Diabetic Nephropathy (Kidney Disease)
What is diabetic kidney disease?
Diabetic kidney disease (DKD) is kidney disease that is due to diabetes. It is also
called diabetic nephropathy. Nephropathy means your kidneys aren't working well.
Type 1 and type 2 diabetes are the most common causes of kidney disease.
There are 5 stages of DKD. The final stage is kidney failure (end-stage renal disease
or ESRD). Going from one stage to the next can take many years.
What causes diabetic kidney disease?
Both high blood pressure and high blood sugar damage the kidneys.
As kidney disease gets worse, physical changes in the kidneys often lead to higher
Uncontrolled high blood pressure can speed the progress toward ESRD.
High blood sugar linked to diabetes damages the kidney in several different ways.
Mainly, it damages the blood vessels that filter the blood to make urine.
What are the symptoms of diabetic kidney disease?
At first, most people with DKD don't have symptoms. Having your kidney function checked
is the only way to know if there are problems. Over the years, as kidney disease develops,
small amounts of the blood protein albumin begin to show in your urine. This first
stage of chronic kidney disease is called moderately increased albuminuria (previously
called microalbuminuria). The kidneys can still filter waste during this stage.
As the disease worsens, more albumin leaks into the urine. This stage is called severely
increased albuminuria (previously called macroalbuminuria). As the albumin increases,
the kidneys can’t cleanse the blood as well. Wastes are left in the blood. Blood pressure
often rises as well.
It is rare for kidney damage to happen in the first 10 years of diabetes. Kidney failure
often happens 15 to 25 years after the first symptoms of diabetes. If you have had
diabetes for more than 25 years without any signs of kidney failure, your risk of
having it decreases.
How is diabetic kidney disease diagnosed?
If you have diabetes, it’s important to be checked regularly for kidney disease. To
do this, your healthcare provider will monitor the waste products in your blood and
urine. Your provider will test your urine to check for a protein called albumin. Normally,
urine should not have any albumin. Even a small amount of albumin in your urine is
a sign of early kidney damage. The main waste product checked for in the blood is
known as creatinine.
If kidney disease is found, your healthcare provider will address it as part of your
diabetes treatment plan.
What is the treatment for diabetic kidney disease?
Treatment will depend on your symptoms, age, and general health. It will also depend
on how severe the condition is.
Treatment may include:
Following the correct diet, including possibly being advised to watch your protein
Strict monitoring and controlling of blood sugar levels, often with medicine and insulin
Medicine to lower blood pressure (especially angiotensin-converting enzyme inhibitors
or aldosterone receptor blockers)
Not taking other medicines that harm the kidneys. These include some pain medicines
(NSAIDs) as well as even some commonly used diabetes medicines that are not safe to
use in people with advanced kidney disease (or which may need to be used in smaller
doses.) If your DKD becomes more severe, you will need a referral to a kidney specialist
For kidney failure, you will need dialysis to cleanse the blood. Dialysis is a process
to filter the toxins out of the blood.
Over time, kidney transplant may also be a consideration. You may also benefit from
having a pancreas transplant at the same time at this stage.
Can diabetic kidney disease be prevented?
The progression of DKD can be slowed by closely managing diabetes. This includes:
Watching your A1C level
Eating a healthy diet
Staying at a healthy weight
Getting enough sleep
Taking medicines to lower blood pressure
Taking a statin medicine to improve lipid control
Key points about diabetic kidney disease
Diabetic kidney disease is kidney disease that is due to diabetes.
Both type 1 and type 2 diabetes are the most common cause of kidney disease.
There are 5 stages of the disease. The final stage is kidney failure. Going from one
stage to the next can take many years.
Most people don't have symptoms. Having your kidney function checked is the only way
to know if there are problems.
Have your urine tested regularly to check for a protein called albumin. Even a small
amount of albumin in your urine is a sign of early kidney damage.
Treatment may include proper diet, exercise, controlling blood sugar levels, and medicine
to lower blood pressure.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.