Diabetic nephropathy: stages

Stages of development and the "natural" course of diabetic nephropathy are studied in more detail in type 1 diabetes, which is associated with the possibility of an almost accurate fixation of the time of onset of diabetes mellitus.

The modern classification of the stages of development of diabetic nephropathy was developed by the Danish researcher of the CE. Mogensen in 1983

Stages of development of diabetic nephropathy proposed by the CE. Mogensen (1983)

Stage of diabetic nephropathy	Main characteristics	Time of appearance from the onset of diabetes mellitus
I. Hyperfunction of the kidneys	Hyperfiltration, hyperperfusion, renal hypertrophy, normoalbuminuria (less than 30 mg / day)	The debut of diabetes mellitus
II. Initial structural changes in the kidneys	Thickening of the glomerular basement membrane Expansion of mesangium, hyperfiltration, normoalbuminuria (less than 30 mg / day)	More than 2 years More than 5 years
III. The onset of diabetic nephropathy	Microalbuminuria (30 to 300 mg / day), normal or moderately elevated GFR	More than 5 years
IV. Severe diabetic nephropathy	Proteinuria, hypertension, decreased glomerular filtration rate, sclerosis of 50-75% of glomeruli	More than 10-15 years
V. Uremia	GFR less than 10 ml / min, total glomerulosclerosis	More than 15-20 years

Proteinuria - the first clinical sign of a pathological process in the kidneys - appears only in the IV stage of development of diabetic nephropathy. The first 3 stages are asymptomatic and do not appear clinically. These three stages constitute the so-called "asymptomatic, preclinical" period of development of diabetic nephropathy. During this period, all functional changes in the kidneys (hyperfiltration, hyperperfusion of kidneys, microalbuminuria) can not be detected during routine examination of patients and require the use of special techniques. The tactics of examination using special methods are justified by the fact that only these first three (asymptomatic) stages of diabetic nephropathy can be reversible with a thorough and early initiated correction of hyperglycemia.

The appearance of proteinuria indicates that already about 50% of the glomeruli are sclerotized and the process in the kidneys has become irreversible. Since the onset of proteinuria in diabetes mellitus, GFR begins to decrease with a mathematically calculated value of 1 ml / min per month (or about 10-15 ml / min per year), which leads to the development of TERMAL renal failure even 5-7 years after detection resistant proteinuria. At this stage, even the most thorough correction of violations of carbohydrate metabolism is no longer able to stop or significantly slow down such a rapid progression of diabetic nephropathy.

From the onset of diabetes, the stage of microalbuminuria develops, as a rule, in 5 years, the stage of proteinuria is 15-20 years, the stage of chronic kidney failure is 20-25 years later.

[1], [2], [3], [4], [5], [6]