What is diabetic nephropathy?

Nephropathy is the deterioration of kidney function. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD.

According to the CDC, diabetes is the most common cause of ESRD. In 2011, about 26 million people in the U.S. were reported to have diabetes, and more than 200,000 people with ESRD due to diabetes were either on chronic renal dialysis or had a kidney transplant. Both type 1 and type 2 diabetes can lead to diabetic nephropathy, although type 1 is more likely to lead to ESRD.

There are five stages of diabetic nephropathy. The fifth stage is ESRD. Progress from one stage to the next can take many years.

What causes diabetic nephropathy?

Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy. Hypertension is believed to be both a cause of diabetic nephropathy, as well as a result of the damage that is created by the disease. As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure.

Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly.

The high blood sugar associated with diabetes also causes damage to the kidney through many different and complicated pathways. Most of this damage is directed toward the blood vessels that filter the blood to make urine.

Can diabetic nephropathy be prevented?

The onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.

How can diabetic nephropathy be detected early?

You should have your urine tested at regular intervals to check for a protein called albumin. Normally, urine should not have any albumin. Having even a small amount of albumin in your urine is a sign that early kidney damage is present.

What is the treatment for diabetic nephropathy?

Specific treatment for diabetic nephropathy will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment may include any, or a combination of, the following:

• Proper diet

• Exercise

• Strict monitoring and controlling of blood glucose levels, often with medication and insulin injections

• Medication to lower blood pressure

Treatment of hypertension with either ACE inhibitors or angiotensin receptor blockers (ARBs) is especially effective in slowing the progression of diabetic kidney disease.

Treatment for ESRD often initially includes dialysis to cleanse the blood. Eventually, kidney transplant may also be a consideration.