Symptoms of diabetic nephropathy

At the initial stages (I and II), the course of diabetic nephropathy is asymptomatic. When performing the Reberg test, an increase in SCF is noted (> 140-150 ml/min x 1.73 m2 ⁾.

At stage III (the stage of incipient diabetic nephropathy), symptoms are also absent, microalbuminuria (20-200 mg/l) is determined with normal or increased SCF.

Starting from the stage of severe diabetic nephropathy (stage IV), patients develop clinical symptoms of diabetic nephropathy, which primarily include:

• arterial hypertension (appears and increases rapidly);
• swelling.

Laboratory tests determine:

• proteinuria (> 150 mg protein per day);
• decrease in SCF (steadily progressing, by approximately 1 ml/min per month);
• dyslipidemia,
• the level of creatinine, urea nitrogen, potassium - at the upper limit of the norm, then above the norm;
• nephritic syndrome, the signs of which are massive proteinuria (> 3.5 g/day), hypoalbuminemia, hypercholesterolemia, develops in 30% of patients with diabetic nephropathy.

At this same stage, a rapid increase in the severity of other micro- and macrovascular complications of diabetes usually begins, i.e. the development of clinical manifestations of coronary heart disease, obliterating atherosclerosis of the lower extremities, atherosclerotic cerebrovascular insufficiency, diabetic foot syndrome, diabetic retinopathy and neuropathy.

Stage V of diabetic nephropathy (stage of uremia) is characterized by:

• uncontrollable increase in blood pressure;
• progression of fluid retention in the body, including the development of heart failure and pulmonary edema;
• the addition of specific symptoms of chronic renal failure (itching of the skin, uremic bad breath, uremic gastropathy and polyneuropathy, etc.), normochromic anemia, osteodystrophy.

Diagnostic criteria for albuminuria

Characteristics of albuminuria	Albuminuria		Urine albumin concentration, mg/l	Urine albumin/creatinine ratio, mg/mmol
	In the morning portion, mcg/min	Per day, mg
Normoalbuminuria	<20	<30	<20	<2.5 in men <3.5 in women
Microalbuminuria	20-200	30-300	20-200	2.5-25 for men 3.5-25 for women
Macroalbuminuria	>200	>300	>200	>25

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