In the United States, about 1 in 3 people living with diabetes have diabetic nephropathy. Diabetic nephropathy affects the kidneys' usual work of removing waste products and extra fluid from the body.

The best way to prevent or delay diabetic nephropathy is by living a healthy lifestyle and keeping diabetes and high blood pressure managed.

Over years, diabetic nephropathy slowly damages the kidneys' filtering system. Early treatment may prevent this condition or slow it and lower the chance of complications. Diabetic kidney disease can lead to kidney failure. This also is called end-stage kidney disease.

Kidney failure is a life-threatening condition. Treatment options for kidney failure are dialysis or a kidney transplant. One of the important jobs of the kidneys is to clean the blood. As blood moves through the body, it picks up extra fluid, chemicals and waste. The kidneys separate this material from the blood.

It's carried out of the body in urine. If the kidneys are unable to do this and the condition is untreated, serious health problems result, with eventual loss of life. In the early stages of diabetic nephropathy, there might not be symptoms. In later stages, symptoms may include:.

Make an appointment with your health care professional if you have symptoms of kidney disease. If you have diabetes, visit your health care professional yearly or as often as you're told for tests that measure how well your kidneys are working.

A typical kidney has about 1 million filtering units. Each unit, called a glomerulus, joins a tubule. The tubule collects urine. Conditions such as high blood pressure and diabetes harm kidney function by damaging these filtering units and tubules. The damage causes scarring. The kidneys remove waste and extra fluid from the blood through filtering units called nephrons.

Each nephron contains a filter, called a glomerulus. Each filter has tiny blood vessels called capillaries. When blood flows into a glomerulus, tiny bits, called molecules, of water, minerals and nutrients, and wastes pass through the capillary walls. Large molecules, such as proteins and red blood cells, do not.

The part that's filtered then passes into another part of the nephron called the tubule. The water, nutrients and minerals the body needs are sent back to the bloodstream.

The extra water and waste become urine that flows to the bladder. The kidneys have millions of tiny blood vessel clusters called glomeruli.

Glomeruli filter waste from the blood. Damage to these blood vessels can lead to diabetic nephropathy. The damage can keep the kidneys from working as they should and lead to kidney failure. Over time, diabetes that isn't well controlled can damage blood vessels in the kidneys that filter waste from the blood.

This can lead to kidney damage and cause high blood pressure. High blood pressure can cause more kidney damage by raising the pressure in the filtering system of the kidneys.

Diabetic nephropathy kidney disease care at Mayo Clinic. Mayo Clinic does not endorse companies or products. ACE inhibitors and ARBs are particularly useful for people with diabetic kidney disease because they decrease the amount of albumin in the urine and can prevent or slow the progression of diabetes-related kidney disease.

In fact, the kidney benefits of ACE inhibitors and ARBs are so robust that health care providers sometimes prescribe them for people with diabetic kidney disease who have normal blood pressure.

Still, despite their kidney-protecting abilities, ACE inhibitors and ARBs do have their downsides. For instance, ACE inhibitors cause a persistent dry cough in 5 to 20 percent of the people who take them, even up to 50 percent among Asian populations.

Some people get used to the cough; others find it so disruptive that they cannot continue taking an ACE inhibitor. For them, ARBs are often a good alternative, because ARBs do not cause a cough.

In rare cases, you can have more serious side effects with ACE inhibitors and ARBs. These include a condition called hyperkalemia, in which too much potassium accumulates in the blood.

To monitor for these and other side effects, health care providers sometimes run blood tests soon after starting these drugs. In some people, the medications will need to be stopped. SGLT2 inhibitors — In addition to the measures described above, some people with type 2 diabetes and kidney disease will get a medication called a sodium-glucose co-transporter 2 SGLT2 inhibitor.

These medications lower blood sugar by increasing the excretion of sugar in the urine; they include canagliflozin brand name: Invokana , empagliflozin brand name: Jardiance , and dapagliflozin brand name: Farxiga.

Your health care provider can talk to you about whether you are a candidate for treatment with an SGLT2 inhibitor if you do not already take one ; this will depend on how advanced your kidney disease is and how much albumin is in your urine. Ongoing monitoring — After beginning treatment and lifestyle changes to stall kidney disease, you will need to have repeat urine and blood tests to determine if urine albumin levels have improved.

If the urine albumin levels have not improved or your kidney function has worsened, your health care provider may need to adjust your medications or recommend other strategies to protect your kidneys. PREGNANCY AND DIABETIC KIDNEY DISEASE. If you have diabetes and are interested in getting pregnant, it is important to talk with your health care provider well in advance, especially if you have diabetic kidney disease.

Diabetes and its attendant problems can increase the risk of complications in pregnancy, especially in women with decreased kidney function. However, many women with mild diabetic kidney disease have normal pregnancies and healthy babies. To ensure the best outcome with a pregnancy, the most important thing you can do is to keep your blood sugar and blood pressure under tight control.

However, women who are pregnant or attempting to get pregnant should not take angiotensin-converting enzyme ACE inhibitors or angiotensin receptor blockers ARBs , as these drugs can cause birth defects.

Instead, other medications such as calcium channel blockers are used during pregnancy to keep the blood pressure in check. See "Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics ". If the steps you need to take to protect your kidneys sound overwhelming, keep this in mind; controlling your blood sugar and blood pressure can help to reduce the risk or severity of several other debilitating diabetes complications, including:.

The same measures that are used in the treatment of diabetic kidney disease are also useful in preventing it. That's true for the lifestyle choices mentioned above, as well as for the tight control of blood sugar levels and blood pressure. Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site www. Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Type 2 diabetes The Basics. Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.

These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Chronic kidney disease Beyond the Basics Patient education: Dialysis or kidney transplantation — which is right for me? Beyond the Basics Patient education: Diabetic neuropathy Beyond the Basics Patient education: Protein in the urine proteinuria Beyond the Basics Patient education: Low-sodium diet Beyond the Basics Patient education: Quitting smoking Beyond the Basics Patient education: Diet and health Beyond the Basics Patient education: Exercise Beyond the Basics Patient education: Losing weight Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: High blood pressure in adults Beyond the Basics Patient education: High blood pressure, diet, and weight Beyond the Basics Patient education: High blood pressure treatment in adults Beyond the Basics Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics.

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These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults Moderately increased albuminuria microalbuminuria in type 1 diabetes mellitus Moderately increased albuminuria microalbuminuria in type 2 diabetes mellitus Diabetic kidney disease: Pathogenesis and epidemiology Kidney transplantation in diabetic kidney disease Treatment of diabetic kidney disease Major side effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers Pregnancy and contraception in patients with nondialysis chronic kidney disease.

Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Patient education: Diabetic kidney disease Beyond the Basics. Formulary drug information for this topic. No drug references linked in this topic.

Show references Diabetic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed May 24, Diabetic kidney disease adult. Mayo Clinic; Mottl AK, et al. Diabetic kidney disease: Manifestations, evaluation, and diagnosis.

Diabetes and chronic kidney disease. Centers for Disease Control and Prevention. Diabetic nephropathy. Merck Manual Professional Version.

Goldman L, et al. Diabetes mellitus. In: Goldman-Cecil Medicine. Elsevier; Elsevier Point of Care. Clinical Overview: Diabetic nephropathy. De Boer IH, et al. Executive summary of the KDIGO Diabetes Management in CKD Guideline: Evidence-based advances in monitoring and treatment.

Kidney International. Office of Patient Education. Chronic kidney disease treatment options. Coping effectively: A guide for patients and their families. National Kidney Foundation. Robertson RP. Pancreas and islet cell transplantation in diabetes mellitus.

Accessed May 25, Ami T. Allscripts EPSi. Mayo Clinic. June 27, Castro MR expert opinion. June 8, Chebib FT expert opinion. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.

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