Diabetic kidney disease in pediatric patients: A current review

Table 2 Diabetic kidney disease stages

Stage	Estimated period	Characteristics	GFR	BP	Biomarker-albuminuria	Biomarker UACR mg/mmoL
1 = hyperfiltration	From diabetes onset to 5 yr	Glomerular hyperfiltration and hypertrophy. No ultrastructure abnormality. A 20% increase in renal size. ↑Renal plasma flow	N/increased	N	Normoalbuminuria < 30 mg/g	< 2
2 = silent	From 2 yr after onset	Mild GBM thickening and interstitial expansion	N	N	Normoalbuminuria < 30 mg/g	< 3
3 = incipient	5–10 yr after onset	More significant changes vs stage 2. Moderate tubular and GBM thickening and variable focal mesangial sclerosis	GFR–N or mild decreased	Increasing BP; +/- hypertension	Microalbuminuria appears Albuminuria 30-300 mg/g	2-20
4 = overt	10-15 yr after onset	Marked GBM thickening and variable focal mesangial sclerosis	GFR-decreased < 60 mL/min/1.73 m2	BP↑	Macroalbuminuria > 300 mg/g	> 20
5 = uremic		Diffuse glomerulosclerosis, ESRD	GFR-marked decreased < 15 mL/min/1.73 m2	BP↑	Decreasing albuminuria

UACR: Urinary albumin to creatinine ratio; GBM: Glomerular basement membrane; GFR: Glomerular filtration rate; BP: Blood pressure; ESRD: End-stage renal disease; ↑: Increase; N: Normal.