What is Diabetic Nephropathy?


Diabetic nephropathy, or diabetic kidney disease, is one of the complications of type 2 diabetes. Your kidneys’ main function is to filter the blood by removing waste and extra fluids. Nephropathy diminishes that function and can cause kidney failure or end-stage renal disease (ESRD). Diabetic nephropathy is divided into five stages, in which the fifth stage is the most severe and requires dialysis, and possibly a kidney transplant. 

What are the five stages of diabetic nephropathy?

Doctors use the glomerular filtration rate (GFR) to test how well your kidneys are working. The highest GFR number is 100. Low GFR levels indicate your kidneys aren’t functioning as well as they should. As kidney disease progresses, the GFR number decreases. The progression between each stage can take years. The chart below explains what to expect at each stage, as well as the estimated GFR range.

Stage Description GFR Range 
One Slight kidney damage, but kidney function is normal. 90>
Two Mild loss of kidney function. Can last between 5 and 15 years after a diabetes diagnosis. Hyperfiltration keeps GFR levels elevated. 89–60
Three Mild to severe loss of kidney function. Occurs in 30-50 percent of patients, 80 percent go to develop nephropathy over the next decade. Irreversible if GFR levels fall between 40-34. 59–30
Four Severe loss of kidney function. Considered overt nephropathy. 29–15
Five Kidney failure and the development of end-stage renal disease occur. Dialysis and a kidney transplant may be needed. <15

How is diabetic nephropathy diagnosed?

Kidney disease is diagnosed by usually a urine test. Your doctor will test your urine for the protein, albumin. There shouldn’t be albumin in urine, therefore, the presence of albumin in the urine, even in the slightest, could indicate kidney damage.

Signs of kidney disease can be detected in the blood as well. In the blood, doctors look for creatinine, which is a waste product. However, since creatinine levels depend on age, race, body size and gender, “normal” levels vary and aren’t the best way to diagnose kidney disease.

What are the symptoms, risks and causes of diabetic nephropathy?

High blood pressure can also lead to nephropathy in diabetics and can often speed up its progression. Early on in nephropathy, symptoms can go unnoticed, however as the disease progress, you would notice:

  • An increased need to urinate
  • Confusion
  • Loss of appetite
  • Itching
  • Fatigue
  • Shortness of breath
  • Darker urine
  • Water retention causing swelling in the extremities
  • Nausea

Risk factors also include smoking, old age, obesity and elevated cholesterol (dyslipidemia). It’s estimated between 10 and 40 percent of people with type 2 diabetes will develop nephropathy.  Due to higher rates of diabetes and high blood pressure, African-Americans, Hispanics, American Indians and Alaska Natives are at higher risk for kidney failure.

How is diabetic nephropathy treated? Is it curable?

Though there isn’t a cure diabetic nephropathy, this condition is treated by keeping blood sugar and blood pressure under strict control. This can delay the progression of the disease. Doctors may also keep you from taking medicines that could exacerbate the disease. People with ESRD often need dialysis to cleanse the blood.

How can I prevent diabetic nephropathy?

  • Properly maintaining diabetes, such as closely monitoring your blood sugar, is essential to avoid nephropathy.
  • Prevent or take the necessary medication, as prescribed by your doctor, to treat high blood pressure.
  • Maintain a healthy lifestyle such as eating a nutritious diet, exercising, limiting alcohol consumption and not smoking.
  • During your visits to the doctor, ask your provider to test for signs of kidney damage. Some doctors may recommend yearly tests for kidney damage, especially because symptoms may not be noticeable at first.