The earliest feature of diabetic nephropathy is-

Ans. is 'a' i.e., Microalbuminuria STAGES O F DIABETIC NEPHROPATHY: (IDDM)YearStageFindings0Io Raised GFR, increase in Renal size and plasma flow2IIo Thickening in glomerular capillary basement membrane6-10IIIo Microalbuminuria/Albumin excretion rate 30-300mg/day, Appearance of micro albuminuria important predictor of development of overt proteinuria10-15IVo Clinical nephropathy, gross proteinuria, Albumin>300mg/day. Now the changes are irreversible16-25Vo End stage renal diseaseo Microalbuminuria is defined as albumin excretion of 30-300 mg/dQo Overt nephropathy or overt proteinuria is defined as albumin excretion ereater than 300 mg/dQo The appearance of microalbuminuria in type I diabetes mellitus is an important predictor of progression to overt proteinuria >300 mg/day or overt nephropathy.REMEMBERo The early pathological changes and albumin excretion abnormalities are reversible with normalization of plasma glucoseQ.o However, once overt nephropathy develops the pathological chanees are likely irreversible. there is steady decline in GFR and ~50% of individuals reach ESRD in 7-10 yearsQ.