Diabetic Nephropathy - Diagnosis and Treatment

Diagnosis

Diagnosing diabetic nephropathy involves regular monitoring and specific laboratory tests. People with type 2 diabetes, or those who have had type 1 diabetes for more than five years, usually get screened for kidney issues every year.

Routine Screening Tests:

Urinary Albumin Test: This test checks for the presence of albumin, a protein, in urine. Finding albumin in the urine signals that the kidneys may not be filtering blood efficiently.
Urine Albumin/Creatinine Ratio (UACR): By comparing the levels of albumin and creatinine in a urine sample, this ratio shows kidney function. An elevated UACR can suggest early kidney damage, such as microalbuminuria or more noticeable proteinuria.
Estimation of Glomerular Filtration Rate (GFR): The GFR is calculated using the level of creatinine in the blood. This value shows how well the kidneys are cleaning waste products from the blood. Lower GFR numbers mean reduced filtration capacity.

Additional Diagnostic Methods:

Imaging: Ultrasound, X-rays, CT scans, and MRIs help examine kidney structure and blood flow. These tests can reveal abnormalities that affect kidney function.
Kidney Biopsy: Doctors may take a small tissue sample with a needle and examine it under a microscope. This confirms the diagnosis or rules out other kidney diseases.

Blood Tests:

Clinicians may also measure A1C levels for blood glucose control, since high blood sugar can worsen kidney damage.

Test Type	What It Checks	Key Findings
Urine Albumin Test	Albumin level in urine	Proteinuria, microalbuminuria
Urine Albumin/Creatinine Ratio	Albumin & creatinine ratio in urine	Early or advanced damage
GFR (Blood Test)	Creatinine in blood	Lower GFR = poorer function
A1C Level	Average blood sugar over 2–3 months	Glycemic control status

Treatment

Medicines to Manage Diabetic Kidney Disease

Doctors typically begin treating diabetic kidney disease by controlling blood sugar and blood pressure. This slows kidney damage and lowers the chance of other health problems. Medicines play an important role in this process.

Blood Pressure Medications

Doctors often choose angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to lower blood pressure and help protect kidney function.
Providers may prescribe these medicines even if blood pressure is in the normal range, because they can prevent further kidney injury.

Blood Sugar Control

Medicines such as hormone therapy, insulin sensitizers, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists help keep blood sugar at a healthy level.
Some newer treatments, including SGLT2 inhibitors and GLP-1 receptor agonists, may also help protect the heart and kidneys—reducing further complications.

Cholesterol and Kidney Scarring

Statins lower cholesterol, which can decrease the amount of protein found in urine.
A newer nonsteroidal mineralocorticoid receptor antagonist may help reduce kidney scarring. Studies show it can lower the risk of kidney failure and heart problems in people with diabetic kidney disease.

Patients taking these medicines usually have regular blood or urine tests to track their kidney health and see if treatment is working.

Approaches for Severe Kidney Damage

When diabetic nephropathy becomes severe or reaches the last stages, doctors may recommend more advanced treatments.

Dialysis

Hemodialysis uses a machine to clean waste and fluid from the blood. This usually happens at a clinic several times a week, but some people may do it at home.
Peritoneal dialysis uses the lining of the belly to filter blood. A special fluid runs in and out of the abdomen to remove waste. Many people perform this process at home or while at work.

Kidney Transplant

If dialysis is not enough or not desired, a kidney transplant may be an option. Sometimes, a pancreas transplant can be performed along with the kidney for certain patients with diabetes.
The transplant process starts with an evaluation to ensure the person is ready for surgery. If successful, it can replace the need for dialysis.

Supportive Care

When dialysis and transplant are not chosen, symptom management helps keep the patient comfortable. This focuses on quality of life, though life expectancy may be limited.

Beginning the Donor Evaluation Process

Patients with kidney failure might consider a kidney or kidney-pancreas transplant. Preparing for transplant includes an assessment to check if the patient is a good candidate for surgery.

Those interested in donating a kidney or liver, either directly or as part of a paired exchange, usually start by filling out a health questionnaire.

This helps the transplant team learn about any health conditions and decide if it is safe for the donor and the recipient.

New and Developing Therapies

Researchers are studying therapies that could change future treatment for diabetic nephropathy. Regenerative medicine focuses on ways for the body to repair or rebuild damaged kidney tissues.

Some scientists are also exploring whether pancreas islet cell transplants or stem cell therapies could treat diabetes more effectively. If diabetes is controlled or cured, kidney health may improve too.

These possible future treatments, including improved drugs and therapies, are still being tested and may offer better ways to slow or reverse kidney damage in people with diabetes.

Healthy Routines and Household Care

Managing diabetic kidney problems often depends on making smart changes to daily routines.

Keeping track of blood sugar levels as instructed and being consistent with self-monitoring helps catch issues early and adjust any treatment plans if needed.

A nutritious diet is key. Eat plenty of fiber-rich foods, such as fruits, nonstarchy vegetables, whole grains, and legumes. Limit foods high in saturated fat, salt, and processed meats.

Simple sugars and sweets are best kept as occasional treats. To assist, use the table below for a quick guide:

Food Group	Eat More	Eat Less
Fruits & Vegetables	Fresh, variety	Canned in syrup
Grains	Whole grains	White bread/rice
Protein	Legumes, fish	Processed meats
Other	Low-salt products	High-sugar snacks

Physical activity is another important part of a healthy lifestyle. Aim for at least 30 minutes of moderate to vigorous aerobic exercise on most days.

Activities like brisk walking, biking, and swimming are good choices and should total about 150 minutes each week.

Other helpful steps include not smoking and reaching or maintaining a healthy weight. Quitting smoking lowers the risk of kidney and heart problems. For some, weight-loss surgery may be worth discussing with a healthcare provider.

Sometimes, a healthcare professional may advise the use of a daily low-dose aspirin for heart health.

Talk with the care team before starting any new medication or supplement, and inform all medical staff about diabetic kidney disease, especially before any procedures with contrast dyes.

Ways to Manage and Find Support

Dealing with diabetic kidney disease can be difficult, both physically and emotionally. Reaching out for support can make a positive difference.

Many people benefit from joining support groups where they can talk with others who are also managing diabetes and kidney issues. Groups like the National Kidney Foundation provide resources to help people connect.

It helps to keep daily routines and continue with favorite activities if possible. Staying involved in hobbies, work, or social events gives life structure and can improve mood.

When needed, talking with someone trustworthy—like a family member, friend, or counselor—can reduce stress and provide emotional relief.

Here is a list of ways to cope:

Reach out for support from groups or health professionals.
Maintain familiar routines as much as possible.
Talk about feelings with trusted people.
Seek professional help from social workers or counselors.

Managing blood pressure and staying informed about hypertension is also important. Support from others and looking after emotional health can help people adjust to the changes that come with diabetic nephropathy.

Getting Ready for Your Doctor Visit

Key Topics to Discuss at Follow-Up Visits

Patients with diabetic kidney disease (DKD) or those at risk for chronic kidney disease should regularly prepare questions and concerns for their healthcare team. A written list can help make sure important topics are addressed.

Here are some ideas for what to talk about:

Kidney Function:
- How are my kidneys working right now?
- Are there signs of kidney damage or kidney failure?
Managing Other Conditions:
- How is my high blood sugar affecting my kidney disease?
- What should I know about controlling my blood pressure and cholesterol?
- How does the treatment for my type 1 or type 2 diabetes relate to my kidney care?
Lifestyle and Risk Factors:
- Should I change my diet or start a new exercise plan to slow CKD?
- How do smoking and obesity impact my risk for kidney disease?
Medication and Safety:
- When and how should I take my medicines?
- Are there any side effects?
- Do I need to fast or prepare for any lab tests before my appointment?
Resources and Support:
- Are there trusted websites to learn more about diabetic nephropathy, end-stage renal disease, or diabetic retinopathy?
- Is there help with costs for diabetes supplies?

Here’s a simple sample table to organize your questions:

Topic	Questions to Ask
Kidney Function	How well are my kidneys working?
Medicines	When do I take my medicine?
Lifestyle	What diet changes are best for me?
Follow-Up	When is my next appointment?

What Your Healthcare Provider May Ask You

Doctors and specialists, such as nephrologists, will ask about your symptoms, habits, and care routine. They may ask you:

Are you able to follow your treatment plan for DKD or other kidney problems?
Have you felt symptoms of high or low blood sugar?
What foods do you usually eat?
How active are you, and do you sit for long periods?
What is your daily exercise routine?
Are you having trouble with any part of managing your diabetes or kidney disease?
Do you know when to seek urgent care?

Be ready to share details about your lifestyle, any changes in how you feel, and how you are handling your treatment routine. This information helps your doctor recognize patterns, adjust your care, and watch for progression toward end-stage renal disease.

Diabetic Nephropathy – Diagnosis and Treatment