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Diabetes and kidney disease
Diabetic nephropathy is kidney disease or damage that can occur in people with diabetes.
Kimmelstiel-Wilson disease; Diabetic glomerulosclerosis; Nephropathy - diabetic; Diabetic nephropathy
Causes, incidence, and risk factors
Each kidney is made of hundreds of thousands of small units called nephrons. These structures filter your blood and help remove waste from your body.
In people with diabetes, the nephrons thicken and slowly become scarred over time.
In some cases, your family history may also play a role. Not everyone with diabetes develops this kidney problem.
People with diabetes who smoke, and those with type 1 diabetes that started before age 20 have a higher risk for kidney problems.
People of African-American, Hispanic, and American Indian origin are also more likely to have kidney damage.
Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start.
People who have more severe and long-term (chronic) kidney disease may have symptoms such as:
Signs and tests
Your doctor can order tests to detect signs of kidney problems in the early stages. Once a year, you should have a urine test. It looks for a protein called albumin leaking into the urine.
High blood pressure often goes along with diabetic nephropathy. You may have high blood pressure that begins quickly or is hard to control.
Your doctor will also check your kidneys with the following blood tests every year:
A kidney biopsy confirms the diagnosis. A biopsy is done only if there is any doubt about the diagnosis.
When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse.
Keeping your blood pressure under control (under 130/80) is one of the best ways to slow kidney damage.
Eating a low-fat diet, taking drugs to control blood cholesterol, and getting regular exercise can also help prevent or slow kidney damage.
You can also slow kidney damage by controlling your blood sugar levels, which you can do by:
To protect your kidneys, remember the following:
To treat chronic kidney disease, you need to make changes to your diet, and treat problems caused by kidney disease.
Calling your health care provider
Call your health care provider if you have diabetes and you have not had a routine urinalysis to check for protein.
American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2012 Jan;35 Suppl 1:S11-63.
Parving H, Mauer M, Fioretto P, Rossing P, Ritz E. Diabetic Nephropathy. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 38.
Reviewed by:Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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