Kidney disease that develops as a result of diabetes is known as diabetic nephropathy. Anyone can be affected by kidney disease but it is much more common in people with long-term diabetes (20 years or more) due to the effect high blood sugar levels have on the body’s blood filtering system.

Keeping blood glucose levels within the ‘normal’ range for as long possible can significantly reduce the risk of kidney disease and other dangerous complications developing.

What is diabetic nephropathy?

Diabetic nephropathy is the general term used to describe failing kidney function caused by prolonged/uncontrolled diabetes.

It is one of the long-term complications of diabetes, often developing very slowly, over many years, and can lead to people becoming severely ill.

Is estimated that 4 out of every 10 people with diabetes develop nephropathy at some point.

How does diabetes cause nephropathy?

The kidneys are organs that play a number of important roles, including removing waste products from the blood and regulating the amount of fluid and various salts in the body.

To filter blood, the kidneys use a network of tiny functional units called nephrons to filter waste substances out of the body as urine. If tiny blood vessels (capillaries), which feed the nephrons, become damaged, the nephrons can also stop working properly.

If a significant percentage of nephrons stop working, this can lead to problems including protein (albumin) leaking into the urine, waste products not being adequately removed and water retention in the body.

This deterioration of kidney function is what is referred to as kidney disease. The less efficient the kidneys get at carrying out their roles, the more advanced the disease becomes, to the point where they eventually fail. This final stage (there are 5 stages of kidney disease) is known as end-stage renal disease, or ESRD.

Diabetes is one of the main causes of ERSD, accounting for just under half of all cases.

What else can cause nephropathy?

Other factors that can raise the risk of kidney disease include blood pressure and genetics.

Is diabetic nephropathy common?

It is estimated that 4 in every 10 people with diabetes (either type 1 or type 2 diabetes) will develop nephropathy at some point.

It commonly takes over 20 years for patients to reach stage 5. Kidney disease in diabetes develops very slowly, over many years.

What are the symptoms?

There are many symptoms of diabetic nephropathy but these tend to only become noticeable once the condition has reached the latter stages as the kidneys work hard to make up for the failing capillaries. Symptoms to look out for typically include:

  • Swelling of the ankles, feet, lower legs or hands caused by water retention
  • Blood in your urine / darker urine
  • Tiredness and weakness
  • Upset stomach
  • Nausea or vomiting
  • Lack of appetite

Nephropathy screening

Early detection of nephropathy is vital to prevent the kidneys from losing all their function. To help detect the disease, people with diabetes are advised to visit a doctor regularly and get checked for kidney problems. Clinicians can check for waste products in the blood, tiny particles of protein in urine (microalbumin) and blood pressure levels.

Can diabetic nephropathy be prevented?

The best way to prevent diabetic kidney disease is through good management of blood glucose. Studies have shown that improving long-term blood glucose control can greatly reduce the risk diabetic nephropathy.

Findings from the ADVANCE study, published June 2008 in the New England Journal of Medicine, showed that people with type 2 diabetes who reduced their A1c (glycated hemoglobin – an average measure of long-term glycemic control) to 6.5% were 21% less likely to develop kidney disease.

In other large-scale studies, a 1% drop in A1c was linked with a 25% lower risk of microvascular complications, such as nephropathy, in people with both type 1 and type 2 diabetes.

How is diabetic nephropathy treated?

There are various treatment options for patients with diabetic nephropathy. The type of treatment recommended for you will depend on:

  • Your age, medical history and overall health
  • The stage of kidney disease you have
  • How tolerant you are to specific medications, procedures, or therapies

As with any disease, treatment is more effective if started at an early stage – i.e. when microalbumin filter through to the urine (microalbuminuria). Early stage treatment typically involves:

  • Good management of blood sugar levels
  • Keeping blood pressure under control – a small rise in blood pressure can speed up the rate at which kidney disease progresses
  • Following a healthy, balanced diet  – a low-protein diet has been shown to help by reducing protein loss in the urine and increase protein levels in the blood
  • Regular physical activity – helps lower blood pressure and boost overall health
  • Avoiding smoking and alcohol – also effective at reducing blood pressure and improving health

Medication

In some cases, where self-care measures are not enough, your clinician may prescribe blood pressure-lowering drugs such as angiotensin-converting enzyme (ACE) inhibitors.

These are recommended by doctors for most people with diabetes, high blood pressure and kidney disease, and have been shown to protect kidney function and slow progression of the disease, in addition to lowering blood pressure.

Treating kidney failure

If tests show your kidneys are failing to function, you will be diagnosed with end-stage (stage 5) renal disease (ESRD). Note that it commonly takes over 20 years for patients to reach this stage.

The only ways to treat kidney failure is with regular blood-cleansing treatments (dialysis) or through kidney transplantation. Dialysis will need to continue for the rest of the patient’s life or until a requested kidney transplant becomes available.