Macrovascular

Microvascular

HHS

Diabetic Nephropathy

In diabetic nephropathy, the kidneys are likely to be enlarged due to hyperfiltration and hypertrophy of the glomeruli. This is a compensatory response to increased blood glucose levels, which cause an upregulation of intraglomerular pressure and overall glomerular filtration rate (GFR). Over time, this leads to structural changes in the kidney including basement membrane thickening, mesangial expansion, and eventually nodular sclerosis (Kimmelstiel-Wilson lesions), characteristic of advanced diabetic nephropathy. These changes contribute to the enlargement of the kidneys observed on ultrasound.

US in CKD ⇒ bilateral small and contracted kidneys

Skin disorders associated with diabetes

Note whilst pyoderma gangrenosum can occur in diabetes mellitus it is rare and is often not included in a differential of potential causes

Necrobiosis lipoidica

• shiny, painless areas of yellow/red/brown skin typically on the shin
• often associated with surrounding telangiectasia

Infection

• candidiasis
• staphylococcal

Neuropathic ulcers

Vitiligo

Lipoatrophy

Granuloma annulare^^