliferación de la matriz y celularidad

mesangial → aumento del grosor de la MB glomerular → esclerosis glomerular.

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Definicion

Proteinuria persistente Hipertensión arterial Deterioro progresivo de la función renal

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Histopatología

• Hipertrofia glomerular:

• Celularidad mesangial:

• Kimmelstiel-Wilson:

• Engrosamiento mesangial:

Suma Dronavalli, Irena Duka and George L Bakris. The pathogenesis of diabetic nephropathy. nature clinical practice ENDOCRINOLOGY & METABOLISM. AUGUST 2008 vol 4 no 8

Fisiopatologia

Vias hemodinamicas

↑ aferente↑ eferente

Prostanoides, oxido nitrico, Factor de crecimiento

vascular endotelial (VEGF)

Suma Dronavalli, Irena Duka and George L Bakris. The pathogenesis of diabetic nephropathy. nature clinical practice ENDOCRINOLOGY & METABOLISM. AUGUST 2008 vol 4 no 8

Fisiopatologia

Glicosilacion:Membrana basalReversibleIrreversible

Activación de protein quinasa C:Aumento de secreción de prostanoides.Hiperfiltracion glomerular

Al

dosa r

eductasa:

Vía

de l

os

poli

olesS

or

bit

ol

Hiperglucemia

Suma Dronavalli, Irena Duka and George L Bakris. The pathogenesis of diabetic nephropathy. nature clinical practice ENDOCRINOLOGY & METABOLISM. AUGUST 2008 vol 4 no 8

Fisiopatologia

• Prorrenina → Protein cinasas activadas por mitogenos (MAPK)

• Citoquinas.• Estrés oxidativo• Susceptibilidad genetica.

Suma Dronavalli, Irena Duka and George L Bakris. The pathogenesis of diabetic nephropathy. nature clinical practice ENDOCRINOLOGY & METABOLISM. AUGUST 2008 vol 4 no 8

Historia Natural.

 Richard J. MacIsaac and George Jerums. Diabetic kidney disease with and without albuminuria. Current Opinion in Nephrology and Hypertension 2011, 20:000–000

Historia Natural

 Richard J. MacIsaac and George Jerums. Diabetic kidney disease with and without albuminuria. Current Opinion in Nephrology and Hypertension 2011, 20:000–000

Riesgo de Muerte

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Clasificación

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Clasificación

• Mogenssen:Etapa I:

Hipertrofia e hiperfiltracion

glomerular.

Etapa II:Lesiones

estructurales.Normoalbuminuria

Etapa III:Microalbuminu

ria

Etapa IV:Albuminuria Retinopatia

HipertensionCatalá M, Rosalén R. Nefropatía diabética. Medicine 1993;6(34):1442-61

Screening y Tratamiento

Optimizar el control

glucemico (A)

Optimizar el control de la presion arterial (A)

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Screening y Tratamiento

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Screening y Tratamiento

• Albuminuria:- DM tipo 1: después de 5 años del

diagnostico.- DM tipo 2: en todos a partir del

diagnostico.• Creatinina: - En todos los diabeticos

Anua

lmen

te

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Tratamiento

IECAS ARA II

Excepto embarazadas

(A)

Robert G. Nelson, MD, Katherine R. Tuttle. Clinical Practice Guidelines and Clinical Practice Recommendations for DIABETES AND CHRONIC KIDNEY DISEASE. American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007: pp S10-S11

Conclusiones

• Prevención primaria

• Detección temprana

• Tratamiento optimo

Tequila http://micro.magnet.fsu.edu/cocktails/pages/tequila.html