Diabetic nephropathy

About

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About

Diabetic nephropathy is a kidney disorder caused by long-term diabetes, in which high blood sugar damages the glomeruli — the kidneys’ filtering units. Over time, this damage leads to protein leakage into the urine, decreased kidney function, and in advanced stages, chronic kidney disease or kidney failure. 

It is one of the most common complications of diabetes and a leading cause of end-stage kidney disease worldwide. Both type 1 and type 2 diabetes can result in diabetic nephropathy, typically developing after several years of poorly controlled blood sugar levels. Diabetes (diabetic nephropathy causes glomerular damage and can lead to CKD

Is it common?

Yes. Diabetic nephropathy affects approximately 20–40% of people with diabetes. Its prevalence increases with longer duration of diabetes, poor glycemic control, hypertension, and other metabolic risk factors. It is a major contributor to chronic kidney disease and dialysis initiation globally.

Can it be cured?

There is no cure for diabetic nephropathy, but progression can be slowed or sometimes partially reversed with strict blood sugar control, blood pressure management, and lifestyle modifications. Early detection through regular urine and kidney function testing is crucial to prevent serious kidney damage.

Causes

What causes Diabetic Nephropathy?

The primary cause is chronic hyperglycemia, which damages the small blood vessels in the glomeruli. Other contributing factors include:

  • High blood pressure — worsens kidney damage
  • Genetic predisposition — family history increases risk
  • High cholesterol — accelerates vascular damage
  • Smoking — contributes to kidney and vascular injury
  • Inflammation and oxidative stress — from prolonged diabetes

This combination leads to thickening of glomerular membranes, scarring (glomerulosclerosis), and eventual loss of filtering capacity.

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Symptoms

Diabetic nephropathy often develops silently in early stages. Symptoms may appear as the disease progresses:

  • Proteinuria (albumin in urine, often detected on routine testing)
  • Foamy urine
  • Swelling in feet, ankles, hands, or around the eyes
  • Fatigue
  • High blood pressure
  • Decreased kidney function (detected in lab tests)
  • In advanced stages: fluid retention, nausea, confusion, or other signs of kidney failure

Diagnosis

Diagnosis involves laboratory tests and monitoring over time:

Urine tests

  • Urine albumin-to-creatinine ratio (UACR) — detects early protein leakage
  • 24-hour urine protein collection (sometimes used for confirmation)

Blood tests

  • Serum creatinine and eGFR — assess kidney function
  • Electrolytes and BUN — monitor kidney performance

Imaging

  • Ultrasound to evaluate kidney size and rule out obstruction

Additional tests

  • Blood pressure monitoring
  • Glycemic control assessment (HbA1c)

Early diagnosis relies on routine screening in all diabetic patients.

Treatment

Treatment focuses on slowing progression, protecting kidney function, and managing complications.

Lifestyle and metabolic control

  • Strict blood sugar control (HbA1c target individualized)
  • Blood pressure management (target <130/80 mmHg in most patients)
  • Low-salt diet and weight management
  • Regular exercise and smoking cessation

Medications

  • ACE inhibitors or ARBs — reduce proteinuria and protect kidneys
  • Statins — manage cholesterol and reduce vascular risk
  • SGLT2 inhibitors — shown to slow kidney disease progression in diabetes
  • Diuretics — for fluid retention if needed

Advanced interventions

  • Dialysis or kidney transplant for end-stage kidney disease
  • Ongoing monitoring of kidney function and proteinuria to adjust therapy

With early detection and strict control of diabetes and blood pressure, progression to advanced kidney disease can often be delayed for many years.

References

  • Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for Diabetes Management in CKD
  • National Kidney Foundation – Diabetic Nephropathy Overview
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – Diabetic Kidney Disease
  • Mayo Clinic – Diabetic Nephropathy: Symptoms, Diagnosis, and Treatment
  • American Diabetes Association (ADA) – Standards of Care in Diabetes 2025
  • American Society of Nephrology (ASN) – Diabetic Kidney Disease Resources
  • UpToDate – “Diabetic Nephropathy: Clinical Features and Management”
  • StatPearls – Diabetic Nephropathy Review

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Nephrology

Your copay
Depending on insurance

Without Insurance

*Price Effective 12/1/2025
$169
Initial Visit
$109
Follow Up

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