Diabetic Nephropathy: Classification

Stages of diabetic nephropathy.

Stage	Description
I	Renal hyperfiltration (the kidney works more)
II	Only histological changes are visible; the affected person has no symptoms
III	Onset of diabetic nephropathy with microalbuminuria (protein in urine) and, in many patients, hypertension (high blood pressure)
IV	Manifest nephropathy with hypertension (high blood pressure), edema (water retention in tissues)
V	Renal insufficiency (kidney failure)

Stages of diabetic nephropathy (mod. n.)

Stage description	Glomerular filtration rate (GFR) (ml/min)	Urinary albumin/creatinine quotient (mg/g)	Comment
Renal damage with normal renal function			S-creatinine within normal range Blood pressure within normal range rising or hypertension (high blood pressure). Dyslipidemia (lipid metabolism disorder), more rapid progression of arterial occlusive disease (AVD), coronary artery disease (CAD), neuropathy and retinopathy (retinal disease).
1a: Microalbuminuria	> 90	♂ 20-200 * ♀ 30-300 *
1b: macroalbuminuria	> 90	♂ 200 * ♀ > 300 *
Renal injury with renal insufficiency (NI).			S-creatinine borderline or elevated, Hypertension Dyslipidemia Hypolglycemia (hypoglycemia)-proneness to rapid progression of AVC, CHD, neuropathy and retinopathy. Anemia (anemia)-development, Bone metabolism disorder
2: mild NI	60-89	♂ 200 * * ♀ > 300 * *
3: moderate grade NI	30-59	Decreasing
4: high-grade NI	15-29	Decreasing
5: terminal NI	< 15

Pathological classification of diabetic nephropathy (according to).

Stage	Description	Criteria
I	Mild or nonspecific light microscopic changes and widening of the glomerular basement membrane electron microscopically	Biopsy (tissue sampling) does not apply to class II, III, or IV criteria. Glomerular basement membrane > 395 nm in women or > 430 nm in men.
IIa	Mild mesangial expansion	Biopsy does not apply to class III and IV criteria. Mild mesangial expansion in >25% of the mesangium.
IIb	Severe mesangial expansion	Biopsy does not apply to class III and IV criteria. Mild mesangial expansion in >25% of the mesangium.
III	Nodular sclerosis (Kimmelstiel-Wilson)	Biospsy does not apply to class IV criteria ≥ 1 classic Kimmelstiel-Wilson lesion.
IV	Advanced diabetic glomerulosclerosis	Global glomerular sclerosis in >50% of glomeruli. Class I-III lesions

Prognostic assessment of chronic renal failure see below chronic renal failure/classification.