Table of ContentsView AllTable of ContentsSymptomsCausesStagesDiagnosisTreatmentLate-Stage Treatment OptionsOutlookTips for Healthy Kidneys
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Stages
Diagnosis
Treatment
Late-Stage Treatment Options
Outlook
Tips for Healthy Kidneys
Diabeticnephropathyis a form of long-term, chronic kidney disease resulting from having had diabetes for several years. Diabetes causes higher-than-normal blood glucose levels, which damage some of the kidney’s blood vessels over time. Damaged blood vessels in the kidneys and other factors, like inflammation, lead to kidney damage.
Around 40% of people with diabetes eventually develop long-term kidney damage,and it is the leading cause of end-stage renal (kidney) disease worldwide.
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What Are the Symptoms of Diabetic Nephropathy?
Initially, diabetic nephropathy doesn’t cause any symptoms. However, symptoms arise as the kidneys worsen over time.
Some potentialsymptomscould include the following:
What Causes Diabetic Nephropathy?
Diabetic nephropathy is a complication of diabetes mellitus, a medical condition that leads tohigh blood glucose. It can occur in almost all diabetes types, including type 2, type 1, and pancreatogenic. These types differ somewhat, but all involve the body’s ability to produce or respond to the hormoneinsulin.
Scientists aren’t completely clear why some people with diabetes develop kidney disease. Elevated glucose may lead tolong-term damage to the blood vesselsin the kidneys. Other factors common in people with diabetes, like inflammation and high blood pressure, may also play a role.
However, diabetic nephropathy doesn’t occur right when you first get diabetes. It may take around 10 years to develop, though this can vary greatly.
Other Risk Factors
Some factors increase the chance that you’ll develop diabetic nephropathy. For example, you have a higher risk of diabetic nephropathy if you are male or advanced in age. People who’ve had diabetes for a long time also have higher risks, as do people who already have other diabetes complications, likeretinopathy.
Examples of additionalrisk factorsinclude:
You may improve these risk factors via lifestyle changes and medications.
Stages of Kidney Disease
In stage 1, the kidneys are only slightly damaged, and in stage 2, they are a bit more so. However, symptoms are usually absent.
If the kidney damage continues, you might develop stage 3, 4, or 5 (end-stage) disease. Symptoms like swelling and fatigue might begin mildly in stage 3, then expand and worsen as the kidneys become more damaged in advanced kidney disease, stages 4 and 5.
If not treated, stage 5 kidney disease leads to symptoms that are ultimately fatal, likecoma.
How Is Diabetic Nephropathy Diagnosed?
Clinicians take a medical history, perform a medical exam, and check the results of additional tests to diagnose diabetic nephropathy. Usually, someone with diabetic nephropathy already knows that they have diabetes. But if they don’t, a healthcare provider will order blood tests for diabetes, likeblood glucoseandhemoglobin A1c.
Screening people with diabetes for nephropathy is critical, as people with early disease might not know that they have it.
Microalbuminuria Urine Tests
Microalbuminuriaurine testscan be used earliest in the disease. Normally, only very small amounts of protein, calledalbumin, in your blood should end up in your urine. The microalbuminuria test shows if more albumin than usual is in your urine.The term “microalbuminuria” has lately been replaced with “moderately increased albuminuria.”
Serum Creatinine Blood Test
Theserum creatininetest measures the amount of creatinine in the blood. Creatinine is a waste protein that the body disposes of through the kidneys, but its levels increase in kidney disease.
Healthcare providers use serum creatinine to calculate the estimated glomerular filtration rate (eGFR). The eGFR is high in people with normal kidneys but has lower results in people with more advanced kidney disease.
Screening for Kidney DiseaseThe American Diabetes Association recommends using urine microalbuminuria and serum creatinine with eGFR to screen for diabetic nephropathy in people with type 1 diabetes who’ve had it for at least five years and in people with type 2 diabetes as soon as they are diagnosed, with additionally yearly screenings.
Screening for Kidney Disease
The American Diabetes Association recommends using urine microalbuminuria and serum creatinine with eGFR to screen for diabetic nephropathy in people with type 1 diabetes who’ve had it for at least five years and in people with type 2 diabetes as soon as they are diagnosed, with additionally yearly screenings.
Kidney Biopsy
Akidney biopsyis an invasive procedure to remove a sample of your kidney and examine it under a microscope. It is usually not needed to diagnose diabetic nephropathy. However, it might be helpful if it’s not clear if diabetes or some other type of problem led to your kidney disease.
How Is Diabetic Nephropathy Treated?
With the exception of a kidney transplant, treatments don’t cure diabetic nephropathy, but they can help prevent your kidneys from getting worse.
Medications for Blood Glucose Management
It’s critical to keep your blood sugar under control, and many different medications can help with that. Your choices will depend on the type of your diabetes, its severity, and your personal preferences.
Some key examples include the following:
However, many other medications for diabetes are potential options.
Other Medication Types
High blood pressure is common in people who have diabetes and can further damage the kidneys, so some people also need medications to lower their blood pressure. Often, healthcare providers prescribe anACE inhibitor-type medicationlike Capoten (captopril).
Because heart disease is also a big problem in diabetes, many people will also need medication for that, such as astatin druglike Lipitor (atorvastatin). These medications may not directly improve your kidneys but may help prevent heart attack and stroke.
Diet and Other Lifestyle Changes
People with diabetic nephropathy need to follow adietthat is healthy for their diabetes but also their kidneys. The following eating patterns may be beneficial:
Some people with kidney disease may also need to limit the amount of high-potassium foods they eat, but check with a healthcare provider before making this adjustment.
Regular exercise also helps reduce glucose levels, lower blood pressure, and decrease stress in people with diabetic nephropathy, which may all help slow the disease. Ideally, over 150 minutes of aerobic activity a week is recommended. Quitting smoking is also essential.
Other Treatments for Complications
People with stage 3 diabetic nephropathy or higher may also need additional treatment to help reduce issues fromchronic kidney disease.Depending on context, this might include:
People with end-stage (stage 5)kidney failurefrom diabetes will die of the condition unless they are treated with dialysis or a kidney transplant. However, you might need to consider your options during stage 4 disease.
Dialysis
The majority of people with end-stage kidney disease go ondialysis. In this approach, you are connected to a machine that cleans your blood—similar to how your kidneys would have done. However, dialysis doesn’t work as well as a normal kidney, which can be time-consuming.
Some people can now receive training to safely perform dialysis at home, potentially overnight. Discuss all your dialysis options with yournephrologist(kidney specialist) or other healthcare provider.
Kidney Transplant
Some people with diabetic nephropathy can get akidney transplant. In some cases, healthcare providers combine a kidney transplant with a pancreas transplant to treat diabetes directly.
Kidney transplants usually help people live longer and have a higher quality of life compared to dialysis. Since the body has two kidneys—and humans can live with only one—some people have a family member or friend donate a kidney for them, and others might get their kidney from a waiting list.
However, some people with diabetic nephropathy are not able to get transplants, especially if their overall medical condition is fragile.
What’s the Outlook for Someone With Diabetic Nephropathy?
People with diabetes who develop nephropathy have ahigher risk of mortalitythan people with diabetes who don’t. These risks increase with later stages of kidney disease.
Cardiovascular diseaseis a significant concern for all people with diabetes, including those who have diabetic nephropathy. For example, it’s more likely that someone with type 2 diabetes and early-stage nephropathy will have aheart attackorstrokethan that they will develop end-stage kidney disease.
A significant number of people with diabetic nephropathy do eventually develop end-stage disease. But not all do, especially those diagnosed early and optimally treated.
Proportionally, people with type 1 diabetes are more likely to develop end-stage kidney disease compared to people with type 2 diabetes. However, over half of people with diabetes on dialysis for nephropathy have type 2 disease because type 2 is comparatively more common.
If you’ve been diagnosed with diabetes but don’t have kidney damage, take steps to help prevent diabetic nephropathy or at least delay it. And if you already have some degree of kidney damage, you can act to slow or stop your kidney decline.
Summary
Roughly 40% of people with diabetes eventually develop diabetic nephropathy. It usually doesn’t happen until you’ve had diabetes for several years. People with early-stage diabetic nephropathy often don’t have any symptoms, so all people with diabetes need kidney monitoring.
By being proactive about your health, you can help prevent diabetic nephropathy or slow its progression. By working closely with a medical professional on therapies and lifestyle changes, you can decrease your risk of end-stage kidney disease and reduce your risk of heart attack and stroke.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Nordheim E, Geir Jenssen T.Chronic kidney disease in patients with diabetes mellitus.Endocr Connect. 2021;10(5):R151-R159. doi:10.1530/EC-21-0097
Thipsawat S.Early detection of diabetic nephropathy in patients with type 2 diabetes mellitus: a review of the literature.Diab Vasc Dis Res. 2021;18(6):14791641211058856. doi:10.1177/14791641211058856
Cheo SW, Low QJ, Lim TH, et al.A practical approach to chronic kidney disease in primary care.Malays Fam Physician. 2022;17(1):10-19. doi:10.51866/rv1186
Tziomalos K, Athyros VG.Diabetic nephropathy: New risk factors and improvements in diagnosis.Rev Diabet Stud. 2015;12(1-2):110-118. doi:10.1900/RDS.2015.12.110
McGrath K, Edi R.Diabetic kidney disease: diagnosis, treatment, and prevention.Am Fam Physician. 2019;99(12):751-759.
Arnold M, Buelt A.Chronic kidney disease: evaluation and treatment guidelines from the VA/DoD.Am Fam Physician.2020;102(6):378-379.
Wouk N.End-stage renal disease: Medical management.Am Fam Physician. 2021;104(5):493-499.
Pérez-Sáez MJ, Pascual J.Kidney transplantation in the diabetic patient.J Clin Med. 2015;4(6):1269-80. doi:10.3390/jcm4061269
Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T.Diabetic kidney disease: world wide difference of prevalence and risk factors.J Nephropharmacol. 2015;5(1):49-56.
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