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Diabetic nephropathy is one of the chronic vascular complication of diabetes, which develop after several years of diabetes and results in progressive damage and loss of kidney function.  Functional changed occur in the nephrons functional units of the kidney. Diabetic nephropathy is also called as Diabetic Kidney Disease (DKD). Diabetic nephropathy has become the most common single cause of End-stage renal disease (ESRD) and is associated with increased cardiovascular mortality.  Earliest clinical evidence of nephropathy is an appearance of albumin in urine, known as microalbuminuria. Microalbuminuria is also a marker of increased CVD risk.  An annual screen for microalbuminuria should be performed in patients who have had T1DM for more than 5years, and in all Patients with type 2 DM at diagnosis.


Risk factors for Diabetic Nephropathy :

  • Poor glycaemic (blood glucose) control
  • Hypertension
  • Hyperlipidaemia
  • Genetic (Family history)
  • Smoking, Alcohol or Tobacco intake
  • Duration and severity of diabetes


Clinical Features of Diabetic Nephropathy :

During Early stages of  Nephropathy, there are usually no symptoms. As the conditions progress, individuals with diabetic nephropathy may show 

  • Oedema on feet and legs, later oedema may occur throughout the body.
  • Increase blood pressure and elevated levels of cholesterol and triglycerides in the body.
  • Large amount of protein leaking into the urine


Once the kidneys are severely damaged, blood sugar levels may drop because kidney retains insulin or medicines in the body (The half-life of medicines increases). In late stages, the patients become

  • Anaemic (Kidney produces hormone erythropoietin, it stimulate red blood cell production.
  • Breathless
  • Increase Serum potassium level
  • Hyperuricemia



  • Urinary Albumin/Creatinine Ratio (mg/g) Spot Sample for measurement of microalbuminuria
  • Normal: less than 30 mg/g
  • Microalbuminuria : 30 to 299 mg/g
  • Macroalbuminuria: more than 300 mg/g


  • Blood test for serum creatinine: Creatinine is a by-product of muscle metabolism and it is excreted by the kidney. The normal range of serum creatinine is as follow :
  • Adult Males : 0.8-1.4 mg/dL
  • Adult Females :0.6-1.1mg/dL
  • Children : 0.2-1.0 mg/dL


  • Estimate GFR (Glomerular Filtration Rate): eGFR indicates how well the kidneys are functioning.


Treatment :

 Although diabetic nephropathy cannot be cured, the progression of the disease can be slow down by :

  • Avoid nephrotoxic drugs such as Painkillers (NSAID'S and COX-2 inhibitors).
  • Glucose control
  • Intensive treatment of blood pressure should aim for 130/80 mmHg. BP lowering medicines may slow down kidney damage and are started as soon as any amount of proteins is found in the urine.
  • Dietary protein is to be restricted to 0.8 g of proteins/kg body weight and reduce salt in the diet. (5-6gm of Salt/day)
  • Quit Smoking, Alcohol, and Tobacco



This is Copyright Content by Gadge's Diabetes Care Edited and written by Madiha Khan


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