Diabetic nephropathy is the official name for diabetic kidney disease (DKD) and chronic kidney disease (CKD) caused by diabetes. If you want to find out more about what this condition is, where it comes from and how it’s treated, you are in the right place!
Diabetic Kidney Disease Fast Facts
- Diabetic nephropathy is a formal name for diabetic kidney disease (DKD) and Chronic Kidney Disease (CKD).
- People with diabetes are at risk of developing chronic kidney disease because high glucose levels in our blood hurts our kidneys.
- One third of adult diabetics have chronic kidney disease in the USA. In Canada, half of diabetics will show kidney damage at some point in their life.
- Early stages of kidney disease have no noticeable symptoms.
- There is no cure for CKD, but there are lifestyle changes and medical treatments that can slow its progression.
- The final stages of CKD are renal failure. The treatment for kidney failure is dialysis, kidney transplant or supportive care.
Contents
What is diabetic nephropathy?
Who gets diabetic nephropathy?
What can I do to prevent diabetic kidney disease?
What are the symptoms of chronic kidney disease?
How do doctors diagnose chronic kidney disease?
What is the treatment for diabetic kidney disease?
Does diabetic kidney disease have complications?
How does diabetes cause chronic kidney disease?
What is Diabetic Nephropathy?
“Nephropathy” means “kidney disease”, so “diabetic nephropathy” is simply kidney disease caused by diabetes. Diabetes causes kidney disease because, without careful blood sugar control, extra glucose in our blood can permanently injure our kidneys and stop them from working.
Who gets Diabetic Chronic Kidney Disease?
Prevalence
According to Diabetes Canada, as many as half of people who have diabetes will eventually show signs of kidney damage. As of 2014, the American Diabetes Association puts the proportion of diabetics who will develop chronic kidney disease at 40%. In 2017, the CDC reported that one in three adult diabetics has kidney disease.
These numbers are high because diabetic kidney damage is a long and silent process. You will only notice symptoms when enough damage is done that your kidneys are no longer working as well as they should. This means that people don’t always realize that their kidneys are under stress and so don’t access preventative care.
Diabetics at any age can have kidney damage if they do not carefully control their glucose levels. Generally, very few people get a diagnosis of CKD within 10 years of developing diabetes; most cases show up between 10 and 20 years later.
Risk Factors for Diabetic nephropathy
The risk factors are similar but not identical for people who have type 1 diabetes or type 2 diabetes.
Type 1 Diabetes
If you have type 1 diabetes, your chances of developing chronic kidney disease are increased if:
- you are a man
- you are obese
- you have abnormally high lipid levels in your blood
- you have hypertension
- insulin resistance
- vitamin D deficiency
- smoking
Some people also have a combination of many different genetic factors that, all together, make them more prone to kidney damage. If you have a close relative with diabetes who developed chronic kidney disease, you might similarly have a higher risk.
Type 2 Diabetes
People with type 2 diabetes have a more complicated risk profile. Type 2 diabetes progresses through insulin resistance. As a result, many people have had high blood glucose levels for a long time before they are diagnosed. This long period of elevated blood glucose will have been quietly injuring their kidneys long before a patient starts managing their blood sugar.
Pima Indian people in the USA have been screening for type 2 diabetes and collecting data in their communities for a long time. Their observations have been very important in helping us to understand diabetic kidney disease. Firstly they find that around 25% of people with type 2 diabetes aged under 65 years old have diabetic kidney disease, while more than 50% of type 2 diabetics over 65 have chronic kidney disease.
In the UK, a large prospective cohort study found that type 2 diabetics most likely to develop kidney disease had the following things in common:
- obese waist circumference
- high blood pressure
- Asian-Indian heritage
- high plasma triglycerides or cholesterol
- hyperglycaemia
- smoking
Some people are more likely to develop diabetic kidney disease than others. For example, epidemiologists in the USA have noticed that Hispanic Americans, African Americans and Native Americans with type 2 diabetes are more likely to develop end-stage kidney disease than their non-Hispanic, White American peers.This might be due to genetics, but differences in medical care due to racial and economic influences are also likely contributors.
How Can I prevent Diabetic Kidney Disease?
Prevention is always better than mitigation. The good news is that you can prevent or slow down kidney damage with a few simple steps.
- Monitor your blood glucose and take your medication on time.
- Watch what you eat. Follow your doctor’s advice on dietary changes that will help you to keep your blood sugar levels steady and safe.
- Limit your salts. Try to avoid a high-salt diet. Salts can put pressure on your kidneys and they increase your blood pressure.
- Exercise. Frequent exercise helps keep your cardiovascular system healthy and your blood pressure at healthy levels. High blood pressure is linked to kidney damage.
- Work on attaining healthy blood pressure. For diabetics at risk of kidney disease, doctors suggest you should aim for a reading below 30/80 mmHg.
- Stop smoking.
- Cut down on or eliminate alcohol.
- Avoid NSAIDS.
For type 2 diabetics, this is a more difficult situation. You may have accumulated damage before you got a diabetes treatment plan. The good news is that lifestyle changes that prevent diabetic kidney disease can also slow down its progression. If you start building healthy habits now, even if your kidneys show some signs of damage, it will help you keep your kidneys working.
What are the symptoms of diabetic kidney disease?
In its early stages, chronic kidney disease has no symptoms. This is why it is so important to attend check-ups and get your lab tests done when the doctor or diabetes nurse asks for them.
If your CKD progresses to renal failure, you will start to notice symptoms:
- Swelling in your ankles, feet or hands
- blood in your urine
- fatigue
- getting out of breath very easily
- muscle cramps
- losing your appetite or unintentional weight loss
- itchiness
- erectile dysfunction
- nausea
- needing to pee more often – especially at night
- difficulty in sleeping
How do doctors diagnose chronic kidney disease?
Doctors diagnose CKD with a set of laboratory tests. The lab will request a urine sample and a blood sample. They will use biochemistry to measure the proteins in your blood and urine to make sure that your kidneys are doing their job, filtering your blood.
Different countries have their own versions of these tests and set the boundaries of what they consider an abnormal result based on their own policies. The principles behind the tests are the same but the exact cut-offs or the way the number is calculated might be different.
Urinary Protein Test
The first test is a urine test, the albumin to creatinine ratio (ACR). This test compares the amount of albumin in your pee to the amount of creatinine. If your kidneys are working well, they can distinguish between albumin and creatinine, so you will have mostly creatinine in your pee. If your kidneys are not doing a good job, the amount of albumin in your urine will be higher. The higher your ACR number, the less happy your kidneys are.
According to the USA’s Institute of Diabetes, Digestion and Kidney Research, a normal ACR is 30 mg/g or less.
If you have an ACR of more than 30 mg/g, it is a sign that you might have kidney damage.
In the UK and some other countries, ACR is calculated differently. They use mMol instead of grams to measure creatinine. This means the numbers that come out of the ACR calculation will be a bit different.
If your ACR is calculated using mMol:
A normal ACR is less than 3 mg/mMol
ACR between 3 mg/mMol and 30 mg/mMol is a sign of kidney damage.
ACR over 30 mg/mMol indicates severe kidney disease.
The higher your ACR, the less well your kidneys are working.
Some doctors have an even easier method. Scientists have developed a quick test using a dipstick. They can simply dip a piece of paper with a special coating in your urine sample. If you have albumin in your urine, it will stick to the coating and make it change colour. Your doctor will know straight away if you are at risk.
Blood Filtration Test
The lab will also test how well your kidneys can filter your blood using a test called the estimated glomerular filtration rate (e-GFR). The lab will test how much creatinine is in your blood to make sure that your kidneys are getting rid of waste properly. A high GFR is a good sign, it means your kidneys are filtering waste products out of your blood. A low GFR is a sign that your kidneys are not doing well.
A healthy GFR is 90 ml/minute.
If you have a GFR of above 60, it means your kidneys are in OK shape – this is a normal GFR.
A GFR between 15 and 60 means you have kidney disease. Your kidneys are no longer efficiently removing waste products like creatinine from your blood.
A GFR less than 15 is a sign that your kidneys are failing.
Given that the early stages of kidney disease have no noticeable signs, most health systems encourage people with diabetes to get screened for kidney disease. People with type 2 diabetes, and type 1 diabetics diagnosed more than 5 years ago, should get tested every year.
What is the treatment for diabetic kidney disease?
There is no cure for kidney disease. If your kidneys have failed, known as renal failure, or end-stage kidney disease, you will need dialysis or a kidney transplant. If you have chronic kidney disease, you can’t make it better but you can stop it from getting worse or slow the progression down.
Lifestyle Changes
The best way to protect your kidneys from further damage is to make some lifestyle changes:
- The first thing you will be asked to do is focus on controlling your blood glucose. This means being careful about what you eat, regular blood glucose testing and taking your medications on time.
- Lose weight. Yes, we know, you’ve heard it before and it sounds irrelevant. In this case, though, losing some fat from your abdominal fat stores can make a world of difference to your body’s ability to process glucose. Too much fat in your adipose cells prevents your body from responding to insulin.
- Stop smoking. The chemicals in burning tobacco, cannabis and other plants affect your blood vessels. This will, over time, make your blood pressure higher and injure the exquisite capillaries in your kidneys.
- Work on your blood pressure. People with diabetic kidney disease should aim for a blood pressure of 30/80 mmHg. High blood pressure and hypertension are risk factors for kidney disease. High blood pressure puts a lot of strain on the delicate filtering structures of your kidneys. If you can get your numbers down, it will give your kidneys a much-needed rest. Learn more about lowering your blood pressure here.
- Stop using NSAIDS. These over-the-counter pain killers can damage your kidneys if you already have kidney disease.
Medications
As of now there are some drugs that can help reduce the amount of albumin in your urine, but there are not yet treatments that can improve your blood filtering enough to raise your GFR. Your doctor might prescribe you:
- SGLT2 inhibitors. These are drugs that can help you to control your blood glucose. They can also help your kidneys to remove salt from your body. Clinical trials have shown that even people with CKD who don’t have diabetes benefit from these drugs. Commonly used versions include dapagliflozin, bexagliflozin, canagliflozin, empagliflozin and ertugliflozin.
- Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are prescribed to help you manage your blood pressure. Examples of these drugs include: ramipril, enalapril and lisinopril.
- Statins. Lowering your cholesterol levels can help take the pressure off your kidneys.
- Finenerone. This is a pretty new drug that might not be available in your region yet. Right now it is used in some type 2 diabetics with CKD to help reduce the albumin in their urine.
Treatments for End-stage Kidney Disease and Renal Failure
If your diabetic nephropathy progresses to end-stage kidney disease or Renal Failure, it means that your kidneys can no longer do their job. Your care team will work with you to decide the next steps. Usually, you will be signed up for dialysis. This is a process where a machine filters your blood for you. Learn more about dialysis here.
Some patients might be offered a kidney transplant.
If dialysis and organ transplants are not appropriate treatments, doctors might offer palliative care.
Does diabetic kidney disease have complications?
When your kidneys stop working how they should, it can lead to some serious complications, including:
- Hyperkalaemia. When your kidneys are unable to remove salts from your blood, you can accumulate dangerously high potassium levels.
- Anaemia
- Osteoporosis. A build-up of phosphates caused by kidney damage can weaken your bones.
- End-stage kidney disease/Renal Failure.
How does diabetes cause kidney disease?
What do our kidneys do?
Kidneys are extremely important to keep us alive, but what do they actually do and why does it matter if they don’t work?
Our kidneys are a fantastically optimized filtration system for our blood. Our bodies need our kidneys to remove waste products like urea, drug metabolites and extra water, vitamins, salts and minerals, things we don’t need. Preventing toxins from building up in our body and helping us to balance the amount of water, acids, salts and minerals in our blood is essential for us to stay alive.
The excess water and chemicals drain out of our kidneys and into our bladder as urine. Basically, we pee out the extra water and waste products.
Just as importantly, the special filtering system in our kidneys stops us from peeing out important proteins, minerals and sugars we need to use to maintain and operate our bodies. Our kidneys very precisely control the levels of chemicals in our blood so that our bodies have exactly what they need to work.
How does diabetic nephropathy make us sick?
Diabetic kidney disease is a serious condition. People who have diabetes can’t control the amount of glucose in their blood without external help. If you have too much glucose in your blood, over time that glucose can damage the tiny structures inside your kidneys that filter waste products out of your blood.
This means your kidneys are no longer able to remove toxins from your blood selectively. People with kidney damage can’t balance the amount of salts and minerals in their blood as well as they need to. They pee out proteins and other important nutrients before their body has a chance to use them. Over time this damages other organs in our body.
People whose kidneys are damaged will become sick, as acids and other unwanted chemicals build up in their body. This damage, in turn, can damage the kidneys even more.
Our kidneys also control our blood pressure. Eventually, these imbalances cause the rest of the body to stop working properly, and without a way to clean and balance our blood, we will die.
Sources
Chronic kidney disease in the United States, 2019. May 3, 2019. Accessed February 12, 2026. https://stacks.cdc.gov
American Diabetes Association. Standards of Medical Care in Diabetes–2014. Diabetes Care. 2013;37(Supplement_1):S14-S80. doi:10.2337/dc14-S014
Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world wide difference of prevalence and risk factors. J Nephropharmacol. 2015;5(1):49-56.
Umanath, K., & Lewis, J. B. (2018). Update on Diabetic Nephropathy: Core Curriculum 2018. American Journal of Kidney Diseases.
Amaral S, Patzer R. Disparities, race/ethnicity and access to pediatric kidney transplantation. Current Opinion in Nephrology and Hypertension. 2013;22(3):336. doi:10.1097/MNH.0b013e32835fe55b
Definition & Facts for Gastroparesis – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed April 24, 2024. https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/definition-facts
Chronic Kidney Disease Tests & Diagnosis – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed March 11, 2026. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis