This document discusses diabetic nephropathy, which refers to kidney damage caused by diabetes. It defines diabetic nephropathy and outlines its stages of progression from microalbuminuria to end-stage renal failure. Signs and symptoms including albumin in the urine, high blood pressure, swelling, and fatigue are described. The document also provides nursing management strategies such as monitoring blood glucose, providing education, checking urine tests, encouraging smoking cessation, controlling blood pressure, and using ACE inhibitors.

2. objective
Introduction
Definition
Stages of diabetic nephropathy
Signe and symptoms
Nursing management
Summery
Reference
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3. In the end student will be able to:
define nephropathy .1
learn signs and symptoms
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Identify the stages of nephropathy
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How Can You Prevent Diabetic
nephropathy Disease?
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4. Nephropathy is considered one of the 
hardest
and most dangerous complication of diabetes
After the onset of diabetic nephropathy the
disease progresses over several years
reaching the case of renal failure that require
(dialysis)treatment or anew kidney transplant

5. The record in recent year growing and rise
in the number of patient with diabetes
especially type 2 and the number of patient
who have kidney damaged.
Where in the world 2 million people
suffering from chronic renal failure .. There
is also in the United States alone, 300
thousand cases.
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6. Refers to the progressive decrease in renal
function that occur with diabetes mellitus.
Client with type 1 diabetes are most likely to
develop diabetic nephropathy but client type
2 diabetes also are affected.
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7. Stage 1:hyperfilitration,glomerular 
hypertrophy affect on blood flow through
kidneys is increased, kidneys are enlarged
stage2:microalbuminuria affect on albumin , a
blood protein ,is excreted in small amount
Stage3:Gross albuminuria affect large amount
of albumin is excreted Bb becomes elevated
excretion of nitrogen wastes is impaired

8. Stage 4: advanced dysfunction affect sever 
impairment of glomerular filtration is
evidenced by excessive proteinuria
, hypertension and rise in blood urea nitrogen
and creatinine level
Stage 5:end stage renal failure affect kidney
function are severely impaired((dialysis or
renal transplantation is necessary))

10. Albumin or protein in the urine
High blood pressure
Ankle and leg swelling, leg cramps
Weakness, anemia fatigue
poor glucose control
Rise in (BUN) and creatinin level
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11. the nurse monitor the client blood glucose
and hemoglobin
The nurse provides additional teaching if the
clients blood glucose level is not controlled
Check the urine with a test strip to detect
evidence of albuminuria
Smoking cessation
Blood pressure controls
Use of ACE inhibitor is essential as
microalbuminuria
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12. Diabetic nephropathy is a disease that
develops slowly and if treated
early, progression can be delayed.
The national heart lung and blood institute
recommended that the client with diabetes
maintain their BP at or below 130/85mmHg
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13. Barbara K.Timby , nancy E smith 
, introductory medical surgical nursing 18
Edition
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