Diabetic Nephropathy

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(Nephropathy, Diabetic; Diabetic Glomerulosclerosis)

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
Creates 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

Causes

Blood passes through small filters in the kidneys. Changes in the blood 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.

Overtime 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:

High blood pressure also puts stress on your kidneys and increase your risk of kidney damage.

Symptoms

Symptoms may not appear until the kidney damage is very severe. Tell your doctor if you have any of these:

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

If you have any of these symptoms, do not assume they are due to kidney problems. Symptoms may be caused by other conditions.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include the following:

Blood tests to check your kidney function
Urine tests to check for protein in your urine

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:

Lose weight if you are overweight
Exercise
Eat less salt
Stop smoking
Avoid alcohol
Follow your diabetes management plan

Medications

Your doctor may prescribe medicines to help control blood sugar. To help control your blood pressure and protect your kidneys, your doctor may prescribe:

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.
Quit smoking.

RESOURCES

American Diabetes Association http://www.diabetes.org

National Kidney Foundation http://www.kidney.org

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca

The Kidney Foundation of Canada http://www.kidney.ca

References

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/what.php. Updated February 2, 2013. Accessed March 4, 2013.

Diabetic nephropathy. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/online/famdocen/home/common/diabetes/complications/847.html. Updated September 2010. Accessed March 4, 2013.

Living with diabetes: kidney disease (nephropathy). American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html. Accessed February 7, 2011.

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

Revision Information

Reviewer: Brian Randall, MD
Review Date: 02/2013 -
Update Date: 03/04/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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