Classification of Diabetic Nephropathy 2014

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1 Classification of Diabetic Nephropathy 2014 Joint committee on diabetes nephropathy The Japanese Diabetes Society Masakazu Haneda Kazunori Utsunomiya Daisuke Koya Tetsuya Babazono Tatsumi Moriya Japanese Society of Nephrology Hirofumi Makino Kenjiro Kimura Yoshiki Suzuki Takashi Wada Susumu Ogawa The Japanese Society for Dialysis Therapy Masaaki Inaba Yoshihiko Kanno Takashi Shigematsu Ikuto Masakane Ken Tsuchiya

2 Japan Society of Metabolism and Clinical Nutrition Keiko Honda Kazuko Ichikawa Kenichiro Shide estimated glomerular filtration rates egfr chronic kidney disease CKD GFR egfr 2 3 A B 3 GFR 30 ml 1.73 m 2 4 Key words Abstract The Committee on Diabetic Nephropathy revised the classification of diabetic nephropathy in view of the current status of egfr and CKD in Japan. To make revisions for the classification of diabetic nephropathy 2014, the Committee carefully evaluated the report of the Research Group on Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan. The major revisions made were as follows 1. egfr can be used for the evaluation of GFR 2. In stage 3 overt nephropathy, A and B were combined 3. Stage 4 renal failure was defined as GFR less than 30 ml min 1.73 m 2, regardless of albuminuria and 4. The importance of differential diagnosis was stressed in all stages CKD CKD CKD 4 GFR Ccr creatinine clearance CKD GFR egfr GFR egfr 2012 CKD ,355

3 549 egfr 6, GFR 60 ml 1.73 m 2 GFR 30 ml 1.73 m 2 1 GFR 2 3 CKD 1 GFR egfr A B 1 g 4 GFR 30 ml 1.73 m 2 8 GFR 30 ml 1.73 m American Diabetes Association Clinical Practice Recommendations 2013 microalbuminuria macroalbuminuria 30 g mg Cr mg g Cr Increased urinary albumin excretion 9 Clinical Practice Recommendations 2014 microalbuminuria persistent albuminuria mg 24h macroalbuminuria persistent albuminuria 300 mg 24h 10 JDCP study Japan Diabetes Complication and the Prevention prospective study JDDM Japan Diabetes Clinical Data Management Study Group J-DOIT3 Japan Diabetes Optimal Integrated Treatment study for 3 major risk factors of cardiovascular diseases

4 mg gcr g gcr GFR egfr ml 1.73 m URL http: mhlw-grants.niph.go.jp, Wada T, Haneda M, Furuichi K, Babazono T, Yokoyama H, Iseki K, Araki SI, Ninomiya T, Hara S, Suzuki Y, Iwano M, Kusano E, Moriya T, Satoh H, Nakamura H, Shimizu M, Toyama T, Hara A, Makino H The Research Group of Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan. Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes. Clin Exp Nephrol Oct 17. Epub ahead of print 2 GFR 60 ml 1.73 m 2 CKD 3 4 GFR 60 ml 1.73 m 2 GFR egfr 5 GFR 30 ml 1.73 m 2 GFR 2014 CKD A1 A2 A3 Cr mg gcr Cr g gcr GFR ml 1.73m

5 551 CKD MSD MSD MSD MSD MSD MSD MSD MSD MSD MSD 1. http: docs.jsdt.or.jp over view index.html CKD CKD pp1 44 http: mhlw-grants. niph.go.jp 7. Wada T, Haneda M, Furuichi K, Babazono T, Yokoyama H, Iseki K, Araki SI, Ninomiya T, Hara S, Suzuki Y, Iwano M, Kusano E, Moriya T, Satoh H, Nakamura H, Shimizu M, Toyama T, Hara A, Makino H The Research Group of Diabetic Nephropathy, Min-

6 istry of Health, Labour, and Welfare of Japan. Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes. Clin Exp Nephrol Oct 17. Epub ahead of print PMID Clinical Practice Recommendations Diabetes Care 36 Suppl 1 S3, S35, Clinical Practice Recommendations Diabetes Care 37 Suppl 1 S4, S43 44, 2014.

Kengo Furuichi, Miho Shimizu, Akinori Hara, Tadashi Toyama and Takashi Wada

Kengo Furuichi, Miho Shimizu, Akinori Hara, Tadashi Toyama and Takashi Wada doi: 10.2169/internalmedicine.1132-18 http://internmed.jp REVIEW ARTICLE Diabetic Nephropathy: A Comparison of the Clinical and Pathological Features between the CKD Risk Classification and the Classification