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Nutrition & General Wellness

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 amount of the blood protein albumin begin to show in your urine. This first stage of chronic kidney disease is called 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 macroalbuminuria or proteinuria. 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 occurs in the first 10 years of diabetes. Kidney failure usually occurs 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 health care provider will monitor the waste products in your urine. You will also have blood tests. Your health care 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 health care provider will address it as part of your diabetes treatment plan.

What is the treatment for diabetic nephropathy?

Specific treatment for diabetic nephropathy will be determined by your health care provider based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include:

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

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 medications to lower blood pressure.

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 medication and insulin injections
  • Medication 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 health care provider:

  • 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 names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • 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.
Online Medical Reviewer: Grantham, Paula, RN, BSN
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Date Last Reviewed: 11/8/2013
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