Staging Criteria for Diabetic Nephropathy
With the development of Diabetic Nephropathy, there will be different symptoms in different periods. So what are the stages of Diabetic Nephropathy? It is divided into 5 stages. When it reaches the fourth stage, the condition will be irreversible, and most patients will enter end stage renal disease (ESRD).
5 stages of Diabetic Nephropathy and their characteristics
Glomerular hyperfiltration and hypertrophy increase when T1DM is diagnosed. The enlargement of glomerulus and kidney volume is a prominent manifestation. Transient microalbuminuria can disappear after insulin treatment. Glomerular filtration rate is high, which can be reduced after treatment, but often can not return to normal. If the onset of T1DM is before puberty, the duration of this stage is longer.
Kidney damage, but no clinical signs. This period occurs two years after the onset of diabetes mellitus, and some patients continue for many years, even for life. Glomerular basement membranes are usually thickened and mesangial areas are often proliferated. Diabetes mellitus is not well controlled (often ketosis) and microalbuminuria can occur during exercise, which is reversible. Glomerular filtration rate still increases significantly. Blood pressure is normal.
It is the "high-risk period" of diabetic nephropathy, typically 10-15 years after suffering from diabetes. Microalbuminuria is increasing. Glomerular filtration rate is still increasing. Blood pressure begins to rise. Longitudinal studies have shown that antihypertensive therapy can significantly improve microalbuminuria. At this stage, insulin pump therapy or intensive treatment can reduce or stabilize urinary albumin excretion after the blood sugar has improved significantly. Patients who receive routine treatment is easy to develop to obvious nephropathy stage.
The course of disease is more than 15-25 years. About 40% of T1DM patients develop to this stage. Typical pathological changes are found, and the diagnosis is mainly based on clinical manifestations. Urinary protein excretion increases ("0.5g//24h). Most patients develop hypertension and glomerular filtration rate begins to decrease. Effective antihypertensive therapy can slow down the decline of glomerular filtration rate.
For end-stage renal failure, it is characterized by glomerular capillary occlusion, glomerular hyalinization, low glomerular filtration rate, nitrogen retention and high blood pressure.
Not every patient with T1DM will go through the five stages mentioned above. On the contrary, most patients only stay in the first two stages, and there is no obvious renal damage after 20-30 years. However, once it develops to stage 3, i.e. microalbuminuria, it is likely to continue to develop to stage 4 with typical diabetic nephropathy. And treatment should focus on keeping the disease in stage 3. Once it reaches stage 4, the course of the disease is irreversible, and most patients will enter end-stage renal failure.
Therefore, we should strictly control diabetes and hypertension, regularly detect urinary protein, prevent or delay the occurrence and development of diabetic nephropathy as far as possible. For more information on Diabetic Nephropathy, please leave a message below or contact online doctor.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***