Diabetes-Related Nephropathy

Diabetes-related nephropathy is a common diabetes complication that causes kidney damage. “Nephropathy” (nuh-FROP-uh-thee) means kidney disease or kidney damage. Diabetes-related nephropathy is the most common cause of kidney failure in the world. Between 2 and 4 out of every 10 people who have diabetes may develop diabetes-related nephropathy.

Each of your kidneys contains more than a million nephrons. Nephrons help filter your blood and balance your body’s fluids. Extra glucose in your bloodstream can damage glomeruli in your nephrons. Glomeruli perform the first step in filtering blood. Extra glucose can also damage other parts of the nephron. If your kidneys don’t work as they should, toxins that should leave in your pee build up in your blood and body.

You may hear these other terms for diabetes-related nephropathy:

• Diabetes-related kidney disease (DKD)
• Diabetic nephropathy
• Diabetic kidney disease

What are the five stages of diabetes-related nephropathy?

Healthcare providers stage diabetes-related nephropathy according to your estimated glomerular filtration rate (eGFR). Your eGFR calculates how well your kidneys filter your blood (kidney function). A normal eGFR can range from 60 to over 100. The lowest eGFR is 0. An eGFR of 0 means your kidneys aren’t working at all.

The stages of any kidney disease, including diabetes-related nephropathy, include:

• Stage I: Your eGFR is 90 or higher. At this stage, your kidneys have mild damage. But they still function normally. If there’s no other evidence of kidney disease, this eGFR is normal.
• Stage II: Your eGFR may be as low as 60 or as high as 89. You have more damage to your kidneys than in stage I. But they still function well. Providers may consider this eGFR normal if there’s no other evidence of kidney disease.
• Stage III: Your eGFR may be as low as 30 or as high as 59. You may have mild or moderate loss of kidney function.
• Stage IV: Your eGFR may be as low as 15 or as high as 29. You have moderate to severe loss of kidney function.
• Stage V: Your eGFR is below 15. Your kidneys are nearing or at complete failure.

Symptoms of diabetes-related nephropathy

Diabetes-related nephropathy symptoms usually don’t appear until the condition reaches later stages. As it gets worse, some of the first signs of diabetes-related nephropathy may include:

• Swelling (edema), especially around your face, hands and feet
• Nausea and vomiting
• Feeling really tired (fatigue)
• Foamy pee
• Trouble focusing or confusion
• Dry or itchy skin
• Muscle cramps
• Excessive hiccups
• Metallic taste in your mouth
• Not needing to take as much insulin

What is the first sign?

The early stages of diabetes-related nephropathy usually don’t have any noticeable symptoms. You may have protein in your pee (proteinuria). But you can’t tell there’s protein in your pee unless you take a pee test (urinalysis).

Diabetes-related nephropathy causes

Diabetes causes diabetes-related nephropathy. Type 1 or type 2 diabetes may cause it. Type 2 diabetes is more common than type 1 diabetes.

How long does it take diabetes to damage the kidneys?

It takes years for diabetes to cause kidney damage. Most people with type 1 diabetes usually have some kidney damage within two to five years of getting a diabetes-related nephropathy diagnosis. About 3 or 4 out of 10 people usually progress to a more severe stage of diabetes-related nephropathy within 10 to 30 years.

Experts think type 2 diabetes takes a similar amount of time to damage your kidneys. But many people don’t realize they have type 2 diabetes for a long time because there aren’t obvious symptoms. You may find out you have kidney damage shortly after your healthcare provider diagnoses you with type 2 diabetes.

Risk factors

Anyone with type 1 or type 2 diabetes can develop diabetes-related nephropathy. But you’re at a greater risk of developing it if you’re:

• Black
• Native American, Alaska Native or First Nations
• Polynesian
• Maori

Other risk factors include:

• A biological family history of kidney disease
• A body mass index (BMI) greater than 25 (have overweight/obesity)
• High blood pressure (hypertension)
• High blood sugar (hyperglycemia)
• High cholesterol (hyperlipidemia)
• Using tobacco products

How does diabetes affect the urinary system?

Diabetes can affect your urinary system in many ways. It can:

• Cause you to pee more than usual
• Cause urinary incontinence (loss of bladder control)
• Affect the nerves in your urinary bladder so it doesn’t send your brain signals that it’s filling up, which can cause bladder damage

Diabetes can also affect the nerves that contribute to sexual arousal. This may result in:

• Erectile dysfunction
• Vaginal dryness
• Less intense or absent orgasm (anorgasmia)

How doctors diagnose diabetes-related nephropathy

If you have diabetes, you should schedule regular visits with your healthcare provider to check your kidney health. If they suspect you have diabetes-related nephropathy, they may suggest tests to help them diagnose it. These may include:

• Pee tests, including a dipstick test to look for glucose, blood, protein or other signs of diabetes-related nephropathy
• Blood tests to see how well your kidneys filter your blood
• Imaging tests to examine your kidneys and look at the surrounding blood vessels
• Kidney biopsy to look for signs of disease or damage

Sometimes, your provider can make a diagnosis with only pee or blood tests. But if the diagnosis isn’t clear, you may need other tests.

How do you treat diabetes-related nephropathy?

Treatment depends on what stage you’re in, your age and your overall health. You can’t reverse diabetes-related kidney damage. But treating diabetes is the first step in treating diabetes-related nephropathy. The following lifestyle changes can help you manage diabetes:

• Eating more well-rounded foods that are high in fiber and low in fats and calories
• Getting at least 30 minutes of physical activity most days of the week
• Maintaining a healthy weight for you
• Quitting tobacco products
• Cutting back on alcohol
• Treating high blood pressure
• Avoiding medications that may damage your kidneys, like some nonsteroidal anti-inflammatory drugs (NSAIDs)

Your healthcare provider may prescribe the following medications:

• Metformin, SGLT2 inhibitors or GLP-1 agonists to treat diabetes
• ACE inhibitors or ARBs to treat high blood pressure
• Statins to treat high cholesterol

If you have kidney failure or near kidney failure, treatment may include:

• Dialysis to perform the functions of your kidneys
• Kidney transplant from a donor to perform the job of a failing kidney

When should I see my healthcare provider?

If you have diabetes, you should schedule regular appointments with your healthcare provider to monitor your kidney health. Appointments may be every three to six months, or as recommended by your provider.

Around five years after your initial diabetes diagnosis, providers recommend annual diabetes-related nephropathy testing. Kidney damage usually doesn’t appear within the first 10 years of your diagnosis. If you’ve had diabetes for more than 25 years and don’t have kidney damage, you’re less likely to develop diabetes-related nephropathy.

During your appointments, you may wish to ask the following questions:

• What tests do you recommend to diagnose diabetes-related nephropathy?
• How advanced is my diabetes-related nephropathy?
• Should I see a kidney specialist (nephrologist) or another specialist?
• What lifestyle changes can I make to slow down or stop diabetes-related nephropathy?
• What treatments or medications do you recommend?
• How often should I schedule appointments?
• Can you recommend any support groups?

What can I expect if I have diabetes-related nephropathy?

Diabetes-related nephropathy is a slow-moving condition. If you have it, you can’t reverse kidney damage. But an early diagnosis and following your treatment plan can slow down or even stop it from advancing.

Diabetes-related nephropathy may advance to kidney failure, which may be fatal without treatment. The only treatment options for kidney failure are dialysis or a kidney transplant.