Stages of diabetic nephropathy:
Phase I (initial): Clinical (-), signs (-), general laboratory examinations (-), less than 10 years features: ① GFR increased; ② kidney volume increase (glomerular filtration rate ↑, tubular injury ↑); ③ urinary protein negative.
Phase II (glomerular injury period): Sustainable 10 years, 30 to 40 years. Glomerular filtration rate increased 20% to 30%; or with renal volume increased in urine with a little protein after exercise, rest and recovery.
Phase III (of early diabetic nephropathy): Although the glycemic control in this period is better, but increased urinary protein, urinary protein excretion resting rate of 20 ~ 200mg/min, urine (-), but albumin radioimmunoassay showed trace proteinuria, glomerular filtration rate increased.
Phase IV (clinical diabetic nephropathy period): normal urinary protein (+), proteinuria excretion rate> 200mg/min, 20% of patients with hypertension, edema, glomerular filtration rate began to decline, the condition is intermittent , fatigue and illness was poorly controlled, can be persistent proteinuria was, as proteinuria> 3g/24h, poor prognosis.
Fifth (uremia, renal failure, terminal phase): For the last 2 to 3 years of diabetes, the disease more than the typical 20 to 25 years history of diabetes, there is azotemia. When the GFR decreased to the normal 1 / 3, the nitrogenous substances such as urea, creatinine retention is more evident. An end-stage irreversible decline in GFR, renal weakness, edema and hypertension further evil, and urinary protein increased to hypoproteinemia occurred. Glomerular degeneration, glomerular 1 / 3 → vascular permeability increased microvascular disease, renal failure is one of the reasons.
Late: diabetes renal failure, not associated with other microvascular disease, such as retinal neuropathy. Such as autonomic neuropathy, there may be paralysis of the bladder, urinary tract obstruction or re-combined retrograde pyelonephritis → renal failure. 40 years old and have arteriosclerosis, hypertension, coronary heart disease, stroke and cerebrovascular disease are increasing the possibility of occurrence of renal failure.
How to diagnose diabetic nephropathy? Diagnosis of diabetic nephropathy is as follows:
1. Has many years of history of diabetes and glycemic control is not ideal (not in the normal blood glucose levels continue.)
2. Urine check to proteinuria based, rarely hematuria. Proteinuria of diabetic nephropathy as the disease progresses gradually increased, even massive proteinuria.
3. Proteinuria increased, often accompanied by increased blood pressure, renal function of the decline.
4. Clinical Pathology in the nodular glomerular sclerosis, diffuse sclerosis, and exudative lesions mainly be involved tubules, interstitial and blood vessels.
5. Often accompanied by diabetic retinopathy.
6. To rule out chronic kidney (inflammation, uric acid nephropathy, hypertensive renal arteriosclerosis disorders such non-diabetic kidney disease.
Phase I (initial): Clinical (-), signs (-), general laboratory examinations (-), less than 10 years features: ① GFR increased; ② kidney volume increase (glomerular filtration rate ↑, tubular injury ↑); ③ urinary protein negative.
Phase II (glomerular injury period): Sustainable 10 years, 30 to 40 years. Glomerular filtration rate increased 20% to 30%; or with renal volume increased in urine with a little protein after exercise, rest and recovery.
Phase III (of early diabetic nephropathy): Although the glycemic control in this period is better, but increased urinary protein, urinary protein excretion resting rate of 20 ~ 200mg/min, urine (-), but albumin radioimmunoassay showed trace proteinuria, glomerular filtration rate increased.
Phase IV (clinical diabetic nephropathy period): normal urinary protein (+), proteinuria excretion rate> 200mg/min, 20% of patients with hypertension, edema, glomerular filtration rate began to decline, the condition is intermittent , fatigue and illness was poorly controlled, can be persistent proteinuria was, as proteinuria> 3g/24h, poor prognosis.
Fifth (uremia, renal failure, terminal phase): For the last 2 to 3 years of diabetes, the disease more than the typical 20 to 25 years history of diabetes, there is azotemia. When the GFR decreased to the normal 1 / 3, the nitrogenous substances such as urea, creatinine retention is more evident. An end-stage irreversible decline in GFR, renal weakness, edema and hypertension further evil, and urinary protein increased to hypoproteinemia occurred. Glomerular degeneration, glomerular 1 / 3 → vascular permeability increased microvascular disease, renal failure is one of the reasons.
Late: diabetes renal failure, not associated with other microvascular disease, such as retinal neuropathy. Such as autonomic neuropathy, there may be paralysis of the bladder, urinary tract obstruction or re-combined retrograde pyelonephritis → renal failure. 40 years old and have arteriosclerosis, hypertension, coronary heart disease, stroke and cerebrovascular disease are increasing the possibility of occurrence of renal failure.
How to diagnose diabetic nephropathy? Diagnosis of diabetic nephropathy is as follows:
1. Has many years of history of diabetes and glycemic control is not ideal (not in the normal blood glucose levels continue.)
2. Urine check to proteinuria based, rarely hematuria. Proteinuria of diabetic nephropathy as the disease progresses gradually increased, even massive proteinuria.
3. Proteinuria increased, often accompanied by increased blood pressure, renal function of the decline.
4. Clinical Pathology in the nodular glomerular sclerosis, diffuse sclerosis, and exudative lesions mainly be involved tubules, interstitial and blood vessels.
5. Often accompanied by diabetic retinopathy.
6. To rule out chronic kidney (inflammation, uric acid nephropathy, hypertensive renal arteriosclerosis disorders such non-diabetic kidney disease.
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