Definition

Diabetic nephropathy is kidney damage that occurs with diabetes. It is the job of the kidneys to:

• Filter blood
• Catch needed substances and return them to circulation
• Create urine to pass waste out of the body

Damage from diabetes can prevent the kidneys from working well. In some cases, this can lead to kidney failure.

Anatomy of the Kidney Copyright © Nucleus Medical Media, Inc.

Causes

Blood passes through small filters in the kidneys. Changes in the blood vessels due to diabetes can cause damage to these filters. Blood sugar levels that are not well-controlled can have the greatest impact on the kidney filters.

Over time, the damage to the filters increases. The damaged filters cannot clean the blood properly and protein from the blood can leak into the urine. If left untreated, this can lead to kidney failure.

Risk Factors

Factors that may increase your chance of diabetic nephropathy include Type 1 diabetes and Type 2 diabetes with:

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

Symptoms

Before symptoms appear early indications may include:

• Protein in your urine when it is tested
• Elevated blood urea nitrogen and creatine when your blood is tested
• High blood pressure

Symptoms may not appear until the kidney damage is severe. Symptoms may include:

• Fluid buildup may appear as swelling in feet or hands
• Weakness
• Loss of appetite, nausea, and vomiting
• Difficulty sleeping
• Confusion and trouble concentrating

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids will be tested. This can be done with:

• Blood tests to check kidney function
• Urine tests to look for protein

You may have an ultrasound of your kidneys

If testing shows severe kidney disease you may have a kidney biopsy

Treatment

Talk with your doctor about the best treatment plan for you.

Treatment is aimed at preventing or slowing further kidney damage. It may involve lifestyle changes and medications. Diabetes and blood pressure will both need to be controlled. This may help prevent further kidney damage.

Prevention

To help reduce your chances of diabetic nephropathy:

• See your doctor regularly. During checkups, you will have your blood pressure, urine, blood, and organs monitored for changes.
• Control blood glucose levels. Follow your diabetes treatment regimen as directed.
• Work with your doctor to maintain a healthy blood pressure (less than 130/80 mmHg).
• Exercise daily.
• If you smoke, talk to your doctor about ways to quit.