Diabetes can affect more than your blood sugar. Over time, high blood glucose can damage the tiny blood vessels in your kidneys, making it harder for them to filter waste and extra fluid from your blood.
The concerning part is that diabetes-related kidney disease may develop without noticeable symptoms in its early stages. A person can feel completely well while kidney damage is beginning. That is why regular kidney testing is an important part of diabetes care.
The good news is that early detection, appropriate treatment, blood sugar management and blood pressure control can help protect kidney function and slow the progression of kidney disease.
In this guide, we'll explain how diabetes affects your kidneys, which risk factors matter, what tests doctors use and what you can do to support your kidney health.
What Is Diabetes-Related Kidney Disease?
Diabetes-related kidney disease, also called diabetic kidney disease or diabetic nephropathy, occurs when diabetes damages the kidneys over time.
Your kidneys perform several essential functions:
Filter waste products and excess fluid from your blood.
Help maintain the body's fluid and electrolyte balance.
Help regulate blood pressure.
Support red blood cell production and bone health.
When high blood glucose damages the kidneys' small blood vessels and filtering structures, these organs may gradually become less effective at performing their normal functions.
Kidney damage does not happen to everyone with diabetes, and the rate of progression varies from person to person. Early diagnosis and appropriate treatment can help reduce the risk of further damage.
How Does Diabetes Damage the Kidneys?
Persistently elevated blood glucose can place stress on the kidneys' filtering system. Over time, this may damage the tiny blood vessels and filtering units called glomeruli.
Several factors can contribute to this process:
1. High Blood Sugar Over Time
When blood glucose remains above your recommended target for long periods, it can damage blood vessels throughout the body, including those in the kidneys.
2. High Blood Pressure
High blood pressure can put additional strain on kidney blood vessels. Diabetes and high blood pressure often occur together, increasing the risk of kidney damage.
3. Other Health and Lifestyle Factors
Smoking, cardiovascular disease, excess body weight and a family history of kidney disease can also influence a person's risk.
Having diabetes does not automatically mean you will develop kidney disease. However, managing blood glucose, blood pressure and other risk factors is an important part of protecting your kidneys.
Who Is at Higher Risk of Kidney Disease?
People with diabetes may have a greater risk of kidney disease if they:
Have had diabetes for many years.
Frequently have blood glucose levels above their recommended targets.
Have high blood pressure.
Have cardiovascular disease.
Smoke.
Have a family history of kidney disease or kidney failure.
These factors do not confirm that kidney damage is present. Blood and urine tests are needed to assess kidney health.
Can You Have Kidney Disease Without Symptoms?
Yes. Early kidney disease often causes no obvious symptoms.
You may not experience pain, changes in urination or any other noticeable warning signs during the early stages. This means that feeling healthy does not necessarily mean your kidneys are functioning normally.
As kidney disease progresses, some people may develop swelling in their feet or ankles, fatigue, changes in urination or other symptoms. However, these symptoms can have several different causes and cannot diagnose kidney disease on their own.
If you have type 2 diabetes, ask your healthcare professional about regular kidney screening, even if you feel well.
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Which Tests Detect Kidney Disease in People With Diabetes?
Blood and urine tests can detect kidney problems before symptoms appear. Two important tests are the estimated glomerular filtration rate (eGFR) and the urine albumin-to-creatinine ratio (uACR). They measure different aspects of kidney health and are most useful when considered together.
1. eGFR Blood Test
The estimated glomerular filtration rate (eGFR) estimates how effectively your kidneys filter waste from your blood. It is calculated using your blood creatinine level and other information, including age and sex.
A lower eGFR may indicate reduced kidney function. However, a single result does not always establish chronic kidney disease. Your healthcare professional will interpret it alongside previous results, other tests and your medical history.
2. Urine Albumin-to-Creatinine Ratio (uACR)
The uACR test measures the amount of albumin, a protein, in your urine relative to creatinine.
Healthy kidneys generally keep most albumin in the bloodstream. When the kidney filters become damaged, albumin can leak into the urine.
A uACR result of less than 30 mg/g is generally considered normal. A result of 30 mg/g or higher may indicate kidney damage and usually requires further assessment.
Albumin in the urine can be an early sign of kidney disease even when eGFR is still within the normal range. Temporary factors, such as an infection or strenuous exercise, can also affect results, so repeat testing may be necessary.
3. How Often Should You Get Tested?
People with type 2 diabetes should generally have their kidney health assessed at least once a year using both eGFR and urine albumin testing. People with type 1 diabetes are generally screened annually beginning five years after diagnosis.
Your healthcare professional may recommend more frequent testing if you already have kidney disease or if previous results are abnormal.
Medical note: Test results should be interpreted by a healthcare professional. Chronic kidney disease is generally defined by kidney abnormalities that persist for at least three months.
How Can You Help Protect Your Kidneys?
There is no single food, drink or supplement that can guarantee protection against kidney disease. A consistent approach to diabetes management and regular medical care can help reduce the risk of kidney damage.
1. Keep Blood Sugar Within Your Recommended Range
Managing blood glucose can help reduce the risk of diabetes complications, including kidney disease.
Follow your prescribed diabetes treatment plan, attend recommended checkups and discuss your A1C results with your healthcare professional. Your personal blood glucose targets may differ depending on your age, other health conditions and risk of low blood sugar.
2. Manage Blood Pressure
High blood pressure can damage the kidneys and increase the risk of cardiovascular complications.
Monitor your blood pressure as advised and discuss your target with your healthcare team. If you have diabetes and kidney disease, your clinician may recommend medicines such as ACE inhibitors or ARBs when appropriate.
These medicines are not suitable for everyone and should only be used under medical supervision.
3. Choose a Balanced, Kidney-Friendly Eating Pattern
A balanced eating pattern can support blood sugar, blood pressure and overall health.
Consider these habits:
Eat a variety of vegetables and appropriate portions of whole grains.
Include suitable sources of protein.
Limit excessive salt and highly processed foods.
Reduce sugary drinks and foods high in added sugar.
Adjust portions to your individual nutritional needs.
If you already have kidney disease, your dietary needs may change. Potassium, phosphorus, sodium and protein recommendations depend on kidney function, medications and laboratory results. A registered dietitian familiar with kidney disease can help you plan suitable meals.
4. Stay Physically Active
Regular physical activity can help support blood glucose management, blood pressure and cardiovascular health.
Choose activities that suit your ability, such as walking, cycling or other moderate exercise. Start gradually if you are not used to exercising and ask your healthcare professional about any precautions relevant to your health.
5. Avoid Smoking
Smoking damages blood vessels and increases cardiovascular risk. Quitting smoking can benefit your overall health and help reduce risks associated with diabetes and kidney disease.
If you need help quitting, ask your healthcare professional about support programmes and suitable treatments.
6. Be Careful With Painkillers and Supplements
Frequent use of certain pain medicines, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, can harm the kidneys in some circumstances. The risk may be higher in people with existing kidney disease or dehydration.
Do not start or stop prescribed medicines on your own. Tell your healthcare professional about all medicines, vitamins, herbal remedies and supplements you use, especially if you have abnormal kidney test results.
How Is Diabetes-Related Kidney Disease Treated?
Treatment depends on kidney function, urine albumin levels, blood pressure, blood glucose, cardiovascular risk and other medical conditions.
Your healthcare professional may recommend:
Blood pressure treatment: ACE inhibitors or ARBs may be appropriate for people with diabetes, high blood pressure and albuminuria.
Diabetes medicines: Certain medicines, including SGLT2 inhibitors, can help protect kidney and cardiovascular health in eligible people with type 2 diabetes and chronic kidney disease.
Other kidney-protective treatment: Some patients may benefit from additional medicines depending on their kidney function, potassium levels and other clinical factors.
Regular monitoring: Repeat blood and urine tests help assess whether kidney function is stable or changing.
Specialist care: A nephrologist may be needed if kidney disease is advanced, progressing quickly or difficult to manage.
These treatments are not appropriate for every person. Medication choices and doses must be individualized, particularly when kidney function is reduced.
Can Diabetes-Related Kidney Disease Be Reversed?
Some early abnormalities, such as elevated urine albumin, may improve with effective treatment. However, established kidney damage is not always reversible.
The goal of treatment is to protect remaining kidney function, reduce the risk of progression and lower the risk of related health problems.
Early detection matters because treatment and monitoring can begin before significant symptoms develop. Even if you feel well, keep up with recommended kidney screening if you have diabetes.
What Are the Warning Signs of Kidney Disease?
Diabetes-related kidney disease may not cause noticeable symptoms in its early stages. As kidney function declines, some people may develop symptoms such as:
Swelling in the feet, ankles or legs.
Unusual tiredness or weakness.
Changes in urination frequency or amount.
Persistent foamy urine, which may indicate protein in the urine.
Poor appetite, nausea or vomiting.
Persistent itching or muscle cramps.
Difficulty concentrating.
These symptoms can occur for many reasons and do not necessarily mean you have kidney disease. However, if you have diabetes and notice persistent or unexplained changes, arrange a medical assessment.
When Should You Seek Medical Help?
Contact your healthcare professional if you experience persistent swelling, repeated changes in urination, unusual fatigue or other symptoms that concern you.
Seek urgent medical attention if you develop difficulty breathing, chest pain, confusion, severe weakness or persistent vomiting that prevents you from keeping fluids down.
Do not wait for symptoms to appear before getting your routine kidney tests.
Frequently Asked Questions
1. Can Type 2 Diabetes Cause Kidney Disease?
Yes. Type 2 diabetes can damage the kidneys over time, particularly when blood glucose or blood pressure remains above recommended targets. However, not everyone with diabetes develops kidney disease. Regular screening and appropriate treatment can reduce the risk of progression.
2. What Are the First Signs of Kidney Damage From Diabetes?
Early kidney damage often causes no noticeable symptoms. Increased albumin in the urine can be an early sign, even when kidney filtration remains relatively normal. Urine albumin testing and an eGFR blood test can help detect kidney problems.
3. How Often Should People With Diabetes Check Their Kidneys?
People with type 2 diabetes should generally have eGFR and urine albumin-to-creatinine ratio (uACR) testing at least once a year. People with type 1 diabetes are generally screened annually beginning five years after diagnosis. Your healthcare professional may recommend a different schedule based on your results and individual risk.
4. Can Kidney Damage From Diabetes Be Reversed?
Some early abnormalities may improve with treatment, but established kidney damage may not be fully reversible. Managing blood glucose and blood pressure, taking prescribed medication and monitoring kidney function can help slow progression.
5. Does Foamy Urine Always Mean Kidney Disease?
No. Foamy urine can occur for reasons other than kidney disease. However, persistent foamy urine may indicate protein in the urine, particularly in people with diabetes or high blood pressure. A urine test can help determine whether further evaluation is needed.
6. What Foods Should People With Diabetes Eat to Protect Their Kidneys?
A balanced eating pattern with appropriate portions, vegetables, suitable protein sources and less excess sodium can support overall health. People with established kidney disease may need to adjust their potassium, phosphorus, protein or fluid intake according to their test results and medical advice. There is no single kidney-protective diet that is suitable for everyone.
7. Can Kidney Disease Develop Even If My Blood Sugar Is Controlled?
Yes. Good blood glucose management lowers the risk but does not eliminate it completely. Blood pressure, genetics, age, cardiovascular health and other conditions can also influence kidney health. Continue recommended screening even when your blood sugar is within your target range.
Key Takeaways
Diabetes can damage the kidneys' filtering structures over time.
Early kidney disease often has no obvious symptoms.
The eGFR blood test and urine albumin-to-creatinine ratio are important kidney screening tests.
People with type 2 diabetes should generally have both tests at least once a year.
Managing blood glucose, blood pressure and other health risks can help protect kidney function.
Kidney medications, dietary changes and supplements should be discussed with a qualified healthcare professional.
Early detection and consistent follow-up can help slow kidney disease progression.
Conclusion
Living with diabetes does not mean you will inevitably develop kidney disease. However, protecting your kidneys should be an important part of your long-term diabetes care.
Keep your blood glucose and blood pressure within your recommended targets, follow your prescribed treatment plan and attend regular kidney screening appointments. Remember that kidney disease can develop silently, so feeling well is not a substitute for testing.
If you have diabetes, ask your healthcare professional whether your latest eGFR and urine albumin results have been checked. Detecting kidney problems early can help you take appropriate steps to protect your health.
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- Why Is My Urine Foamy? Causes & When to See a Doctor
- High Blood Pressure: Symptoms, Causes & What Your Numbers Mean
- How Sleep Affects Blood Sugar: Can Poor Sleep Make Diabetes Harder to Manage?
Medical Disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Kidney screening schedules, treatment options and dietary recommendations vary depending on individual health needs. Consult a qualified healthcare professional before changing your medication, diet or exercise routine. Seek urgent medical care for severe or rapidly worsening symptoms.
References
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetic Kidney Disease. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Chronic Kidney Disease Tests & Diagnosis. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis
National Kidney Foundation. Diabetes and Kidney Health. https://www.kidney.org/kidney-topics/diabetes-and-your-eyes-heart-nerves-feet-and-kidneys
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Managing Chronic Kidney Disease. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/managing
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