What Is Diabetic Nephropathy?
Diabetic nephropathy — kidney disease that results from diabetes — is the number one cause of kidney failure. Almost a third of people with diabetes get diabetic nephropathy.
People with both diabetes and kidney disease do worse overall than people with kidney disease alone. This is because people with diabetes tend to have other long-standing medical conditions, such as high blood pressure, high cholesterol, and blood vessel disease (atherosclerosis). People with diabetes also are more likely to have other kidney-related problems, such as bladder infections and nerve damage to the bladder.
Kidney disease in type 1 diabetes is slightly different from that in type 2 diabetes. In type 1 diabetes, kidney disease rarely begins in the first 10 years after diagnosis of diabetes. In type 2 diabetes, some patients already have kidney disease by the time they are diagnosed with diabetes.
What Are the Symptoms of Diabetic Nephropathy?
There are often no symptoms with early diabetic nephropathy. As the kidney function worsens, symptoms may include:
- Swelling of the hands, feet, and face
- Trouble sleeping or concentrating
- Poor appetite
- Nausea
- Weakness
- Itching (end-stage kidney disease) and extremely dry skin
- Drowsiness (end-stage kidney disease)
- Abnormalities in the heart's regular rhythm (because of increased potassium in the blood )
- Muscle twitching
As kidney damage progresses, your kidneys cannot remove the waste from your blood. The waste then builds up in your body and can reach poisonous levels, a condition known as uremia. People with uremia are often confused and occasionally become comatose.
How Is Diabetic Nephropathy Diagnosed?
Your doctor may run routine tests to evaluate your kidney health, including:
Urinary albumin test. This screens for the protein albumin in your urine.
Glomerular filtration rate (GFR) blood test. This shows how well your kidneys are filtering your blood. The lower your GFR, the more kidney function you've lost.
Treatments are available that can help slow progression to kidney failure. That's why you should have your urine tested every year if you have diabetes.
Diabetic Nephropathy Stages
The stages of diabetic nephropathy are based on how progressed your kidney disease is. Your doctor will check how well your kidneys are filtering out waste through a measure called the estimated glomerular filtration rate (eGFR). Healthy kidneys in young adults have an eGFR of about 120.
Stages of diabetic nephropathy
Stage | Function Level | Glomerular Filtration Rate (GFR) |
| Stage 1 | Kidneys function at a normal level | GFR of 90 or higher |
| Stage 2 | Mild kidney function loss | GFR from 60 to 89 |
| Stage 3 | Moderate kidney function loss | GFR from 30 to 59 |
| Stage 4 | Severe kidney function loss | GFR from 15 to 29 |
| Stage 5 | End-stage of kidney disease, or near complete kidney failure | GFR below 15 |
How Is Diabetic Nephropathy Treated?
Lowering blood pressure and maintaining blood sugar control are necessary to slow the progression of diabetic nephropathy. There are medications available that have been found to slow down the progression of kidney damage. They include:
- SGLT2 inhibitors, including bexagliflozin (Brenzavvy), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro), help control high blood sugar.
- Angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage. Although ACE inhibitors , including lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace), are usually used to treat high blood pressure and other medical problems, they are often given to people with diabetes to avoid other problems, even if their blood pressure is normal.
- Angiotensin receptor blockers (ARBs) are similar to ACE inhibitors and are just as effective.
- Finerenone, a nonsteroidal, selective mineralocorticoid receptor antagonist (or nsMRAs), can help slow the progression of kidney disease by lowering the effects of the hormone aldosterone.
- Semaglutide is an injectable drug that can help you lose weight, control your blood sugar, and slow down kidney disease.
Can diabetic nephropathy be reversed?
Unfortunately, the kidney damage caused by diabetic nephropathy can't be reversed. If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure needs treatment with dialysis or a kidney transplant.
But you can slow down the progression of the disease by watching what you eat, staying active, avoiding harmful medications, quitting smoking, keeping your weight in check, and taking the medications your health care provider prescribes. Take steps to control your diabetes, cholesterol, and blood pressure to avoid further kidney damage.
Diabetic Nephropathy FAQs
What is the first sign of diabetic nephropathy?
You'll rarely notice symptoms of diabetic nephropathy early on, but signs can include being more fatigued than usual and leg swelling.
How do ACE inhibitors and ARBs prevent diabetic nephropathy?
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) block the effects of a hormone called angiotensin II. This hormone worsens kidney disease by increasing the pressure on the filters of your kidneys.
How long can you live with diabetic nephropathy?
One study has found that, on average, diabetic nephropathy may shorten your lifespan by about 16 years.
