Diabetic Nephropathy

What Is It?

Diabetic nephropathy is kidney disease that is a complication of diabetes. It can occur in people with type 2 diabetes, the most common diabetes type, or in people with type 1 diabetes, the type that begins at an early age and requires insulin. Up to 40 percent of people with type 1 diabetes eventually develop significant kidney disease, which sometimes requires dialysis or a kidney transplant. A much smaller percentage of people with type 2 diabetes develop kidney disease.

Diabetic nephropathy is caused by damage to the tiniest blood vessels. As kidney disease progresses, proteins leak into the urine, and the kidneys gradually lose their ability to remove waste products from the blood.

More than one-third of the 50,000 people in the United States diagnosed each year with end-stage kidney disease have diabetes.

Symptoms

Diabetic nephropathy is called a "silent" problem because there are usually no symptoms in the early stages of the disease. Some of the earliest symptoms include ankle swelling and mild fatigue. Later symptoms include extreme fatigue, nausea, vomiting and urinating less than usual.

Diagnosis

The first sign of kidney damage is protein in the urine, which a doctor can measure in microscopic amounts, called microalbuminuria. Small amounts of albumin show up in the urine five to 10 years before major kidney damage happens.

Your doctor will suggest regular monitoring of urine and blood tests to check the health of your kidneys. As kidney problems progress, other urine and blood tests will be done to check how well your kidney is functioning.

Occasionally, a doctor may be concerned that kidney injury in a diabetic person is related to a separate problem. In that case, other tests, such as Ultrasound or even a kidney biopsy, may be recommended. In a biopsy, a small piece of kidney tissue is removed through a needle and examined in a laboratory.

Expected Duration

Kidney disease is a lifelong condition that cannot be reversed once damage is done. The disease is progressive, meaning it continues to get worse. However, good control of blood sugar and blood pressure can slow the progression of the disease.

Prevention

The best way to prevent diabetic nephropathy is to control your blood sugar. In addition, your blood pressure should be monitored frequently, and high blood pressure should be treated promptly. Two types of blood pressure medicines protect against kidney damage in ways that go beyond lowering your blood pressure. These medications are excellent choices for controlling blood pressure in people with diabetes. They include angiotensin-converting enzyme inhibitors (ACE inhibitors) — lisinopril (Zestril, Prinivil), enalapril (Vasotec), moexipril (Univasc), benazepril (Lotensin) and others — and angiotensin receptor blockers (ARBs), such as losartan (Cozaar), valsartan (Diovan) and others. Avoiding medications that can harm the kidneys also can help to prevent kidney disease.