Upload
residentes1hun
View
1.343
Download
2
Embed Size (px)
Citation preview
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