Five Stages of Diabetic Nephropathy

Five Stages of Diabetic Nephropathy can be divided into five stages according to the change of renal function, structure and clinical manifestation. Now this classification has been accepted by many clinical doctors. The detailed manifestations go as follows:
The first stage is renal glomerular high filtration stage. GFR(glomerular filtration rate)increase, and the size of kidney becomes bigger are the main feature of this stage. Even patients who have been diagnosed with this disease just now can have this kind of change. At the same time, the renal blood volume, the perfusion of capillary blood vessels and the inner pressure all increase. The damage in this stage is reversible. In other words, it can turn normal after injection of insulin. But usually complete recover is difficult to achieve.
In the second stage, protein which is discharged into urine is normal. However, the structure of glomeruli in this stage is changed already. The membrane of renal glomerular capillary blood vessels increases. The matrix in mesangium increases as well. GFR(glomerular filtration rate)level is normal and corresponds with blood sugar. GFR(glomerular filtration rate)is more than 150mL/min. The glycosylated hemoglobin is often more than 9.5%. Patients with Diabetic Nephropathy often have normal blood pressure in the first and second stage.
In the third stage, UAE is continuously higher than 20～200ug/min. High filtration may be the main reason for continuous albumin. Of course, it is also due to the long time not control of metabolism. In this stage, blood pressure is a little high. Declining blood pressure can reduce the discharge of albumin to some degree.
In the fourth stage, the characteristic of Diabetic Nephropathy is large amount of protienuria. UAE is more than 200pg/min, which is nonselective proteinuria. In this stage, blood pressure increases. GBM becomes thicker obviously.The matrix of mesangium becomes wider. Deserted glomeruli increases, which takes up about 36%.
With a lot of protein lost in urine, patients can have hypoproteinemia and edema, which form the typical characteristic of Diabetic Nephropathy. Edema is relatively serious and has poor reaction to diuretic. Besides due to low protein in plasma, patients also have retention of sodium. That’s because insulin changed the sodium in tissues. Long time high insulin use can lead to the metabolic change of sodium, especially when patients keep high sodium diet.
In the fifth stage, patients with Diabetic Nephropathy may suffer from continuous large amount of proteinuria and develop into clinical Diabetic Nephropathy stage. The basilar membrane of glomeruli becomes thicker. More glomeruli become necrotic. Renal function declines progressively, which leads to renal failure. Blood pressure also increases. Edema and hypoproteinemia can also be diagnosed. Patients with Diabetic Nephropathy mostly have gastrointestinal reaction caused by azotemia such as declined appetite, vomiting, nausea, and even serious high blood pressure, edema and so on.