Pre-clinical (normoalbuminuria)

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Urinary albumin excretion< 30 mg/g creatinine
< 5 year, renal hypertrophy, hyperfiltration, intrarenal hypertension, thick GBM (cannot predict progression), loss of heparan sulfate (negative charge)-->albuminuria
Mesangial expansion/sclerosis (PAS+)
Pathogenesis
- Glomerular hypertension, hyperfiltration, proteinuria, hyperglycemia, advanced glycosylation end products, growth hormone, atrial natriuretic peptide, insulin-like growth factor I, angiotensin II (efferent arteriole constriction), connective tissues growth factor, transforming growth factor-β, hyperlipidemia