Tong Shantang Hospital: how to stage diabetic nephropathy2017-09-20 17:08
Clinically, diabetic nephropathy is pided into early and clinical diabetic nephropathy two. Staging is based on the number of urinary albumin discharge, early is the amount of microalbuminuria, clinical diabetic nephropathy for significant albuminuria. In recent years, according to the type 1 diabetes (T1DM) patients with long-term study and follow-up observation, the development of T1DM nephropathy has a more comprehensive understanding of the process of renal disease done a detailed staging. In patients with type 2 diabetes mellitus (T2DM), there is no detailed staging due to the inability to determine the onset time and the lack of long-term follow-up data, and now refer to the T1DM staging method. For the diagnosis of T1DM glomerular hyperfiltration and hypertrophy increased. Glomerular and renal volume increases are outstanding manifestations. There is a transient microalbuminuria, with insulin treatment can disappear. Glomerular filtration rate is high, after treatment can be reduced, but often can not return to normal, if the incidence of T1DM before puberty, then this period lasted longer.
how to stage diabetic nephropathy
Diabetic nephropathy detailed stages are pided into five phases, the characteristics of each period are as follows:
Ⅰ, for the diagnosis of T1DM glomerular hyperfiltration and hypertrophy increased. Glomerular and renal volume increases are outstanding manifestations. There is a transient microalbuminuria, with insulin treatment can disappear. Glomerular filtration rate is high, after treatment can be reduced, but often can not return to normal, if the incidence of T1DM before puberty, then this period lasted longer.
Phase II, with renal damage, but no clinical signs. This period occurs two years after the onset of diabetes, some patients at this stage for many years, or even life. Glomerular basement membrane is usually thickened, mesangial area often hyperplasia. Diabetes control (often ketosis) and exercise can occur when the microalbuminuria, is reversible. Glomerular filtration rate is still significantly increased. Normal blood pressure.
Ⅲ, diabetic nephropathy is the "high-risk period", the typical person is suffering from diabetes 10-15 years later. Microalbuminuria is increasing. Glomerular filtration rate is still increased. Blood pressure began to increase. Longitudinal studies have shown that antihypertensive therapy can significantly improve microalbuminuria. This stage of treatment with insulin pump or intensive treatment can be significantly improved in blood glucose, urinary albumin discharge decreased or stable. And conventional treatment is easy to develop to the obvious stage of kidney disease.
IV, duration of 15 to 25 years, about 40% of T1DM patients developed to this stage. Pathological changes in the typical, and the diagnosis is mainly based on clinical manifestations, urinary protein excretion increased (> 0.5g / 24h), the majority of patients with high blood pressure, glomerular filtration rate began to decline. Effective antihypertensive therapy can slow down the rate of glomerular filtration rate.
V stage, end stage renal failure, is characterized by universal glomerular capillary occlusion, accompanied by glomerular glaucoma, glomerular filtration rate has been very low, nitrogen retention, high blood pressure.
Not every T1DM patient will go through the above five stages, on the contrary, most patients only stay in the beginning of two stages, 20 to 30 years after the course of no significant kidney damage. However, once the development of stage Ⅲ microalbuminuria stage, it is likely to continue to Ⅳ development, the emergence of typical diabetic nephropathy. Treatment should be trying to stay in the disease phase III, once to the Ⅳ period, the course was irreversible, the vast majority of patients will enter the end stage renal failure.
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