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The kidney is frequently affected in diabetes
As patients with diabetes mellitus frequently suffer renal disease, monitoring
of renal function is
an important part of follow-up.
Diabetes is now one of the most common causes of
The associated renal disease can be divided into three forms:
diabetic vascular disease, diabetic glomerular damage, and increased
susceptibility to infection
and papillary necrosis.
Diabetes causes increased severity of atherosclerosis in large, medium and small
to renal ischaemia.
In addition, diabetes causes hyaline arteriolosclerosis in
afferent arterioles,resulting in ischaemic glomerular damage.
Diabetic glomerular damage involves diffuse thickening of the glomerular
membrane leading to an increase in permeability, proteinuria and,
occasionally, the nephrotic syndrome.
Exudative lesions due to a combination of
basement membrane and abnormal mesangium may be visible as masses of
fibrin protein (fibrin caps) on the surface of the glomerulus.
Changes in mesangium lead to excess mesangial matrix formation.
This initially occurs in an even pattern throughout the glomerulus (diffuse
but later takes the form of laminated spheres, which are known as
'Kimmelstiel-Wilson nodules' (nodular diabetic glomerulosclerosis)
Diabetic glomerulosclerosis causes progressive hyalinization of glomeruli, with
capillary loops and death of individual nephrons.
Over a period of years this leads to chronic renal failure.
The most important infiltrative disease of the glomerulus is amyloidosis
The kidney is a target organ in amyloidosis, a condition in which extracellular
protein is deposited in a variety of tissues.
For a more detailed discussion, see amyloidosis.
The amyloid is deposited as fibrils in the GBM and in the mesangium. As amyloid
in the basement membrane, the membrane thickens and its permeability is
increased, so that the
first manifestation is proteinuria. With heavy deposition of amyloid, the
increases until the patient develops features of the
Amyloid is an important cause of the nephrotic syndrome in adults. Heavy amyloid
in the mesangium, in combination with increased mesangial matrix formation, can
lead to expansion of the mesangium, ultimately leading to compression of the
system, and transition into chronic renal failure.
Amyloid is also deposited in
of intrarenal vessels, particularly afferent arterioles.
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