Diabetes duration

Stage

Clinical features

Prognosis

Since disease onset

1: Increased eGFR, renal hypertrophy

eGFR increased to 160 mL/min/1.73 m2, kidney enlargement (20%) and increase in renal plasma flow (10%-15%), no albuminuria or hypertension

Potentially reversible

2-5 years

2: Onset of histologic changes, altered structure and function of basement membrane

Thickening and altered electrical charge of basement membrane, mesangial proliferation, normal eGFR, no albuminuria, no clinical symptoms

May be partially reversible

5-10 (15) years

3: Early clinical nephropathy

Albuminuria 30-300 mg/24 h, eGFR reduced from 160 to 130 mL/min/1.73 m2, ± HTN

Lesion progression may be stopped, sometimes reversible

10 (15)-25 years

4: Overt nephropathy

Persistent and irreversible proteinuria, eGFR <60 mL/min/1.73 m2 and sustained HTN, edema, dyslipidemia

Lesion progression may be slowed and sometimes stopped

>15 years

5: Renal failure

End-stage kidney disease with eGFR <15 mL/min/1.73 m2, HTN

Irreversible progression to end-stage renal failure