Diabetes-Related Nephropathy

What is diabetes-related nephropathy?

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.

Is diabetes-related nephropathy serious?

Yes, diabetes-related nephropathy is serious.

Diabetes-related nephropathy may lead to kidney failure. Kidney failure can be fatal.

What are the stages of diabetes-related nephropathy?

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:

• Stage I. Your GFR is 90 or higher. At this stage, your kidneys have mild damage but still function normally.
• Stage II. Your GFR 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.
• Stage III. Your GFR may be as low as 30 or as high as 59. You may have mild or severe loss of kidney function.
• Stage IV. Your GFR may be as low as 15 or as high as 29. You have severe loss of kidney function.
• Stage V. Your GFR is below 15. Your kidneys are nearing or at complete failure

Who does diabetes-related nephropathy affect?

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

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

Other risk factors include:

• A family history of kidney disease.
• High blood pressure.
• Using tobacco products.
• Hyperglycemia (high blood sugar).
• Hyperlipidemia (high cholesterol).

How common is diabetes-related nephropathy?

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.

What are diabetes-related nephropathy symptoms?

Diabetes-related nephropathy symptoms usually don’t appear until it has affected at least 80% to 90% of your kidneys. These symptoms include:

• Swelling in your face, hands and feet (edema).
• Nausea and vomiting.
• Tiredness or fatigue.
• Dyspnea (shortness of breath).
• Loss of appetite.
• Foamy or bubbly pee.
• Difficulty focusing or confusion.
• Dry, itchy skin.
• Muscle cramps.
• Not needing to take as much insulin.

What are the signs or symptoms in the early stages of diabetes-related nephropathy?

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.

What causes diabetes-related nephropathy?

Type 1 or type 2 diabetes causes diabetes-related nephropathy.

Is diabetes-related nephropathy contagious?

No, diabetes-related nephropathy isn’t contagious. You can’t spread diabetes-related nephropathy to another person.

How is diabetes-related nephropathy diagnosed?

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.

What tests will be done to diagnose diabetes-related nephropathy?

The following tests help diagnose diabetes-related nephropathy:

Urinalysis

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.

Blood tests

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

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.

Magnetic resonance imaging (MRI) tests and computed tomography (CT) scans help enhance the visibility of your blood vessels and blood supply to your kidneys.

Kidney biopsy

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.

How is diabetes-related nephropathy treated?

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:

• Incorporating more foods that are high in fiber and low in fats and calories.
• Exercising regularly.
• Managing your weight.
• Quitting smoking or using other tobacco products.

If you have high blood pressure, it’s also essential to treat it. Your healthcare provider may prescribe medications to treat high blood pressure.

Can diabetes-related kidney damage be reversed?

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.

What medications are used to treat diabetes-related nephropathy?

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:

Diabetes

Many different Food and Drug Administration (FDA)-approved medications can treat diabetes in certain people. Some examples include:

• Biguanides (metformin). Biguanides reduce how much glucose your liver produces. They also improve how insulin works in your body and slow the conversion of carbohydrates into sugar.
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors. SGLT2 inhibitors help your kidneys by removing glucose from your body through your pee.
• Glucagon-like peptide 1 (GLP-1) agonists. GLP-1 agonists increase the release of insulin, reduce glucose release from your liver after you eat and delay food emptying from your stomach, which may also help with weight loss.

High blood pressure

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.

High cholesterol

Statins decrease your bad cholesterol and increase your good cholesterol. They can benefit certain people who have diabetes-related nephropathy.

What treatments are used to treat diabetes-related nephropathy?

If you have advanced diabetes-related kidney disease, treatment options include:

• Dialysis. If your kidneys don’t work correctly, dialysis performs the functions of your kidney. During dialysis, a machine removes your blood, filters out waste products and excess fluid and returns blood to your body.
• Kidney transplant. During a kidney transplant, you’ll receive health kidneys from a different person (kidney donor).

How can I prevent diabetes-related nephropathy?

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.

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

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.

How do I take care of myself?

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:

• Taking your diabetes and blood pressure medications as prescribed by your healthcare provider.
• Monitoring your blood sugars and blood pressure levels closely.
• Following a healthy diet, such as a Mediterranean diet or a DASH diet.
• Exercising for at least 30 minutes a day most days of the week. Aim for at least 150 minutes of exercise each week. You can walk, run, bike, swim or find other cardiovascular activities you enjoy.
• Avoiding taking medications that may damage your kidneys. This may include some non-steroidal anti-inflammatory medicines (NSAIDs).
• Maintaining your appointments with your healthcare provider and completing all lab work.
• Quitting smoking or using tobacco products.
• Limiting the amount of alcohol you drink.
• Getting between seven and nine hours of sleep each night.

When should I see my healthcare provider?

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.

What questions should I ask my healthcare provider?

• How do you know that I have diabetes-related nephropathy?
• Should I see a nephrologist (kidney doctor) or another specialist?
• What tests will you conduct to diagnose diabetes-related nephropathy?
• How advanced is my diabetes-related nephropathy?
• What lifestyle changes can I make to slow down or stop my diabetes-related nephropathy from advancing?
• What medications do you recommend?
• What treatments do you recommend?
• How often should I schedule appointments?
• Can you recommend any support groups for people with 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.