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* diabetic nephropathy
 #809550  
  sameera531 - 06/22/15 08:02
 
  An 18-year-old man with a 12-year history of type 1 diabetes mellitus comes to the physician for a follow-up
examination. Medications include 25 U of NPH insulin and 10 U of regular insulin in the morning and 10 U of NPH
insulin and 10 U of regular insulin before dinner. His hemoglobin A1c was 14.5% 12 weeks ago. His current pulse is
80/min, respirations are 20/min, and blood pressure is 145/95 mm Hg. Examination shows scattered retinal
microaneurysms bilaterally. The remainder of the examination shows no other abnormalities. Laboratory studies
show:
Hemoglobin A1c 13%
Serum
Na+
130 mEq/L
K
+
3.2 mEq/L
Cl−
101 mEq/L
HCO3

23 mEq/L
Glucose 325 mg/dL
Creatinine 1.5 mg/dL
Cholesterol 350 mg/dL
Urine
Blood negative
Glucose 4+
Protein 1+
Ketones negative
Which of the following is the most likely renal diagnosis?
(A) Cholesterol renal emboli
(B) Diabetic nephropathy
(C) Hypertensive glomerulosclerosis
(D) Hypokalemic nephropathy
(E) Sodium-losing nephropathy



can anyone plz explain the answer & electrolyte findings ,tq
 
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* Re:diabetic nephropathy, sample question
#3225077
  sameera531 - 06/22/15 08:08
 
  i didnt get why hyponatremia, anyone can explain  
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* Re:diabetic nephropathy
#3225087
  becko222 - 06/22/15 09:07
 
  Hi sameera I think B is Rt Ans bcoz Diabetic retinopathy & nephropathy occur in the same time app 10 yrs
hYPOnat occur here as compensatory Due 2 inc of Glucose(serum Na decby 1.35 meq for each 100mg/dl inc in plasma glc).
hope it's helps.
 
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* Re:diabetic nephropathy
#3225088
  letsdream - 06/22/15 09:10
 
  Just guessing that because he is suffering from type 1 dm which is an autoimmune disorder , he might be suffering from other autoimmune disorders such as addison (adrenal insufficiency) which justify the hyponatremia and hyperkalemia
but the diagnosis i think is diabetic nephropathy
 
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* Re:diabetic nephropathy
#3225090
  letsdream - 06/22/15 09:12
 
  @becko222
and what about hypokalemia?
 
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* Re:diabetic nephropathy
#3225091
  letsdream - 06/22/15 09:13
 
  ooops my mistake
sorry
 
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* Re:diabetic nephropathy
#3225092
  sameera531 - 06/22/15 09:37
 
  tq  
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* Re:diabetic nephropathy
#3225231
  druzma126 - 06/22/15 23:24
 
  HypO Na is due to dilution effects..every 100 mg increase of glucose leads to 1.6 decrease of Na thats why it is at lower limit of normal value...occur in both DM1 n DM2.

Hypo K is due to effect of Insulin.As patient is on insulin that causes intracellular shift...so K will be at its lower normal limits.

His Hb A1c ic 13 that is beyond normal 6..and he has DM retinopathy..so its cause is DM nephripathy.
 
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