Diabetes and The Kidneys: What You Should Know About Diabetic Nephropathy

Diabetic Nephropathy is the onset of kidney disease that can result from both Type 1 and Type 2 diabetes. It is a very serious condition and the number one cause of kidney failure in the United States. This isn’t too surprising when you consider that nearly one-third of all individuals in the United States living with diabetes will eventually develop diabetic nephropathy.

What is Diabetic Nephropathy?

Diabetic nephropathy reduces the kidneys’ ability to properly do their job, which is to remove waste and excess fluids from the body.

Kidneys filter the blood as it passes through clusters of small blood vessels within the organ known as “glomeruli”. The cleaned blood returns to the rest of the body through a vein, while waste products and excess fluids are removed from the body through urination. In cases of diabetic nephropathy, this process is inhibited by damage to the fragile filtering systems of the kidneys.

There are five stages of diabetic nephropathy. The earlier it is discovered the quicker treatment can be provided to slow or even prevent the progression of the disease.

Five Stages of Diabetic Nephropathy

Stage 1: Kidney damage is present, but the organs still function normally.

Stage 2: Kidneys begin to lose some function.

Stage 3: Kidneys experience a mild to severe loss of function.

Stage 4: Kidneys are severely damaged with a dramatic loss of function.

Stage 5: This is End Stage Renal Disease (ESRD), the kidneys no longer function, and dialysis is required.

The Link Between Diabetes and Kidney Disease

Why are people living with diabetes at greater risk of kidney disease than those who aren’t? According to Johns Hopkins Medicine, high blood sugar and high blood pressure can be the culprits that lead to diabetic nephropathy.

Hypertension (high blood pressure) is a complication associated with diabetes, that is particularly prevalent among individuals who have trouble effectively managing the disease through regular blood sugar testing, insulin treatments and other prescribed medications.

It's believed that uncontrolled hypertension can both contribute to diabetic nephropathy and be a symptom of the damage the disease causes – a double-edge sword so to speak. Additionally, prolonged high blood sugar associated with diabetes can damage the kidneys in other ways, most notably by weakening the blood vessels that filter the blood.

Does Diabetes Type Matter?

Diabetic nephropathy is the same disease regardless of whether you have Type 1 or Type 2 diabetes. However, there are some differences in the way it progresses. For instance, nephropathy rarely begins within the first 10 years after someone is diagnosed with Type 1 diabetes. Contrarily, many individuals newly diagnosed with Type 2 diabetes already have some level of kidney damage, likely due to other contributing factors such as high blood pressure, high cholesterol, and nerve damage.

Symptoms of Diabetic Nephropathy

One of the most dangerous aspects of diabetic nephropathy is that telltale symptoms rarely present themselves in the early stages of the disease. In fact, of the five stages, it’s quite normal for a person to feel completely fine well into the third stage. However, after reaching stages 4 and 5, it’s common for a person to start feeling ill and experience the following symptoms.

– Swelling of the hands, feet, and face

– Trouble sleeping or concentrating

– Lack of appetite

– Nausea

– Muscle twitching

– Increased need to urinate

– Fatigue

– Shortness of breath

– Persistent itchiness (usually close to end-stage kidney disease)

– Drowsiness (usually close to end-stage kidney disease)

How is Diabetic Nephropathy Diagnosed?

Certain blood tests can be used to diagnose kidney disease. However, it is most often detected with a urine test. Doctors look for a protein called “albumin” in the urine. When the kidneys are functioning properly there should be zero traces of this protein in the urine. However, when the kidneys are damaged, albumin becomes present. Having even a trace amount of albumin in the urine is a sign that early kidney damage has already occurred.

How Often Should I Be Tested?

According to the American Diabetes Association (ADA), people with Type 1 diabetes should be tested for nephropathy five years after being diagnosed, after which they should be tested annually. Individuals with Type 2 diabetes should be tested at the time of diagnosis and also be tested once per year after that. Of course, if you are living with diabetes and experience any of the associated symptoms of nephropathy, it is vital that you see your doctor right away. The sooner kidney disease is detected, the better the chances of preventing kidney failure.

Can Diabetic Nephropathy Be Prevented?

There is no way to eliminate the risk for diabetic nephropathy, however, there are things you can do to slow or even prevent the diseases development.

  1. Proper Diabetes Management – The root cause of nephropathy is hyperglycemia related to poor blood sugar control. It is critical that you follow your doctor-prescribed blood sugar testing schedule using a glucose meter and test strips. If you are having problems maintaining proper blood sugar levels, ask your doctor about using a continuous glucose monitoring (CGM) device that can provide added control. If you administer insulin by syringe or pen, follow your medication schedule. If you use an insulin pump or patch delivery system, be sure they are functioning and that you are using them properly.
  1. Manage Hypertension – Usually accelerated by poor blood sugar control, high blood pressure increases the risk of kidney disease and speeds the progression once developed. Dietary changes, such as lowering sodium and potassium intake, as well as doctor-prescribed ACE inhibitors or angiotensin receptor blockers (ARBs), can be effective in managing hypertension and, thereby, slowing the progression of nephropathy.
  1. Maintain A Healthy Weight – Carrying too much weight increases the risk of hypertension, which increases the risk of kidney disease. Ask your doctor about creating a dietary and physical activity program to help you shed those excess pounds.
  1. Don’t Smoke – Cigarettes damage the kidneys, so if you are experiencing nephropathy, they will only make matters worse. It can be hard to quit, but the good news is there are many effective smoking cessation products available. You can also ask your doctor about programs that might help you stop.

Can Diabetic Nephropathy Be Reversed?

Unfortunately, the answer is no. Once kidney damage has occurred it cannot be reversed. However, with proper care and treatment diabetic nephropathy can be slowed and full kidney failure can be avoided. That’s why early detection is so important.


If you’re living with Type 1 or Type 2 diabetes you are at higher risk for developing kidney disease. However, as with most complications surrounding diabetes, the better you manage your disease and the more often you make smart lifestyle choices, the less your risk becomes. If you haven’t already been tested for nephropathy, ask your doctor about getting tested. The sooner you know, the better your chances of slowing the disease and preventing kidney failure.


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