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Diabetes and kidney disease

Kidney disease or kidney damage that occurs in people with diabetes  is called diabetic nephropathy. This condition is a complication of diabetes.

Alternative Names

Diabetic nephropathy; Nephropathy - diabetic; Diabetic glomerulosclerosis; Kimmelstiel-Wilson disease 

Causes

Each kidney is made of hundreds of thousands of small units called nephrons. These structures filter your blood, help remove waste from the body, and control fluid balance.

In people with diabetes, the nephrons slowly thicken and become scarred over time. The kidneys begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin. 

Kidney damage is more likely if you:

  • Have uncontrolled blood sugar
  • Have high blood pressure
  • Have type 1 diabetes that began before you were 20 years old
  • Have family members who also have diabetes and kidney problems
  • Smoke
  • Are African American, Mexican American, or Native American

Symptoms

Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start.

People who have more severe and long-term (chronic) kidney disease may have symptoms such as:

Exams and Tests

Your health care provider will order tests to detect signs of kidney problems. 

A urine test looks for a protein called albumin leaking into the urine.

  • Too much albumin in the urine is often a sign of kidney damage.
  • This test is also called a microalbuminuria  test because it measures small amounts of albumin.

Your health care provider will also check your blood pressure. This is because if you have diabetic nephropathy, you likely also have high blood pressure.

A kidney biopsy  may be ordered to confirm the diagnosis or look for other causes of kidney damage. 

If you have diabetes, your health care provider will also check your kidneys by using the following blood tests every year:

Treatment

When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse.

Follow your health care provider's advice to keep your condition from getting worse.

CONTROL YOUR BLOOD PRESSURE

Keeping your blood pressure under control (below 130/80) is one of the best ways to slow kidney damage.

  • Your doctor may prescribe medicines to lower your blood pressure and protect your kidneys from more damage.
  • Taking these medicines, even when your  blood pressure is in a healthy range, helps slow kidney damage.

CONTROL YOUR BLOOD SUGAR LEVEL

You can also slow kidney damage by controlling your blood sugar level, which you can do by:

  • Eating healthy foods
  • Taking medicine or insulin as instructed by your health care provider
  • Checking your blood sugar level as often as instructed and keeping a record of your blood sugar numbers so that you know how meals and activities affect your level

OTHER WAYS TO PROTECT YOUR KIDNEYS

  • Before having an MRI, CT scan, or other imaging test in which you receive a contrast dye, tell the health care provider who is ordering the test that you have diabetes. Contrast dye can cause more damage to your kidneys.
  • Before taking an NSAID pain medicine, such as ibuprofen or naproxen, ask your health care provider if there is another kind of medicine that you can take instead. NSAIDs can damage the kidneys, especially when you use them often.
  • Know the signs of urinary tract infections and get them treated right away.

Support Groups

Many resources can help you understand more about diabetes. You can also learn ways to manage your kidney disease.

Outlook (Prognosis)

The health care provider may need to stop some of your medicines because they can harm your kidneys if diabetic nephropathy is getting worse.

Diabetic kidney disease is a major cause of sickness and death in people with diabetes. It can lead to the need for dialysis or a kidney transplant .

When to Contact a Medical Professional

Call your health care provider if you have diabetes and you have not had a urine test to check for protein.

References

American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37 Suppl 1:S14-S80.

National Kidney Foundation. KDOQI Clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60:850-886.

Parving H, Mauer M, Fioretto P, et al. Diabetic nephropathy. In: Taal MW, Chertow GM, Marsden PA, et al., eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 38.

Updated: 8/5/2014

Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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