Additional Diabetes Information:
There are three characteristics of obvious Diabetic Mellitus with Nephropathy: Large amount of Proteinuria, reduction of Glomerular Filtration Rate and Hypertension.
In many countries overseas, Diabetic Mellitus with Nephropathy is the first reason of later period Renal Failure. In Type 1 Diabetes, 30%~40% of the patients with the course of disease over 15 years will have kidney disease; while in Type 2 Diabetes, there are 25% kidney disease patients. In America, there are 5%~10% are Type 1 Diabetes, the rest 90~95% are Type 2 Diabetes.
Therefore, 60% of the patients who need to take hemodialysis are Type 2 Diabetes. No matter which type the patient suffers, Diabetic Mellitus with Nephropathy patients have been told that they will pass by five stages. The manifestation of each stage is as follows:
The first stage: It is manifested as increasing volume of the kidney, and the volume increases 25% examined by B-ultrasonic. Increasing Glomerular Filtration Rate (GFR), normal biopsy and blood pressure can be seen on the primary stage of Diabetic Mellitus with Nephropathy. These reactions can turn to normal in several weeks or months by strictly blood sugar control and insulin treatment.
The second stage: It shows normal Urinary Albumin when taking a rest, but it will increase after the exercise. GFR will turn to the normal level. This period can also be reversed, and blood pressure is normal. Basilar membrane incrassation and Mesangial Matrix increase can be seen when taking renal biopsy.
The third stage: It is also called early stage Diabetic Mellitus with Nephropathy. Latterly, blood pressure may mildly increase. If patients do not actively take measures to treat Diabetic Nephropathy, 90% of them will develop into obvious Diabetic Mellitus with Nephropathy.
The fourth stage: Obvious Diabetic Mellitus with Nephropathy, which is also known as clinical Diabetic Nephropathy period. Continuous Proteinuria may occur in this period, and urine protein can be detected by the test. TUPr is more than 0.5 grams/24 hours, which amount to Urinary Albumin Excretion Rate is more than 200 micrograms / min.
If the blood pressure was not well controlled, patients with reduction of Glomerular Filtration Rate and Hypertension may has worse Glomerular Filtration Rate, which will decrease to 1 ~ 1.22 ml, and the patient will develop into Renal Insufficiency within 5 to 8 years.
The fifth stage: It is end-stage Diabetic Mellitus with Nephropathy. Blood pressure will increase obviously, Glomerular Filtration Rate will decrease to 10 ml/min, Urea Nitrogen and Creatinine will increase, and Edema and Hypertension will further sharpen. Hypoproteinemia at this time may appear. This period usually accompany with Diabetic Retinopathy and Diabetic Neuropathy.