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Diabetic Nephropathy

(Nephropathy, Diabetic; Diabetic Glomerulosclerosis)

Pronounced: die-a-BET-ik nuh-FROP-uh-thee


Diabetic nephropathy is kidney damage that occurs with diabetes. It is the job of the kidneys to:

  • Filter blood
  • Catch needed substances and return them to circulation
  • Create urine to pass waste out of the body

Damage from diabetes can prevent the kidneys from working well. In some cases, this can lead to kidney failure.

Anatomy of the Kidney
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Blood passes through small filters in the kidneys. Changes in the blood vessels due to diabetes can cause damage to these filters. Blood sugar levels that are not well-controlled can have the greatest impact on the kidney filters.

Over time, the damage to the filters increases. The damaged filters cannot clean the blood properly and protein from the blood can leak into the urine. If left untreated, this can lead to kidney failure.

Risk Factors

Factors that may increase your chance of diabetic nephropathy include Type 1 diabetes and Type 2 diabetes with:


Before symptoms appear early indications may include:

  • Protein in your urine when it is tested
  • Elevated blood urea nitrogen and creatine when your blood is tested
  • High blood pressure

Symptoms may not appear until the kidney damage is severe. Symptoms may include:

  • Fluid buildup may appear as swelling in feet or hands
  • Weakness
  • Loss of appetite, nausea, and vomiting
  • Difficulty sleeping
  • Confusion and trouble concentrating


You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids will be tested. This can be done with:

  • Blood tests to check kidney function
  • Urine tests to look for protein

You may have an ultrasound of your kidneys

If testing shows severe kidney disease you may have a kidney biopsy


Talk with your doctor about the best treatment plan for you.

Treatment is aimed at preventing or slowing further kidney damage. It may involve lifestyle changes and medications. Diabetes and blood pressure will both need to be controlled. This may help prevent further kidney damage.

Lifestyle Changes

Lifestyle changes that will help control your blood sugar and blood pressure include:

  • Lose weight if you are overweight.
  • Exercise.
  • Eat less salt and protein.
  • If you smoke, talk to your doctor about ways to quit.
  • Avoid alcohol.
  • Follow your diabetes management plan.


Your doctor may prescribe medications to help control blood sugar, reduce protein in the urine, protect your kidneys, and treat high blood pressure, such as:

  • Angiotensin-converting enzyme inhibitors (ACE inhibitors)
  • Angiotensin receptor blockers (ARBs)
  • Aldosterone antagonists
  • Medications to lower cholesterol

Treatments for Kidney Failure

If the damage to your kidneys progresses to kidney failure, you may need dialysis. Dialysis takes over for your kidneys. Blood passes out of your body into a machine. The machine filters waste out of the blood then pumps blood back to you.

If the kidney failure progresses you may eventually need a kidney transplant.


To help reduce your chances of diabetic nephropathy:

  • See your doctor regularly. During checkups, you will have your blood pressure, urine, blood, and organs monitored for changes.
  • Control blood glucose levels. Follow your diabetes treatment regimen as directed.
  • Work with your doctor to maintain a healthy blood pressure (less than 130/80 mmHg).
  • Exercise daily.
  • If you smoke, talk to your doctor about ways to quit.

American Diabetes Association

National Kidney Foundation


Canadian Diabetes Association

The Kidney Foundation of Canada


Bjornstad P, et al. Early Diabetic Nephropathy in Type 1 Diabetes – New Insights. Curr Opin Endocrinol Diabetes Obes. 2014 Aug; 21(4): 279–286. Available at:

Diabetic nephropathy. EBSCO DynaMed Plus website. Available at: Updated August 18, 2016. Accessed August 24, 2017.

Diabetic nephropathy. Cleveland Clinic website. Available at: Accessed August 24, 2017.

Diabetic nephropathy. Family Doctor—American Academy of Family Physicians website. Available at: Updated June 2017. Accessed August 24, 2017.

Kidney Disease (Nephropathy). American Diabetes Association website. Available at: Updated February 9, 2017. Accessed August 24, 2017.

Last reviewed September 2018 by September 2017 Michael Woods, MD, FAAP  Last Updated: 8/24/2017