Is stage three diabetic nephropathy severe?

Written by Zhou Qi
Nephrology
Updated on September 22, 2024
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Stage three of diabetic nephropathy refers to patients who have persistent microalbuminuria, indicating a relatively mild state of the disease at this time. In fact, diabetic nephropathy is divided into five stages. During the first and second stages, patients generally do not exhibit specific symptoms clinically and may even test negative for proteinuria; however, an increase in kidney size and glomerular filtration rate may occur. By the third stage, patients begin to exhibit small or micro amounts of urinary albumin. The pathological damage to the kidneys at this stage is not considered particularly severe. Patients may experience hyalinization of small arteries and nodular lesions in the glomeruli. Within the staging of diabetic nephropathy, this does not constitute a particularly severe phase; however, the condition of the patients may continue to progress, leading to significant proteinuria and even renal failure.

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Written by Hu Lin
Nephrology
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What are the symptoms of diabetic nephropathy?

The symptoms of diabetic nephropathy mainly include the following aspects: The first one is proteinuria, where patients may notice an increase in foam in their urine, and upon examination, proteinuria will test positive. The second symptom is edema, which may initially appear as intermittent swelling but gradually develops into swelling of both lower extremities or even the entire body. Of course, pleural effusion and ascites may also occur. The third type of symptom is hypertension; diabetic nephropathy combined with hypertension often involves stubborn high blood pressure, which requires multiple antihypertensive drugs to control. The fourth point is that in the later stages of diabetes, signs of renal failure gradually appear, such as nausea, vomiting, difficulty breathing, anemia, renal osteopathy, skin itching, and more. The fifth is extrarenal manifestations, such as diabetic retinopathy presenting with vision loss or even blindness, and diabetic neuropathy leading to numbness and abnormal sensations in the hands and feet. Additionally, it is common for patients with diabetic nephropathy to also experience cardiovascular and cerebrovascular complications, such as coronary heart disease, myocardial infarction, stroke, and more.

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Written by Zhou Qi
Nephrology
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How to check for diabetic nephropathy?

For the examination of diabetic nephropathy, patients first need to undergo routine urinalysis and check for the urinary albumin excretion rate. Generally speaking, one characteristic of diabetic nephropathy is the presence of urinary protein. A urinary albumin excretion rate between 20 and 200 µg/min is an important basis for diagnosing early diabetic nephropathy. If a patient’s urinary albumin excretion rate consistently exceeds 200 µg/min, significant diabetic nephropathy is often considered. Of course, this is under the assumption that the patient has had diabetes for at least ten years and has diabetic retinopathy. A kidney biopsy is needed for confirmation. Of course, to assess the impact of diabetic nephropathy on kidney function, blood tests for serum creatinine and urea nitrogen are necessary.

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Written by Zhou Qi
Nephrology
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Is diabetic nephropathy with facial swelling serious?

Patients with diabetic nephropathy who experience facial swelling should not use this symptom as a basis for judging the severity of their condition. Diabetic nephropathy is divided into five stages. The condition is relatively mild during the first three stages. By the fourth stage, patients begin to exhibit significant proteinuria, and by the fifth stage, they experience severe renal failure. Conditions in these last two stages are quite severe. However, patients might also experience facial swelling during the first three stages, and while the likelihood of facial swelling increases during the fourth and fifth stages, some patients in these stages might not show obvious edema. Therefore, it is difficult to determine the severity of the condition based solely on swelling. Patients need to undergo 24-hour urinary protein quantification and blood tests to assess kidney function in order to judge the severity of their condition.

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Written by Luo Han Ying
Endocrinology
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Is early diabetic nephropathy reversible?

Diabetic nephropathy clinically mainly manifests as an increase in urine protein on routine urine tests. Thus, diabetic nephropathy can be classified into different stages. In the early stages, microalbuminuria appears, and at this early phase, diabetic nephropathy is actually reversible. However, if the condition progresses with significant proteinuria, it becomes difficult to reverse diabetic nephropathy through intervention treatments. Most clinical patients may experience a slight reduction in urine protein or maintain this condition long-term without further progression. However, some patients have already experienced an increase in creatinine levels by the time they reach this stage of diabetic nephropathy, making it particularly challenging to reverse the condition once creatinine levels rise. Therefore, for diabetic nephropathy, early detection and treatment are crucial, with the most important goal being the prevention of the disease's onset.

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Written by Zhou Qi
Nephrology
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Symptoms of stage 2 diabetic nephropathy

Diabetic nephropathy is divided into five stages. Speaking in terms of the severity of the condition, in the second stage, the clinical manifestations are not very obvious, and the patient's kidney size may increase. Generally, at rest, the patient's urine protein is negative, but after activity, there might be traces of albumin in the urine. Due to the presence of a small amount of protein in the urine, there may be an increase in urine foam, and the patient may experience mild edema, although the symptoms of this edema are also not very noticeable. At this stage, the damage of diabetes to other organs of the body is not very evident, therefore, retinopathy is not severe, and the patient’s vision decline is not significant. The patient may also have concurrent issues like hypertension and hyperlipidemia.