How to Screen for Diabetes-Related Nephropathy

Protein will start to appear in the urine when the kidneys become damaged. One of the first proteins to appear is albumin. A urine protein test measures the amount of albumin present in a urine sample.

Here are what the results mean, generally speaking:

• less than 30 milligrams (mg) is considered within a healthy range
• 31 to 300 mg may indicate early kidney disease (microalbuminuria)
• above 300 mg is considered more advanced kidney disease (macroalbuminuria)

This test measures how well your kidneys are working to filter blood.

It does this by analyzing the level of creatinine in the blood. Creatinine is a toxin the kidneys normally filter out. A person’s rate of estimated blood filtration is calculated using this measurement plus other physical factors, such as age, sex, and body size.

Here are what the results mean:

• A GFR of 60 or higher is in the normal range.
• A GFR below 60 may mean kidney disease.
• A GFR of 15 or lower may mean kidney failure.

Imaging tests are noninvasive tests that create an image of the organs, bones, or tissues inside the body. There are three common types of imaging tests used to screen for diabetes nephropathy:

Kidney ultrasound

Also called a renal ultrasound, it uses sound waves to produce a real-time video image of the inside of the body.

CT scan

A CT scan uses X-rays to create a 3D cross-section image of the inside of the body. Some CT scans require a contrast agent, also referred to as a dye, to be introduced to the body, either by injection or ingestion, to improve the image quality.

Also referred to as a renal biopsy, this test removes a small piece of the kidneys for examination. It’s an invasive test. The biopsy is done using a needle or with minor surgery. A biopsy can uncover scarring, inflammation, or protein deposits that cannot be uncovered using other tests.

The general guideline for people with diabetes is to get their kidney function screened every year.

For people with type 2 diabetes, screenings begin at diagnosis. For people with type 1 diabetes, screenings can begin 5 years after diagnosis.

Kidney disease symptoms are often subtle and easily missed. Because of this, certain risk factors can point to the need to be more diligent about screening.

According to the National Kidney Foundation, these risk factors include:

• family history of kidney failure
• high blood pressure
• heart disease
• chronic urinary tract infections (UTIs)
• kidney stones
• prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen

Doctors use both a urine protein test and eGFR test to diagnose diabetic nephropathy.

EGFR results are more precise and used to identify specific stages of kidney disease. Generally, an eGFR above 90 is considered healthy. Below that, the results are divided into stage 1 (mild kidney damage) through stage 5 (kidney failure).

Diabetic nephropathy is a common diabetes complication. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 1 in 3 people with diabetes have kidney disease in the United States.

Over time, the kidneys lose their ability to filter waste from the blood and eventually fail completely. When the kidneys no longer work, dialysis or an organ transplant is needed to stay alive.

Diabetes nephropathy is also difficult to detect. Common symptoms, such as nausea, changes in urination, swelling limbs, or muscle aches, may be easily dismissed or confused with other conditions.

Regular screenings are the most effective way to monitor changes in kidney health. They can make early detection possible so treatment and lifestyle changes can slow or stop the progression of diabetic nephropathy.

Regularly screening your kidney health is a part of actively managing diabetes. It’s the most effective way to detect the signs early and improve the odds of a better outcome.