Clinical Manifestations of Diabetic Nephropathy at Different Stages

Most patients are diagnosed with Diabetic Nephropathy when they have already had symptoms of obvious proteinuria, edema, serious hypertension,etc. When blood glucose level is more than 120mg/dL (6.7mmol/L), it can cause the condition of glomerulus hyperfiltration and if the blood sugar concentration can not be effectively controlled at the ideal level for a long term, it will gradually damage to kidney or even lead to Diabetic Nephropathy. In order to effectively prevent and treat Diabetic Nephropathy, it is quite important for patients to know what are the clinical manifestations of Diabetic Nephropathy. Here are the manifestations of Diabetic Nephropathy at different stages as follows:

Stage I: this is a stage of glomerulus hyperperfusion and it is charactered with increased glomerular filtration rate (GFR). Besides, renal plasma flow, blood perfusion of the glomerular capillary and renal internal pressure all increase.
This damage to kidney is consistent with high level of blood glucose, which is reversible and be treated with insulin. At this stage of Diabetic Nephropathy, the key of the treatment is well controlling blood sugar concentration. There is no pathlogical damages of kidney.

Stage II: Urinary Albumin Excretion Rate (UAER) is normal (20μg/minor <30mg/24h) at this stage. Besides, patients often have normal blood pressure. But the glomerular structure is changed, glomerular basement membrane is thickened and matrixes of mesangial cell are increased. In addition, GFR is usually higher than the normal range.

Stage Ⅲ: primary Diabetic Nephropahty: it mainly represents persistent high level of UAER more than 20 to 200ug/min (30～300m g/24h). At the primary stage, when UAER is 20～70μg/min, GFR begins to decline to the normal (130mL/min). Patients' blood pressure is usually slightly increased and UAER can be declined by lowering blood pressure. Besides, at the stage it becomes more obvious of GBM incrassation and the increase of mesangial cell's matrixes. The condition of glomerular diffuse lesions appears and some of glomerulus is ruined.

Stage Ⅳ: clinical Diabetic Nephropathy: at this stage, it is charactered with masses of albuminuria in urine, UAER more than 200 μg/min and Hypertension. Besides, the condition of GBM incrassation and the increase of mesangial cell's matrixes becomes more obvious. The ruined glomerulus increases. Proteinuria won't be reduced with the decline of GFR. Masses of protein's leakage can lead to edema and hypoproteinemia. The condition of masses of proteinuria, edema, Hypertension can be found among 30 percent of patients with Diabetic Nephropathy. Patients usually have serious edema, which can not be rectified with diuretics. GFR of patients at this stage declines 1mL/min each month. However, most patients' serum creatinine is not so high.

Stage Ⅴ: Renal Failure: once patients with Diabetes have persistent proteinuria and develop into Diabetic Nephropathy, GBM is extensively thickened, the glomerular capillary lumen is progressively narrowed, and more and more glomerulu is ruined, which leads to declined renal function or even Renal Failure.
Consequently, GFR is usually less than 10mL/ min, BUN and serum creatinine increase together with symptoms such as Hypertension, Hypoproteinemia and edema. Further more, patients often suffer gastrointestinal reaction caused by azotemia such as anorexia, vomiting, anemia, serious Hyperkalemia, metabolic acidosis, or even uremic neuropathy and cardiomyopathy, the complication of which threatens patients' life.


All those mentioned are the clinical manifestations of Diabetic Nephropathy at different stages. Patients with Diabetes should take series of measures such as diet, treatment, tests to effectively prevent from Diabetic Nephropathy. For patients with Diabetic Nephropathy they should take positive treatment to well control the condition.