糖尿病肾病六教材.pptVIP

Diabetic Nephropathy Diabetic nephropathy is the leading cause of chronic renal failure in the industrialised world. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. Although both type 1 diabetes mellitus (insulin-dependent diabetes mellitus [IDDM]) and type 2 diabetes mellitus (non–insulin-dependent diabetes mellitus [NIDDM]) lead to ESRD, the great majority of patients are those with NIDDM. Stage 2 (developing diabetes) Clinically silent phase with continued hyper filtration and hypertrophy The GFR remains elevated or has returned to normal, but glomerular damage has progressed to significant microalbuminuria (small but above-normal level of the protein albumin in the urine). Significant microalbuminuria will progress to end-stage renal disease (ESRD). Therefore, all diabetes patients should be screened for microalbuminuria on a routine basis. Stage 3 (overt, or dipstick-positive diabetes) Glomerular damage has progressed to clinical albuminuria. Basement membrane thickening due to AGEP The urine is dipstick positive, containing more than 300 mg of albumin in a 24-hour period. Hypertension (high blood pressure) typically develops during stage 3. Stage 4 (late-stage diabetes) Glomerular damage continues, with increasing amounts of protein albumin in the urine. The kidneys’ filtering ability has begun to decline steadily, and blood urea nitrogen (BUN) and creatinine (Cr) has begun to increase. The glomerular filtration rate (GFR) decreases about 10% annually. Almost all patients have hypertension at stage 4. Stage 5 (end-stage renal disease, ESRD) GFR has fallen to 10 ml/min and renal replacement therapy (i.e., haemodialysis, peritoneal dialysis, kidney transplantation) is needed. (ii) Glomerular Basement Membrane (GBM): The GBM is a tri-laminar structure, 0.3 microns in t