Diabetic Kidney Disease

Condition Basics

What is diabetic kidney disease?

Diabetic kidney disease is damage to your kidneys caused by diabetes. This is sometimes called diabetic nephropathy. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage.

What causes it?

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.

What are the symptoms?

There are no symptoms in the early stages. So it's important to have regular urine tests to find kidney damage early. As your kidneys are less able to do their job, you may have swelling in your body, often in your feet and legs. Other symptoms may include poor appetite, weight loss, and weakness.

How is it 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 called 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).

How is diabetic kidney disease treated?

The main treatment for diabetic kidney disease is medicine to lower your blood pressure and prevent or slow kidney damage. Lifestyle changes can help. Keeping your blood sugar levels within your target range can also help slow kidney damage.

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Prevention

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.

Symptoms

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:

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.

Exams and Tests

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, sex, and race 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.footnote 1

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Treatment Overview

The main treatment is medicine to lower your blood pressure and prevent or slow the damage to your kidneys. Medicines include:

  • Angiotensin-converting enzyme inhibitors, also called ACE inhibitors.
  • Angiotensin II receptor blockers, also called ARBs.

There are other steps you can take. For example:

  • Keep your blood sugar levels within your target range.
  • Work with your doctor to keep your blood pressure under control.
  • Eat heart-healthy foods, and exercise regularly.
  • Limit your protein. Eating too much protein is hard on your kidneys. Talk to your doctor or dietitian about how much protein is best.
  • Limit your salt. This helps keep high blood pressure from getting worse.

As kidney damage gets worse, your blood pressure and cholesterol level rise. You may need to take more than one medicine to treat these problems. If damage becomes severe, you may need kidney dialysis or a transplant.

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Self-Care

  • 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.

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References

Citations

  1. American Diabetes Association (2021). Standards of medical care in diabetes—2021. Diabetes Care, 44(Suppl 1): S1–S232. Accessed January 5, 2021.

Credits

Current as of: December 2, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
Tushar J. Vachharajani MD, FASN, FACP - Nephrology