Diabetic nephropathy: Is it time yet for routine kidney biopsy?

Table 1 Diabetic nephropathy stages

Stage 1 Early hyperfunction and hypertrophy	ACR < 30 mg/g creatinine
Stage 2 Morphologic lesions without signs of clinical disease	ACR > 30 and < 300 mg/g creatinine
Stage 3 Microalbuminuria	ACR > 300 mg/g creatinine and/or persistent
	proteinuria with serum concentration of creatinine 2.0 mg/dL
Stage 4 Overt nephropathy	Serum concentration of creatinine 2.0 mg/dL with proteinuria
Stage 5 End-stage renal disease with uremia	On dialysis

ACR: Albumin to creatinine ratio.