Diabetic Nephropathy (Kidney Disease)

What is diabetic nephropathy?

Nephropathy means your kidneys are not working well. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD.

Diabetes, both type 1 and type 2, is the most common cause of kidney disease. Type 1 is more likely to lead to ESRD.

There are 5 stages of diabetic nephropathy. The final stage is ESRD. Progress from one stage to the next can take many years.

What causes diabetic nephropathy?

Both high blood pressure and high blood sugar damage the kidneys.

• As kidney disease gets worse, physical changes in the kidneys often lead to increased blood pressure.
• Uncontrolled high blood pressure can speed the progress toward ESRD.
• High blood sugar related 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 nephropathy?

Over 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 or microalbuminuria. The kidneys are still able to filter waste during this stage.

As the disease worsens larger amounts of albumin leak into the urine. This stage may be called severely increased albuminuria or macroalbuminuria. As the amount increases, the kidneys can’t cleanse the blood as well. Wastes are left in the blood. Blood pressure often rises as well.

Overall, kidney damage rarely happens in the first 10 years of diabetes. Kidney failure usually 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 developing it decreases.

How is diabetic nephropathy 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 healthcare provider will test your urine to check for a protein called albumin. Normally, urine should not contain any albumin. Having even a small amount of albumin in your urine is a sign that early kidney damage is present.

If kidney disease is detected, your healthcare provider will address it as part of your diabetes treatment plan.

What is the treatment for diabetic nephropathy?

Your healthcare provider will figure out the best treatment for you based on:

• How old you are
• Your overall health and past health
• How sick you are
• How well you can handle specific medicines, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Treatment may include:

• Proper diet, including possibly a recommendation to moderate your protein intake.
• Exercise
• Strict monitoring and controlling of blood glucose levels, often with medicine and insulin injections
• Medicine to lower blood pressure, especially angiotensin-converting enzyme inhibitors or aldosterone receptor blockers.
• Care to avoid other medicines that injure kidneys. These include some pain medicines (NSAIDS) as well as even some commonly used diabetes medicines that are not safe to use in patients with advanced kidney disease (or which may need to be used in smaller doses.)

For ESRD, you will need dialysis to cleanse the blood. Dialysis is a process to filter the toxins out of the blood.

Eventually, kidney transplant may also be a consideration.

Can diabetic nephropathy be prevented?

The progression of diabetic nephropathy can be slowed by closely managing diabetes. This includes taking medicines to lower blood pressure and taking a statin medicine to improve lipid control.

Key points about diabetic nephropathy

• Nephropathy means your kidneys aren’t working well. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD. Diabetes is the most common cause of ESRD.
• Have your urine tested regularly to check for a protein called albumin. Normally, urine should not contain any albumin. Having even a small amount of albumin in your urine is a sign that early kidney damage is present.

Treatment may include:

• Proper diet
• Exercise
• Strict monitoring and controlling of blood glucose levels, often with medicine and insulin injections
• Medicine to lower blood pressure

For ESRD, you will need dialysis to cleanse the blood. Eventually, kidney transplant may also be a consideration.

Next steps

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 you.
• 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 visit.
• Know how you can contact your provider if you have questions.