Diabetic nephropathy: stages

Diabetic nephropathy may be
classified as occurring in five stages*:

Stage 1
hyperfiltration: increase in GFR
may be reversible

Stage 2 (silent or latent phase)
most patients do not develop
microalbuminuria for 10 years
GFR remains elevated

Stage 3 (incipient nephropathy)
microalbuminuria (albumin excretion
of 30 - 300 mg/day, dipstick negative)

Stage 4 (overt nephropathy)
persistent proteinuria (albumin
excretion > 300 mg/day, dipstick
positive)
hypertension is present in most
patients
histology shows diffuse
glomerulosclerosis and focal
glomerulosclerosis (Kimmelstiel-Wi
lson nodules)

Stage 5
end-stage renal disease, GFR typically
< 10ml/min
renal replacement therapy needed
The timeline given here is for type 1
diabetics. Patients with type 2
diabetes mellitus (T2DM) progress
through similar stages but in a
different timescale - some T2DM
patients may progress quickly to the
later stages