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Clinical stage of diabetic nephropathy

2017-05-07 16:07
The following five phases are used to guide clinical treatment and prognosis.
Phase i:
Increased glomerular filtration rate and increased renal volume have been associated with a new diagnosis of IDDM, while renal blood flow and glomerular capillary perfusion pressure and internal pressure increased.
Two phase:
Normal albuminuria stage. This period of urinary protein excretion rate is normal (less than 20 micrograms / minute or 30 mg /24 hours), after exercise increased UAE but after rest can return to normal. During this period, glomerular structure changes, GBM thickening and mesangial matrix increased.
Three phase:
Mild early diabetic nephropathy. This period of patients with mild blood pressure, blood pressure can be reduced by reducing the excretion of urine microalbumin. The thickening of the GBM and the increase of the mesangial matrix were more pronounced in the patients, with the presence of glomerular nodular and diffuse lesions as well as hyaline changes of the small arteries, and the onset of glomerular depletion.
Four phase:
Clinical diabetic nephropathy or overt diabetic nephropathy. This period is characterized by a large number of albumin, urinary protein quantitation is greater than 0.5 grams per hour for 24 non selective proteinuria, severe urinary protein is greater than every 24 hours of 2 grams. With the loss of a large amount of urine protein, hypoalbuminemia and edema may occur. Increased blood pressure. The patient's GBM was significantly thickened, the mesangial matrix widened, and the abandoned glomeruli increased.
Five phase:
End stage renal failure. Diabetic patients once appear persistent proteinuria development for clinical diabetic nephropathy, due to extensive thickening of glomerular basement membrane, glomerular capillary lumen stenosis and more glomerular filtration function were abandoned, kidney decreased, resulting in azotemia and renal failure, the patient of GFR < 10ml/min, serum creatinine and blood urea nitrogen increased with severe hypertension, hypoalbuminemia, edema, anorexia, nausea and vomiting secondary uremic neuropathy and myocardial lesions.
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