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A 50 y/o man comes for a routine check up. He has no present complaints. He has DM II, stable angina and gout. He takes glyburide and atenolol. He smokes two packs a day and occasionaly consume alcohol. His father had an early myocardial Infarction, his brother has DM. His BP is 140/90 mmHg and HR is 65/min. Physical exam shows no abnormalities.T here is concern about end organ damage in this pt due to DM. Which of the following is the earliest renal abnormality that could be seen in this pt?
A-Nodular sclerosis
B-Glomerular Basement Memb. Thickening
C-Mesengial expansion
D-Immune deposits
E-Glomerular hyperfiltration
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E-Glomerular hyperfiltration
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please can u post the answer with explanation sarim!!
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"E" is correct.
-In pts with Diabetes M. , the vessels become thick and hard (Arteriosclerosis).
-In the kidneys of these pts. "Efferent arteriosclerosis" can lead to the following sequential consequences:
G.Hyperfiltration--->GBM thickening--->Mesangial expansion--->Nodular sclerosis
-Glomerular hyperfiltration is the earliest renal abnormality in pts with DM.
-It is the major pathological mechanism of glomerular injury in these pts.
-It creates "Intraglomerular HTN" leading to progressive glomerular damage and renal Fxn loss.
*The effectiveness of ACE inhibitors in diabetic nephropathy is related to their ability to "Reduce Intraglomerular HTN" and thereby decreasing the glomerular damage.
