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Diabetic nephropathy is a serious kidney-related complication of type 1 diabetes and type 2 diabetes. It is also called diabetic kidney disease. About 25% of people with diabetes eventually develop kidney disease.

Diabetic nephropathy affects your kidneys' ability to do their usual work of removing waste products and extra fluid from your body. The best way to prevent or delay diabetic nephropathy is by maintaining a healthy lifestyle and treating your diabetes and high blood pressure.

Over many years, the condition slowly damages your kidneys' delicate filtering system. Early treatment may prevent or slow the disease's progress and reduce the chance of complications.

Your kidney disease may progress to kidney failure, also called end-stage kidney disease. Kidney failure is a life-threatening condition. At this stage your treatment options are dialysis or a kidney transplant.

Symptoms

In the early stages of diabetic nephropathy, you may not notice any signs or symptoms. In later stages, the signs and symptoms include:

• Worsening blood pressure control
• Protein in the urine
• Swelling of feet, ankles, hands or eyes
• Increased need to urinate
• Reduced need for insulin or diabetes medicine
• Confusion or difficulty concentrating
• Shortness of breath
• Loss of appetite
• Nausea and vomiting
• Persistent itching
• Fatigue

Causes

Diabetic nephropathy results when diabetes damages blood vessels and other cells in your kidneys.

How the kidneys work

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Your kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Severe damage to these blood vessels can lead to diabetic nephropathy, decreased kidney function and kidney failure.

Diabetic nephropathy causes

Diabetic nephropathy is a common complication of type 1 and type 2 diabetes.

Over time, poorly controlled diabetes can cause damage to blood vessel clusters in your kidneys that filter waste from your blood. This can lead to kidney damage and cause high blood pressure. High blood pressure can cause further kidney damage by increasing the pressure in the delicate filtering system of the kidneys.

Risk factors

Your risk of diabetic nephropathy is greater if you have type 1 or type 2 diabetes. Several other factors may increase your risk of diabetic nephropathy, including:

• High blood sugar (hyperglycemia) that's not well-controlled
• High blood pressure (hypertension) that's not controlled
• Being a smoker
• High blood cholesterol
• A family history of diabetes and kidney disease

Complications

Complications of diabetic nephropathy may develop gradually over months or years. They may include:

• Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema)
• A rise in potassium levels in your blood (hyperkalemia)
• Heart and blood vessel disease (cardiovascular disease), possibly leading to stroke
• Damage to the blood vessels of the retina (diabetic retinopathy)
• Anemia
• Foot sores, erectile dysfunction, diarrhea and other problems related to damaged nerves and blood vessels
• Pregnancy complications that carry risks for the mother and the developing fetus
• Irreversible damage to your kidneys (end-stage kidney disease), eventually needing either dialysis or a kidney transplant for survival

Prevention

To reduce your risk of developing diabetic kidney disease:

• Treat your diabetes.With effective treatment of diabetes, you may prevent or delay diabetic kidney disease.
• Manage high blood pressure or other medical conditions.If you have high blood pressure or other conditions that increase your risk of kidney disease, work with your doctor to control them. Ask your doctor about tests to look for signs of kidney damage.
• Follow instructions on over-the-counter medications.When using nonprescription pain relievers such as aspirin and ibuprofen (Advil, Motrin IB, others), follow the instructions on the package. For people with diabetic kidney disease, taking these types of pain relievers can lead to kidney damage.
• Maintain a healthy weight.If you're at a healthy weight, work to maintain it by being physically active most days of the week. If you need to lose weight, talk with your doctor about weight-loss strategies, such as increasing daily physical activity and reducing calories.
• Don't smoke.Cigarette smoking can damage your kidneys and make existing kidney damage worse. If you're a smoker, talk to your doctor about strategies for quitting smoking. Support groups, counseling and medications can all help you to stop.