Increased GFR or decreased GFR in DM causes diabetic nephropathy?

Hi everyone,

I am a little confused about the pathogenesis of diabetic nephropathy in DM. Is it...

...hyperglycaemia inducing vasodilation in the renal arteries ---> increased GFR ---> damage to the glomerulus ---> eventually, end stage renal disease?

OR

...hyaline arterial stenosis of renal arteries ---> decreased GFR ---> nephrotic syndrome ---> end stage renal disease?

OR

...hyperglycaemia inducing matrix proliferation in the glomerulus ---> decreased GFR ---> damage to the glomerulus ---> end stage renal disease?

OR

...none of the above?

Would appreciate it if anyone who can shed some light! Thanks!

Authored By Syaza Faizul on Sunday 8th December 2013