Stages of Diabetic Kidney Disease

Medically Reviewed by Minesh Khatri, MD on December 05, 2021

If you're living with diabetes, there's a chance you could get a problem with your kidneys called "diabetic kidney disease." You may hear some people refer to it as diabetic nephropathy. It happens when high blood pressure or high blood sugar from diabetes hurts your kidneys.

Diabetic kidney disease makes it harder for your kidneys to take waste out of your body. The problems gradually get worse as the disease moves through five stages. Treatment can help you manage symptoms and help prevent complications.

In the early stages of kidney disease, there are no symptoms, which is why it's important to get your kidneys checked regularly. Your doctor will likely take blood and urine samples at least once a year to look for a specific protein called microalbumin in your urine.

Stage 1

In this phase, your kidneys begin to work a little harder than normal and may get a little bigger. Your urine has a little bit of protein in it.

This is an early and mild stage of the disease. There are many ways to treat it, and there are things you can do to improve your condition, such as:

  • Keep your blood pressure and blood sugar under control.
  • Eat a healthy diet, including limiting salt intake.
  • Stay active (30 minutes of exercise a day).
  • Stick to a healthy weight.
  • If you smoke, quit.

Stage 2

This stage develops slowly over time. Your kidneys are still working pretty well but may show some signs of damage, with increased amounts of protein in the urine.

You can help keep your kidneys healthy by following some of the same tips as you tried in stage 1.

Stage 3

At this point, you probably still won't have any symptoms, but some people may notice things like swelling in their hands or feet. You may also start to get high blood pressure and anemia.

Besides taking care of your health with the same steps as in stage 1, it's important to get treated by a kidney specialist called a nephrologist.

Stage 4

This stage is a serious condition, and you'll need to manage it closely to prevent kidney failure. Your kidneys may not work well, and you'll likely get symptoms such as swelling in your hands and feet, and changes in how often you pee.

You may also get high potassium levels and a buildup of acidity and phosphorus in your blood.

In stage 4, more protein usually ends up in your urine. Your nephrologist will help you keep your blood pressure under control, which will lower the amount of protein in your urine and help prevent kidney failure.

Stage 5

Your kidneys stop working or are close to it, a problem called "kidney failure." You may get symptoms such as:

If your kidneys stop working, you will need a treatment called dialysis or a kidney transplant. Dialysis is a way to clean your blood and remove fluid from the body. It can be done in two different ways: hemodialysis and peritoneal dialysis. If you get a kidney transplant, you'll have an operation to get a healthy kidney from a living or deceased donor.

Show Sources


Mayo Clinic: "Diabetic Nephropathy," "Acute Kidney Failure."

National Institutes of Diabetes and Digestive and Kidney Diseases: "Your Kidneys and How They Work," "Diabetic Kidney Disease."

Diabetes: "The stages in diabetic renal disease. With emphasis on the stage of incipient diabetic nephropathy."

Journal of Diabetes Investigation: "A new Classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy."

American Kidney Fund: "Stages of Diabetic Disease," "High phosphorus."

National Kidney Foundation: "Key Points: Living with Stage 4 Kidney Disease."

© 2021 WebMD, LLC. All rights reserved. View privacy policy and trust info