Kidney damage in diabetes mellitus

Macroangiopathy
Affection of large arteries (a. renalis and its branches up to aa. arcuatae) -Atherosclerosis.

Microangiopathy
These are diabetické nefropatie –damage to arterioles (hyalinization of vas afferens and efferens) and glomerular capillaries ( diabetic glomerulosclerosis ).

Diabetic glomerulosclerosis

 * In 50% of DM type I, in 15–30% of DM II. type.
 * Microscopic
 * 1) Thickening of the basal membranes of the glomerular capillaries (more kolagenu, less GAG- increased permeability) and enlargement of the glomeruli;
 * 2) proliferation of the mesangial matrix between the glomerular capillaries, the matrix has the form of an eosinophilic mass similar to hyaline, it is PAS+, initially it is diffuse, later it forms nodes in part of the glomeruli (nodular diabetic glomerulosclerosis of Kimmelstiel-Wilson )
 * 3) in more advanced stages, so-called insudative lesions (drop-shaped deposits of plasma proteins with lipids) appear under the parietal sheet of Bowman's capsule and under the glomerular capillaries.
 * Makroskopicky
 * At first Hyperemia of the kidney is visible, later fine granulation of the surface and a slight reduction in size, terminally the picture of the so-called end-stage kidney occurs - a non-functional, strongly Atrophic kidney with a coarsely granulated surface, a hard-to-peel capsule and a faded pattern without discernible cortex and medulla.

Tubulointerstitial disorders

 * Inflammatory – more common pyelonephritis up to purulent Necrosis of papillae;
 * dystrophic - accumulation of glycogen in cells of the proximal tubule (bulky, bright cytoplasm - the so-called Armani zone ), Steatosis of cells and thickening of tubular basement membranes, fibrosis of the interstitium, or the presence of lipophages in the interstitium;
 * the functional consequences are the development of renal hypertension (overproduction of renin with reduced renal perfusion) and Proteinuria (up to the development of Nephrotic syndrome with Renal failure).

Related Articles

 * Diabetes mellitus
 * Complications of diabetes mellitus
 * Nephrotic syndrome
 * Nephritic syndrome
 * Diabetic glomerulosclerosis (preparation)