Diabetic Neuropathy - Symptoms | Diagnosis | Treatment | Prevention
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Diabetic Nephropathy - Symptoms, Diagnosis, Treatment and Prevention

Published on Jun 24, 2022 and last reviewed on Jul 27, 2023   -  5 min read


Diabetic kidney disease is an injury to the renal blood vessels due to an increase in the levels of glucose in the blood occurring in people with diabetes.

What Is Diabetic Kidney Disease?

Kidney disease occurring as a complication of diabetes is called diabetic nephropathy. In this disease, the kidney's filters, the glomeruli, get impaired. Because of the impairment, renal function becomes abnormal. The kidneys lead an unusual amount of protein into the urine called proteinuria. The protein that is mainly excreted in the urine is albumin. A rise in the level of albumin in the urine (albuminuria) indicates kidney damage due to diabetes. Depending upon the albumin lost in the urine, diabetic kidney disease is divided into two categories -

  • Microalbuminuria- It refers to the presence of a small amount of albumin in urine. Albumin is a type of protein, found in large amounts in the bloodstream. It is a possible sign of kidney damage. It is advisable to take a microalbuminuria test during routine examinations.

  • Macroalbuminuria /Proteinuria- As the kidney damage progresses, the amount of albumin in urine increases, and microalbuminuria changes to macroalbuminuria. It is a noticeable sign of kidney damage.

What Causes Diabetic Nephropathy?

  • The kidney's normal function includes filtration of the blood, regulation of blood pressure, and water and electrolyte balance. A kidney consists of millions of filtering units called nephrons.

  • These nephrons get harmed due to high levels of sugar in the blood. This damage prevents the normal functioning of the kidney and develops leakage of protein and blood into the urine.

  • Moreover, the raised blood sugar causes the proteins in the glomeruli to link together, called the "cross-linked" proteins. These cross-linked proteins initiate the localized scarring process. This process is called glomerulosclerosis.

  • It takes a long period to develop glomerulosclerosis. The condition worsens when the sclerotic tissue replaces the healthy tissue. Regulation of blood pressure is also hampered in many patients causing high blood pressure (hypertension) and damaging the kidneys.

  • Chronic kidney disease requires a long time to develop symptoms after diabetes. The long-term duration of diabetes increases the chances of kidney damage. Diabetic kidney disease is more likely to develop when the blood glucose level and blood pressure are too high.

What Are the Symptoms of Diabetic Nephropathy?

As the condition worsens in chronic kidney disease, the kidneys gradually progress to end-stage renal disease or kidney failure. The first indication of diabetic kidney disease is considered to be microalbuminuria.

  • Microalbuminuria - It is considered to be the first sign of kidney damage. It can persist as microalbuminuria or can progress into proteinuria.

  • Proteinuria - It is an irreversible condition where protein leaks into the urine. It marks a gradual decline in kidney function and end-stage renal disease.

  • Edema - Swelling of the feet, ankles, hands, and eyes. Puffiness around the eyes. Swelling is caused due to fluid retention.

  • Delirium - Confusion or difficulty in concentration.

  • Apnea - Shortness of breath.

  • Polyuria - Increased need for urination.

  • Anemia - A decrease in circulating red blood cells causes anemia. A feeling of tiredness is felt due to anemia.

  • Electrolyte Imbalance - As the kidney function deteriorates, calcium, phosphate, phosphorus, and magnesium disturb the electrolyte balance. Bone thinning or fractures due to calcium and phosphate imbalance can occur.

What Are the Risk Factors Associated With Diabetic Nephropathy?

Risk factors in people with diabetes that increase the chances of developing kidney disease are

  • Tobacco chewing or smoking.

  • Intake of foodstuffs containing sugar.

  • High intake of salt-containing food.

  • Obesity.

  • Presence of heart disease.

  • Family history of kidney failure.

  • Sedentary lifestyle.

  • Unhealthy eating patterns.

  • Patients not following the course of hypoglycemic medications.

How to Treat Diabetic Nephropathy?

1. To Treat Hypertension -

Angiotensin-converting enzyme inhibitors (ACE) and angiotensin II receptor blockers are the two types of medications used to control high blood pressure. ACE inhibitors work by decreasing the amount of angiotensin II in the bloodstream, which is responsible for constricting the blood vessels. As a result, the blood vessels relax, which further prevents high blood pressure. Angiotensin II receptor blockers can be used in patients allergic to ACE inhibitors.

2. To Control Hyperglycemia -

Hyperglycemia is an increased level of sugar in the blood. Hypoglycemic medication is prescribed to control the blood glucose level. Good management of glucose levels in the blood can help avoid or delay the progression of kidney diseases, cardiovascular diseases, and stroke.

3. To Control Risk Factors -

Drugs are crucial in controlling cholesterol levels, heart disease, peripheral arterial disease, and stroke. One should adopt healthy lifestyle habits to regulate the worsening of the condition. Maintenance of body weight and regular physical activity help keep a check on secondary complications. Quitting tobacco use in any form should be made as timely as possible.

How to Prevent Diabetic Nephropathy?

  • People with diabetes should be tested routinely for the presence of any kidney damage, which can prevent or delay kidney damage and end-stage renal disease. Once diabetic kidney disease has been diagnosed, people with diabetes should take steps to prevent it from worsening.

  • Kidney damage is inconceivable to get worse when the blood sugar level and blood pressure level is under control. To control blood pressure, regular physical activity, weight loss, reduction in salt intake, limiting alcohol intake, and quitting smoking may have to be done. Drugs like ACE innovators can be prescribed by the physician to lower blood pressure. Following the course of medication can keep a check on high blood pressure.

  • Lifestyle changes need to be done with a workout diet plan. It can help in preventing obesity. A reduction in salt and protein intake is suggested.

  • Bladder or kidney infections can present signs and symptoms like a burning sensation during urination, a frequent urge to urinate, reddish urine, fever, and pain in the back.

  • Avoid the consumption of painkillers like Aspirin. Aspirin and other painkillers can make kidney damage worse. Such painkillers should be taken only after consulting a physician. Too many painkillers can increase the risk of kidney damage.

  • The presence of other medical conditions like heart disease, liver disease, and high cholesterol level needs medical attention.


Every patient who has diabetes does not develop kidney disease. Regularly testing the sugar levels help early diagnosis of chronic kidney disease. Early diabetes treatment is the most effective and can help prevent other medical conditions. Managing blood sugar levels, blood pressure, and cholesterol levels reduce the risk factors for heart disease and stroke. People with prediabetic situations can avoid the occurrence of type II diabetes mellitus, which is a vital step in precluding renal disorders.

Frequently Asked Questions


What Are the Clinical Features of Nephropathy?

Diabetic nephropathy affects the kidneys and interferes with their normal function (filtration). The signs and symptoms of nephropathy are as follows:
Swelling in feet and ankles.
- Urge to urinate.
- Shortness of breath.
- Confusion.
- Itching.
- Proteinuria.
- Nausea.
- Vomiting.


What Is the Treatment for Diabetic Nephropathy?

Diabetic nephropathy is treated by:
- Lifestyle changes like exercise, diet, and avoiding smoking and alcohol consumption may aid in managing blood sugar and blood pressure levels.
- Anti-hypertensive medications to control blood pressure.
- Anti-diabetic medications such as Metformin to manage blood glucose levels.
- In the advanced stage - Kidney transplants and dialysis are suggested.


How Do I Know the Early Warning Signs of Kidney Disease?

Here are the early warning signs of kidney disease:
- Swelling around the eyes.
- Poor sleep.
- Foamy urine.
- Weakness.
- Poor appetite.
- Swollen feet and ankles.
- Itching.


How Is Diabetic Nephropathy Diagnosed?

The following criteria are used in the diagnosis of diabetic nephropathy:
- First, a urine test is done to examine the albumin in the urine. The high albumin in urine indicates nephropathy.
- Glomerular filtration rate (GFR) is another criterion for evaluating diabetic nephropathy. Low GFR is a sign of kidney disorder.
- The high albumin: creatinine ratio also signifies nephropathy.
In addition, imaging investigations like CT (computed tomography) and MRI (magnetic resonance imaging) are also helpful in diagnosing diabetic nephropathy.


What Is Stage 4 Diabetes?

Stage 4 diabetic kidney disease is a severe condition. The characteristic features of this stage are listed down:
- Swollen feet and hands.
- Frequent urge to urinate.
- High potassium levels in the blood.
- High blood pressure.
- Proteinuria.
The doctor may have regular follow-ups to prevent complications.


Are Diabetic Nephropathy and Kidney Failure the Same?

Diabetic nephropathy is a severe condition that drastically affects the kidney’s function. Usually, the tiny blood vessels in the kidney filter the waste products from the blood. In diabetic nephropathy, the kidney's filters are damaged due to high blood glucose and blood pressure levels. In contrast, kidney failure or end-stage kidney disease (ESRD) marks the final stage of diabetic nephropathy. According to the classification, kidney failure is the fifth stage of diabetic nephropathy.


How Long Does It Take for Diabetic Nephropathy to Develop?

Type 1 and type 2 diabetes is the leading cause of nephropathy. During the initial stages of symptoms, the affected individual does not have any severe symptoms. However, a few functional changes in the kidney may develop in two to five years. However, it takes ten to 30 years for the disease to progress into a severe condition. Therefore, diet, lifestyle modification, and medications to control diabetes and hypertension may prevent complications.


Is Diabetic Nephropathy Life-Threatening?

The progression of the disease into a life-threatening condition called kidney failure or end-stage renal disease (ESRD) takes 10 to 30 years. The risk factors include diabetes, uncontrolled hypertension, smoking, high cholesterol, etc. During end-stage renal disease, the kidney loses its ability to filter waste products. Thus, the toxins accumulate in the body to cause severe complications like fluid retention, cardiovascular disease, etc.


Is Diabetic Nephropathy Reversible?

Diabetic nephropathy is not entirely curable. However, the following measures need to be followed to prevent its progression and complication:
- Maintain blood sugar levels.
- Control blood pressure and cholesterol levels.
- Avoid smoking and alcohol consumption.
- Maintain a proper diet to prevent obesity.

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Last reviewed at:
27 Jul 2023  -  5 min read




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