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Type 2 Diabetes and Kidney Disease: What’s the Link?

Medically Reviewed by Minesh Khatri, MD on April 18, 2020

Your kidneys act as a filter, clearing waste out of your blood and sending it out of your body in your urine.

When you have type 2 diabetes, you’re more likely to develop kidney disease. It doesn’t happen to everyone with diabetes, but it’s a common complication that happens over time if your diabetes isn’t under good control.

You may hear this condition called diabetic kidney disease (DKD), chronic kidney disease (CKD), diabetic nephropathy, or kidney disease of diabetes.

What Happens

There are tiny filters in your kidney called glomeruli. When your blood sugar is too high, it puts extra strain on these filters. The damage builds up over time.

Eventually, the filters start to let protein that should stay in your body pass through along with the waste. Essentially, they begin to leak.

Symptoms and Diagnosis

In the early stages, you won’t have symptoms and won’t know that your kidneys are being overworked.

Most people don’t show symptoms early on. So it’s important to keep up with the kidney tests that your doctor recommends. This includes providing urine samples and getting blood tests.

When your kidneys aren’t working well, too much of a protein called albumin will show up in your urine. Blood tests will show whether your kidneys are filtering your blood properly.

Once kidney disease starts to get worse, you may notice some changes. These can include:

What Raises Your Risk

The longer you have uncontrolled diabetes, the more likely you are to develop kidney disease. If your blood glucose level is too high, your chances of kidney damage rise.

Other things that can raise your risk include:

Prevention

One of the most important steps you can take to protect your kidneys is to manage your diabetes. That may cut your risk by a third. You’ll need to check your blood glucose levels, take your medications, follow diet recommendations, and keep up with doctor’s appointments.

Also, be sure you manage any other conditions, such as high blood pressure, as part of a healthy, active lifestyle.

Take care to follow directions carefully when you take over-the-counter pain relievers. Accidentally taking too much can damage your kidneys.

And if you smoke, quit. (Your doctor can help with that, too.)

Treatment

If your kidneys show signs of damage, your doctor will develop a plan to slow the disease, focused first on getting blood glucose levels and blood pressure under control.

You can take several positive steps on your own, such as:

Medication may help. Certain types of blood pressure drugs called ACE inhibitors and ARBs have been shown to slow kidney disease. The medicine can work even if you don’t have high blood pressure. Also, new classes of diabetes drugs called SGLT2 inhibitors, GLP-1 agonists, and  nonsteroidal mineralocorticoid receptor antagonists (MRAs) can also help diabetic kidney disease. Of course, you’ll also need to take any medications that your doctor recommends for your type 2 diabetes.

Your doctor may also recommend that you cut down on protein to ease the strain on your kidneys.

Kidney Failure

If your kidney disease worsens to the point of kidney failure, that means your kidneys are working at less than 15% of their normal ability. Kidney failure is also called end-stage renal disease, or ESRD. People in kidney failure need dialysis or a kidney transplant. But most people with diabetic kidney disease don’t end up with kidney failure. Again, the key is to get type 2 diabetes under control, take care of your health, and keep up with any tests and treatments that your doctor recommends.

WebMD Medical Reference

Sources

SOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases: "Diabetic Kidney Disease."

Mayo Clinic: "Diabetic Nephropathy."

American Diabetes Association: "Kidney Disease."

Clinical Diabetes, July 2007.

American Kidney Fund: "Diabetes," "Kidney Failure (ESRD) Causes, Symptoms and Treatments."

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