Diabetic nephropathy

Diabetic nephropathy is usually diagnosed during routine testing that's a part of your diabetes management. If you're living with type 1 diabetes, screening for diabetic nephropathy is recommended beginning five years after your diagnosis. If you are diagnosed with type 2 diabetes, screening will begin at the time of diagnosis.

Routine screening tests may include:

Urinary albumin test. This test can detect the blood protein albumin in your urine. Typically, the kidneys don't filter albumin out of the blood. Too much of the protein in your urine can indicate poor kidney function.

Albumin/creatinine ratio. Creatinine is a chemical waste product that healthy kidneys filter out of the blood. The albumin/creatinine ratio — a measure of how much albumin is in a urine sample relative to how much creatinine there is — provides another indication of kidney function.

Glomerular filtration rate (GFR). The measure of creatinine in a blood sample may be used to estimate how quickly the kidneys filter blood (glomerular filtration rate). A low filtration rate indicates poor kidney function.

Other diagnostic tests may include the following:

Imaging tests. Your doctor may use X-rays and ultrasound to assess your kidneys' structure and size. You may also undergo CT scanning and magnetic resonance imaging (MRI) to determine how well blood is circulating within your kidneys. Other imaging tests may be used in some cases.

Kidney biopsy. Your doctor may recommend a kidney biopsy to take a sample of kidney tissue. You'll be given a numbing medication (local anesthetic). Then your doctor will use a thin needle to remove small pieces of kidney tissue for examination under a microscope.

The first step in treating diabetic nephropathy is to treat and control your diabetes and high blood pressure (hypertension). This includes diet, lifestyle changes, exercise and prescription medications. With good management of your blood sugar and hypertension, you may prevent or delay kidney dysfunction and other complications.

Medications

In the early stages of diabetic nephropathy, your treatment plan may include medications to manage the following:

Blood pressure control. Medications called angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used to treat high blood pressure.

Blood sugar control. Medications can help control high blood sugar in people with diabetic nephropathy. Metformin (Fortamet, Glumetza, others) improves insulin sensitivity and lowers glucose production in the liver. Glucagon-like peptide 1 (GLP-1) receptor agonists help lower blood sugar levels by slowing digestion and stimulating insulin secretion in response to rising glucose levels. SGLT2 inhibitors limit the return of glucose to the bloodstream, leading to increased glucose excretion in the urine.

High cholesterol. Cholesterol-lowering drugs called statins are used to treat high cholesterol and reduce protein in the urine.

Kidney scarring. Finerenone (Kerendia) disrupts molecular activity believed to cause inflammation and tissue scarring in diabetic nephropathy. Research has shown that the drug may reduce the risk of kidney function decline, kidney failure, cardiovascular death, nonfatal heart attacks and hospitalization for heart failure in adults with chronic kidney disease associated with type 2 diabetes.

Your doctor will likely recommend follow-up testing at regular intervals to see whether your kidney disease remains stable or progresses.

Treatment for advanced diabetic nephropathy

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Kidney transplant

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If your disease progresses to kidney failure (end-stage kidney disease), your doctor will likely discuss options for care focused on either replacing the function of your kidneys or making you more comfortable. Options include:

Kidney dialysis. This treatment removes waste products and extra fluid from your blood. The two main types of dialysis are hemodialysis and peritoneal dialysis. In the first, more common method, you may need to visit a dialysis center and be connected to an artificial kidney machine about three times a week, or you may have dialysis done at home by a trained caregiver. Each session takes 3 to 5 hours. The second method may be done at home as well.

Transplant. In some situations, the best option is a kidney transplant or a kidney-pancreas transplant. If you and your doctor decide on transplantation, you'll be evaluated to determine whether you're eligible for this surgery.

Symptom management. If you choose not to have dialysis or a kidney transplant, your life expectancy generally would be only a few months. You may receive treatment to help keep you comfortable.

Potential future treatments

In the future, people with diabetic nephropathy may benefit from treatments being developed using regenerative medicine. These techniques may help reverse or slow kidney damage caused by the disease. For example, some researchers think that if a person's diabetes can be cured by a future treatment such as pancreas islet cell transplant or stem cell therapy, kidney function may improve. These therapies, as well as new medications, are still under investigation.