Some people with type 2 diabetes develop kidney disease. This occurs when the kidneys no longer filter blood effectively.

Nephropathy, or kidney disease, is one of the most serious complications that many people with diabetes may experience. It’s the leading cause of kidney failure in the United States. Diabetic nephropathy, or diabetic kidney disease (DKD), develops in 30% to 40% of people with diabetes.

DKD can cause end stage kidney disease (ESRD), which occurs when the kidneys no longer work effectively enough for day-to-day life. People with ESRD either use dialysis to manage their kidneys’ daily functioning or receive a kidney transplant.

According to the National Kidney Foundation, as of 2018, more than 785,883 Americans had ESRD and needed dialysis to live.

Diabetic nephropathy has few early symptoms or warning signs. Kidney damage from nephropathy can occur for as long as a decade before the first symptoms appear.

Often, no symptoms of kidney disease appear until the kidneys are no longer functioning properly. Symptoms that indicate your kidneys could be at risk may include:

  • fluid retention
  • swelling of your feet, ankles, and legs
  • decreased appetite
  • frequent exhaustion and weakness
  • frequent headaches
  • upset stomach
  • nausea
  • vomiting
  • insomnia
  • difficulty concentrating

Early diagnosis of kidney disease is essential for preserving good health. If you have prediabetes, type 2 diabetes, or other known diabetes risk factors, your kidneys are already overworked and their function should be tested each year.

Other risk factors for kidney disease can include:

  • high blood pressure
  • high blood glucose
  • obesity
  • high cholesterol
  • a family history of kidney disease
  • a family history of heart disease
  • cigarette smoking
  • advanced age

The following populations have a higher risk of DKD:

  • African Americans
  • American Indians
  • Mexican Americans

This may be due to a higher prevalence of diabetes among these groups.

Genetics may contribute to your risk of DKD.

Kidney disease doesn’t have just one specific cause. Experts believe its development is likely associated with years of unregulated blood glucose. Other factors, such as genetic predisposition, likely play important roles as well.

Over time, having high blood glucose can damage the blood vessels in your kidneys. Damaged blood vessels may work less effectively.

High blood pressure can also contribute to kidney damage. According to the National Institute of Diabetes and Digestive and Kidney Diseases, many people who have diabetes may also develop high blood pressure.

How do kidneys work?

Your kidneys are your body’s blood filtration system. Each kidney is made up of hundreds of thousands of nephrons that clean waste from your blood. This waste and extra water become urine. Your kidneys also help regulate your blood pressure and generate hormones.

Over time, especially if you have type 2 diabetes, your kidneys can become overworked because they’re constantly removing excess glucose from your blood. The nephrons become inflamed and scarred and no longer work as well.

Eventually, the nephrons may no longer be able to fully filter your body’s blood supply. When your kidneys are damaged, the nephrons become leaky, and protein that your body would have reabsorbed is instead lost through your urine.

Much of that is a protein called albumin. By testing a sample of your urine, healthcare professionals can determine your body’s levels of albumin and find out how well your kidneys are functioning.

Having a small amount of albumin in your urine is referred to as microalbuminuria. When larger amounts of albumin are found in your urine, the condition is called albuminuria (macroalbuminuria) or proteinuria.

Healthcare professionals can use an albumin-to-creatinine ratio (ACR) test or a urine albumin test to find out how much albumin is in your urine.

Does diabetes cause kidney failure?

The dangers of kidney failure are much greater if you have macroalbuminuria.

ESRD is the fifth stage of progressive kidney disease. If you have ESRD, it means that your kidneys have a filtration rate of less than 15 mL/min.

The treatment for ERSD is dialysis, which involves having your blood filtered by a machine and pumped back into your body.

If you have DKD, treatment involves preserving your kidney function. Steps that doctors may recommend include:

  • Managing high blood pressure: If you have high blood pressure, a healthcare professional may prescribe medication to help lower your blood pressure. Eating low sodium, heart-healthy foods and taking your medications as prescribed may help you reach your blood pressure goal.
  • Managing your blood glucose levels: Check your blood glucose levels regularly. Keeping your daily blood glucose levels close to the levels your doctor recommends may help preserve your kidney function.
  • Taking prescribed medication: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), two types of blood pressure medication, may help slow kidney disease progression, even in people without high blood pressure. Your medication and dosage may change over time.

Other lifestyle habits that may help you manage kidney disease include:

  • following a healthy eating plan for diabetes or working with a registered dietitian
  • getting 30 minutes or more of physical activity each day
  • quitting smoking, if you smoke
  • getting at least 7 to 8 hours of sleep each night
  • finding ways to cope with stress, which can contribute to high blood pressure
  • seeking support or treatment for depression, if you experience it

If you have kidney failure or ESRD, treatment may involve dialysis or a kidney transplant.

The main ways to prevent diabetic nephropathy include the following:


The best way to preserve kidney health is to be mindful of your diet. People with diabetes who have partial kidney function need to be even more vigilant about managing their:

  • blood glucose levels
  • blood cholesterol levels
  • lipid levels

Most people should aim to maintain a blood pressure of 140/90 mm Hg. The doctor treating your high blood pressure may recommend an individual goal. Even if you have mild kidney disease, high blood pressure can cause the disease to progress more quickly.

A doctor may recommend that you:

  • eat foods low in salt
  • avoid adding salt to meals
  • maintain a moderate weight, or lose weight if you’re overweight or have obesity
  • avoid drinking alcohol

A doctor may recommend that you follow a low fat, low protein diet or work with a registered dietitian to come up with an individualized eating plan to support your kidney health.


Getting at least 30 minutes of daily physical activity can help lower both blood pressure and blood glucose.

Exercise has the added benefit of stress relief, which can help lower blood pressure.

Talk with your doctor about the type and intensity of physical activity that would be best for you.


Most people with type 2 diabetes who have high blood pressure take ACE inhibitors for heart disease treatment, such as captopril and enalapril (Vasotec). These drugs also have the potential to slow the progression of kidney disease.

Doctors also commonly prescribe ARBs.

Kerendia (finerenone) is a prescription medication that can reduce the risk of:

  • sustained glomerular filtration rate (GFR) decline
  • ESRD
  • death from cardiovascular conditions
  • nonfatal heart attack
  • hospitalization for heart failure in adults with chronic kidney disease (CKD) associated with type 2 diabetes

Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists are other possible medication options for people with type 2 diabetes and CKD. These drugs can reduce the risk of CKD progression and cardiovascular events.

Stopping smoking

If you smoke cigarettes, consider seeking support for quitting.

Smoking is a risk factor for diabetic nephropathy. It can make kidney damage worse.

Diabetic nephropathy is a serious complication of both type 1 and type 2 diabetes. It occurs when your kidneys lose their ability to effectively filter waste from your blood over time.

Maintaining healthy blood pressure and blood glucose levels may help prevent or slow the progression of diabetic nephropathy. A doctor may prescribe medications to help preserve kidney function.

If you have kidney failure, you may undergo dialysis to filter waste from your blood.