Classifications(China) o Background retinopathy I microaneurysms dots of hemorrhages II yellow and white hard exudates, haemorrhage III white soft exudates, haemorrhages spots o Proliferative retinopathy Ⅳ new vessel formation、 haemorrhage into the vitreous V new vessel formation and fibrosis Ⅵ retinal detachment
Classifications (China) ⚫ Background retinopathy Ⅰ microaneurysms、dots of hemorrhages Ⅱ yellow and white hard exudates , haemorrhages Ⅲ white soft exudates , haemorrhages spots ⚫ Proliferative retinopathy Ⅳ new vessel formation、haemorrhage into the vitreous Ⅴ new vessel formation and fibrosis Ⅵ retinal detachment
Diabetic nephropathy o dn is the leading cause of eSrd(end-stage renal disease) almost 40 %of Type 1 dm died of uremia Incidence of dn in type 2 DM is about 20% In eu, dn accounts for 1/3 of dialysis and kidney transplantation cases In China, dn also accounts for quite a lot of dialyses and kidney transplantations
Diabetic nephropathy ⚫ DN is the leading cause of ESRD (end-stage renal disease) – Almost 40％of Type 1 DM died of uremia – Incidence of DN in type 2 DM is about 20％ – In EU，DN accounts for 1/3 of dialysis and kidney transplantation cases – In China, DN also accounts for quite a lot of dialyses and kidney transplantations
Stages of diabetic nephropathy (1) stage I increased kidney DM already filtration agnosise GFR个1 enlarged kidneys(B- ultrasonic) GFR>130ml/min Stage II clinically silent phase DM 2 5year GFR 120-40% renal enlargement with continued glomerular hypertrophy, hyperfiltration and hypertrophy expansion of the mesangial matrix thickening of the glomerular basement membrane resulting in glomerulosclerosis Stage ili concealed DN microalbuminuria DM5-10year microalbuminuria 1/5 patients with hypertension (20-200μg/ min retinopothy↑ or30~300mg/24h) proteinuria 0. 15-0.5g/24h GFR> or =normal
Stages of diabetic nephropathy(1) stage I increased kidney DM already filtration diagnosised GFR↑↑ enlarged kidneys(B- ultrasonic) GFR>130ml/min Stage II clinically silent phase DM 25year GFR ↑2040％ renal enlargement， with continued glomerular hypertrophy, hyperfiltration and hypertrophy expansion of the mesangial matrix thickening of the glomerular basement membrane resulting in glomerulosclerosis Stage III concealed DN microalbuminuria DM510year microalbuminuria 1/5 patients with hypertension (20-200µg/min retinopothy↑ ,or30300mg/24h) proteinuria 0.150.5g/24h GFR> or =normal
Stages of diabetic nephropathy(2) Stage IV Overt Nephropathy DM10-25year albuminuria>300mg/d 60-70% patients proteinuria>0.5g/d with hypertention GFR↓( when UAER=100 nd ede mg/24h, ger begin to decrease about lm/min/month) retinopathy↑↑ Stage v end-stage renal disease, ESRD DM15-30 year albuminuria totemic→ uremia GFR< 1/3 of normal
Stages of diabetic nephropathy(2) Stage IV Overt Nephropathy DM1025year albuminuria>300mg/d 6070％ patients proteinuria>0.5g/d ， with hypertentio GFR↓(when UAER=100 and edema mg/24h , GER begin to decrease， about 1ml/min/month) retinopathy ↑↑ Stage V end-stage renal disease, ESRD DM1530 year albuminuria azotemic→ uremia GFR< 1/3 of normal
Classification of diabetes neuropathy (1) Peripheral neuropathy Autonomic neuropathy symmetric multiple peripheral neuropathy diabetic myelopathy sensibility multiple neuropathy diabetic spinal ataxia numbness type spinal muscular atrophy pain type Cerebropathy numbness-pain type Hypoglycemia cerebropathy sensomotor multiple neuropathy diabetic coma acute or sub-acute motor multiple cerebrovascular disease neuropathy asymmetricsingle or multiple peripheral neuropathy member or torso mononeural cranial nerves disease radiculopathy proximal motor neuropathy autonomic neuropathy
Classification of diabetes neuropathy （1） Peripheral neuropathy symmetric multiple peripheral neuropathy sensibility multiple neuropathy numbness type pain type numbness-pain type sensomotor multiple neuropathy acute or sub-acute motor multiple neuropathy asymmetricsingle or multiple periphearal neuropathy member or torso mononeural cranial nerves disease radiculopathy proximal motor neuropathy autonomic neuropathy Autonomic neuropathy diabetic myelopathy diabetic spinal ataxia spinal muscular atrophy Cerebropathy Hypoglycemia cerebropathy diabetic coma cerebrovascular disease