I n t e r n a L medicine questions Bank

Diabetic nephropathy: stages

Diabetic nephropathy may be classified as occurring in five stages*: Stage 1

• 
  hyperfiltration: increase in GFR
  
• 
  may be reversible
  

Stage 2 (silent or latent phase)

• 
  most patients do not develop microalbuminuria for 10 years
  
• 
  GFR remains elevated
  

Stage 3 (incipient nephropathy)

• 
  microalbuminuria (albumin excretion of 30 - 300 mg/day, dipstick negative)
  

Stage 4 (overt nephropathy)

• 
  persistent proteinuria (albumin excretion > 300 mg/day, dipstick positive)
  
• 
  hypertension is present in most patients
  
• 
  histology shows diffuse glomerulosclerosis and focal glomerulosclerosis (Kimmelstiel-Wilson nodules)
  

Stage 5

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  end-stage renal disease, GFR typically < 10ml/min
  
• 
  renal replacement therapy needed
  

The timeline given here is for type 1 diabetics. Patients with type 2 diabetes mellitus
(T2DM) progress through similar stages but in a different timescale - some T2DM patients may progress quickly to the later stages


8 2-A 14-year-old boy develops haematuria following an upper respiratory tract infection. What is the likely diagnosis?

	A.	IgA nephropathy
	B.	Focal segmental glomerulosclerosis
	C.	Diffuse proliferative glomerulonephritis
	D.	Rapidly progressive glomerulonephritis
	E.	Mesangiocapillary glomerulonephritis

8 3-Which one of the following statements regarding minimal change glomerulonephritis is incorrect?

	A.	Has a good prognosis
	B.	The majority of cases are steroid responsive
	C.	Is a common cause of nephrotic syndrome
	D.	Hypertension is found in approximately 50% of patients
	E.	Haematuria is rare

Hypertension and haematuria are rare in minimal change glomerulonephritis