The diagnosis of diabetic nephropathy and installment

If there are a lot of proteinuria, patients with diabetes microalbuminuria merger diabetic retinopathy, the course of 5 ~ 10 years should consider DKD.

DKD installment

Stage I: kidney volume increase, glomerular filtration rate rise (GFR > 90 ml/(1.73 m2) min.), no clinical symptoms.
Phase II: normal urinary albumin: fast microalbuminuria ACR < 30 ug/gCr, GFR 60 ~ 89 ml/min. 1.73 m2); Blood pressure more than normal.
Phase III: early DKD: 30 ~ 300 ug/gCr, ACR GFR30 ~ 59 ml/(min. 1.73 m2); Moderately elevated blood pressure.
Stage IV: the advent of DKD: a massive proteinuria, ACR > 300 ug/gCr, > 0.5 g / 24 h urine protein, GFR15 ~ 29 ml/(min. 1.73 m2); High blood pressure, edema, hyperlipidemia.
V: late DKD: GFR < 10 ml/(min. 1.73 m2), uremia.
* before the third phase of the urine routine urine protein were negative, can only through rapid microalbuminuria found abnormal.

DKD differential diagnosis

Proteinuria is not equal to diabetic DKD. In the following situations, pay attention to the differential diagnosis: (1) without retinopathy; (2) the GRF drops rapidly; (3) proteinuria appear sharply increase or nephrotic syndrome; (4) urine sediment activity performance, there are red and white blood cells; (5) merge other system diseases, such as autoimmune disease symptoms or signs; 6. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonist (ARB) after starting treatment, GRF falling fast; Long time all landowners nephrotic syndrome, but normal renal function. The above situation prompt other kidney disease, diabetes can merge kidney puncture is recommended to assist in making the diagnosis.