Progress in standardized diagnosis of diabetic kidney disease

doi:10.3877/cma.j.issn.2095-3216.2019.03.007

Abstract

Abstract:

Diabetic kidney disease (DKD) is a serious complication of diabetes mellitus, and is common cause of end-stage renal disease (ESRD). The clinical diagnosis of DKD usually depends on the history of diabetes, the characteristics of urinary albumin, the presence or absence of retinopathy, and the presence or absence of active urine sediment, etc. However, more and more studies have suggested the high misdiagnosis rate of this clinical diagnosis method. This paper reviewed the progress of DKD diagnosis.

Key words: Diabetes mellitus, Diabetic kidney disease, Non-diabetic renal disease, Diagnosis

Dongqin Tian, Kaixiang Liu, Zhipeng Zhan, Xisheng Xie. Progress in standardized diagnosis of diabetic kidney disease[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(03): 132-137.

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References 44

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分期	尿白蛋白(mg/g Cr)或尿蛋白(g/g Cr)	GFR ml/(min·1.73 m²)
1期(肾病前期)	正常白蛋白尿(<30)	≥30^b
2期(早期肾病期)	微量白蛋白尿(30～299)^c	≥30
3期(显性肾病期)	大量白蛋白尿(≥300)或持续性蛋白尿(≥0.5)	≥30^d
4期(肾衰竭)	任何尿白蛋白和(或)尿蛋白水平^e	<30
5期(透析期)	任何持续性透析状态	?

分期	尿白蛋白(mg/g Cr)或尿蛋白(g/g Cr)	GFR ml/(min·1.73 m²)
1期(肾病前期)	正常白蛋白尿(<30)	≥30^b
2期(早期肾病期)	微量白蛋白尿(30～299)^c	≥30
3期(显性肾病期)	大量白蛋白尿(≥300)或持续性蛋白尿(≥0.5)	≥30^d
4期(肾衰竭)	任何尿白蛋白和(或)尿蛋白水平^e	<30
5期(透析期)	任何持续性透析状态	?

分级	描述	诊断标准
Ⅰ	光镜下轻度或非特异性改变，电镜证实肾小球基底膜增厚	肾活检未达到Ⅱ、Ⅲ、Ⅳ级诊断标准；年龄大于9岁者肾小球基底膜厚度>395 nm(女性)或>430 nm(男性)
Ⅱa	轻度系膜扩张	肾活检未达到Ⅲ、Ⅳ级诊断标准；所观察到的肾小球系膜轻度扩张的比例>25%
Ⅱb	重度系膜扩张	肾活检未达到Ⅲ、Ⅳ级诊断标准；所观察到的肾小球系膜重度扩张的比例>25%
Ⅲ	结节性硬化(K-W结节)	肾活检未达到Ⅳ级诊断标准；至少有一个已确诊的K-W结节
Ⅳ	晚期糖尿病肾小球硬化	弥漫性肾小球硬化，硬化小球比例>50%；可见Ⅰ到Ⅲ级病变

分级	描述	诊断标准
Ⅰ	光镜下轻度或非特异性改变，电镜证实肾小球基底膜增厚	肾活检未达到Ⅱ、Ⅲ、Ⅳ级诊断标准；年龄大于9岁者肾小球基底膜厚度>395 nm(女性)或>430 nm(男性)
Ⅱa	轻度系膜扩张	肾活检未达到Ⅲ、Ⅳ级诊断标准；所观察到的肾小球系膜轻度扩张的比例>25%
Ⅱb	重度系膜扩张	肾活检未达到Ⅲ、Ⅳ级诊断标准；所观察到的肾小球系膜重度扩张的比例>25%
Ⅲ	结节性硬化(K-W结节)	肾活检未达到Ⅳ级诊断标准；至少有一个已确诊的K-W结节
Ⅳ	晚期糖尿病肾小球硬化	弥漫性肾小球硬化，硬化小球比例>50%；可见Ⅰ到Ⅲ级病变

病变		标准	评分
间质病变		?	?
?	间质纤维化和小管萎缩	无间质纤维化和小管萎缩	0
?	?	<25%	1
?	?	25%～50%	2
?	?	>50%	3
间质炎症		无	0
?	?	炎症仅涉及间质纤维化和小管萎缩部分	1
?	?	无间质纤维化和小管萎缩部位也存在炎症	2
血管病变		?	?
?	小动脉玻璃样变	无	0
?	?	至少一个区域的小动脉玻璃样变性	1
?	?	多个区域的小动脉玻变玻璃样变性	2
大血管病变		?	有/无
?	动脉硬化(以病变最重的动脉为评分标准)	无内膜增厚	0
?	?	内膜增厚且厚度小于中膜	1
?	?	内膜增厚且厚度超过中膜	2

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