Tervaert et al reported a flow chart for classifying diabetic nephropathy. The authors are from multiple institutions in Europe and the United States.
Patient selection: diabetes
Parameters:
(1) percent of glomeruli showing global glomerulosclerosis, with lesions from Class I to III
(2) nodular sclerosis in glomeruli
(3) percent mesangial expansion
(4) mesangium thickness relative to capillary lumen
(5) thickness of glomerular basement membrane (GBM) in mm in patient >= 9 years old
(6) sex
|
Global Sclerosis
|
Nodular Sclerosis
|
Mesangial Expansion
|
Mesangium vs Capiillary
|
GBM Thickened
|
Class
|
|
> 50%
|
NA
|
NA
|
NA
|
NA
|
IV
|
|
<= 50%
|
yes
|
NA
|
NA
|
NA
|
III
|
|
<= 50%
|
no
|
> 25%
|
greater
|
NA
|
IIB
|
|
<= 50%
|
no
|
> 25%
|
not greater
|
NA
|
IIA
|
|
<= 50%
|
no
|
<= 25%
|
NA
|
yes (below)
|
I
|
|
<= 50%
|
no
|
<= 25%
|
NA
|
yes (below)
|
0
|
|
GBM
|
Sex
|
Interpretation
|
|
> 395 nm
|
female
|
yes
|
|
<= 395 nm
|
female
|
no
|
|
> 430 nm
|
male
|
yes
|
|
<= 430 nm
|
male
|
no
|
