Symptoms and Prognosis of Stage 4 Diabetic Nephropathy

Diabetic nephropathy is one of the most serious microvascular complications of diabetes. In the early stage, there are no obvious discomforts besides slight kidney enlargement, increased blood pressure and microalbuminuria. With continuous illness progression, there will be glomerular sclerosis; decrease of GFR, persistent proteinuria, edema, high blood pressure and in the end stage there will be renal failure or even uremia. Patients’ life quality will be affected and sometimes it can be life-threatening.

Diabetic nephropathy can be divided into 5 stages according to clinical symptoms and severity of renal damages. Stage 4 diabetic nephropathy is called clinical or dominant diabetic nephropathy and patients will begin to have obvious clinical manifestations.

What are the symptoms of stage 4 diabetic nephropathy?

This stage is featured by large amount of proteinuria and urinary protein quantitative is persistently higher than 0.5g/24h and it is non-selective proteinuria. In severe cases, daily urinary protein can be more than 3.5g and patients will have hypoalbuminemia, edema, and high blood pressure accompanied by different levels of nitrogen retention and fundus lesions. Mesangial matrix will increase and glomerular basement membrane will be further thickened.

Proteinuria is often accompanied by slight microscopic hematuria and small amount of casts.

GFR will decrease, but creatinine level in most patients is usually not very high.

What is the prognosis of stage 4 diabetic nephropathy?

The natural process for each diabetic nephropathy stage is about 3-5 years. That is to say, it takes at most 12 years to develop into renal failure without timely and proper treatments. Usually stage 4 diabetic nephropathy patients will develop large amount of proteinuria (daily urine protein more than 3.5g) and nephrotic syndrome within 3-4 years and in serious cases patients might develop effusion in abdomen and chest. Proper treatments and daily nursing cares can slow down its progression and reduce damages to renal tissues and renal functions.

1. Control blood sugar and blood pressure. The ideal blood pressure should be below 130/80mmHg and controlling high blood pressure can help improve kidney functions.

2. Limit protein intake and have low-salt diets and in case of edema limit water intake.

3. Seek Chinese herbal medicines which are good at controlling blood sugar and protect kidney functions.