Diabetic Nephropathy (Kidney Disease)

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 blood pressure.
• 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 intake.
• Exercise
• Strict monitoring and controlling of blood sugar levels, often with medicine and insulin injections
• 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 (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 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.

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.

Medical Reviewer: Robert Hurd MD

Medical Reviewer: Ronald Karlin MD

Medical Reviewer: Raymond Kent Turley BSN MSN RN

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