Diabetic Nephropathy

By Eileen B. Wyner, NP
Bulfinch Medical GroupEileen W

Diabetic Nephropathy (DN) or kidney disease is a potential complication of Diabetes. It may occur in people who have been living with Diabetes for a long time, as well as in people whose Diabetes is poorly controlled.  All people with Diabetes are at risk for DN but it appears that risk may be higher for people who are of Hispanic, African American, or Native American ethnicity.   

We are born with two kidneys which are responsible for several important bodily functions, the most well known being the making of urine (necessary for the removal of waste products from the bloodstream).  The kidneys also help to control blood pressure by regulating our water and mineral balance (also known as our electrolyte balance), and maintain red blood cell count by signaling the bone marrow to increase production of these cells.  Kidney disease occurs when blood sugars are continually too high. The filter system in the kidneys becomes damaged, allowing small amounts of protein to leak out through the urine. This is a painless condition without any symptoms at first, but over time will lead to high or hard to control blood pressure and lower extremity swelling if not treated.

The first step in preventing DN is maintaining good blood sugar control—the closer to goal you can keep your A1C safely, the better it is for your kidneys.  The next step is getting a microalbumin test when you see your health care provider.  This test checks for the presence of a protein called albumin in the urine.  Albumin is normally found in the blood and filtered by the kidneys; when kidneys are working properly albumin is not found in the urine.  When the kidneys are damaged, small amounts of albumin leak out into the urine.  This condition is called microalbuminuria.  The American Diabetes Association recommends receiving a microalbumin test at diagnosis and at least annually afterwards.

Managing elevated microalbuminuria includes working hard at getting your A1C to goal and starting a medication from the class ACE or ARB.  You may know these medications by their common names:  lisinopril or diovan. These medications are used for blood pressure control and are also a good choice for protecting your kidneys.  You may already be on one of these medications and the dose may need to be adjusted as needed.

Long term complications of DN can increase your chance of developing heart or blood vessel disease. Your kidneys may fail and you may need to start dialysis to filter your blood.  You may even need a kidney transplant. There is no cure for DN, however early identification and treatment can decrease worsening complications. When you go for your next Diabetes appointment, ask your health care provider about a microalbumin test to check your kidney status and start working on preserving it.