Diabetic Nephropathy: Causes, Symptoms and How to Protect Your Kidneys

Diabetic nephropathy is kidney damage caused by long-term high blood sugar. It's the most common reason adults end up on dialysis, but many people slow or stop its progress with the right steps. If you have diabetes, this should be on your radar—early action changes outcomes.

What it looks like — signs and tests

Early stages often have no symptoms. Doctors spot trouble with two simple tests: a urine albumin-to-creatinine ratio (ACR) and a blood test for estimated glomerular filtration rate (eGFR). ACR shows protein leaking into urine; eGFR estimates kidney filtering. If ACR is higher than 30 mg/g or eGFR drops below normal, your provider will follow up more closely.

Later signs to watch for include swelling in ankles or hands, more tiredness, loss of appetite, and changes in urination. These can come from reduced kidney function, so tell your clinician if you notice them.

Clear, practical steps to slow progression

Control blood sugar. Aim for an A1c target your doctor sets. Good glucose control cuts kidney damage risk. Ask about SGLT2 inhibitor medicines (like empagliflozin or dapagliflozin) — they lower blood sugar and have strong evidence for protecting kidneys in people with diabetes.

Control blood pressure. Target numbers vary, but many people with diabetic nephropathy aim for around 130/80 mmHg or lower based on doctor advice. ACE inhibitors or ARBs are often first-line drugs because they reduce protein in the urine and slow damage.

Cut salt and watch protein. Lowering sodium helps blood pressure and swelling. Your clinician or dietitian can say if you should limit protein intake—too much protein can stress damaged kidneys, but too little is also harmful.

Avoid things that harm kidneys. Skip regular NSAIDs (ibuprofen, naproxen) unless your doctor okays them. Stay hydrated but don’t overdo fluids if your doctor advises limits. Quit smoking — it speeds kidney decline.

Get regular checks. Repeat ACR and eGFR at least once a year, more often if results are abnormal. Bring a list of medicines to appointments; some drugs need dose changes as kidney function changes.

Need help putting this into practice? Start with one thing: check your last A1c and urine test, and book a talk with your provider about blood pressure goals and SGLT2 options. Small, steady changes protect kidneys far better than last-minute fixes.