Symptoms of stage 2 diabetic nephropathy

Written by Zhou Qi
Nephrology
Updated on January 10, 2025
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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.

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Written by Zhou Qi
Nephrology
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Late-stage symptoms of diabetic nephropathy

When patients with diabetic nephropathy reach the advanced stage, they actually already have severe renal failure. Prior to this, patients generally exhibit noticeable proteinuria. Continued progression of the disease will lead to the destruction of most of the renal tissues, causing renal failure. This condition is quite serious; patients often experience significant edema, even severe generalized edema. The accumulation of a large amount of fluid in the body leads to an increase in blood volume, and both the preload and afterload on the heart increase, often accompanied by symptoms of heart failure. When patients experience heart failure, they may find it impossible to lie flat and may experience chest tightness, shortness of breath, and difficulty breathing after activity, potentially endangering their lives.

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Written by Hu Lin
Nephrology
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Early symptoms of diabetic nephropathy

The early symptoms of diabetic nephropathy primarily include the presence of microalbuminuria, which is characterized by an albumin excretion rate of 30 to 300 mg per 24 hours, or a ratio of albumin to creatinine in spot urine ranging from 30 to 300 mg/g. However, this value needs to be tested three times over six months, with at least two of these tests meeting the above criteria for a diagnosis. Additionally, in the early stages of diabetes, patients' blood pressure tends to be within the normal range, but there is a trend toward elevation. Some patients may experience changes in the diurnal rhythm of their blood pressure, and the glomerular filtration rate may slightly increase or remain within the normal range.

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Written by Zhou Qi
Nephrology
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How to reduce proteinuria in diabetic nephropathy.

A major clinical feature of diabetic nephropathy is the occurrence of proteinuria, which, if the condition continues to progress, can lead to kidney failure. Controlling proteinuria in the early stages of the disease is indeed very important. In terms of treatment, it is primarily necessary to use medications or insulin to control the patient's blood sugar, as hyperglycemia is the fundamental cause of diabetic nephropathy. Additionally, these patients often also have hypertension, necessitating the use of antihypertensive drugs to control blood pressure. When the patient's kidney function is not severely impaired, ACE inhibitors or ARBs can be the preferred choice of antihypertensive drugs, as they not only control blood pressure but also reduce proteinuria. However, if the patient's serum creatinine is significantly elevated, such as over 264 µmol/L, these drugs should no longer be used. (Medications should be used under the guidance of a doctor.)

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Written by Zhou Qi
Nephrology
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Can diabetic nephropathy be controlled?

The treatment of diabetic nephropathy is indeed a medical challenge currently. This disease is related to metabolic disorder, with factors such as high blood sugar state advanced glycation end products and oxidative stress contributing to the damage of the glomerular capillaries. Presently, there is no cure for this disease, nor is there a specific effective treatment. However, many patients have used certain treatments that can effectively delay the progression of the disease. Clinically, common measures include controlling blood sugar, blood pressure, and blood lipids. Additionally, combining the use of ACE inhibitors or angiotensin receptor blockers with sodium-glucose cotransporter 2 inhibitors can reduce the pressure within the renal corpuscles and lower urine protein levels.

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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.