Diabetic nephropathy is the name given to kidney damage caused by diabetes. It develops slowly, over many years, and is also referred to as kidney disease or chronic kidney disease. Diabetic kidney disease is another name given to diabetic nephropathy.
With the right support you can reduce your risk of developing this complication. Also, if it’s spotted early enough, diabetic nephropathy can be slowed down with certain treatment.
On this page:
- What do the kidneys do?
- What causes diabetic kidney disease?
- What are the symptoms of kidney disease?
- How can I reduce my risk of kidney disease if I have diabetes?
- What are the screening tests for kidney disease?
- What is the treatment for diabetic kidney disease?
- More information and support
What do the kidneys do?
Most people have two kidneys, each about the size of a fist. They are located just below the rib cage, one on each side of your spine in your lower back. One of the main jobs of your kidneys is to filter your blood. They get rid of extra fluid and waste products from your body when you wee.
What causes diabetic kidney disease?
When you have high blood glucose levels, also called blood sugar levels, this can damage the small blood vessels and tiny filters in your kidneys.
High blood pressure can do this too. Damage to these filters can cause them to leak and not work as well, and when this happens, abnormal amounts of protein from the blood can leave your body in your urine. This is often an early sign of kidney disease.
What are the symptoms of kidney disease?
You may not have any symptoms in the early stages of kidney disease. This is why it's so important to have tests for kidney disease every year. Spotting it early means you can have treatment to slow it down.
Kidney disease can get worse over time and eventually the kidneys may stop working altogether, known as kidney failure. This is not common, but people with kidney failure may need dialysis or a transplant. Kidney Care UK have more information about treatments for kidney disease on their website.
As kidney disease progresses, you could notice symptoms like:
- feeling really tired
- swollen ankles, feet and hands
- being short of breath
- feeling sick
- weight loss and poor appetite
- needing to wee more often at night
- itching skin
- muscle cramps.
These symptoms can be caused by your kidneys struggling to clear extra fluid and waste products from your body. But other health conditions can also cause these symptoms, so it’s important to talk to your doctor for more information and advice if you are worried that you have symptoms of kidney disease.
How can I reduce my risk of kidney disease if I have diabetes?
There are lots of things you can do to look after your kidneys and reduce your risk of developing kidney disease or slow any problems down including:
- getting support to keep your blood sugar levels within your target range
- keeping your blood pressure down
- getting support to stop smoking
- asking your GP about medication
- eating a healthy balanced diet and keeping active
- losing weight if you need to
- going to all your medical appointments.
We have lots of information and support to help you. Have you tried our Learning Zone? It has free courses including one called Diabetes Checks and Results which includes a video guide on kidney checks.
You can also download a free copy of our diabetes and kidney disease leaflet from our online shop.
Tests for kidney disease
There are two tests for kidney disease are included in your annual review. You should normally have these tests every year.
Find out more about the diabetes checks and services you can expect:
Urine test (ACR)
A simple urine test called ‘albumin: creatinine ratio (ACR)’ looks for abnormal amounts of protein called albumin in the urine. This urine test can spot kidney disease in its early stages, which is important because it means treatment can be started to stop it from progressing.
Blood test (eGFR)
This tests for a waste product called creatinine. Your creatinine level and other information, such as height, weight and sex, are used to estimate your glomerular filtration rate (eGFR). This is a measure of how well your kidneys are working.
It may take around a week to receive your test results. And you might need to have further tests. If you want more information while you are waiting, call our helpline and speak to one of our advisors for support.
Home testing for UACR
Some people might be sent a home-based test by their healthcare team, which allows you to measure albumin and creatinine concentrations in a sample of your urine, and your albumin-to-creatinine ratio (ACR).
To do the test, you'll need the testing kit that's been designed to use with an app. Your team will send you an online link to register. The app guides you step-by-step through the testing process, and the results are automatically sent to your electronic record so they can be reviewed by your doctor.
We have developed an Information Prescription which can help you understand your test results and develop an action plan.
What is the treatment for diabetic kidney disease?
Almost one in five people with diabetes will need treatment for diabetic nephropathy. The type of treatment you need will depend on the stage of your kidney disease:
Medication
Keeping your blood pressure at your target level can help stop kidney disease from getting worse. Your doctor may offer you tablets to help with this, such as ACE inhibitors and ARBs. These are both groups of medications with several different drugs available in each group.
Both ACE inhibitors and ARBs help to protect the kidneys from further damage, as well as lower blood pressure. That’s why they are also made available to people without high blood pressure.
People with type 2 diabetes and kidney disease might have a different type of medication called sodium-glucose cotransporter-2 inhibitors, or SGLT-2 inhibitors.
This group of medications prevent the kidneys from reabsorbing glucose back into the blood, which helps lower blood sugar levels in people with type 2 diabetes. They also help protect the kidneys and can slow down the progression of kidney disease.
Speak to your GP about whether one of these medications could be right for you.
Changes to your diet
You may also need to avoid certain foods or have a limit on the amount of fluid you have - including water - but you’ll need support from a registered dietitian to help you with the changes to your diet.
Other treatments
If you do develop end-stage kidney disease and your kidneys fail, your treatment options include dialysis or a kidney transplant. The good news is, as treatments and early diagnosis continue to improve, fewer people will go on to develop end-stage kidney disease.
What is end-stage kidney disease?
Read our information below on end-stage kidney disease, which was written in partnership with Imperial College Healthcare NHS Trust's kidney & transplant team and renal diabetes team.
End-stage kidney disease
What is end-stage kidney disease?
End-stage kidney disease is when your kidneys are working at less than 15% of their usual ability. This means they cannot filter out waste products and extra water from the blood. This can lead to serious health problems or even be life-threatening without treatment.
Diabetes and kidney disease
In the UK, although end-stage kidney disease is rare, diabetes causes more than one-third of end-stage kidney disease cases. Having both diabetes and end-stage kidney disease is tough. Diabetes increases your risk of heart disease and infections, which makes it harder to manage kidney disease.
Special care and guidance from your healthcare team will help you manage your diabetes and kidney disease. Whether you’re on dialysis, waiting for a kidney transplant, or getting supportive care, it’s important to find the right balance.
As your kidneys get worse, waste products and extra water will start to build up in your body. You will need to talk to your healthcare team about your options and make a supported decision about dialysis, a transplant, or supportive care.
Dialysis
Most people with end-stage kidney disease will start on dialysis. There are two types of dialysis – haemodialysis and peritoneal dialysis.
In haemodialysis, you are connected to a machine that cleans your blood of waste products and extra water. This can be done either at home or in a dialysis centre.
Peritoneal dialysis uses the lining of your abdomen, which is called the peritoneum, as a filter to clean your blood of waste products and extra water and is usually done at home.
For people with diabetes, dialysis can be challenging. During haemodialysis, for people who take blood glucose lowering medication such as insulin or a sulphonylurea, blood sugar levels may drop too low and cause a hypo. Meal planning can be hard because diabetes and end-stage kidney disease have different dietary needs.
Work with your healthcare team to make a plan that fits both your kidney and diabetes needs. A dietitian can guide you to make food choices that work for you. You can also wear your continuous glucose monitor or bring your blood sugar meter to dialysis sessions to check your level during and after dialysis.
Kidney transplants
In the UK, 20% of people with end-stage kidney disease get a kidney transplant.
A kidney transplant may give you a better quality of life than dialysis – but managing diabetes after a transplant can be difficult. The medicines that you need to take to prevent your body from rejecting your new kidney can cause high blood sugar levels. Some people who did not have diabetes before might get a new diagnosis of diabetes after a transplant.
Looking after your blood sugar levels is important before a kidney transplant. Make sure you go to all your medical appointments and work with your healthcare team to manage your diabetes. After a transplant, monitor your blood sugar levels closely. Be prepared that your diabetes medicines may be adjusted, or new medicines may be started.
Pancreas and kidney transplants
A combined pancreas and kidney transplant may be possible for some people with end-stage kidney disease and type 1 diabetes, or type 2 diabetes if they take insulin and are not overweight.
A pancreas-kidney transplant treats both your diabetes and end-stage kidney disease. A new working pancreas will help your body make insulin, which means you will no longer need insulin injections. It does not cure diabetes, but it does slow down the damage that diabetes has caused to your eyes, nerves, and blood vessels. It can also reduce the risk of heart disease and stroke. In fact, a working pancreas can help protect your new kidney and may even help you live longer.
However, the surgery for a pancreas-kidney transplant is harder to do and has more risks. It takes about 6-8 hours to put a new pancreas and kidney in your lower belly. Your own pancreas and kidneys are usually left in place unless they are causing problems.
The recovery time after the surgery is longer than with just a kidney transplant. After the transplant, you will need to take important medications to stop your body from rejecting your new pancreas and kidney.
Speak to your healthcare team about a combined pancreas-kidney transplant. Since the surgery for this type of transplant is riskier, you and your healthcare team will have to think carefully about whether it’s the best choice for you.
Look after your health and blood sugar levels before a transplant. After the transplant, work with your healthcare team to monitor your blood sugar levels and kidney function closely. You will need regular check-ups to monitor how well your new pancreas and kidney are working. Be prepared for changes to your medications if needed. Taking your medications as prescribed is very important to help your transplant work well and to keep you healthy.
Supportive care
Supportive care focuses on managing symptoms and having a good quality of life rather than extending life through dialysis or a transplant. Some people, like those who are older or have poor health, may prefer supportive care. As your kidneys get worse, you might feel tired, itchy, sick, and have swollen legs.
A healthcare team with experience in supportive care can help you manage your symptoms and keep your blood sugar levels safe. They can also guide you to emotional and spiritual support to help you live with dignity and peace.
Finding the right balance
Managing diabetes and end-stage kidney disease is a delicate balance. Each treatment choice has its own challenges. That’s why it’s important to have a personalised approach to your care.
Stay informed about your health and talk openly with your healthcare team to help you make decisions that are right for you. With the right information, support, and motivation, you will have the power to overcome these challenges and live a fulfilling life.
More information and support about kidney disease
Your diabetes team should be able to answer most of your questions. And we’re here to provide support and information when you need it too.
If you have more questions, or just want someone to listen, give our helpline a call. You’ll be able to talk things through with our trained advisors who have counselling skills and an extensive knowledge of diabetes.
The National Kidney Federation has kidney disease leaflets and can put you in touch with a local group. Kidney Care UK also offers resources and support including a telephone counselling service that you may find useful.
Kidney Research UK are dedicated to research into kidney disease. We’ve been working together to identify the most important areas of future research, so that we can stop kidney disease in people with diabetes.
