Overview

Diagnosis

Diabetic nephropathy is typically diagnosed during routine diabetes management checkups. People with type 2 diabetes should get tested every year, and those with type 1 diabetes should begin annual testing five years after diagnosis.

Routine tests used for diagnosis include:

  • Urinary albumin test: Detects the presence of albumin, a protein that should not appear in the urine if kidneys are functioning properly.

  • Albumin/creatinine ratio: Compares the levels of albumin and creatinine in urine to evaluate kidney performance.

  • Glomerular filtration rate (GFR): Measures how efficiently the kidneys filter blood; a low GFR indicates impaired kidney function.

Other diagnostic tests may include:

  • Imaging tests: Ultrasound, X-rays, CT scans, or MRI scans help assess kidney size, structure, and blood flow.

  • Kidney biopsy: Involves taking a small sample of kidney tissue with a thin needle under local anesthesia for laboratory analysis.

Treatment

Managing diabetic nephropathy starts with controlling blood sugar and blood pressure. Lifestyle changes, medications, and regular monitoring play a key role in slowing kidney damage and preventing complications.

Medications commonly used include:

  • ACE inhibitors and ARBs: Help manage high blood pressure and reduce kidney strain.

  • Blood sugar–lowering drugs: Insulin, metformin, GLP-1 receptor agonists, and SGLT2 inhibitors assist in maintaining healthy glucose levels and protecting kidney function.

  • Statins: Lower cholesterol and reduce protein loss in urine.

  • Finerenone (Kerendia): May reduce kidney scarring and lower the risk of heart failure or kidney failure progression.

Treatment for Advanced Diabetic Nephropathy

When kidney failure (end-stage kidney disease) develops, treatment focuses on replacing lost kidney function or maintaining comfort. Options include:

  • Kidney dialysis:

    • Hemodialysis filters the blood using a machine, typically done three times per week.

    • Peritoneal dialysis uses the lining of the abdomen to filter waste and can often be done at home.

  • Kidney transplant: In some cases, a kidney or combined kidney-pancreas transplant is the best long-term solution.

  • Symptom management: For those who opt out of dialysis or transplant, care focuses on comfort and quality of life.

Potential Future Treatments

Researchers are exploring regenerative medicine approaches, including stem cell therapy and pancreas islet cell transplants. These may help restore kidney function and potentially reverse damage in the future.

Lifestyle and Home Remedies

Healthy daily habits can help manage blood sugar and blood pressure, reducing further kidney damage.

  • Monitor blood sugar levels regularly.

  • Exercise most days of the week for at least 30 minutes.

  • Eat a balanced diet rich in fiber, fruits, vegetables, and whole grains.

  • Quit smoking and maintain a healthy weight.

  • Discuss daily low-dose aspirin use with your healthcare provider.

  • Inform all healthcare professionals about your kidney condition to avoid contrast dye tests that can harm the kidneys.

Coping and Support

Living with diabetic nephropathy can be emotionally and physically challenging.

  • Connect with support groups for diabetes and kidney disease.

  • Maintain a normal daily routine when possible.

  • Talk openly about your feelings with trusted friends, counselors, or healthcare professionals.

Preparing for Your Appointment

When meeting your healthcare provider, consider asking questions such as:

  • How well are my kidneys functioning now?

  • What treatment options are best for me?

  • How can I keep my condition from worsening?

  • How do these treatments fit into my diabetes management plan?

  • How will we monitor progress over time?

Request an appointment

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