Diabetes and Kidney Disease

Diabetes is the number one cause of kidney failure. Almost a third of people with diabetes develop kidney disease (also called diabetic nephropathy).

People with diabetes and kidney disease do worse overall than people with kidney disease, alone. This is because people with diabetes tend to have other long-standing medical conditions, like high blood pressure, high cholesterol and blood vessel disease (atherosclerosis). People with diabetes also tend to have other kidney-related problems, such as bladder infections, and nerve damage to the bladder.

Kidney disease in type 1 diabetes is slightly different than in type 2 diabetes. In type 1 disease, kidney disease begins acutely and may start at an early or young age. Overt disease, when present, is obvious after about 15 years of having type 1 diabetes.

In type 2 diabetes, many patients have kidney disease at the onset, when they are diagnosed with diabetes. Because type 2 diabetes is frequently found in the middle or older aged person with other chronic medical conditions, kidney disease may have been caused by other conditions.

What Are the Symptoms of Kidney Disease?

Although there are often no symptoms with early kidney damage, they may include:

• Swelling of the hands, feet and face.
• Weight gain.
• Itching (end-stage kidney disease) and extremely dry skin.
• Drowsiness (end-stage kidney disease).
• Blood in the urine (rare).
• Abnormalities in the hearts' regular rhythm, because of increased potassium in the blood.
• Muscle twitching.

As kidney damage progresses, your kidneys cannot remove the waste from your blood. The waste then builds up in your body and can reach poisonous levels, a condition known as uremia. People with uremia are often confused or comatose. Uremia is worsened by high blood pressure.

How Is Kidney Disease Diagnosed?

The disease is detected by finding protein in the urine. That's why you should have your urine tested every year.

How Is Kidney Disease Treated?

Lowering blood pressure and maintaining blood glucose control are absolutely necessary to slow the progression of kidney problems. Some medicines called angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage. Although ACE inhibitors -- including Altace, Lotensin and Capoten -- are usually used to treat high blood pressure and other medical problems, they are often given to people with diabetes to prevent complications, even if their blood pressure is normal.

If a person has side effects from taking ACE inhibitors, another class of drugs called angiotensin receptor blockers can be given instead.

If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure requires treatment with dialysis or a kidney transplant.

Get tips on monitoring complications of diabetes
Learn more about urine testing for people with diabetes
View the full table of contents for the Diabetes Guide.

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.

Edited by John A. Seibel, MD, WebMD, December 2006.