Diabetes-related nephropathy is a progressive disease that affects your kidneys. Long-standing diabetes causes diabetes-related nephropathy. Symptoms don’t appear until later stages, but they include swelling, peeing more often, foamy pee, nausea and fatigue. Treatment includes managing your diabetes and blood pressure.
Diabetes-related nephropathy is a condition that affects your kidneys. Another name for diabetes-related nephropathy is diabetes-related kidney disease (DKD).
Your kidneys filter waste from your body. Common waste products include nitrogen waste products such as urea, muscle waste (creatinine) and many other toxins. Your kidneys also help balance your body’s fluids and electrolytes. Each kidney contains more than a million nephrons, which help filter your blood and keep all of this in balance.
Each nephron contains groups of tiny blood vessels called glomeruli (glo-mare-yoo-lye). Glomeruli perform the first step in filtering your blood. Glomeruli have semi-permeable membranes. These semi-permeable membranes allow water and soluble wastes to pass through, which eventually leave your body in your urine (pee).
Diabetes causes diabetes-related nephropathy. If you have diabetes, your body can’t properly process the blood sugar (glucose) from the foods and drinks you consume. Extra glucose in your bloodstream may damage the glomerular membranes as well as other parts of the nephron.
Damaged glomeruli can’t properly filter fluids. If the glomeruli can’t properly filter fluids, toxins that should leave in your pee accumulate in your blood and body.
Yes, diabetes-related nephropathy is serious.
Diabetes-related nephropathy may lead to kidney failure. Kidney failure can be fatal.
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There are certain diabetes-related nephropathy stages according to your estimated glomerular filtration rate (eGFR).
Your eGFR is a calculation of how efficiently your kidneys filter substances. A normal eGFR is about 100. The lowest eGFR is 0, which means there is no remaining kidney function.
The stages of any kidney disease, including diabetes-related nephropathy, include:
Other risk factors include:
Diabetes-related nephropathy is common. It’s the most common cause of end-stage renal (kidney) disease in the world.
About 40% of people who have diabetes develop diabetes-related nephropathy.
Diabetes-related nephropathy symptoms usually don’t appear until it has affected at least 80% to 90% of your kidneys. These symptoms include:
The early stages of diabetes-related nephropathy usually don’t exhibit any symptoms. You may have protein in your pee (proteinuria). But you can’t tell there’s protein in your pee unless your healthcare provider conducts a urinalysis.
Type 1 or type 2 diabetes causes diabetes-related nephropathy.
No, diabetes-related nephropathy isn’t contagious. You can’t spread diabetes-related nephropathy to another person.
If you have diabetes, you should see your healthcare provider every three to six months (or as instructed by your provider) to check your health. If your healthcare provider suspects you may have diabetes-related nephropathy, they may order tests.
The following tests help diagnose diabetes-related nephropathy:
A urinalysis (urine test) examines the visual, chemical and microscopic aspects of your pee. Your provider will use a dipstick to conduct a urinalysis. Your healthcare provider may recommend a few different types of urinalysis tests.
To use a dipstick, you’ll pee into a special container at your healthcare provider’s office or a hospital. Then, a healthcare provider will place a strip of paper coated with special chemicals (dipstick) into the container. The dipstick will change color if protein (albumin) is in your pee.
If your healthcare provider needs a more precise measurement, they may recommend a urine protein test. To test for urine protein, your pee sample goes to a lab for testing. Lab technicians compare how much protein and creatinine are in your pee (protein-to-creatinine ratio). If your urine sample has a much higher ratio of protein to creatinine, it may indicate diabetes-related nephropathy.
An eGFR test calculates your kidneys’ ability to filter blood.
Your healthcare provider will use a thin needle (21 gauge, slightly smaller than the size of a standard earring) to withdraw a small amount of blood from a vein in your arm. Your healthcare provider then uses a formula, some of your general basic health information and the creatinine levels in your blood to determine your eGFR.
Imaging tests can help your healthcare provider determine your kidneys’ health.
Ultrasounds are noninvasive imaging tests that can show the structure and size of your kidneys.
During a kidney biopsy, your healthcare provider will remove a small piece of your kidney tissue to examine at a lab under a microscope.
Your healthcare provider will first numb the area with a local anesthetic so you won’t feel any pain. They’ll also give you a light sedative to help you relax. Then, they’ll insert a needle through your skin and into your kidney to collect the tissue sample.
Treatment depends on what stage you’re in, your age and your overall health. Treating your diabetes is the first step in treating diabetes-related nephropathy. The following can help you manage your diabetes:
If you have high blood pressure, it’s also essential to treat it. Your healthcare provider may prescribe medications to treat high blood pressure.
No, you can’t reverse diabetes-related kidney damage. But you can slow down or even stop further kidney damage by taking medications as prescribed by your healthcare provider, eating well and being physically active.
To slow down diabetes-related nephropathy, it’s essential that you control your diabetes, lower your blood pressure and lower your cholesterol. Your healthcare provider may prescribe the following medications to help treat these conditions:
Many different Food and Drug Administration (FDA)-approved medications can treat diabetes in certain people. Some examples include:
Angiotensin-converting enzyme (ACE) inhibitors block the production of the angiotensin II hormone. Your body naturally uses this hormone to control blood pressure. Your blood pressure should come down after treatment with ACE inhibitors.
Angiotensin II receptor blockers (ARBs) block the angiotensin II hormone from binding with receptors in your blood vessels. ARBs work the same way as ACE inhibitors to help lower your blood pressure.
In addition to lowering blood pressure, ACE inhibitors and ARBs also help slow down the progression of diabetes-related nephropathy.
Statins decrease your bad cholesterol and increase your good cholesterol. They can benefit certain people who have diabetes-related nephropathy.
If you have advanced diabetes-related kidney disease, treatment options include:
The best way to prevent diabetes-related nephropathy is to manage your diabetes and lower your blood pressure. Be sure to follow your treatment plan as prescribed by your healthcare provider.
Diabetes-related nephropathy is a slow-moving condition. If you have diabetes-related nephropathy, you can’t reverse damage to your kidney. However, an early diagnosis and following your treatment plan can slow down or even stop diabetes-related nephropathy from advancing.
Diabetes-related nephropathy may advance to kidney failure, which may be fatal. The only treatment options for kidney failure are dialysis or a kidney transplant.
Your healthcare provider will work with you to develop a treatment plan, which may include medications and changes to your lifestyle. Your treatment plan may include:
If you have diabetes, you should schedule regular appointments with your healthcare provider every three to six months or as recommended by your healthcare provider.
If you have diabetes, your healthcare provider will recommend annual diabetes-related nephropathy testing five years after your initial diagnosis. Kidney damage usually doesn’t appear within the first 10 years of your diabetes 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.
A note from Cleveland Clinic
Diabetes-related nephropathy is a condition that damages your kidneys. It may lead to kidney failure, which can be fatal. If your healthcare provider has diagnosed you with diabetes-related nephropathy, it’s natural to feel fearful or sad. However, with an early diagnosis and adherence to your treatment plan, you can slow down or even stop diabetes-related nephropathy from advancing.
Going through treatment for diabetes-related nephropathy can be stressful. Your healthcare provider is here to help. They are here to answer all of your questions and help preserve your quality of life.
Last reviewed by a Cleveland Clinic medical professional on 09/15/2022.
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