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Diabetic Nephropathy

Definition

Diabetic nephropathy is kidney damage that occurs with diabetes. It is the job of the kidneys to:

  • Filter blood
  • Catch needed substances and return them to circulation
  • Create urine to pass waste out of the body

Damage from diabetes can prevent the kidneys from working well. In some cases, this can lead to kidney failure .

Anatomy of the Kidney
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Causes

Blood passes through small filters in the kidneys. Changes in the blood vessels due to diabetes can cause damage to these filters. Blood sugar levels that are not well-controlled can have the greatest impact on the kidney filters.

Over time, the damage to the filters increases. The damaged filters cannot clean the blood properly and protein from the blood can leak into the urine. If left untreated, this can lead to kidney failure.

Risk Factors

Factors that may increase your chance of diabetic nephropathy include Type 1 diabetes and Type 2 diabetes with:

Symptoms

Symptoms may not appear until the kidney damage is severe. Symptoms may include:

  • Fluid buildup may appear as swelling in feet or hands
  • Weakness
  • Loss of appetite
  • Difficulty sleeping
  • Confusion and trouble concentrating

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests

Treatment

Talk with your doctor about the best treatment plan for you.

Treatment is aimed at preventing or slowing further kidney damage. It may involve lifestyle changes and medications. Your doctor will also work with you to help control your diabetes and blood pressure. This may help prevent further kidney damage.

Lifestyle Changes

Lifestyle changes that will help control your blood sugar and blood pressure include:

Lifestyle changes that will help control your blood sugar and blood pressure include:

  • Lose weight if you are overweight.
  • Exercise.
  • Eat less salt.
  • If you smoke, talk to your doctor about ways to quit.
  • Avoid alcohol.
  • Follow your diabetes management plan.

Medications

Your doctor may prescribe medications to help control blood sugar and protect your kidneys, such as:

  • Angiotensin-converting enzyme inhibitors (ACE inhibitors)
  • Angiotensin receptor blockers (ARBs)

Treatments for Kidney Failure

If the damage to your kidneys progresses to kidney failure, you may need dialysis . Dialysis takes over for your kidneys. Blood passes out of your body into a machine. The machine filters waste out of the blood then pumps blood back to you.

If the kidney failure progresses you may eventually need a kidney transplant .

Prevention

To help reduce your chances of getting diabetic nephropathy, take the following steps:

  • See your doctor regularly. During checkups, you will have your blood pressure, urine, blood, and organs monitored for changes.
  • Control blood sugar levels. Follow your diabetes treatment regimen as directed.
  • Work with your doctor to maintain a healthy blood pressure (less than 130/80 mmHg).
  • Exercise daily.
  • If you smoke, talk to your doctor about ways to quit.

Revision Information

  • American Diabetes Association

    http://www.diabetes.org

  • National Kidney Foundation

    http://www.kidney.org

  • Canadian Diabetes Association

    http://www.diabetes.ca

  • The Kidney Foundation of Canada

    http://www.kidney.ca

  • American Academy of Family Physicians. Information from your family doctor: diabetic nephropathy. Am Fam Physician. 2005 Jul 1;72(01):100.

  • Diabetic nephropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 15, 2014. Accessed September 18, 2014.

  • Diabetic nephropathy. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/online/famdocen/home/common/diabetes/complications/847.html. Updated February 2014. Accessed September 18, 2014.

  • Living with diabetes: kidney disease (nephropathy). American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html. Updated December 10, 2013. Accessed September 18, 2014.

  • Nephropathy in diabetes. Diabetes Care. 2004;27 Suppl 1:S79-83.