Diabetic nephropathy is a common complication of diabetes, also called diabetes mellitus, that affects your kidneys. It is caused by damage to the tiny blood vessels in your kidneys that filter waste and excess water from your blood. Over time, the damage can cause your kidneys to lose their ability to function properly. In some cases, diabetic nephropathy can lead to kidney failure and require dialysis or a kidney transplant. In this article, we’ll explore the causes, symptoms, stages, and treatment options for diabetic nephropathy and ways to prevent it.
What is diabetic nephropathy?
Diabetic nephropathy is a progressive diabetic kidney disease that is a serious complication of diabetes and can cause kidney damage and even lead to kidney failure. Kidneys are vital organs that filter waste from your blood and remove it from your body. When nephropathy damages your kidneys, they can no longer do their job properly which can lead to a buildup of toxins and fluid in your body, as well as high blood pressure. If you have type 1 diabetes or type 2 diabetes, you are at a greater risk for kidney failure because over 40% of cases are caused by diabetes. Diabetic nephropathy is a slow-progressing disease that can take many years to develop, but if left untreated, nephropathy can be fatal.
What causes diabetic nephropathy?
The exact cause of nephropathy is unknown but it is thought to be a combination of genetic and environmental factors. If you have diabetes, you can develop high levels of blood sugar, also called glucose, which can damage the small blood vessel called glomeruli in your kidneys, causing nephropathy. Your kidneys work by using tons of these tiny blood vessels to filter your blood and remove waste products. When your blood vessels are damaged, they can no longer do their job properly, and nephropathy can develop.
Diabetes is the leading cause of nephropathy but other factors that increase your risk of kidney failure include:
- Hypoglycemia, which is high blood sugar levels
- Being overweight or obese
- Hypertension, which is high blood pressure
- Being African-American, Latino, or Native American
- Having a family history of kidney disease or diabetes
- High blood cholesterol levels
- Other diabetic complications
- Being diagnosed with type 1 diabetes before the age of 20
What are the symptoms of diabetic nephropathy?
The early stages of nephropathy often have no symptoms but as the disease progresses, you may experience the following symptoms:
- Foamy or bubbly urine that is caused by more protein in your urine
- Swelling in your feet, ankles, legs, eyes, arms, and hands
- High blood pressure
- Needing to urinate more often
- Lack of appetite
- Difficulty concentrating
- Feeling unwell in general
- Constant itchiness and dry skin
- Shortness of breath
What are the complications of diabetic nephropathy?
If nephropathy is left untreated, it can progress to kidney failure. Kidney failure is a serious condition that can be life-threatening. Symptoms of kidney failure and other complications of diabetic nephropathy include:
- Fluid retention, which can cause swelling in your feet, legs, and ankles
- High blood pressure
- Fluid in the lungs which is also called pulmonary edema
- Cardiovascular disease or heart disease that can cause cardiovascular events like a heart attack or stroke
- Diabetic retinopathy, which is damage to your eye tissue
- Anemia which is a low level of red blood cells
- Erectile dysfunction
- Foot sores, which are also called foot ulcers
- End-stage renal disease, also called end-stage kidney disease, is when kidney disease has caused irreversible damage to your kidneys
- Hyperkalemia or high potassium levels
- Bone disorders that are caused by an imbalance of minerals in your blood
- Pregnancy complications
If you are experiencing any of these symptoms, it is important to see your doctor as soon as possible.
How do doctors diagnose diabetic nephropathy?
There is no one test to diagnose nephropathy but your doctor will likely test your blood and urine regularly if you have diabetes. They may also order the following tests if they suspect you may have diabetic nephropathy:
A urinalysis is when your doctor analyzes a urine sample that can show protein, particularly albumin, in your urine which is a sign of kidney disease.
Blood urea nitrogen blood test
A blood urea nitrogen, or BUN blood test can show urea nitrogen in your blood which can indicate kidney failure.
A kidney biopsy, also called a renal biopsy, is when a small sample of kidney tissue is removed and examined for signs of nephropathy.
Serum creatinine blood test
A serum creatinine blood test can show serum creatinine level in your blood which is normally filtered out if your kidneys are functioning normally. Your doctor can then take this creatinine ratio number and calculate an estimated glomerular filtration rate, or GFR, which tells them how effective your kidneys are functioning.
What are the different stages of kidney disease?
There are five stages of kidney disease:
- Stage one is when your kidney function is normal but you have a high risk for nephropathy.
- Stage two is when your kidney function is mildly impaired and it loses some function.
- Stage three is when your kidney function is moderately impaired.
- Stage four is when your kidney function is severely impaired.
- Stage five is end-stage renal disease or kidney failure.
Please note that at stage five you have complete renal failure which means that your kidney has lost all function and you will need dialysis or kidney transplantation to live.
How is nephropathy treated?
The goal of treatment for nephropathy is to slow the progression of the disease and prevent complications. Treatment will usually start with a physical exam but may include:
Blood pressure medications
Angiotensin-converting enzyme inhibitors, also called ACE inhibitors, or angiotensin receptor blockers, also called ARB inhibitors, are medications that can help to lower your blood pressure and prevent nephropathy from progressing.
Kerendia is a medication that can help to reduce the decline of your kidney function.
If you have diabetes, taking insulin as prescribed by your doctor can help to control your blood sugar levels.
Making dietary changes such as eating less salt, eating a healthy diet, and maintaining a healthy weight can help to lower and maintain your blood pressure levels and prevent obesity. Other dietary restrictions include limiting your intake of protein as this can help to reduce the amount of waste products in your blood. Exercising regularly can also help to lower your blood pressure, help you maintain a healthy weight, and help manage your diabetes. If you smoke, quitting smoking can help reduce the progression of kidney disease.
End-stage renal disease treatments
If nephropathy progresses to end-stage renal disease, you will need either dialysis or a kidney transplant. Dialysis is a process that uses a machine to filter your blood and remove waste products from your body. A kidney transplant is when a healthy kidney from a deceased donor or living donor is transplanted into your body.
Can nephropathy be prevented?
You can help to prevent nephropathy by managing your diabetes and keeping your blood glucose levels under control. Maintaining a healthy weight, eating a healthy diet, exercising regularly, and quitting smoking if you smoke can also help with the prevention of nephropathy. Treating high blood pressure early can also help to prevent nephropathy from developing or progressing. If you have nephropathy, it is important to follow your treatment plan and see your doctor or health care provider regularly.
Diabetic nephropathy is a serious kidney complication that can occur in people with diabetes and can lead to kidney failure and end-stage renal disease. Treatment for nephropathy includes blood pressure medications, lifestyle changes, and insulin therapy if you have diabetes. You can help to prevent nephropathy and keep your kidneys healthy by managing your diabetes, maintaining a healthy weight, eating a healthy diet, and exercising regularly. If you have nephropathy, it is important to follow your diabetes treatment plan and see your doctor or health care provider regularly for blood or urine tests. If you are experiencing any of the symptoms listed above, or if you think you may be at risk for nephropathy, please talk to your doctor or health care provider.
References and Sources:
National Institute of Diabetes and Digestive and Kidney Diseases
National Library of Medicine
- Renal function in diabetic nephropathy
- Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment
- FDA approves drug to reduce risk of serious kidney and heart complications in adults with chronic kidney disease associated with type 2 diabetes
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