Diabetic nephropathyis one of the most common and serious chronic compliions associated with diabetes mellitus. In this tutorial, let'sdiscuss how the mechanisms underlying diabetic nephropathy correlate with the al presentation as well as the treatment of the disease. Now fortunately the mechanisms
underlying diabetic nephropathy, directly correlate withthe al presentation. And the first alfinding of the disease is somewhat paradoxicallyan increased kidney filtration rate orglomerular filtration rate. So, diabetic nephropathy,if you break down the term into nephro and pathy literally means kidneydisease caused by diabetes.
Now typically kidney disease is marked by a decreased filtration rate, so why is it that the first al stage of diabetic nephropathy is that of an increased glomerularfiltration rate? Well recall that the earliest mechanism contributing to diabetic nephropathy is an increased pressurestate, over hereblue.
And this is due to hypertension and efferent vasoconstriction. So let's use a common garden hose to help illustrate how thisincreased pressure state will ultimately resultan increased glomerular filtration rate. So, imagine you have this garden hose and it has a small holein the middle of it.
So first you're gonna open up the spigot and increase the pressureand flow through the hose. Intuitively, this isgoing to increase the rate at which water is leakingfrom the holethe hose. Next, you partially kink off the end of the hose distal to the hole, and once again this isgonna further increase the rate at which waterleaks from the hose.
This is essentially what'soccurringthe glomerulus with the hypertension representing the opening up of the spigot and increasing the pressurebefore the glomerulus,front of the glomerulus, and the efferent vasoconstriction representing the kinking off of the hose, which causes this back pressure.