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Diabetes and kidney disease

Diabetic nephropathy; Nephropathy - diabetic; Diabetic glomerulosclerosis; Kimmelstiel-Wilson disease

Kidney disease or kidney damage often occurs over time in people with diabetes. This type of kidney disease is called diabetic nephropathy.

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Male urinary system
Pancreas and kidneys
Diabetic nephropathy

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Causes

Each kidney is made of hundreds of thousands of small units called nephrons. These structures filter your blood, help remove waste from the body, and control fluid balance.

In people with diabetes, the nephrons slowly thicken and become scarred over time. The nephrons begin to leak, and protein (albumin) passes into the urine. This damage can happen years before any symptoms of kidney disease begin.

Kidney damage is more likely if you:

Symptoms

Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start.

People who have more severe and long-term (chronic) kidney disease may have symptoms such as:

Exams and Tests

Your health care provider will order tests to detect signs of kidney problems.

A urine test looks for a protein called albumin leaking into the urine.

Your provider will also check your blood pressure. High blood pressure damages your kidneys and is harder to control when you have kidney damage.

A kidney biopsy may be ordered to confirm the diagnosis or look for other causes of kidney damage.

If you have diabetes, your provider will also check your kidneys by using the following blood tests every year:

Treatment

When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse.

Follow your provider's advice to keep your condition from getting worse.

CONTROL YOUR BLOOD PRESSURE

Keeping your blood pressure under control (below 140/90 mm Hg) is one of the best ways to slow kidney damage.

CONTROL YOUR BLOOD SUGAR LEVEL

You can also slow kidney damage by controlling your blood sugar level through:

OTHER WAYS TO PROTECT YOUR KIDNEYS

Support Groups

Many resources can help you understand more about diabetes. You can also learn ways to manage your kidney disease.

Outlook (Prognosis)

Diabetic kidney disease is a major cause of sickness and death in people with diabetes. It can lead to the need for dialysis or a kidney transplant.

When to Contact a Medical Professional

Call your provider if you have diabetes and you have not had a urine test to check for protein.

Related Information

Diabetes
High blood pressure - adults
Chronic kidney disease
End-stage kidney disease
Blood sugar test
Retinopathy of prematurity
Low blood sugar
High potassium level
Kidney transplant
Peritonitis
Type 2 diabetes - what to ask your doctor
ACE inhibitors

References

American Diabetes Association. 10. Microvascular complications and foot care: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S105-S118. PMID: 29222381 www.ncbi.nlm.nih.gov/pubmed/29222381.

Brownlee M, Aiello LP, Cooper ME, Vinik AI, Plutzky J, Boulton AJM. Complications of diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 33.

Tong LL, Adler S, Wanner C. Prevention and treatment of diabetic kidney disease. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 31.

Vijan S. In the clinic. Type 2 diabetes. Ann Intern Med. 2015;162(5):ITC1- ITC16. PMID: 25732301 www.ncbi.nlm.nih.gov/pubmed/25732301.

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Review Date: 2/22/2018  

Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Internal review and update on 03/28/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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