A patient has IDDM diagnosed at age of 15 years. The most reliable indicator for diabetic nephropathy is

Answer is B (Urinary protein > 550 mg/day for 3 consecutive sample): The most reliable indicator for diabetic nephropathy is presence of ove proteinuria. Urinary protein > 550 mg/day in 3 consecutive samples confirms the diagnosis of ove proteinuria, reflects irreversible pathological changes in kidneys and confirms progression to end stage renal disease (diabetic nephropathy) This is evident from the following lines from Harrisons text: Once ove proteinuria is present there is steady state decline in G.F.R. and -50% of individuals reach end stage renal disease in 7-10 days. Once nephropathy becomes ove the pathological changes are irreversible. Stages of diabetic nephropathv: (IDDM) Year Stage Findings 0 I Raised GFR, increase in Renal size and plasma flow 2 II Thickening in glomerular capillary basement membrane 6-10 III Microalbuminuria 10-15 IV Ove proteinuria, Clinical nephropathy, changes become irreversible. 16-25 V End stage renal disease.