The clinical manifestations of diabetic nephropathy include outer manifestations of kidney and renal performance.
(1)Outer manifestations of kidney:
Typical patient show symptoms like more drink, more eat, more urine, body weight loss, and skin itching etc. The light patient can also be no symptoms. Diabetic nephropathy, in the early stage, is not always accompanied by other complications of diabetes. But in the end stage, it is often accompanied by symptoms, including: ①cardiovascular diseases such as heart failure or myocardial infarction. ② retinopathy, such as retinal hemorrhage and arteriosclerosis. ③ neuropathy, such as dysuria, urinary retention.
(2)Kidney performance:
1) Changes of renal function in the early stage: filtration rate of glomeruli of kidney increases in early diabetes, filtration fraction of it also increases.
2)Proteinuria: the most mainly clinical manifestations of this disease in the early stage. The early microalbuminuria or intermittent proteinuria developes into the late persistent proteinuria, until organic changes of the kidney appears. Then, renal failure appears. Generally speaking, the course of the disease is 10-15 years. In the early stage, there are no significant renal function decline, but as the disease progresses, proteinuria can be gradually increased. Then, tube of urine, red and white blood cell, and the slow decline of renal function appear.
3) Nephrotic syndrome: severe kidney glomerular sclerosis may occur typical performance of nephrotic syndrome, including large amount of proteinuria (> 3.5g/24h) and hypoproteinemia, and edema, which often accompanied by high blood pressure and decline of creatinine clearance rate. More than 90% of patients may be associated with diabetic retinopathy. According to statistics, the nephrotic syndrome will be developed to chronic renal failure in 4 years, and few people survive more than 5 years.
4) Changes of renal function: in the late stage of diabetes, about 50% a 70% of patients have renal impairment. Patients with persistent proteinuria show a progressive deterioration of renal function. Approximately 25% of diabetic end-stage patients develop into the late uraemia.
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