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You have diabetic nephropathy, or diabetic kidney disease (DKD), when diabetes damages your kidneys. About 1 in 3 adults with diabetes have this condition. Since it doesn't usually cause symptoms, people with diabetes need tests for it at least once a year.

Early detection and treatment of diabetic kidney disease will give you the best outcome. When DKD progresses, it can lead to kidney failure. That means your kidneys lose most of their ability to work, and you need regular dialysis or a kidney transplant.  

How Is Diabetes Related to Kidney Disease?

After it uses food for energy or as it repairs itself, your body creates waste products and toxins. The main job of your kidneys is to filter these waste products and excess water out of your blood and transform them into urine. Your kidneys have lots of small, specialized blood vessels that filter out the wastes while keeping useful molecules, like protein, in your blood.

But diabetes interferes with this process.

When your diabetes is uncontrolled, your kidneys' filtration system works harder than normal. After years of this extra work, the filters break down and leak protein into your urine.

“If you look at the adult population in the U.S., diabetes is the most common cause of kidney disease and failure,” says Anjay Rastogi, MD, PhD, clinical chief of nephrology at the David Geffen School of Medicine at UCLA.

“Other causes are quite uncommon, and some of them even qualify as rare diseases. Diabetes, on the other hand, is very common.”

Kidney disease can play out differently depending on whether you have type 1 or type 2 diabetes.

 “When you have type 1 diabetes, you know within a reasonable time that you have it," Rastogi says. "Type 2 is different. You could be type 2 for a long time and still not know.

“This really makes a difference because by the time you diagnose a patient with type 2 diabetes, they might’ve had it for a very long time.”

That's why people with type 2 should start getting their kidneys tested as soon as they're diagnosed. By contrast, doctors start screening people with type 1 about 5 years after their diabetes diagnosis, he says.

What Are the Risk Factors of DKD?

“Not everybody with diabetes will have kidney damage," says Pankaj Shah, MD, an endocrinologist at the Mayo Clinic. "Some people get it sooner than others. Some don't develop it at all. But there are certain, clear risk factors for DKD.”

These include:

  • Smoking
  • Obesity
  • Uncontrolled blood sugar
  • High cholesterol
  • High blood pressure

Some other risk factors for DKD are less controllable, such as:

  • A family history of diabetes and kidney disease
  • Your ancestry and ethnicity (it’s more common in African American, American Indian, and Hispanic people)
  • Older age (especially when you're over 60)

What Are the Symptoms of DKD?

“Kidney disease, in general, is silent. It doesn't cause symptoms until usually the very end,”  Rastogi says. “Most of the time, patients don't even realize it. That's why we have to do screening.”

Usually, doctors find the first sign of DKD during a screening. If you have the condition, tests will show higher levels of albumin (a protein made by your liver) in your pee.

In late-stage DKD, you may notice certain symptoms. These could include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Weakness
  • Fatigue
  • Itching
  • Muscle cramps, especially in your legs
  • You need less insulin, which happens because diseased kidneys lead to less insulin breakdown

If you notice any of these things, see your doctor.

What Are the Complications of DKD?

The No. 1 cause of death in kidney patients is heart (cardiovascular) disease,  Rastogi says. And diabetes already puts you at higher risk of heart disease.

 "So if you have diabetic kidney disease, your cardiovascular disease burden is quite high,” he says.

Shah calls this a vicious cycle.

“When there’s kidney disease, it causes blood pressure to go up," he says. "This causes kidney disease, which again causes blood pressure to go up. And diabetes accelerates this whole process.  

"Essentially, all three of these are compounding each other's complications.”

What Are the Treatment Options for DKD?

“Treatment depends upon what stage you’re in,” Rastogi says. “We first try to get you on all the right medications.”

When you have small amounts of protein in your urine (microalbuminuria), doctors have several treatments that can help keep your DKD from getting worse.  

But if your medical team finds your kidney disease when you have higher amounts of protein in your pee (macroalbuminuria), you’re more likely to develop kidney failure.

In that case, you have fewer options.

“There are measures that we can take to have a longer and hopefully healthier lifespan. For example, embarking on dialysis,” says Shah. “But dialysis isn’t the only option. Kidney transplant is a very good option also.”

How Can You Keep Your Kidneys Healthy With Diabetes?

If you have diabetes, there are things you can do to improve your kidney health:

Check your levels regularly. “Blood glucose control, blood pressure control, and cholesterol control. All of those things are important,” says Rastogi.

You are what you eat. Diet is very important, Rastogi says. He suggests plant-based diets and limiting your protein intake. He says it's important to choose foods wisely to make sure you aren’t undernourished.  Keep an eye on your salt intake, too. Watch for hidden sodium in processed food and restaurant meals.  

Stop smoking. It’s not healthy to smoke in any situation. That's especially true if you want to lower your risk of DKD.

Work your mind and body. Rastogi recommends “exercise, mindfulness, and meditation.” Regular exercise helps to prevent DKD or keep it from getting worse.  Relaxation techniques reduce stress and are good for your mental health. 

Take charge of your health.  Be proactive about your condition. Ask lots of questions. And follow your doctor's instructions, including taking medications as prescribed.

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Photo Credit: Alden Chadwick / Getty Images

SOURCES:

Pankaj Shah, MD, endocrinologist, Mayo Clinic, Rochester, MN.

Anjay Rastogi, MD, nephrologist, David Geffen School of Medicine at UCLA, Los Angeles.

National Institutes of Health: “Diabetic Kidney Disease.”

CDC: “Chronic Kidney Disease (CKD).”

American Diabetes Association: “Kidney Disease (Nephropathy).”

Mayo Clinic: “Diabetic nephropathy (kidney disease).”

Mount Sinai: “Albumin - blood (serum) test.”

National Kidney Foundation: “Diabetes - A Major Risk Factor for Kidney Disease.”