In 20 14, the American Diabetes Association (ADA) and NKF reached a consensus that DKD refers to chronic kidney diseases caused by diabetes, mainly including glomerular filtration rate (GFR) below 60mml min- 1 1.73m2 or urinary albumin/creatinine ratio (ACR). Diabetic glomerular disease refers to glomerular disease caused by diabetes, which is confirmed by renal biopsy.
The diagnosis of diabetic nephropathy can be divided into pathological diagnosis and clinical diagnosis. Renal pathology is considered as the gold standard of diagnosis. Diabetes mainly causes glomerular diseases, such as mesangial hyperplasia, basement membrane thickening and K-W(Kimmelstiel-Wilson) nodules. It is the main basis of pathological diagnosis. Diabetes can also cause tubulointerstitial and renal microvascular lesions, such as tubulointerstitial fibrosis, tubular atrophy, hyaline degeneration of efferent artery or renal microvascular sclerosis. These changes may also be caused by other reasons, and they are only used as auxiliary indicators in diagnosis.
At present, the clinical diagnosis of diabetic nephropathy is based on urinary albumin and diabetic retinopathy. Early diabetic nephropathy can be manifested as negative urine albumin, and the symptoms are not obvious, which is easy to be ignored. However, there is still a lack of more reliable and sensitive indicators for early detection of diabetic nephropathy than microalbuminuria.