Diabetic Nephropathy

Topic Overview

What is diabetic nephropathy?

Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage.

What causes diabetic nephropathy?

The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its job as well. Later it may stop working completely. This is called kidney failure.

For reasons doctors don't yet understand, only some people with diabetes get kidney damage. Out of 100 people with diabetes, as many as 40 will get kidney damage.¹

Certain things make you more likely to get diabetic nephropathy. If you also have high blood pressureor high cholesterol, or if you smoke, your risk is higher. Also, Native Americans, African Americans, and Hispanics (especially Mexican Americans) have a higher risk.²

What are the symptoms?

There are no symptoms in the early stages. So it’s important to have regular urine tests to find kidney damage early. Sometimes early kidney damage can be reversed.

The first sign of kidney damage is a small amount of protein in the urine, which is found by a simple urine test.

As damage to the kidneys gets worse, your blood pressure rises. Your cholesterol and triglyceride levels rise too. As your kidneys are less able to do their job, you may notice swelling in your body, at first in your feet and legs.

How is diabetic nephropathy diagnosed?

The problem is diagnosed using simple tests that check for a protein called albumin in the urine. Urine does not usually contain protein. But in the early stages of kidney damage—before you have any symptoms—some protein may be found in your urine, because your kidneys aren't able to filter it out the way they should.

Finding kidney damage early can keep it from getting worse. So it’s important for people with diabetes to have regular testing.

• If you have type 1 diabetes, get a urine test every year after you have had diabetes for 5 years.
• If your child has diabetes, yearly testing should begin at puberty.
• If you have type 2 diabetes, start yearly testing at the time you are diagnosed with diabetes.

How is it treated?

The main treatment is medicine to lower your blood pressure and prevent or slow the damage to your kidneys. These medicines include:

• Angiotensin-converting enzyme inhibitors, also called ACE inhibitors.
• Angiotensin II receptor blockers, also called ARBs.

You may need to take more than one medicine, especially if you also have high blood pressure.

And there are other steps you can take. For example:

• Work with your doctor to keep your blood pressure down, usually below 130/80.
• Work with your doctor to keep your cholesterol level as close to normal as you can. You may need to take medicines for this.
• Keep your heart healthy by eating a low-fat diet and exercising regularly. Preventing heart disease is important, because people with diabetes are 2 to 4 times more likely to die of heart and blood vessel diseases. And people with kidney disease are at an even higher risk for heart disease.
• Watch how much protein you eat. Eating too much is hard on your kidneys. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you.
• Watch how much salt you eat. Eating less salt helps keep high blood pressure from getting worse.
• Don't smoke or use other tobacco products.

How can diabetic nephropathy be prevented?

The best way to prevent kidney damage is to keep your blood sugar under tight control. You do this by staying at a healthy weight, exercising regularly, and taking your medicines as directed.

At the first sign of protein in your urine, you can take high blood pressure medicines to keep kidney damage from getting worse.

Frequently Asked Questions

Learning about diabetic nephropathy:	What is diabetic nephropathy? What causes it? What are the symptoms? Who is at risk?
Being diagnosed:	What tests are done to diagnose diabetic nephropathy? What tests are done to see if the disease is getting worse?
Getting treatment:	How is it treated? What if it gets worse?
Living with diabetic nephropathy:	What can I do to slow the disease? How can I change my diet when I have kidney disease?

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Author:	Caroline Rea, RN, BS, MS	Last Updated: December 12, 2008
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Tushar J. Vachharajani, MD, FASN, FACP - Nephrology
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