Endocrine & metabolic · UKMLA & AKT
Diabetic nephropathy
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Chronic hyperglycaemia → RAAS activation → afferent arteriole dilation → raised intraglomerular pressure → glomerular hyperfiltration
- Early disease: kidneys are bilaterally enlarged due to hyperfiltration and hypertrophy - the opposite of most CKD causes
- Late disease: kidneys return to normal size then atrophy as glomerulosclerosis progresses
On ultrasound, bilaterally enlarged kidneys in a diabetic patient = diabetic nephropathy (early). Other causes of enlarged kidneys: polycystic kidney disease, amyloidosis, HIV nephropathy. Shrunken kidneys are NOT a feature of early diabetic nephropathy.
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