Review Question - QID 104338

The patient's presentation is consistent with end-stage renal failure secondary to diabetic nephropathy. Screening for microalbuminuria (protein) is indicated in patients with diabetes to detect the development of diabetic nephropathy.

Important complications of diabetes mellitus include retinopathy, nephropathy, neuropathy, increased atherosclerosis, and infections. Diabetic nephropathy occurs in part due to nonenzymatic glycosylation of the glomerular basement membrane and the afferent and efferent arterioles, along with osmotic damage to the glomerular capillary endothelial cells. Patients with diabetes should be screened for the presence of small amounts of albumin in the urine (microalbuminuria) with a spot urine collection. Note that a urine dipstick is not sensitive enough to detect microalbuminuria.

Roett et al. report that the progression of diabetic neuropathy can be slowed by optimizing glycemic control and employed ACE inhibitors or ARBs, however, intense glucose and blood pressure control can lead to incrased negative outcomes.

Agaba conducted a study of diabetic patients presenting with end-stage renal disease at a teaching hospital in Nigeria. As seen in the patient in the question stem, retinopathy, hypertension and peripheral vascular disease were present in 50-75% of the patients. Dyslipidemia, myocardial ischemia, left atrial hypertrophy, and LVH were also common.

Illustrations A and B show the Kimmelstiel-Wilson nodules (nodular glomerulosclerosis) typical of diabetic nephropathy. Note the expansion of the mesangium forming eosinophilic nodules and the thickening of the glomerular capillary walls.

Incorrect Answers:
Answer 1: Hematuria may occur in diabetic nephropathy, but detection of microalbuminuria is the most important screening test.
Answer 2, 3, 4: Leukocyturia, urine nitrites, and leukocyte esterase are seen in urinary tract infections.