How to diagnose diabetic nephropathy

Diabetic nephropathy is a serious complication of diabetes. Mainly renal vascular disease, microvascular and macrovascular involving former glomerular sclerosis, which cause renal artery, renal arteriosclerosis.
For patients already diagnosed with diabetes, you should pay close attention, especially urinary protein albumin in urine, renal function and blood pressure, as the course of the gradual emergence of microalbuminuria, proteinuria, renal dysfunction ensemble, the diagnosis of diabetic nephropathy is not difficulties. History of diabetes for several years with persistent microalbuminuria (UAE often in the 20 ~ 200 μg / min or 30 ~ 300 mg / d room), which should be suspected "of early diabetic nephropathy"; If history is longer, urinary protein, Even massive proteinuria and nephrotic syndrome, which should be considered "clinical diabetic nephropathy" diagnosis. Difficult cases of renal biopsy should be performed to check if there is no significant glomerular cell proliferation, and diffuse mesangial matrix and GBM extensively widened thickening (early to rely on electron microscopic examination confirmed), especially when nodules appear Kimmelstiel-Wilson, diagnosis can be established.
The clinical diagnosis of diabetic nephropathy:
(1) For early diabetes or diabetes and kidney disease also found that the diagnosis requires a combination of damage to other organ systems, such as diabetes, diabetic retinopathy and peripheral neuropathy, kidney damage, but the performance can be ruled out due to other causes, as well as diabetes Some features, such as hematuria rare kidney disease, kidney failure, although entering the period but no significant reduction in urinary protein excretion, renal volume increase or decrease the degree of renal function is not parallel (renal amyloidosis should be differentiated) for renal biopsy if necessary biopsy.

(2) In the course of diabetes sudden renal dysfunction, renal function should first rule out other causes of loss, especially for the early stage of diabetes, proteinuria <lg/24h person. When diabetes is often not accurately reflect serum creatinine in patients with renal function, mainly due to reduction of malnutrition and muscle mass so that creatinine generation decline, causing increased serum creatinine and GFR decline is not parallel; while ketone bodies will enable increased creatinine measurements. When DN kidney failure, can be caused by many clinical manifestations of uremia, may also be caused by other complications of diabetes, should be carefully identified. Such as diabetic autonomic neuropathy can cause a range of performance, gastroparesis cause nausea, vomiting; sensory peripheral neuropathy caused limb abnormalities; orthostatic hypotension.
(3) primary glomerular disease often some characteristic changes, a number of significant pathology hematuria; hypertensive renal arteriosclerosis mainly involving people efferent arterioles, and often have retinal arteriosclerosis and left ventricular hypertrophy Heart. Renal amyloidosis and light chain deposition nephropathy in mesangial area, although visible tuberous sclerosis, but Congo red stain was negative, and there are other characteristic features; addition, primary glomerular disease may be associated with diabetes and hypertension coexist in the pathogenesis without contact.