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The five step in the development of diabetic nephropathy

2017-02-06 14:36

The first stage: the performance of the kidney volume increased, B ultrasound found that kidney volume increased by 25%. Glomerular filtration rate (GFR) increased (measured by isotope method), more than 120 ml minutes, or even up to 150 ml minutes. Parallel to blood glucose level. Abnormal renal biopsy, blood pressure is not high, in the early onset of diabetes. These reactions can return to normal after a few months of intensive glycemic control and insulin therapy.

The second stage: showed no increase in urinary albumin excretion at rest, but increased urinary albumin after exercise. As for the heart rate of treadmill peers maximum heart rate 75%, lasted 20 minutes and 1 hours urinary albumin excretion exceeded 20 micrograms minutes. Glomerular filtration rate returned to normal. If the patient continues to filter too much, it means a high risk of diabetic nephropathy. This period can also be reversed, blood pressure is not high, renal biopsy of the basement membrane thickening and mesangial matrix increased.

Third stage: also known as early diabetic nephropathy. The change in the glomerular filtration rate was relatively normal after conversion from exercise albuminuria to persistent albuminuria, up to 20~200 micrograms per minute. In later stages, blood pressure may be mildly elevated. If you do not actively take treatment measures, more than 90% of patients will develop a significant diabetic nephropathy.

The fourth phase: diabetic nephropathy significantly, also known as diabetic nephropathy clinical period: this period of continuous proteinuria, the urine can detect the urine protein, urinary protein more than 0.5 grams of 24 hours, the equivalent of the urinary albumin excretion rate of more than 200 micrograms of minutes. Glomerular filtration rate decreased with hypertension. If the blood pressure is not well controlled, the glomerular filtration rate will deteriorate at an average rate of about 1~1.22 ml per minute per month, allowing patients to develop end-stage renal failure within 5 to 8 years. Renal biopsy suggestive of glomerular sclerosis. This period even if the treatment is also irreversible.
The fifth stage: for the end stage diabetic nephropathy, that is, uremia period. During this period, only dialysis therapy can delay life, or kidney transplantation, but there are still a large number of unknown risks, such as rejection, etc.. During this period, the patient's blood pressure was increased, urinary protein is not caused by other kidney diseases that late renal failure will decline, decline in glomerular filtration rate up to 10 mL min, blood urea nitrogen and creatinine, edema and hypertension aggravate the hypoproteinemia.

The five stage of diabetic nephropathy, often in the first and the two stage when the patient consciousness without any symptoms, only to do the laboratory inspection found that microalbuminuria, this time if the intervention, the effect is very good, often to fully recover.

If you wait until the symptoms out of treatment, generally in the middle and late stages, can not be reversed, the treatment is only as long as possible to extend the deterioration of time, delay life, no way to reverse.

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