Diabetic nephropathy

Diabetic kidney disease is damage to your kidneys caused by diabetes. This is sometimes called diabetic nephropathy. In severe cases it can lead to kidney failure. But not everyone with diabetes has kidney damage.

There are no symptoms in the early stages of diabetic kidney disease. If you have kidney damage, you may have small amounts of protein leaking into your urine. (This is called albuminuria.)

As diabetic kidney disease progresses, your kidneys can't do their job as they should. They can't clear toxins or balance the chemicals in your blood very well. You may:

• Lose more protein in your urine.
• Have higher blood pressure.
• Have higher cholesterol and triglyceride levels.

You may have symptoms if your kidney disease gets worse. They include:

• Swelling (edema), first in the feet and legs and later throughout your body.
• Poor appetite.
• Weight loss.
• Weakness.
• Feeling tired or worn out.
• Nausea or vomiting.
• Trouble sleeping.

If the kidneys are severely damaged, blood sugar levels may drop. That's because the kidneys can't remove excess insulin or filter medicines that increase insulin production.

Diabetic kidney disease is diagnosed using tests that check how well your kidneys are working. These include a test that checks for a protein (albumin) in the urine. Another test checks how well your kidneys are filtering waste from your blood. This is called the estimated glomerular filtration rate (eGFR).

An albumin urine test can detect very small amounts of protein in the urine. This allows doctors to find kidney disease early. Starting treatment early can prevent further damage to the kidneys.

The eGFR is measured using a formula that compares a person's size, age, and sex to blood creatinine levels. As kidney disease gets worse, the eGFR number goes down.

When your doctor will start checking your kidney function depends on the type of diabetes you have. After testing starts, it should be done every year.

The main treatment is medicine to lower your blood pressure and prevent or slow the damage to your kidneys. Medicines include:

• Angiotensin-converting enzyme inhibitors, also called ACE inhibitors.
• Angiotensin II receptor blockers, also called ARBs.

There are other steps you can take. For example:

• Keep your blood sugar levels within your target range.
• Work with your doctor to keep your blood pressure under control.
• Eat heart-healthy foods, and exercise regularly.
• Talk to your doctor or dietitian about how much protein is best.
• Limit your salt. This helps keep high blood pressure from getting worse.

As kidney damage gets worse, your blood pressure and cholesterol level rise. You may need to take more than one medicine to treat these problems. If damage becomes severe, you may need kidney dialysis or a transplant.

To manage your diabetes and slow or stop damage to your kidneys

• Keep your blood sugar in your target range. The American Diabetes Association recommends a hemoglobin A1c (Hb A1c) target level of less than 7%. Talk to your doctor about your target. The lower your A1c, the better your chance of stopping kidney damage.
• Keep your blood pressure in your target range. Doctors recommend certain types of blood pressure medicines for people who have diabetes and kidney disease. Examples include ACE inhibitors and angiotensin II receptor blockers (ARBs). Your doctor may have you take one of these even if you don't have high blood pressure.
• Take all of your medicines. You may have more than one. For example, you may take medicines for diabetes, cholesterol, and blood pressure. It's very important to take all of them just as your doctor tells you to and to keep taking them.
• Eat healthy foods. Follow an eating plan that is best for your diabetes and your kidneys. You may want to work with a dietitian to make a plan. This will help you know how much carbohydrate to have for meals and snacks. It will also make sure that you get the right amount of salt (sodium), fluids, and protein.
• Stay at a healthy weight. If you need help to lose weight, talk to your doctor or dietitian. Even small changes can make a difference. Try to be aware of your portion sizes. Eat more fruits and vegetables. And try to be active each day.
• Exercise. Get at least 30 minutes of activity on most days of the week. For many people, walking is a good choice. Being more active can help you manage your blood sugar and stay at a healthy weight. It also can help you lower your cholesterol and blood pressure.

To improve your kidney health

• Follow your treatment plan. Check your blood sugar as many times a day as your doctor recommends. Go to all of your follow-up appointments. Be sure to have all the tests your doctor orders. Call your doctor if you think you are having a problem with your medicines.
• Avoid certain medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) can damage your kidneys. Some examples of NSAIDs are ibuprofen and naproxen. It is important to talk to your doctor about all medicines that you take.
• Avoid smoking or using other tobacco products. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.