What to know about T2DM and kidney disease

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One of the main functions of the kidneys is removing various waste products and filtering them into the urine. The kidneys contain millions of blood vessels and small holes, which help filter small molecules, such as waste products.

Diabetic nephropathy is a potential complication of diabetes that describes kidney damage. High levels of blood sugar, known as hyperglycemia, can cause the kidneys to filter too much blood. This places extra effort on the filters, which can result in damage.

Over an extended time, the kidneys may start to leak, and useful protein becomes lost in the urine. The stress can eventually cause the kidneys to lose their filtering ability, leading to waste products building up in the blood. Eventually, this can result in kidney failure.

Read on to learn more about microalbuminuria and diabetic nephropathy.

Approximately 1 in 3 adults with diabetes, including both type 1 and 2, may have chronic kidney disease.

In the early stages of diabetic nephropathy, a person may not show any symptoms. A healthcare professional may identify that the individual is developing diabetic nephropathy during routine screening. This is due to the presence of creatinine, a waste product, in the urine.

As the condition progresses, a person may start to notice the following symptoms:

• fatigue
• foamy urine
• swelling in the legs, feet, and hands
• being short of breath
• feeling sick
• blood in the urine

The primary cause of diabetic nephropathy is long periods of high blood sugar levels, or hyperglycemia.

Over time, this can damage the blood vessels and filters within the kidneys. Eventually, this damage causes a slow and progressive loss of kidney function.

A 2021 review suggests that certain nonmodifiable risk factors, which are factors a person cannot change, may increase the risk of developing diabetic nephropathy. These include having a family history of the condition or being of certain heritages, such as the American population of Mexicans, Africans, and Pima people of Native Americans.

Additionally, there are also modifiable factors, which are those that a person can control or change. These include:

• smoking
• having overweight
• not exercising regularly
• not following a diabetes eating plan
• eating foods high in salt

A potential risk factor for kidney disease is hypertension, which is known as high blood pressure. Evidence notes that hypertension is common in people living with T2DM. Research suggests this may be due to an increase in sodium reabsorption and increased blood pressure in the kidneys.

The type of treatment for diabetic nephropathy will depend on the stage of kidney disease.

Managing and preventing diabetic nephropathy primarily involves controlling blood sugar levels. Some antidiabetic medications, such as sodium-glucose cotransporter-2 inhibitors, may help manage the condition.

A person may require medication that can simultaneously lower blood pressure and protect the kidneys from further damage. These drugs include angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers.

Lifestyle changes, such as a moderate diet, regular exercise, and smoking cessation, can also play a crucial role in managing diabetic nephropathy.

If a person develops late stage kidney disease, or their kidneys start to fail, they may require dialysis or a kidney transplant.

Preventing diabetic nephropathy involves a person managing their T2DM in line with their care plan. This may include monitoring and controlling blood sugar levels through a balanced diet, regular physical activity, and adhering to medication as a doctor prescribes.

Managing other risk factors, such as stopping smoking, if applicable, maintaining a moderate weight, and in some cases, managing comorbid conditions, such as high blood pressure, are also important.

Prolonged periods of high blood sugar levels due to type 2 diabetes can damage the kidneys. Over time, this may cause kidney disease, which is known as diabetic nephropathy. Diabetic nephropathy can lead to severe kidney damage and, without management, can progress to kidney failure.

Early detection through regular screenings, effective control of blood sugar levels and blood pressure, lifestyle modifications, and prompt medical intervention are vital in preventing or slowing the progression of diabetic nephropathy in individuals with type 2 diabetes.