2013年6月15日星期六

Diabetic Nephropathy Stages

I stage when diagnosing T1DM, the GFR and thickness have increased. The increases of glomerular and kidneys is the typical manifesto. Patients have transient microalbuminuria, after using insulin, it will disappear. The high GFR can lower after treatment, but cannot return to normal. If T1DM occurs before adolescence, this stage will last for a long time.
Ⅱstage, in this stage, kidneys damage has occurred, but no clinical symptoms. This stage appears after 2 years for DM onset. Some patients will last for many years in this stage, even for life time. The thickness of Glomerular basement membrane often increases, and mesangial area will proliferate. When the DM is not controlled well and taking exercise, patients will occur to microalbuminuria, but it’s reversible. The GFR still increase, and pressure is normal.
Ⅲ Stage. This stage is the high-risk period of DN. The typical patients are after 10-15 years’ Diabetic Mellitus. Microalbuminuria continuously increases and GFR still increase. Blood pressure begins to rise. It’s indicated in the longitudinal study that anti-hypertensive treatment can obviously improve microalbuminuria. Using insulin pump or intensive treatment in this stage can be conducted after blood sugar being improved obviously; the output of urinary albumin reduces or remains unchanged. Learn About: Why do I Sweat a Lot with Stage 4 Kidney Failure
Ⅳ stage. Patients entering this stage often have 15-25 years’courses. About 40% patients with T1DM will develop into this stage. There will be typical changes in pathology. The diagnosis is mainly relied on clinical manifestos. The output of urinary protein will increase (more than 0.5/ 24h). Most patients will have high blood pressure. The GFR begins to drop. The effective anti-hypertensive treatments can slower the rate of GFR dropping.
Ⅴ stage. This stage is terminal kidney failure. The characteristic is the glomerular capillary blockage, accompanied glomerular hyaline variety. The GFR has been enough low; with nitrogen retention and obvious hypertension.

Not all patients with T1DM will pass the above five stages. Most of patients will stop at the second stage, after 20-30 years, they still have no obvious kidney damage. But if patients develop into the third stage (Microalbuminuria stage), it’s possible to develop into the fourth stage, appearing typical DN. For the treatment, it should attempt to make the disease stop at the third stage. Once developing into fourth stage, the disease will be irreversible, and most patients will enter into the terminal Renal Failure.If you fail to find the info you want, you can email to kidneyask@hotmail.com for a reply.

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