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

Ans. is 'b' i.e Urinary protein > 550mg/day for 3 consecutive sample Presence of urinary protein>300 mg /day indicates progression to overt proteinuria.Once overt 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 overt the pathological changes are irreversibleStages of diabetic nephropathy : (IDDM)YearStageFindings0IRaised GFR, increase in Renal size and plasma flow2IIThickening in glomerular capillary basement membrane6-10IIIMicroalbuminuria/Albumin excretion rate 30-300mg/day, Appearance of micro albuminuria important predictor of development of overt proteinuria10-15IVClinical nephropathy, gross proteinuria, Albumin>300mg/day. Now the changes are irreversible16-25VEnd stage renal disease