Diabetic nephropathy

• Facts:
  Nephrotic syndrome
  Two forms (diffuse and nodular glomerulosclerosis)
  Earliest renal abnormality is glomerular hyperfiltration
• History / PE:
  Patients with longstanding, uncontrolled DM
  Retinopathy or neuropathy
  
• Diagnosis:
  Thickened GBM
  Increased mesangial matrix
  Proteinuria
  Progressive decline of GFR
  Kimmelstiel-Wilson nodules (nodular glomerulosclerosis)
• Treatment:
  Tight control of blood sugar
  ACEIs for DM I
  ARBs for DM II