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Chapter 53: Diabetic Kidney Disease

A 64-year-old man with moderately controlled type 2 diabetes, hypertension and CKD with nephrotic range proteinuria and sCr of 2.4 is admitted to the hospital because he has suffered a cerebrovascular accident. Which is the best single answer concerning this patient?

A. Intensive glycemic control of type 2 diabetes does not decrease incidence of nephropathy and cardiovascular mortality.

B. Type 2 diabetic patients with CKD always have nephrotic range albuminuria.

C. In type 2 diabetes, proteinuria correlates with increased incidence of coronary heart disease but not with stroke.

D. In both type 1 and type 2 diabetes, hypertension usually indicates evidence of diabetic nephropathy.

The answer is A. Intensive glycemic control of type II diabetes does not decrease incidence of nephropathy and cardiovascular mortality. The ACCORD trial indicated an increased risk of overall mortality with intensive glucose lowering in this population. Recent meta-analyses have indicated a decrease in cardiovascular disease outcomes, specifically nonfatal myocardial infarctions and risk of progression of nephropathy, but could not confirm that there was any decrease in nephropathy incidence or cardiovascular mortality.

Which is the best single answer concerning structural changes to the kidney during the course of diabetic nephropathy?

A. Afferent and efferent arteriolar hyalinosis are nonspecific findings and are found in a variety of glomerular diseases.

B. Greater than 90% of patients with type 2 diabetes have evidence of retinopathy at the time of diagnosis of overt nephropathy.

C. Kimmelstiel Wilson lesions are observed in a minority of patients diagnosed with diabetic nephropathy.

D. Thickening of the glomerular basement membrane is a late finding in diabetic nephropathy.

E. Kidney hypertrophy always indicates that the patient will develop overt nephropathy.

The answer is C. Kimmelstiel–Wilson lesions are observed in a minority of patients diagnosed with diabetic nephropathy.

A 47-year-old Hispanic woman is referred because of detection of dipstick positive proteinuria. She is obese and has carried the diagnosis of diabetes for the past 7 years. She also has moderately controlled hypertension and osteoarthritis. She smokes one pack of cigarettes per day but does not use other drugs or alcohol. Of note, her mother and one of her three siblings also have diabetes. Which is the best answer concerning this patient?

A. Because she has only been diagnosed with diabetes for 7 years, her proteinuria is probably not due to diabetic ...

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