<prompt> A patient has IDDM diagnosed at age of 15 years. The most reliable indicator for diabetic nephropathy is:Urine albumin 50 mg per day in 3 consecutive samplesUrinary protein 550 mg per day for 3 consecutive samplesDevelopment of diabetic retinopathyHematuria  <response>: Ans. is b i.e Urinary protein 550mgday for 3 consecutive sample Presence of urinary protein300 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 : IDDMYearStageFindings0IRaised GFR, increase in Renal size and plasma flow2IIThickening in glomerular capillary basement membrane6-10IIIMicroalbuminuriaAlbumin excretion rate 30-300mgday, Appearance of micro albuminuria important predictor of development of overt proteinuria10-15IVClinical nephropathy, gross proteinuria, Albumin300mgday. Now the changes are irreversible16-25VEnd stage renal disease 