Diabetic kidney disease

Kidney damage caused by diabetes is called diabetic nephropathy or diabetic kidney disease. It develops slowly over time. But the good news is, there are lots of ways to prevent kidney disease or spot it early. And when it’s spotted early enough, treatment can slow down diabetic nephropathy.

Key points about kidney disease and diabetes

  1. High blood glucose (sugar) and blood pressure can damage your kidneys.
  2. Diabetes and high blood pressure are the most common causes of kidney disease in Aotearoa New Zealand.
  3. There are lots of ways to reduce your chances of developing kidney disease or stop it from getting worse.
  4. Kidney disease can be spotted early through a urine (pee) and blood test.
  5. Getting your annual diabetes health checks are an important way to help prevent or spot kidney disease.

What causes kidney disease in people with diabetes?

You need your kidneys to work properly because they act as filters to remove waste and extra fluid from your body. You can read more about the important jobs your kidneys have in your body.

Having too much glucose (sugar) in your blood can damage the small blood vessels and filters in your kidneys. High blood pressure also damages your kidneys. When this happens, your kidneys can’t filter very well, causing things like waste products to build up and protein to leak from your body through your pee.

What are the symptoms of kidney disease?

Because kidney disease develops slowly over many years, most people don’t have any symptoms in the early stages.

But if it develops into the later stages, you might notice things like:

  • feeling tired
  • nausea (feeling sick)
  • being short of breath
  • puffiness or swelling around your eyes or ankles
  • blood in your pee
  • needing to pee more than normal.

These can also be caused by other things, so talk to your healthcare team if you notice anything that’s not normal for you.

How is kidney disease diagnosed?

When you have diabetes, you should get tested at least once a year to check for kidney damage. This can help spot early signs, before symptoms develop.

There are 2 main types of tests that look for kidney damage, a urine (pee) and a blood test.

  • Urine test – this looks for small amounts of protein in your pee. Protein leaking into your pee is an early sign of kidney damage.
  • Blood test – this can tell how well your kidneys are filtering your blood. Read more about a kidney function blood test.

How is kidney disease treated?

The type of treatment will depend on what stage of kidney disease you have. The good news is, if kidney disease is spotted early, treatments can slow down kidney damage.

If you have diabetes and kidney disease, you will probably be advised to do these things:

  • Keep your blood glucose, blood pressure and cholesterol levels within your target range.
  • Make healthy lifestyle choices, eg, eat foods lower in salt and eat more fruits and vegetables. You should also aim for a healthy body weight, make physical activity part of your daily routine and get support to quit smoking. 
  • Take certain medicines, such as an ACE inhibitor, angiotensin receptor blocker or empagliflozin. These help protect your kidneys and reduce blood pressure and/or blood glucose.
  • Make changes to your diet to help protect your kidneys. A registered dietitian can help you with these.
  • Avoid certain medicines that can damage the kidneys, like ibuprofenIf you have kidney disease you should always discuss with your pharmacist or healthcare provider before you take a new medicine.

If kidney damage gets worse and you develop end-stage kidney disease, this means your kidneys are starting to fail. If this happens, treatment options include a kidney transplant or dialysis.

How can I prevent diabetic kidney disease?

To reduce your risk of developing kidney disease, try to:

  • Keep your blood glucose levels within your target range.
  • Keep your blood pressure and cholesterol levels down.
  • Eat healthily, stay active and aim for a healthy body weight.
  • If you smoke, get support to stop.
  • Have your free diabetes health checks every year. 

Read more about how to protect your kidneys and how food and exercise can help treat diabetes.

What support is available for people with kidney disease?

There’s lots of advice and support out there for you.

  • Talking to your healthcare team is a great start. They can explain your test results, tell you about the different treatment options and provide advice that’s right for you.
  • Talking to other people with diabetes can help. Find your local support group.
  • Find information and advice at Kidney Health NZ. You can also call them for free on 0800 KIDNEY (0800 543 639). 

Learn more

The following links provide further information about diabetic kidney disease. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Complications – kidney Kidney Health NZ
Diabetic nephropathy (kidney disease) Diabetes UK
Chronic kidney disease NHS, UK
Chronic kidney disease PatientInfo, UK
Diabetes National Kidney Foundation, US
Chronic kidney disease and diabetes Kidney Health NZ
Diabetic kidney disease Patient Info, UK

References

  1. Living with kidney disease A comprehensive guide for coping with chronic kidney disease Ministry of Health, NZ, 2014
  2. Antihypertensive agents for preventing diabetic kidney disease Cochrane Library, 2012
  3. Type 2 diabetes management guidelines. Management of diabetic renal disease Ministry of Health and NZSSD, NZ, 2021

Reviewed by

Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Alice Miller, FRNZCGP, Wellington Last reviewed: 21 Apr 2021