Diabetes and Diabetic Nephropathy

Overview

Diabetes is a chronic condition that affects blood sugar regulation. Over time, high blood sugar can damage the kidneys, leading to diabetic nephropathy, a type of kidney disease. This condition can cause the kidneys to lose their ability to filter waste from the blood, resulting in fluid retention, high blood pressure, and further kidney damage. Early detection and management of blood sugar levels are crucial to prevent progression to kidney failure.

Diabetes-related nephropathy is a condition that affects your kidneys. Another name for diabetes-related nephropathy is diabetes-related kidney disease (DKD).

What are the stages of diabetes-related nephropathy?

There are certain diabetes-related nephropathy stages according to your estimated glomerular filtration rate(eGFR).

Your eGFR is a calculation of how efficiently your kidneys filter substances. A normal eGFR is about 100. The lowest eGFR is 0, which means there is no remaining kidney function.

The stages of any kidney disease, including diabetes-related nephropathy, include:

Stage I. Your GFR is 90 or higher. At this stage, your kidneys have mild damage but still function normally.
Stage II. Your GFR may be as low as 60 or as high as 89. You have more damage to your kidneys than in stage I, but they still function well.
Stage III. Your GFR may be as low as 30 or as high as 59. You may have mild or severe loss of kidney function.
Stage IV. Your GFR may be as low as 15 or as high as 29. You have severe loss of kidney function.
Stage V. Your GFR is below 15. Your kidneys are nearing or at complete failure

What are diabetes-related nephropathy symptoms?

Diabetes-related nephropathy symptoms usually don’t appear until it has affected at least 80% to 90% of your kidneys. These symptoms include:

Swelling in your face, hands and feet (edema).
Nausea and vomiting.
Tiredness or fatigue.
Dyspnea (shortness of breath).
Loss of appetite.
Foamy or bubbly pee.
Difficulty focusing or confusion.
Dry, itchy skin.
Muscle cramps.
Not needing to take as much insulin.

What tests will be done to diagnose diabetes-related nephropathy?

The following tests help diagnose diabetes-related nephropathy:

Urinalysis

A urinalysis (urine test) examines the visual, chemical and microscopic aspects of your pee. Your provider will use a dipstick to conduct a urinalysis. Your healthcare provider may recommend a few different types of urinalysis tests.

To use a dipstick, you’ll pee into a special container at your healthcare provider’s office or a hospital. Then, a healthcare provider will place a strip of paper coated with special chemicals (dipstick) into the container. The dipstick will change color if protein (albumin) is in your pee.

If your healthcare provider needs a more precise measurement, they may recommend a urine protein test. To test for urine protein, your pee sample goes to a lab for testing. Lab technicians compare how much protein and creatinine are in your pee (protein-to-creatinine ratio). If your urine sample has a much higher ratio of protein to creatinine, it may indicate diabetes-related nephropathy.

Blood tests

An eGFR test calculates your kidneys’ ability to filter blood.

Your healthcare provider will use a thin needle (21 gauge, slightly smaller than the size of a standard earring) to withdraw a small amount of blood from a vein in your arm. Your healthcare provider then uses a formula, some of your general basic health information and the creatinine levels in your blood to determine your eGFR.

How is diabetes-related nephropathy treated?

Treatment depends on what stage you’re in, your age and your overall health. Treating your diabetes is the first step in treating diabetes-related nephropathy. The following can help you manage your diabetes: