ISSN 2398-2950      

Diabetes mellitus: glomerulonephropathy

ffelis
Contributor(s):

Carmel Mooney


Introduction

  • A potentially serious complication of diabetes mellitus Diabetes mellitus (DM) but is poorly defined in cats.
  • In humans diabetic nephropathy is a leading cause of morbidity and mortality in chronically diabetic patients.

Pathogenesis

Pathophysiology

  • In humans it is characterized clinically as a triad of proteinuria, hypertension and eventually renal impairment:
    • Progressive stages are described as hyperfiltration (associated with elevated glomerular filatration rate), structural change (basement membrane thickening and mesangial expansion) without clinical effect, microalbuminuria, macroalbuminuria, hypertension and eventually development of azotemia and end stage renal disease.

Timecourse

  • In humans it usually takes at least 10-15 years to develop even if the diabetes is appropriately diagnosed and managed.

Evidence for existence of diabetic glomerulonephropathy in cats

  • Histopathological changes consistent with diabetic glomerulopathy (mesangial proliferation, diffuse glomerular sclerosis) have been described in a small number of diabetic cats.
  • Concurrent hypertension Hypertension and diabetes mellitus have been described in a few cats with ocular lesions and mean systolic blood pressure is higher in diabetic cats compared to healthy cats:
    • In studies suggesting diabetic cats are not hypertensive a high cut-off of 180 mmHg was used which may misdiagnose some normotensive cats based on ACVIM guidelines.
  • Urine protein:creatinine Urinalysis: protein  Urinalysis: creatinine ratios are higher in diabetic than in healthy cats and microalbuminuria Proteinuria is more common.
  • It is not uncommon for diabetic cats to have concurrent renal azotemia Azotemia.

Evidence against existence of diabetic glomerulonephropathy in cats

  • There are no reports detailing the progression through glomerular lesions, microalbuminuria, macroalbuminuria, hypertension, azotemia, and end stage renal disease in cats as in humans.
  • Hypertension although decribed in a few diabetic cats is not common.
  • Chronic kidney disease Kidney: chronic kidney disease is common in older cats and most diabetic cats are older so the co-existence of these conditions is not unexpected:

Diagnosis

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Treatment

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Callegari C, Mercuriali E, Hafner M et al (2013) Survival time and prognostic factors in cats with newly diagnosed diabetes mellitus: 114 cases (2000-2009). JAVMA 243 (1), 91-95 PubMed.
  • Al-Ghazlat S A, Langston C E, Greco D S et al (2011) The prevalence of microalbuminuria and proteinuria in cats with diabetes mellitus. Top Companion Anim Med 26 (3), 154-157 PubMed.
  • Sennello K A, Schulman R L, Prosek R et al (2003) Systolic blood pressure in cats with diabetes mellitus. JAVMA 223 (2), 198-201 PubMed.
  • Nakayama H, Uchida K, Ono K et al (1990) Pathological observations in 6 cases of feline diabetes mellitus. Nihon Juigaku Zasshi​ 52 (4), 819-822 PubMed.

Other sources of information

  • International Renal Interest Society. Available at: http://www.iris-kidney.com.
  • Brown S, Atkins C, Bagley R et al (2007) Guidelines for the identification, evaluation and management of systemic hypertension in dogs and cats. JVIM 21 (3), 542-558 PubMed.

Can’t find what you’re looking for?

We have an ever growing content library on Vetlexicon so if you ever find we haven't covered something that you need please fill in the form below and let us know!

 
 
 
 

To show you are not a Bot please can you enter the number showing adjacent to this field

 Security code