Will Diabetes Cause Kidney Disease and Stages of Diabetic Nephroapthy?
In medical field, the pathological theory of Diabetes caused kidney disease is as following:
1. High blood sugar will cause the abnormality of the biochemical formation of the glomeruli, so the permeability of the vessels will increase which will lead to the leakage of red blood cells and protein.
2. The high blood sugar will increase the activity of irrelevant enzyme after entering the cells, thus promoting the synthetizing of enzyme and protein into complex. It will deposit on the glomeruli and seriously damage the gomeruli which will lead to Renal Failure.
3. The reason that Diabetes can lead to Kidney Failure is also because patients with Diabetes is easy to get various infection. Repeated urinary tract infection will cause cortical necrosis of the kidney.
In the end stage of Diabetic Nephropathy, the gomerular softening will be more obvious and the affected glomeruli will be more and more. Finally it will cause the symptoms like urine protein and Kidney Failure.
How to diagnose Diabetic Nephropathy?
There are usually no clinical symptoms in the early stage of Diabetic Nephropathy. In the end stage, there may appear serious metabolic disorder and symptoms in multi-systems in the whole body. The clinical manifestations mainly depend on the stages and degrees of declined renal function.
Mogensen divides Diabetic Nephropathy into 5 stages: stage 1: high glomerular filtration period; stage 2: silent period; stage 3: continuous microalbuminuria stage; stage 4: clinical Proteinuria period; stage 5: Renal Failure period.
Stages of Diabetic Nephropathy
Stage 1: It is characterized by high glomerular filtration and slight enlarged kidneys. The manifestations include increased GFR and hemodynamic changes such as plasma flow in glomerular capillary pan increases and internal pressure in blood capillary heightens. GFR will rise by 25% to 40%. The volume of kidneys can increase about 25%, but there are neither obvious changes in histopathology nor clinical symptoms, which can not be checked out by general clinical diagnostic method at the moment.
Stage 2: When patients have a good rest, urine protein discharge won’t increase, so this stage is called silent period. When patients do some exercise, there may appear urine protein discharge increases. In this stage, glomerulus occurs structural damage, but it is reversible. GFR may much higher and can higher than 150ml/min. Blood pressure can rise for part of patients. If early treatment can be taken, structure and function of glomerulus can restore to normal.
Stage 3: The manifestation is that urine albumin discharge continuously increase and the level can be 20 to 200μg/min. Urine albumin discharged is highly selective Proteinuria, so this stage is called microalbuminuria stage and it is the early stage of Diabetic Nephropathy. In this stage GFR will gradually recover to normal level, blood pressure may rise slightly but it won’t achieve the level of high blood pressure.
There is usually serious edema with most Diabetic Nephropathy patients and the effect of diuretic is bad. Part of the reason is due to sodium retention of Diabetic Nephropathy is heavier than other Nephrotic Syndrome except low plasma protein.
Stage 4: As diabetic nephropathy progresses, increasing numbers of glomeruli are destroyed by progressive nodular glomerulosclerosis. Consequently, urine albumin increases to the point that it may be detected by ordinary urinalysis techniques. At this stage, a kidney biopsy generally clearly shows diabetic nephropathy.
Stage 5: This is End Stage Renal Failure Stage. Once Diabetic patients suffer from continued Albuminuria, glomerular capillary will be narrow and more glomerulus ruined because GBM thicken a lot. Renal filtrating function will reduce and finally cause a Renal Failure
So we can see, if Diabetes can be treated at the early stages, Diabetic Nephropathy or Renal Failure can be prevented.
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