DM nephropathy

clinical course:

Stage 1:
  因hyperglycemia->prostaglandin and NO ↑-->hyperfiltration,kidney hypertrophy

Stage 2:
pathology finding:
 GBM thickness,kimmelstiel-wilson nodule

Stage 3:
microalbuminemia= 30-300mg/day or 30-300ug/mg Cr(ACR)


Stage 4:
 macroalbuminemia= >300mg/ day albumin or >500mg/day protein

Stage 5:
ESRD,uremic(fluid retention)

Work up:
spot urine:albumin,Creatinine
24 hr urine

Complication:
-microvascular:眼,neuro,GI
-macrovascular:CAD,CAV

*type 1 DM  with retinopathy(+)-->100% nephropathy(+)
  type 2 DM  with retinopathy(+)-->60% nephropathy(+)

Diagnosis:
Previous diagnosis DM(+),DM retinopathy(+), proteinuria

**if
  late onset DM
  hematuria
  no retinopathy
  heavy proteinuria(>7g/day)
--->survey other causes!!!!


Treatment:
1.ACEI/ARB
2.if HTN: ACEI/ARB+diuretics(keep BP <130/80)
3.Keep LDL<100(70) under statin control
4. 限蛋白飲食:0.8g/kg-day