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Diabetic Nephropathy

Diabetic Nephropathy
Complications of Diabetes
Written by Dr Rajesh Kesari MD   

Failing Kidneys in long standing Diabetes

Uncontrolled Diabetes damages kidneys in many ways. These complications are related to the microvascular complications. The small blood vessels become fragile and start leaking, the original specialized cells of kidney are replaced by collagen fibres causing shrinking of the kidneys- the filtration mechanism of kidneys is disrupted and kidneys can no longer effectively carry out their working of removing unwanted nitrogenous wastes from our blood. Kidneys also loose the ability to preserve the proteins present in blood and some may be lost with urine, initially causing microalbuminuria ( a frequently ordered test) but with time may result into macroalbuminuria (large amounts of protein being filtered out with urine).

The test for Urine Microalbumin should be done atleast once in six moths and more frequently if indicated, a raised level of Microalbumin is the earliest indicator of damage to kidneys and with medications and proper treatment of Diabetes, progression of the disease may be arrested.

Symptoms of Chronic Kidney Disease

Symptoms of Kidney disease depend on the percentage of kidneys functioning, initially there may not be any symptoms at all, but as more and more toxic substances are retained in the blood and protein is lost some symptoms may become obvious like

  • Fatigue, Weakness
  • Headache
  • Swelling of Body
  • Excessive thirst and urination
  • Nausea and vomiting 
  • Dark circles under eyes...

Related important issues

High BP and Kdneys

Testing Kidney Function

Diet in Kidney Disease

Disease Progression

Hypoglycemia (Low Sugar)

Diabetes treatment in


Anemia in Kidney disease

High Blood Pressure harmful for Kidneys

High blood glucose together with high blood pressure plays havoc on kidneys, the damage to kidneys is accelerated with high blood pressure. But the kidneys themselves are responsible for controlling blood pressure through by secretion of some hormones and controlling the amount of salt and water absorbed back in blood- so any damage to kidneys may result in a viscious cycle which only accelerates the damage. Treatment of Diabetes is focused on controlling Blood pressure  together with Blood Glucose and Cholesterol.

Measuring the damage-Testing in Kidney Disease

The Functioning of kidneys is measured as the GFR (Glomerular filtration rate)- which means the amount of blood filtered by both the kidneys per minute and is expressed in ml/minute; in daily clinical practice it is calculated from the Serum creatinine levels, age and weight of the patient using a formula called Cockroft equation. It is an approximate measure of the percentage functioning of kidneys- more acute testing of kidneys can be done by measuring clearence of radioactive labeled isopotes, but this is quite costly and not easily available.

Some other tests which may be requested by your doctor - as they are essential for Diabetes treatment and monitoring of such patients are:- Kidney Function Test- Serum Creatinine, Blood Urea Nitrogen, Uric Acid, Serum Electrolytes- Sodium, Potassium, Calcium, Phosphorus, Cholesterol, Albumin etc...Some Hormonal tests like Thyroid ( TSH, Ft3, Ft4) Parathyroid ( intact PTH), Serum Vitamin D 25 Hydroxy, 24 Hour Urine Microalbumin or Albumin/ Protein depending on you condition and stage of the disease. 


Patients with Chronic Kidney Disease may be required to take special care of their diet, decrease their total protein intake- proteins are present in meat, poultry, eggs, milk , cheese,and other milk products, Soya, lentils, kidney beans etc.

Progressive disease

Damage to kidneys start after 5-10 years of Diabetes duration, the functioning of kidneys only deteriorates after this if no steps are taken to control blood glucose, blood pressure and blood cholesterol levels.

With failing kidneys- Blood Dialysis may be required, wherein blood is cleared of toxins using artificial kidneys, But with progressing disease Dialysis may not be help ful and ultimately a Kidnet transplant may be required.


Hypoglycemia may also be caused due to kidney failure, as the body fails to excrete the sugar lowering drugs and their action gets prolonged. The action of insulin may also be prolonged as it is cleared from the body Kidneys.

Anemia of Chronic Kidney Disease

Kidneys also play a major role in formation of Red Blood cells, decreased kidney function causes Anemia- low hemoglobin levels.

Diabetes treatment in Kidney Disease

Some medicines used in Diabetes treatment like Metformin cause lactic acidosis and may damage kidneys- they have to be stopped if any derangements in kidney function is noted while on such medication. Most of the oral medicines used in treatment of Diabetes increase the risk of Hypoglycemia or damage the kidneys itself, so their use is limited in treatment of Diabetes in persons with Diabetic Nephropathy. Insulin may be required for treatment of Diabetes in such patients


Important for Diabetics

Check Kidney function regularly Control Blood Sugar Do start taking insulin injections if your doctor advises so Control Blood Pressure Control  Cholesterol


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