Diabetic nephropathy: Everything you need to know

Doctor going over test results with patient

If you have diabetes or hypertension  — or both — the first step in kidney health is keeping those conditions under control. 

The kidneys contain millions of tiny blood vessels that filter waste from the blood. Diabetes, if not managed well, can damage the kidneys and increase the risk of kidney damage and failure. 

What is diabetic nephropathy?

A complication commonly seen in patients with type 1 or type 2 diabetes, diabetic nephropathy is a form of chronic kidney disease that causes a deterioration in kidney function — which can eventually lead to kidney failure (aka end-stage renal disease or ESRD).

Our bodies create waste while digesting protein. Blood flows through vessels with tiny holes in them that work as filters, pushing waste through the holes for it to eventually leave the body in your urine.

Essential elements such as protein and red blood cells are not filtered and remain in the bloodstream. If you have poorly controlled blood sugars, this causes damage to the filters of the kidneys. Over time, the filters begin to leak, allowing valuable proteins to pass through, into the urine. 

  • Microalbuminuria happens when low protein levels are in the urine. A kidney disease diagnosis at this stage comes with options to mitigate it. 
  • Macroalbuminuria happens when significant amounts of protein make it into the urine. If left untreated, this can lead to a decline in kidney function and, ultimately, end-stage renal disease (ESRD).

ESRD is the result of overworked kidneys and is a serious condition that will require a transplant or dialysis. Dialysis is the process of having a machine filter your blood. 

After your diagnosis

Treatment includes diabetes management and screenings to track kidney function, as well as treatment of any existing hypertension and obesity. In addition, in severe cases, medications are specifically indicated to prevent or slow the progression of chronic kidney disease.

Here are some questions you might ask your provider:


  • What treatments do you suggest?
  • How well are my kidneys functioning?
  • How do treatments vary or work into my diabetes treatment plan?
  • How will we know if these treatments are working?


Ask about restrictions, such as fasting, before any tests. Use this list as a reference for ongoing visits.

  • Are there pamphlets or online sources you suggest?
  • How does the management of diabetes affect the treatment of other diseases? How can I coordinate care?
  • How often should I check my blood sugar? 
  • When should I call you or seek emergency care?
  • What is my target range for blood glucose?
  • What is the proper dosage for prescribed medicines? When should I take my medications? Do I take them with food?
  • What modifications to my diet would help me control my:
    • Cholesterol
    • Blood pressure
    • Blood sugar
  • When should I make a follow-up appointment?
  • Are resources available if I cannot afford diabetes supplies?


In your routine care, your physician might ask:

  • Are you exercising? If so, what type of exercise? How often?
  • Do you sit for long periods of time?
  • Have you experienced low blood sugar? Do you know what to do if your blood sugar is too low or too high?
  • Do you understand your treatment program and feel sure you can follow it?
  • How are you coping with diabetes?
  • What’s a regular day’s diet like?
  • What challenges are you experiencing in controlling your diabetes?

Treatment options for ESRD

The goal is either to replace kidney function or to make you more comfortable. Current options for those include the following:

  • Kidney dialysis. It removes waste and surplus fluid from your blood.
    •  Hemodialysis is the more common choice and requires a visit to a dialysis center. Patients visit about three times weekly to connect to an artificial kidney machine. A caregiver can provide dialysis from home in about 3 to 5 hours. 
    • Peritoneal dialysis uses the peritoneum in the patient’s abdomen. It exchanges fluid and dissolved substances for the blood. This method can fix electrolyte issues and remove surplus fluid and toxins.
  • Transplant. A kidney or kidney-and-pancreas transplant is often the most effective option. A physician will assess your qualifications. 
  • Symptom management. Without dialysis or a transplant, your life expectancy would be a few months. A doctor can administer treatment to help keep you comfortable.

Diabetic nephropathy can be diagnosed relatively early in its progression — and with proper mitigative steps (see below), its progression can be prevented or slowed. Further, researchers in regenerative medicine are developing treatments for diabetic nephropathy that could reverse or slow damage. A pancreas islet cell transplant or stem cell therapy could improve kidney function.

Not all diabetic patients develop kidney disease. Other factors that affect kidney health include the following:

  • Blood glucose control
  • Blood pressure
  • Genetics

Those with diabetes and hypertension can help reduce risk by managing those conditions.

What are the symptoms of diabetic nephropathy?

Symptoms don’t manifest until the function is all but absent in many cases, and they aren’t specific. It often begins with fluid buildup but can include:

  • An upset stomach
  • Difficulty concentrating
  • Loss of sleep
  • Poor appetite
  • Weakness

How do you test for diabetic nephropathy?

Diabetes management includes routine screening for diabetic nephropathy. Type 1 diabetes patients should have tests five years after they’re diagnosed. Screening should begin at diagnosis for type 2 diabetics.

Routine screenings are as follows:

  • Urinary albumin test. It can detect albumin, a blood protein, in the urine. The kidneys don’t normally filter albumin out of the blood, so elevated levels mean impaired kidney function.
  • Albumin/creatinine ratio. Healthy kidneys filter creatinine, a chemical waste, out of the blood. The albumin/creatinine ratio is an indicator of kidney function. 
  • Glomerular filtration rate (GFR). Creatinine amounts in a blood sample can show how the kidneys filter blood. A low filtration rate suggests poor kidney function.
  • Imaging tests. A physician might use ultrasound and X-rays to check kidney structure and size. Computerized tomography (CT), magnetic resonance (MR), or other imaging tests can determine the blood flow rate within your kidneys.  
  • Kidney biopsy. Your provider might want to take a sample of kidney tissue. After administering a local anesthetic, the doctor removes small pieces of tissue for analysis.

Ways to prevent diabetic nephropathy

See your doctor regularly. Your physician will check the following:

  • Blood (for waste products)
  • Blood pressure
  • Organs (for diabetes complications)
  • Urine (for protein)

Keep your blood sugar within your target range. This can reduce the risk of microalbuminuria by 33%, or even reverse it. You can prevent microalbuminuria from advancing to macroalbuminuria by 50%.

How can I control my diabetic nephropathy?

There are several ways to mitigate diabetic nephropathy.

  • Exercise. Stay active most days of the week for at least 30 minutes. Include moderate to vigorous aerobic exercise. Effective activities include the following:
    • Biking
    • Brisk walking
    • Running
    • Swimming
  • Medication: Not all drugs to treat kidney disease work well for diabetics. Some raise glucose levels or mask low-glucose symptoms. Doctors often prescribe ACE inhibitors to diabetics with hypertension. These medications, including captopril and enalapril, can inhibit kidney disease while treating hypertension. They are also effective for diabetics who don’t have hypertension. Additional medications include a class of medicines known as SGLT2 inhibitors, along with angiotensin II receptor blockers (ARBs) and another newer medicine called finerenone. Recent studies suggest that a combination treatment may be safe and effective under the supervision of medical professionals. 
  • Nutrition: Some physicians prescribe a low-protein diet for patients with macroalbuminuria because protein appears to increase the kidneys’ workload. Low-protein diets can reduce protein loss in the urine and improve levels in the blood. Consult your doctor before beginning a low-protein diet. Also, high-fiber foods are beneficial, such as:
    • Fruits
    • Legumes
    • Non-starchy vegetables
    • Whole grains
    • Processed meats

Watch intake of the following:

  • Saturated fats
  • Sodium
  • Sweets
  • Self-care. Control of blood pressure and blood glucose is critical. Hypertension can exacerbate progression, even in mild cases. Maintain a healthy weight and take daily aspirin. Don’t smoke, and if you do smoke, quit. Also, you can lower your blood pressure by doing the following:
    • Avoid alcohol and tobacco
    • Eat less salt
    • Lose weight
  • Testing safely. Tell your provider about your medical history and disclose your diabetic nephropathy diagnosis. Angiograms and computerized tomography scan that a doctor might order use contrast dye, which could cause contrast-induced nephropathy.

After the kidneys fail, a patient must begin dialysis. People often consult the following when deciding what to do next:

  • Diabetes educator
  • Doctor
  • Kidney transplant surgeon
  • Nephrologist (kidney specialist)
  • Psychologist
  • Social worker

Support after diabetic nephropathy diagnosis

Coping is an invaluable part of your diagnosis. Here are some suggestions.

  • Maintain. Stick to your routine when you can. Work if possible, and keep doing activities you enjoy if your condition allows it. Staying active can help you manage emotions after your diagnosis.
  • Talk. Speak with someone you trust. Your diagnosis can be stressful, and friends or family members who are attentive listeners are pleasant to have around. Faith leaders and other trusted figures can also help. Ask your provider for counselor or social worker referrals.

Be sure you’re up-to-date with nephropathy screenings

Wilmington Health’s Endocrinology department consists of specialists who provide TRUE Care. They diagnose and treat conditions of the glands and the endocrine system. Along with your primary care physician, they can help you manage diabetes and hypertension for proper kidney health. Visit us online to learn more.