Diabetic nephropathy is kidney damage that occurs with diabetes. It can keep the kidneys from doing their job of removing waste and extra fluid from the body. In some people, this can lead to kidney failure.

Anatomy of the Kidney

Causes

Blood passes through small filters in the kidneys. Changes in the blood vessels due to diabetes can cause damage to these filters. This can make it hard for them to clean the blood properly and cause protein from the blood to leak into the urine. If left untreated, this can lead to kidney failure.

Risk Factors

Things that may raise the risk of this problem are Type 1 diabetes and Type 2 diabetes with:

Poor control of blood glucose
High blood pressure —puts further stress on the kidneys and increases the risk of kidney damage
High cholesterol

Symptoms

Problems may not appear until kidney damage is severe. A person may have:

Weakness
Lack of hunger
Nausea and vomiting
Swelling in the feet or hands
Problems sleeping
Confusion and trouble with focus

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Blood tests will be done to check kidney function. Urine tests will be done to look for protein, which is an early sign of kidney damage.

If the diagnosis is not clear, a kidney biopsy may be done to test for damage.

Treatment

The goal of treatment is to prevent or slow damage. Diabetes and blood pressure will both need to be controlled. Treatment options are:

Lifestyle Changes

Lifestyle changes that will help control blood sugar and blood pressure are:

Reaching or maintaining a healthy weight
Exercising regularly
Limiting salt and protein
Not smoking
Avoiding alcohol

Medications

Medicine may be given to help control diabetes, reduce protein in the urine, protect the kidneys, and treat high blood pressure. Options are:

Angiotensin-converting enzyme inhibitors (ACE inhibitors)
Angiotensin receptor blockers (ARBs)
Aldosterone antagonists
Medicines to lower cholesterol

Treatments for Kidney Failure

Dialysis may be needed for those with kidney failure. Dialysis takes over the job of the kidneys. Blood passes out of the body into a machine. The machine filters waste out of the blood then pumps blood back to the body.

If the kidney failure progresses, a kidney transplant may be needed.

Prevention

People with diabetes and high blood pressure can lower the risk of this problem by following their care plan.

RESOURCES:

American Diabetes Association
http://www.diabetes.org

National Kidney Foundation
http://www.kidney.org

CANADIAN RESOURCES

Canadian Diabetes Association
http://www.diabetes.ca

The Kidney Foundation of Canada
http://www.kidney.ca

References:

Diabetic kidney disease. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/diabetic-kidney-disease. Accessed August 17, 2021.

Diabetic nephropathy. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/diabetic-nephropathy. Accessed August 17, 2021.

Kidney disease (nephropathy). American Diabetes Association website. Available at: https://www.diabetes.org/diabetes/complications/kidney-disease-nephropathy. Accessed August 17, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board James Cornell, MD
Last Updated: 8/17/2021

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