Nefropatía Diabética
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Transcript of Nefropatía Diabética
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Nefropatíadiabética
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ENFERMEDAD RENAL DIABETICA
NEFROPATÍA DIABÉTICA
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CAUSA MÁS
FRECUENTE
30%Desarrolla Nefropatía
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DIABÉTICOS
36
%
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FisiopatologíaENFERMEDAD RENAL EN DIABETES
MELLITUS
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FACTORES GENÉTICOS
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Mora-Fernandez. NefroPlus 2008
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PRODUCTOS FINALES DE LA GLICOSILACIÓN AVANZADA
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CÉLULAS MESANGIALES
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Aumento de
Producción de
Proteínas de
la Matriz
extracelular
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SRAA Intra-
renal
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HIPERFILTRAC
IÓN
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Esclerosis nodular (lesión de Kimmelstiel-Wilson)depósitos hialinos en las arteriolas glomerulares
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AJKD 2014
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DiagnósticoENFERMEDAD RENAL EN DIABETES
MELLITUS
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ALBUMINURIA
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ALBUMINURIA
L E V E M E N T E
I N C R E M E N TA D O
M O D E R A DA M E N T E
I N C R E M E N TA D O
S E V E R A M E N T E
I N C R E M E N TA D O
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ALBUMINURIA
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CREATININA
Y ESTIMACIÓN DE
FILTRACIÓN
GLOMERULAR
(mdrd)
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DEFINICIÓN CLÍNICA DE HIPERFILTRACIÓN
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Diabetologia 2009
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CLASIFICACION CLÍNICA DE MOGENSEN
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Diagnóstico Diferencial
Fierro J. Rev Med Clin Condes 2009
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TratamientoENFERMEDAD RENAL EN DIABETES
MELL ITUS
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PREVENCIÓN ES LA
CLAVE
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HbA1c < 7%
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¿QUÉ HACER CON LOS
HIPOGLICEMIANTES ORALES?
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Objetivo
< 140/80; < 150/80< 130/80 si microalbuminuria
JNC 8 < 140/90; < 150/90
< 140/90
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NEJM 2010
PAS <140 EstándarPAS <120 Intensivo
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IECA o
ARA2
Disminuyen albuminuriaDisminuyen la progresión a albuminuria (en microalbuminuria)
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Fried et al. NEJM 2013
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2013
Fried et al. NEJM 2013
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ANTAGONISTAS DE LAS ALDOSTERONA
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Eur J Int Med 2014
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ALISKIREN
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70%A 10 años
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TRIGLICERIDOS Y COLESTEROL NO HDL ELEVADO
HDL ELEVADO
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ESTATINAS
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OR 5,67
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SOBREPESO, OBESIDAD
Y SÍNDROME
METABÓLICO
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RECOMENDACIONES NUTRICIONALES
- ADA Diabetes Care 2014
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DERIVACIÓN
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TRATAMIENTO DE REEMPLAZO RENAL EN NEFROPATÍA DIABÉTICA
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TRASPLANTE
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