Diabetic nephropathy progresses through a series of stages with increasing severity, eventually culminating in end-stage renal failure (ESRF). Aggressive medical management during early stages can slow or prevent progression in many patients.
Parameters:
(1) glomerular filtrate rate (GFR)
(2) urine albumin excretion
(3) blood pressure
GFR (percent of normal)
Urine Albumin
Blood Pressure
Stage
130 - 140%
< 30 mg per day
normal
I
90 - 140%
< 30 mg per day
normal
II
usually normal
30 to 300 mg per day
increases if left untreated
III
may be normal early, then declines
> 300 mg per day
hypertension in most
IV
low
> 300 mg per day
hypertension, often poorly controlled
V
where:
• Stage I nephropathy shows an increase in glomerular filtration.
• Normal urine albumin excretion is < 20 micrograms per minute or < 30 mg per day.
• Hyperfiltration in Stage II is a poor prognostic sign seen in patients with poor diabetic control.
Stage
Renal Failure
I
NA
II
NA
III (incipient)
incipient
IV (overt)
overt
V (ESRF)
symptomatic end-stage (ESRF)
Signs and symptoms seen in Stage V:
(1) lethargy
(2) progressive weakness
(3) anorexia
(4) nausea and vomiting
(5) fluid retention
(6) diarrhea
(7) pruritis
Laboratory findings in Stage V:
(1) anemia
(2) electrolyte abnormalities
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