Diabetic Nephropathy

Diabetic nephropathy is a description of the damage to a person's kidneys that can occur due to diabetes mellitus, more commonly called diabetes. The damage to the kidneys interferes with normal kidney function.

What is going on in the body?

The kidney is made up of several million filtering units. Each filtering unit contains a membrane to filter the blood, which is how urine is made. Diabetes, a condition that causes high blood sugar levels, can slowly damage these filtering membranes through a mechanism that is not well understood. As this condition gets worse over time, kidney failure may occur.


What are the signs and symptoms of the condition?

If people with diabetes are not screened for diabetic nephropathy, many years may pass before symptoms develop. The earliest sign of this condition is usually an abnormally high level of protein in the urine that occurs without symptoms.

Symptoms of diabetic nephropathy start only after severe kidney damage has occurred and may include:

  • swelling in the legs
  • nausea and vomiting
  • malaise, a vague feeling of illness
  • fatigue
  • headache
  • itching
  • frequent hiccups
  • unintended weight loss
  • swelling of the face
  • unintended weight gain due to fluid buildup

What are the causes and risks of the condition?

Diabetes mellitus ,most often type 1 diabetes, causes this condition. It can occur in people whether or not they take insulin for their diabetes. However, tight control of the blood sugar can help people delay or avoid the onset of kidney damage and slow its progression. The more out of control the blood sugar is over time, the more likely kidney damage is to occur.

What can be done to prevent the condition?

Three primary methods are recommended to prevent or at least delay the onset of diabetic nephropathy: close or tight control of blood sugar levelscontrol of blood pressure. People with diabetes may even benefit from having blood pressure that is lower than normal.the use of medications known as angiotensin-converting enzyme (ACE) inhibitors, such as captopril (i.e., Capoten) or lisinopril (i.e., Prinivil, Zestril), or ARB-medications, such as losartan (i.e., Cozaar).

How is the condition diagnosed?

Urine testing is done in healthy people with diabetes to screen for diabetic nephropathy. These tests generally show increased amounts of protein in the urine if diabetes has damaged the kidneys. Sometimes, the urine is collected over a 24-hour period to get a more exact measurement of the amount of kidney damage. If kidney damage is severe, blood tests will show decreased kidney function.


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Written by James Broomfield, MD

Last reviewed on 10/4/2006