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 normally.

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 1 stage to the next can take many years.

What causes diabetic kidney disease?

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.

People with diabetes also often develop high blood pressure. This can also damage your kidneys.

What are the symptoms of diabetic kidney disease?

Until DKD is severe, most people with it don't have symptoms. Having your kidney function checked by a simple blood and urine test is the only way to know if there are problems. Normal kidneys don't leak protein. But with diabetic nephropathy, protein shows up in your urine. Albumin is the most common protein in the blood. Albumin leaks into the urine in diabetic nephropathy. Increasing albumin in urine (called albuminuria) is a sign that the kidneys are less able to filter It also is linked to worsening heart and blood vessels problems in people with diabetes.

A routine urine dipstick test doesn't pick up albuminuria (albumin in the urine) until you are leaking more than 300 to 500 mg a day. This used to be referred to as macroalbuminuria. It's now also called severely increased albuminuria. For amounts less than 300 mg a day, the term is moderately increased albuminuria. This change in wording shows that any amount of protein in the urine is abnormal.

It is rare for kidney failure 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 keep track of your blood and urine. Your provider will test your urine to check for the 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. It's used as a measure of your kidney filtration rate. It goes up as your kidneys' ability to filter does down.

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 how much protein you eat

• Exercise

• Strict checking on and controlling of blood sugar levels, often with medicine and insulin injections

• Medicine to lower blood pressure. These include angiotensin-converting enzyme inhibitors and aldosterone receptor blockers.

• New medicines for diabetes that prevent DKD or its getting worse. These include SLGT2 inhibitors and GLP1 agonists.

• Not taking other medicines that harm the kidneys. These include some pain medicines 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 (nephrologist).

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

• Exercising

• Not smoking

• Staying at a healthy weight

• Getting enough sleep

• Limiting alcohol

• 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 1 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 correct diet, exercise, controlling blood sugar levels, and medicine to lower blood pressure.

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.