People with diabetes have a lot to juggle when it dabetes to Type diabetes complications kidneys comolications Berry Compote Ideas. A complicafions may recommend a kidney transplant if diabetic nephropathy reaches RMR and exercise final stages and if a suitable donor can provide a kidney. For more information on CDC's web notification policies, see Website Disclaimers. You and your dietitian can plan your diet together. Chebib FT expert opinion. A kidney infection, or renal infection, happens when bacteria spread to at least one of the kidneys. Medicines can help control high blood sugar in people with diabetic nephropathy.

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DIABETIC KIDNEY DISEASE RISK FACTORS. Having a family history of kidney disease or belonging to certain ethnic groups eg, African American, Mexican, Pima Indian can increase your risk of diabetic kidney disease.

Although you cannot do anything to change your family history, there are several factors that increase your risk of developing diabetic kidney disease that you can change and control.

These include:. DIABETIC KIDNEY DISEASE DIAGNOSIS. Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis. The urine test is looking for a protein called albumin.

If there is a very large amount of albumin in your urine, it means you have diabetic kidney disease. You may be told that you have "microalbuminuria" or "high albuminuria". That simply means that you have trace amounts of albumin in your urine, but it still means that you are at risk for getting diabetic kidney disease, assuming you do not have kidney disease caused by another condition.

See "Patient education: Protein in the urine proteinuria Beyond the Basics ". The same urine test that is used to diagnose diabetic kidney disease will also be used to monitor your condition over time. See 'Ongoing monitoring' below. The key complication of diabetic kidney disease is more advanced kidney disease, called chronic kidney disease.

Chronic kidney disease can, in turn, progress even further, eventually leading to total kidney failure and the need for dialysis or kidney transplantation. DIABETIC KIDNEY DISEASE TREATMENT. People with diabetes often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important.

That's because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems. For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to:.

Most people with type 2 diabetes and kidney disease should be treated with a sodium-glucose co-transporter 2 SGLT2 inhibitor.

See 'SGLT2 inhibitors' below. Lifestyle changes — Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have diabetic kidney disease:.

Blood sugar control — Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. See "Patient education: Glucose monitoring in diabetes Beyond the Basics ".

A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. Even small decreases in the A1C lower the risk of diabetes-related complications to some degree.

Managing your blood sugar involves lifestyle changes eg, diet and exercise as well as medications. Type 1 diabetes is treated with insulin. For type 2 diabetes, other medications are often used; some are not recommended for use in people with kidney problems, while others may help slow the progression of kidney disease.

Your doctors will work with you to determine what combination of medications is best for you. Managing high blood pressure — Many people with diabetes have hypertension high blood pressure.

Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye.

A health care provider can diagnose high blood pressure by measuring blood pressure on a regular basis. See "Patient education: High blood pressure in adults Beyond the Basics ". The treatment of high blood pressure varies. If you have mild hypertension, your health care provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake.

These measures can sometimes reduce blood pressure to normal. See "Patient education: High blood pressure, diet, and weight Beyond the Basics ".

If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several high blood pressure medications. Your provider can discuss the pros and cons of each medication and the goals of treatment.

See "Patient education: High blood pressure treatment in adults Beyond the Basics ". Blood pressure medications — All people with diabetic kidney disease need at least one medication to lower their blood pressure, and in most cases two medications are needed.

Several medications can be used for this purpose, but a medication known as an angiotensin-converting enzyme inhibitor abbreviated ACE inhibitor or a related drug known as an angiotensin receptor blocker ARB should be used because they limit the worsening of kidney disease.

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. Diabetic kidney disease is diagnosed when the level of albumin in the urine is raised and there is no other obvious cause for this. Urine tests are part of the routine checks that are offered to people with diabetes from time to time.

Urine tests can detect albumin protein and measure how much is present in the urine. The standard routine urine test is to compare the amount of albumin with the amount of creatinine in a urine sample. This is called the albumin:creatinine ratio ACR.

Creatinine is a breakdown product of muscle. A blood test can show how well the kidneys are working. The blood test measures the level of creatinine, which is normally cleared from the blood by the kidneys. If your kidneys are not working properly, the level of creatinine in the blood goes up.

An estimate of how well your kidneys are working can be made by taking into account the blood level of creatinine, your age and your sex. This estimate of kidney function is called the estimated glomerular filtration rate eGFR.

All people with diabetes have a risk of developing diabetic kidney disease. However, a large research trial showed that there are certain factors that increase the risk of developing this condition.

These are:. This means that having a good control of your blood glucose level, keeping your weight in check and treating high blood pressure will reduce your risk of developing diabetic kidney disease.

If you have early diabetic kidney disease microalbuminuria , the risk that the disease will become worse is increased with:. In people with proteinuria described above , end-stage kidney failure develops in approximately 1 in 12 people after 10 years.

If this occurs then you would need kidney dialysis or a kidney transplant. All people with diabetes have an increased risk of developing cardiovascular diseases, such as heart disease, stroke and peripheral arterial disease.

If you have diabetes and diabetic kidney disease, your risk of developing cardiovascular diseases is increased further. The worse the kidney disease, the further increased the risk.

This is why reducing any other cardiovascular risk factors is so important if you have diabetic kidney disease see below. Kidney disease has a tendency to increase blood pressure.

In addition, increased blood pressure has a tendency to make kidney disease worse. Treatment of high blood pressure is one of the main treatments of diabetic kidney disease. There are several types and brands of this type of medication.

ACE inhibitors work by reducing the amount of a chemical called angiotensin II that you make in your bloodstream. This chemical tends to narrow constrict blood vessels. Therefore, less of this chemical causes the blood vessels to relax and widen and so the pressure of blood within the blood vessels is reduced.

ACE inhibitors are medicines that are often used to treat high blood pressure. However, the way they work also seems to have a protective effect on the kidneys and heart. This means that they help to prevent or delay the progression of the kidney disease. The ones available in the UK are: azilsartan , candesartan , eprosartan , irbesartan , losartan , olmesartan , telmisartan and valsartan.

AIIRAs work in a similar way to ACE inhibitors. One may be used instead of an ACE inhibitor if you have problems or side-effects with taking an ACE inhibitor. For example, some people taking an ACE inhibitor develop a persistent cough.

Dr Krishna Vakharia , 23rd March The National Institute for Health and Care Excellence NICE has recommended a different medication called finerenone.

This medication works differently to ACE and AIIRA. They have advised it can be used in people under certain conditions - and usually when the above two have been tried. Good control of your blood sugar glucose level will help to delay the progression of the kidney disease and to reduce your risk of developing associated cardiovascular diseases, such as heart disease and stroke.

Strict blood pressure control is likely to reduce the risk of developing cardiovascular diseases and prevent or delay the progression of kidney disease. Most people should already be taking an ACE inhibitor or AIIRA described above.

These medicines lower blood pressure. Certain medicines can affect the kidneys as a side-effect which can make diabetic kidney disease worse. For example, you should not take anti-inflammatory medicines unless advised to by a doctor. You may also need to adjust the dose of certain medicines that you may take if your kidney disease becomes worse.

A medicine to lower your cholesterol level is commonly advised. This will help to lower the risk of developing some complications such as heart disease, peripheral arterial disease and stroke.

Management of diabetes ; Scottish Intercollegiate Guidelines Network - SIGN March - updated November Diabetes type 1 and type 2 in children and young people: diagnosis and management ; NICE Guidelines Aug - updated May Diabetic foot problems: prevention and management ; NICE Guidelines August - last updated October Type 2 diabetes in adults: management ; NICE Guidance December - last updated June Type 1 diabetes in adults: diagnosis and management ; NICE Guidelines August - last updated August Stewart MW ; Treatment of diabetic retinopathy: Recent advances and unresolved challenges.

World J Diabetes. doi: Kopel J, Pena-Hernandez C, Nugent K ; Evolving spectrum of diabetic nephropathy. Finerenone for treating chronic kidney disease in type 2 diabetes ; NICE Technology appraisal guidance, March Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.

Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.

For details see our conditions. In this series. In this series: Diabetes Diabetes and High Blood Pressure Diabetes Foot Care Diabetic Neuropathy Diabetic Amyotrophy Blood Sugar Tests. In this series Diabetes Diabetes and High Blood Pressure Diabetes Foot Care Diabetic Neuropathy Diabetic Amyotrophy Blood Sugar Tests.

In this article What is diabetic kidney disease? How does diabetic kidney disease develop and progress? How common is diabetic kidney disease? What are the symptoms of diabetic kidney disease? How is diabetic kidney disease diagnosed and assessed?

Diabetes comolications when your body does not make enough insulin or cannot kieneys insulin kidheys. Type diabetes complications kidneys is a hormone. Type diabetes complications kidneys controls how much sugar is in your blood. A high level of sugar in your blood can cause problems in many parts of your body, including your heart, kidneys, eyes, and brain. Over time, this can lead to kidney disease and kidney failure. There are two main types of diabetes.