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Symptoms of diabetic nephropathy
Last reviewed: 23.04.2024
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In the initial stages (I and II), the course of diabetic nephropathy is asymptomatic. In the Reberg sample, there is an increase in GFR (> 140-150 ml / min x 1.73 m 2 ).
At stage III (stage of beginning diabetic nephropathy), symptoms are also absent, microalbuminuria (20-200 mg / L) is detected with normal or elevated GFR.
Beginning with the stage of severe diabetic nephropathy (stage IV), patients develop clinical symptoms of diabetic nephropathy, which primarily include:
- arterial hypertension (appears and rapidly increases);
- edema.
At laboratory researches are defined:
- proteinuria (> 150 mg protein per day);
- decrease in GFR (steadily progressing, about 1 ml / min per month);
- dyslipidemia,
- the level of creatinine, urea nitrogen, potassium - at the upper limit of the norm, then above the norm;
- nephritic syndrome, the signs of which are massive proteinuria (> 3.5 g / day), hypoalbuminemia, hypercholesterolemia, is developing in 30% of patients with diabetic nephropathy.
At the same stage, a rapid increase in the severity of other micro- and macrovascular complications of diabetes usually begins. Development of clinical manifestations of IHD, obliterating atherosclerosis of lower limbs, atherosclerotic discirculatory encephalopathy, diabetic foot syndrome, diabetic retinopathy and neuropathy.
For the V stage of diabetic nephropathy (stage uremia) are characterized by:
- uncontrollable growth of arterial pressure;
- progression of fluid retention in the body, incl. With the development of heart failure and pulmonary edema;
- Attachment of specific symptoms of chronic renal failure (skin itching, uremic smell from the mouth, uremic gastropathy and polyneuropathy, etc.), normochromic anemia, osteodystrophy.
Diagnostic criteria for albuminuria
|
Characteristics of albuminuria |
Albuminuria |
Concentration of albumin in urine, mg / l |
The ratio of albumin / creatinine urine, mg / mmol |
|
|
In the morning portion, mcg / min |
Per day, mg |
|||
|
Normoalbuminuria |
<20 |
<30 |
<20 |
<2.5 in males |
|
Microalbuminuria |
20-200 |
30-300 |
20-200 |
|
|
Macroalbuminuria |
> 200 |
> 300 |
> 200 |
> 25 |
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