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Diabetic Nephropathy is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime indication for Dialysis in many countries. It involves steadily increasing proteinuria, accompanied by elevated blood pressure, with a progressive decline in GFR. Then, what is the pathogenesis of diabetic nephropathy? (Have a question? Get an answer from free online service now!)
The precise factors that are responsible for diabetic nephropathy are preliminary being determined. There are four changes occur:
1. The renal hemodynamic abnormalities
It plays a key role in diabetic nephropathy, and may even the initiating factors.
(1) In the condition of high blood sugar, inner glomerular is in a hypertransfusion and high filtration state. Glomerular epithelial cells become detached from the basement membrane.
(2) The glomerular basement membrane Ⅳ collagen makes sugar nucleic acid increased, the basement membrane thickening, and finally forms the mesangial diffuse and nodular lesions, and glomerular sclerosis.
(3) In the case of increased pressure, protein filtration increase and deposit on the mesangial area and glomerular basement membrane, promote matrix l hyperplasia, form a vicious cycle, and can cause nodular and diffuse glomerular sclerosis.
Diabetic nephropathy is closely related to the high blood sugar. Poor blood glucose control can accelerate the development of diabetic nephropathy; good blood glucose control can obviously delay its development. The increased end-products of hyperglycemia and glycosylation can lead to mesangial cell proliferation, extracellular matrix increasing, mesangial expansion and glomerular basement membrane thickening, etc.
3. Genetic factors
Most people with diabetes won't appear renal lesions. But patients with good control of blood sugar for a long-term also can appear diabetic nephropathy. Recent studies have found that the different GLUT1 menus of mesangial cells between individuals are likely to be a cause of kidney damage. And the occurrence of diabetic nephropathy also show the family gathered phenomenon. The incidence of patients with a family history of high blood pressure is higher than patients without that. In addition, there are differences in prevalence of diabetic nephropathy between different ethnic groups. It showed that the occurrence of diabetic nephropathy is associated with genetic factors.
4. High blood pressure
It has no direct relation with the diabetic nephropathy. But it may accelerate the progress of diabetic nephropathy, the deterioration of renal function, and increase the excretion of urine albumin.
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