Preventing diabetic kidney disease

Diabetes is the leading cause of kidney failure in the United States. Early detection of kidney damage increases your likelihood of preventing kidney failure. Regular visits to your health professional, periodic urine tests, and lifestyle changes may decrease your risk for developing kidney disease (diabetic nephropathy), preventing kidney failure.

You should minimize your risk factors, which include:

• Smoking.
• Consistently high blood glucose levels.
• High blood pressure (hypertension).
• High cholesterol.
• Extreme insulin resistance.

You cannot control some risk factors, such as age, race (African American or Native American), and other genetic factors. But you can reduce your risk for diabetic nephropathy by not smoking, controlling both your blood glucose and your blood pressure, losing weight, and having a yearly screening test for protein in your urine.

When the kidneys are damaged by diabetes, they cannot properly filter wastes from your body and they begin to eliminate an essential protein, albumin. Your health professional can monitor your urine for the amount of albumin you are losing and use this information to detect kidney damage as early as possible.

• A microalbuminuria test detects very small amounts of protein in your urine, indicating early kidney damage. If you have small amounts of protein in your urine, your doctor will prescribe a medicine to slow the progression of the disease. Microalbuminuria also is a sign that you are at risk for heart disease.
• A macroalbuminuria test can reveal large amounts of protein in the urine, indicating severe damage to the kidneys and possible kidney failure.

The difference between these two tests is shown in the table below.

Tests for urine protein

Test	What it detects	Next steps, if you test positive
Microalbuminuria	Extremely small amounts of protein in your urine: This suggests early kidney damage before it is noticeable on exam or by other tests. Microalbuminuria can develop years before kidney failure occurs.	Prevent progression of nephropathy by having a hemoglobin A1c of below 7% and by keeping your blood pressure at or below 130/80. Reduce protein in the diet. Start taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB). Avoid medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), that can damage kidneys.
Macroalbuminuria	Larger amounts of protein in your urine; advanced kidney damage	Follow the above treatments. If kidney damage is severe, begin dialysis.