Nephropathy refers to the deterioration of kidney function. You may have heard about the later stages: early kidney disease or kidney failure.
People with diabetes are on a
Given the serious consequences of nephropathy, it is important for people with diabetes to understand how to monitor and maintain their kidney health.
As many as 40 percent of people with type 2 diabetes (T2D) and 30 percent of people with type 1 diabetes (T1D) are at risk of developing kidney disease. Middle-aged African Americans, Native Americans, and Hispanics are more likely to be diagnosed with diabetic kidney disease than the general population with diabetes.
Kidneys filter waste products from the blood and send them out through the urine. They help regulate the amount of salt and minerals in the body. And they produce hormones that regulate blood pressure, make red blood cells and keep bones strong.
Over time, elevated blood sugar levels damage blood vessels in the kidneys and weaken kidney function. Once this damage reaches a certain level, it is diagnosed as kidney disease.
If this damage is not addressed, this damage can go so far that the kidneys fail and are no longer able to filter waste. When this happens, the work a person’s kidneys did must be replaced, either through regular dialysis sessions or a kidney transplant.
In the worst cases, nephropathy can lead to end-stage renal disease (ESRD), an ultimately fatal organ failure.
Nephropathy shows no obvious symptoms at first.
The symptoms that may occur include:
- fluid retention
- stomach upset
- loss of appetite
However, the above symptoms do not specifically indicate kidney problems and are often dismissed.
A combination of urine and blood tests are used to monitor kidney health and diagnose diabetes-related kidney disease.
Urine samples and microalbuminuria
A urine sample will be taken and checked for signs of protein in your urine.
One such protein is albumin, which is made in the liver and normally found in your blood plasma. When albumin appears in the urine, it is called
Microalbuminuria is also considered a risk marker for cardiovascular disease, along with early kidney disease. Often, your doctor will order a microalbuminuria test if they think you are at risk for kidney damage or kidney disease.
eGFR measurement of renal function
An estimated glomerular filtration rate (eGFR) is calculated from a blood sample.
Creatinine, a normal waste product of muscle use, is measured. Based on blood creatinine levels, age, body size and gender, a calculation is made to determine the person’s eGFR. The eGFR provides one measure of kidney function. For those who have kidney problems, it also identifies what stage of kidney disease the person is in.
How creatinine is measured in this test has a bias that affects African Americans. The measurements established for patients who identify as African American assume higher muscle mass than other people taking this lab test — regardless of the person’s actual physique. This is thought to explain (at least in part) why African Americans tend to have worse outcomes once diagnosed with kidney disease.
The National Institutes of Health (NIH), the National Kidney Foundation and the American Society of Nephrology have all called for changes to the way eGFR is calculated to eliminate this inherent racial bias.
Annual kidney screening for people with diabetes
The American Diabetes Association’s 2022 Standards of Care recommends annual kidney health screening for all people with T2D and for people with T1D beginning 5 years after diagnosis.
Anyone diagnosed with kidney disease may need to complete more frequent screenings to monitor progression and guide their treatment.
When nephropathy is noticed early in its progression, it can be slowed, stopped, and in some cases reversed.
The effectiveness of this intervention depends on a number of factors, including early detection and careful health management.
- keep glucose levels within target range
- controlling blood pressure so that it is within target range
- closely monitoring the use of over-the-counter medicines known to affect the kidneys, including common anti-inflammatories and pain relievers
- a diet that limits protein, sodium, and potassium
- control cholesterol levels
- being active
- do not smoke
- limit alcohol
- deal with stress
The most effective way to maintain kidney health is to actively manage blood glucose levels and blood pressure. Keeping both within the target range supports healthy kidney function and reduces the likelihood of developing diabetes or hypertension.
A number of medications, while not curing diabetic nephropathy, offer some benefit in controlling kidney health and function. Among which:
During phases 1 through 4, actively managing kidney health along with possibly some medication can have a positive effect.
But in stage 5, the kidneys stop working and more drastic action is required.
Kidney dialysis for nephropathy
Dialysis requires that you spend 4 or more hours actively receiving treatment several days a week.
Usually dialysis takes place in a treatment center and you must sit quietly while connected to a dialysis machine as it filters the blood.
Transplants for this diabetes-related complication
Kidney transplantation requires major surgery and extensive pre- and post-operative care. It can be difficult to find a compatible organ donor and can be very expensive. According to this report, the average kidney transplant cost in 2020 was $442,500.
Nephropathy is one of the more serious, potentially life-threatening complications of diabetes. But ending up with diabetes-related kidney disease isn’t inevitable. Managing kidney health through a combination of healthy habits, monitoring, and medication is the formula for keeping the kidneys functioning and avoiding dialysis or a kidney transplant.