The general clinical diabetic nephropathy were pided into early diabetic nephropathy and clinical stage two. Stage is mainly based on urinary albumin excretion, early that microalbuminuria, diabetic nephropathy is obvious in recent years. According to urinary albumin in type 1 diabetes mellitus (T1DM) patients with long-term research and follow-up observation on T1DM nephropathy the whole process of development of a more comprehensive understanding of nephropathy in detail. The stage of type 2 diabetes mellitus (T2DM) patients, because often cannot determine the time of onset, and lack of long-term follow-up, no stage fine, now also refer to T1DM staging method. T1DM diagnosis of glomerular hyperfiltration and hypertrophy increased. Increased glomerular volume is outstanding. Had microalbuminuria, after insulin treatment can disappear. Glomerular filtration rate is high, after treatment can be reduced, but often Not normal. If the T1DM develops before puberty, this stage lasts longer
The detailed stages of diabetic nephropathy are pided into five stages. The characteristics of each stage are as follows:
1 stage: T1DM diagnosis of glomerular hyperfiltration and hypertrophy of glomerulus and renal volume increase. Increase is outstanding. Had microalbuminuria, after insulin treatment can disappear. Glomerular filtration rate is high, after treatment can be reduced, but often can not return to normal, if T1DM at the onset of puberty before this stage lasts for a long time.
2, phase II: kidney damage, but no clinical signs. This period appeared in two years after the onset of diabetes, some patients in this stage for many years, even for life. Usually the glomerular basement membrane thickening and mesangial hyperplasia. Often poorly controlled diabetes (often ketosis) microalbuminuria and exercise when the Department of reversibility. The glomerular filtration rate is significantly increased. Blood pressure is normal.
3, stage III: diabetic nephropathy is "high-risk", typically after 10-15 years of diabetes. Microalbuminuria increasing. Glomerular filtration rate is increased. The blood pressure began to increase. Longitudinal studies have shown that antihypertensive therapy can improve microalbuminuria. This stage with insulin pump therapy or intensive therapy on blood glucose significantly improved after urinary albumin excretion decreased or unchanged. The routine treatment to develop nephropathy stage significantly.
4 stage: in the course of 15-25 years, about 40%% T1DM were developed to this stage. The typical pathological changes, and diagnosis based on clinical symptoms, urinary protein excretion increased (>0.5g//24h), most patients with hypertension, glomerular filtration rate began to fall. The effective rate of anti hypertension treatment slow down the decline in glomerular filtration rate.
5 stage V: for end-stage renal failure, characterized by widespread glomerular capillary obstruction, associated with glomerular hyaline degeneration, low glomerular filtration rate, nitrogen retention, and high blood pressure
Not every T1DM patients will go through these 5 stages, but most of the patients only stay at the beginning of the two stage, duration 20-30 years after kidney damage was not obvious. But once the development of stage III microalbuminuria stage, it is likely to continue to develop in phase IV, which showed a typical diabetic nephropathy. Treatment should try to make the disease remain in phase III, once in the stage, the course is not reversible, most patients will enter end-stage renal failure.