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WHAT IS DIABETES?

Diabetes is a serious, life-long condition where glucose levels in the blood are too high. If untreated, it can lead to serious health complications including damage to the eyes, nerves, heart and kidney. This information concentrates on the effect of diabetes on your kidneys. For further information on diabetes please visit Diabetes UK.

HOW CAN HAVING DIABETES AFFECT THE KIDNEY?

One of the complications of diabetes is kidney disease, also called diabetic nephropathy. This can affect up to a third of people who have diabetes. It develops over many years and can affect anyone with diabetes. This is caused by damage to the small blood vessels in the kidneys. A kidney affected by diabetes can look normal under an ultrasound but under the microscope the kidney can show damage to the filtering units. It is this damage to the filtering units, which causes protein to leak into the urine, which is an important marker for diabetic kidney disease.

Urine infections are also more likely to happen if you have diabetes. These can be treated with antibiotics. This is more likely to happen if you have glucose in your urine so having good control of your diabetes will reduce the chance of infection.

WHAT TESTS ARE NEEDED?

The earliest sign of diabetic kidney disease is leaking of protein called albumin, in the urine. This should be tested at least once a year, along with blood tests to check the function of the kidneys and a measure of your blood pressure. Even small amounts of protein found in the urine is important as if it is present, it is extremely important to have blood pressure control and diabetes control.

WILL I NEED DIALYSIS?

About 25% of people who have type 2 diabetes will have small amounts of protein leak from diabetic nephropathy after 10 years. This over time contributes to gradual reduction in the function of the kidneys. However, only a few people will end up needing dialysis. Renal failure requiring dialysis is the end result of chronic kidney disease. The treatments suggested below slow down damage to the kidneys.

 

IS THERE TREATMENT IF I HAVE DIABETIC KIDNEY DISEASE?

Diabetic kidney disease is not curable, but doctors use treatments to try and stabilise the kidneys.

Blood pressure- The kidneys are very sensitive to high blood pressure, so make sure that your blood pressure is at the target recommended by your doctor or nurse. High blood pressure can damage not only the kidneys but also other parts of the body, so control of high blood pressure is vital.

Getting blood glucose levels to within your target. This is very important. Achieving the target level of glucose will slow the damage to the kidney, and of course also very important to slow the rate of development of other types of diabetic complications.

Control of protein leak in urine- Doctors try to use a type of blood pressure drug called ACE inhibitors or angiotensin receptor blockers (ARB) even with normal blood pressure measurements as they reduce the amount of protein leaking from the kidney. More recently, SGLT-inhibitors seem to have added protective effects on the heart and kidneys.

Diet If you develop severe kidney failure, your diet will need further modification. Specialist dieticians will be able to advise on this. It is important that you eat well to keep your strength up, but there are some foods that can cause problems in kidney failure. Diabetics may need to be very careful about foods containing potassium, which can be fatal if runs too high.

Attend all your medical appointments: Treatment can slow down damage to the kidneys and you will not usually have any symptoms of early damage. This is where treatment is most effective so it is important to make sure that you have your annual diabetes review.

Stop smoking: Kidney disease will get worse more quickly if you smoke. So, by stopping you will be protecting your kidneys.

CAN I HAVE A TRANSPLANT?

The best treatment for someone with complete kidney failure is a transplant. The best type of kidney transplant is from a living donor, and if someone from the family, or a friend, offers a kidney this should be discussed with the kidney unit or local transplant coordinator. Although there is a severe shortage of kidneys available for transplantation, your kidney team should prepare and consider activating you on the wait-list for deceased donation when appropriate. This is when you are called for transplantation when you’ve matched the kidney from someone who has died.

It is possible to cure diabetes by transplanting a pancreas from someone who has died. The new pancreas is able to produce insulin and this means that you won’t have to take insulin. Complications of diabetes, such as eye disease, usually stabilise. A pancreas transplant may be done at the same time as a kidney transplant, though people who already have kidney transplants may be suitable for a 'pancreas after kidney' transplant. This type of transplant is suitable for people with Type 1 diabetes and for some people with Type 2 diabetes but is a large operation with higher risks than a kidney transplant.

Fitness for transplantation depends on how much diabetes has affected other parts of the body, particularly the heart. The transplant team will do a number of investigations, including heart tests, and the criteria for having a pancreas transplant are stricter than for a kidney transplant, because the operation is more stressful to the body.

HOW WILL MY LIFE BE AFFECTED?

Even on dialysis, many diabetic patients are able to lead active lives, working and enjoying life in many ways. If your diabetes has affected other parts of your body, you may have to accept these limitations.

Last reviewed April 2022
Next review April 2025

Reviewed by Dr Oshini Shivakumar 'Specialist Renal Registrar'

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The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.