Clinical manifestations of diabetic nephropathy
1. Glomerular hyperfiltration and renal hypertrophy stage
This initial change is consistent with the level of hyperglycemia and can be partially relieved after blood glucose control. There was no pathological injury in this period.
2. persistent large amount of albumin urinary
GFR is higher than normal. Renal pathology showed GBM thickening, mesangial matrix increasing, urinary albumin excretion rate ( UAE ) increasing ( > 20μ g / min ) after exercise.Return to normal after rest. If the blood sugar can be well controlled in this phase, the patient can stay stable in this phase for a long time.
3. Early diabetic nephropathy, also known as " continuous microalbuminuria period"
GFR began to drop to normal. Renal pathology showed glomerular nodular lesions and arteriolar hyaline changes. UAE continued to rise to 20 ~ 200μ g / min, resulting in microalbuminuria. The patient's blood pressure increased in this period. Treatment with ACEI or ARB drugs can reduce urinary albumin excretion and delay the progression of kidney disease.
4. Clinical diabetic nephropathy
The typical K - W nodule appeared pathologically. Persistent massive albuminuria ( UAE > 200μ g / min ) or albuminuria greater than 500 mg / d, about 30 % of patients may develop Nephrotic syndrome.GFR continues to decline. The characteristic of this period is that urine protein does not decrease with the decrease of GFR. Once a patient enters phase IV, the condition often develops progressively. If it is not controlled, the GFR will decrease by an average of 1 ml / min per month.
5. End - stage renal failure
The above stages are mainly based on type 1 diabetic nephropathy, while type 2 diabetic nephropathy is not obvious.
Tag: manifestations,diabetic nephropathy