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Diabetic Nephropathy is the common complication of diabetes. And researchers have found an upward in the morbidity of diabetes. Currently, it has became the the second leading cause of Kidney Failure or End Stage Renal Disease. Well then, how many stages are there in diabetic kidney disease?
In medicine, according to the clinical course and pathophysiology, Mogensen suggested that diabetic renal disease can be divided into five stages.
1. High Glomerular Filtration Stage and Renal Hypertrophy Stage
The main features are the increase of blood sugar level and the increase of size of the kidney. Actually, there is no pathological damage in stage 1. Diabetic patents depending on insulin have already these changes and at the same time the blood flow of the kidney and the glomerular capillaries perfusion and inside pressure will raise. The early stage changes can be eased or reversible after the treatment of insulin.
2. Normal Albuminuria Stage
This stage is characterized by increase of GFR (glomerular filtration rate) which is higher than the normal level, GFR > 150ml/min. After exercise, urine albumin expelling (UAE) is beyond 20ug/min but it can recover after rest. And glomerular basement menbrane (GBM) thicknes and mesangium matrix increases. If the blood sugar can be controlled well in this stage, patients can be in this stage steadily.
3. Early Stage Diabetic Nephropathy Stage (Continuous microalbuminuria period)
In this stage, GFR begin to decrease to the normal. The main manifestations include that UAE is continuously higher than 20-200ug/min (30-300mg/24h). High filtration is propably one cause of continuous micro albunminuira. And patients may suffer from high blood pressure. The progression of illness condition can be delayed by taking ACEI or ARB.
4. Clinical Diabetic Nephroapthy Stage
The features of this stage are large amount of albuminuria, UAE>200ug/min or continuous urine protein >0.5g/d. About 30% patient may experience Nephropathy Syndrome and GFR decreases contentiously.
5. Renal Failure Stage
GFR <10ml/min. And proteinuria decreases along with the glomerular sclerosis. The symptoms of uremia are obvious. Patients may need to treatment of dialysis.
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