Diabetic nephropathy

Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes.

The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its job as well. Later it may stop working completely. This is called kidney failure.

Diabetic nephropathy is treated with medicine to slow or prevent further kidney damage. It can often be prevented by keeping blood sugar levels within a target range.


What are the symptoms of diabetic kidney disease?

There are no symptoms in the early stages of diabetic kidney disease. If you have kidney damage, you may have small amounts of protein leaking into your urine. (This is called albuminuria.)

As diabetic kidney disease progresses, your kidneys can't do their job as they should. They can't clear toxins or balance the chemicals in your blood very well. You may:

  • Lose more protein in your urine.
  • Have higher blood pressure.
  • Have higher cholesterol and triglyceride levels.

You may have symptoms if your kidney disease gets worse. They include:

  • Swelling (edema), first in the feet and legs and later throughout your body.
  • Poor appetite.
  • Weight loss.
  • Weakness.
  • Feeling tired or worn out.
  • Nausea or vomiting.
  • Trouble sleeping.

If the kidneys are severely damaged, blood sugar levels may drop. That's because the kidneys can't remove excess insulin or filter medicines that increase insulin production.


What causes diabetic kidney disease?

The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its job as well. Later it may stop working completely. This is called kidney failure.


How is diabetic kidney disease diagnosed?

Diabetic kidney disease is diagnosed using tests that check how well your kidneys are working. These include a test that checks for a protein (albumin) in the urine. Another test checks how well your kidneys are filtering waste from your blood. This is called the estimated glomerular filtration rate (eGFR).

An albumin urine test can detect very small amounts of protein in the urine. This allows doctors to find kidney disease early. Starting treatment early can prevent further damage to the kidneys.

The eGFR is measured using a formula that compares a person's size, age, and sex to blood creatinine levels. As kidney disease gets worse, the eGFR number goes down.

When your doctor will start checking your kidney function depends on the type of diabetes you have. After testing starts, it should be done every year.

Kidney function testing

Type of diabetes

When to start yearly testing

Type 1 diabetes

After you've had diabetes for 5 years

Type 2 diabetes

When you are diagnosed with diabetes

Diabetes during childhood

After age 10 and after the child has had diabetes for 5 years

If your doctor thinks that the protein in your urine or a decreased eGFR may be caused by a disease other than diabetes, other blood and urine tests may be done. You may have a small sample of kidney tissue removed and checked. This is called a kidney biopsy.


How can diabetic kidney disease be prevented?

To help prevent kidney damage, keep your blood sugar in your target range and control your blood pressure. Do this by eating healthy foods, staying at a healthy weight, exercising regularly, and taking medicines as directed. If there's protein in your urine, high blood pressure medicines can help keep kidney damage from getting worse.


How is diabetic kidney disease treated?

Diabetic kidney disease is treated with medicines that lower blood pressure and protect the kidneys. These medicines may slow down kidney damage. They are started as soon as any protein is found in the urine or the estimated glomerular filtration rate (eGFR) falls below a certain level.

Medicines used at the start of treatment include:

  • Angiotensin-converting enzyme (ACE) inhibitors. They include enalapril, lisinopril, and ramipril. They can lower the amount of protein being lost in the urine. And they may reduce your risk of heart and blood vessel disease.
  • Angiotensin II receptor blockers (ARBs). They include candesartan cilexetil, irbesartan, and losartan potassium.

If you have high blood pressure, you may need two or more medicines to lower your blood pressure enough to protect the kidneys. By lowering your blood pressure, you may reduce your risk of kidney damage.

It's also important to keep your blood sugar within your target range. This prevents damage to the small blood vessels in the kidneys.

Limiting the amount of salt in your diet can help keep your high blood pressure from getting worse. You may also want to limit the amount of protein in your diet. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.

If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen.

Ongoing treatment

As kidney damage gets worse, blood pressure usually rises. You may need to take different combinations of medicines to control your blood pressure. They include:

  • ACE inhibitors or ARBs.
  • Calcium channel blockers. These lower blood pressure by making it easier for blood to flow through the vessels. Examples include amlodipine and diltiazem.
  • Diuretics. These include hydrochlorothiazide and spironolactone. They help lower blood pressure by removing sodium and water from the body.
  • Glucagon-like peptide-1 (GLP-1) receptor agonists. These help your body make a protein that can raise your insulin level and make you less hungry. They can also lower your blood pressure. Some examples include exenatide and semaglutide.
  • Sodium glucose co-transporter 2 inhibitors (SGLT2 inhibitors). These medicines help remove extra glucose through your urine. They can also help decrease your weight and blood pressure. These include dapagliflozin and empagliflozin.

Treatment for kidney failure

If damage to the blood vessels in the kidneys keeps getting worse, you may later have kidney failure. When that happens, you will likely need dialysis treatment. (This is also called renal replacement therapy.) It's an artificial method of filtering the blood. Or you may need a kidney transplant to survive.


How can you care for yourself when you have diabetic kidney disease?

  • Take your medicines exactly as prescribed. It is very important that you take your insulin or other diabetes medicine as your doctor tells you. Call your doctor if you think you are having a problem with your medicine.
  • Try to keep blood sugar in your target range.
    • Eat a variety of healthy foods and follow your meal plan to know how much carbohydrate you need for meals and snacks. Your doctor may restrict your protein. A dietitian can help you plan meals.
    • If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
    • Check your blood sugar as often as your doctor recommends.
  • Take and record your blood pressure at home if your doctor tells you to. To take your blood pressure at home:
    • Ask your doctor to check your blood pressure monitor. Your doctor can make sure that it is accurate and that the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.
    • Do not use tobacco products or use medicine known to raise blood pressure (such as some nasal decongestant sprays) before taking your blood pressure.
    • Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before taking a reading.
  • Eat a low-salt diet to help keep your blood pressure in your target range.
  • Do not smoke. Smoking raises your risk of many health problems, including diabetic kidney disease. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
  • Do not take ibuprofen, naproxen, or similar medicines, unless your doctor tells you to. These medicines may make kidney problems worse.

Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.

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