Can Type 2 Diabetes Cause Kidney Disease?

If you have diabetes, your kidneys need regular evaluation with urine and blood tests. Regular testing is the best way to detect chronic kidney disease (CKD) early. Treatment should begin as soon as possible to maximize effectiveness and avoid other health concerns.

Type 2 diabetes and kidney disease

The CDC found that over 37 million Americans have diabetes, with approximately 95%¹ having type 2 diabetes. Type 2 diabetes is most prevalent in those over the age of 45, but it is now affecting more children, adolescents, and young adults. Type 2 diabetes is a significant cause of kidney failure. People who develop renal failure need dialysis or a kidney transplant to live.

People with renal disease and type 2 diabetes have a threefold increased risk of dying from a heart attack or stroke compared to people with just type 2 diabetes. The sooner you detect kidney illness, the greater your chances of a favorable outcome. Early detection and management are crucial to halt the disease's development.

What is diabetic kidney disease?

Diabetic kidney disease (DKD) is a condition where diabetes impairs kidney function. The kidney is undoubtedly the most vulnerable organ to diabetic microvascular damage. At least half of all people with type 2 diabetes mellitus will develop kidney disease due to diabetes or another comorbidity.

These include hypertension, dyslipidemia, obesity, renal ischemia, or nephron loss associated with aging.

The kidneys' primary function is to filter waste and excess water from your blood. This produces urine. The kidney tubules return most of the water to the blood and concentrate waste into the urine.

A funnel-like structure collects urine from the tubules (renal pelvis). Urine passes through a tube called a ureter that connects each kidney to the bladder.

Urine exits the bladder via the urethra, the small tube connecting the bladder to the body's exterior. Diabetic nephropathy or kidney disease impairs the function of the kidneys. Trace levels of protein occur in the urine (microalbuminuria). Additionally, your kidneys regulate blood pressure and produce hormones that the body needs to be healthy.

When your kidneys are injured, they cannot filter blood properly, resulting in waste building up in your body.

Moreover, damaged kidneys might result in other health concerns like high blood pressure (hypertension). Each kidney is composed of millions of microscopic filters known as nephrons. Over time, high blood sugar from diabetes may cause damage to the blood arteries in the kidneys and nephrons, impairing their function. 

Many people with diabetes also develop hypertension, which may be harmful to the kidneys. Chronic kidney disease develops slowly and often exhibits no signs or symptoms in its early stages. You will not know whether you have kidney disease until your doctor does a blood test.

Symptoms of diabetic kidney disease

Doctors often detect kidney abnormalities during routine check-ups. Occasionally, a person may be unaware that they have type 2 diabetes. If blood sugar levels remain unregulated, it can gradually harm their kidneys. 

Initial signs of damage might be elevated protein particles in their urine, but no symptoms are associated with this. It may take years before your kidneys are significantly damaged, leading to symptoms. Several of the symptoms of significant kidney failure may include the following:

• Loss of sleep

• Difficulty concentrating

• Upset stomach

• Poor appetite

• Weakness and fatigue

Risk factors

Having diabetes for an extended period raises your risk of developing kidney damage. If you have diabetes, you are at a higher risk of developing kidney damage if your blood glucose and blood pressure are abnormally high. The following risk factors make you susceptible to kidney damage if you have diabetes:

• Smoking cigarettes

• Heart disease

• Not adhering to your diabetic eating plan

• Uncontrolled blood sugar

• Consuming meals rich in sodium and animal protein

• Not exercising regularly

• Obesity

• A family history of kidney failure

Complications of diabetic kidney disease

Diabetic nephropathy complications may develop gradually over the years. They may include:

• Fluid retention: Manifesting as swelling in the arms and legs, hypertension, or fluid in the lungs (pulmonary edema)

• Diabetic retinopathy: The blood vessels in the light-sensitive tissue in the rear of the eye are damaged

• Disorders of the bones and minerals: Caused by the kidneys' failure to maintain the proper balance of calcium and phosphorus in the blood

• Anemia: Reduced red blood cell count

• End-stage renal disease: Irreversible kidney impairment, necessitating dialysis or a kidney transplant for survival

• Foot ulcers, erectile dysfunction, diarrhea, and other nerve and blood vessel damage symptoms

• Increased risk of infections

Can type 2 diabetes cause kidney disease?

Yes, type 2 diabetes can cause kidney disease. The pancreas produces insulin that converts blood sugar for your body to use for energy. In type 2 diabetes, blood sugar levels rise due to insulin resistance. This is when the cells do not react appropriately to insulin.

Your pancreas produces extra insulin in an attempt to stimulate cell response. High blood sugar levels can lead to kidney disease for people with type 2 diabetes. People with kidney disease and type 2 diabetes are more likely to experience heart attacks or a stroke than those with type 2 diabetes.

Who is at risk of getting diabetic kidney disease?

People with diabetes don't all get kidney disease. Genetics, blood glucose control, and blood pressure can all play a role in developing kidney disease. The following demographics are more susceptible to kidney disease.

• Black, Native American, Hispanic, or Latino people are more likely than white people to acquire diabetes, renal disease, and kidney failure.

• Men are more likely to get diabetic kidney disease than women.

• Older people are more susceptible to kidney disease.

Ways to reduce your risk

If you have diabetes, you can significantly lower your chance of developing diabetic nephropathy.

Maintain healthy blood glucose levels

Visit your healthcare provider to determine your A1C levels. The A1C test is a blood test that determines your three-month average blood glucose level. Self-monitoring only reflects your blood sugar measurement at the moment you take it. 

A higher A1C value indicates elevated blood glucose levels during the last three months. Many patients with diabetes have an A1C target of less than 7%. Your doctor will give you a personalized goal. By maintaining your target blood sugar level, you can protect your kidneys. 

To help you meet your A1C target, your healthcare provider may request that you monitor your blood glucose levels. You can work together to use the data to guide your diet, physical activity, and medication choices. Ask your doctor how often you should check your blood glucose level.

Manage your blood pressure

The force exerted by your blood against the walls of your blood vessels is called blood pressure. High blood pressure makes your heart work very hard. It may result in a heart attack, a stroke, or renal failure.

Your doctor may work with you to establish and maintain a healthy blood pressure target. Most patients with diabetes need to keep their blood pressure below 140/90 mm Hg. Ask your doctor what your target is.

Blood pressure-lowering medications may also delay the progression of kidney damage. Two types of blood pressure medications are particularly beneficial for kidney protection: ACE inhibitors and ARBs. They can reduce kidney damage in people with diabetes who also have hypertension and DKD. Pregnant women should avoid ACE inhibitors and ARBs.

If you have type 2 diabetes and chronic kidney disease, you may benefit from other medications. These include sodium-glucose cotransporter-2 inhibitors (SGLT2) or glucagon-like peptide-1 (GLP-1) receptor agonists. These medications may prevent chronic kidney disease and heart conditions from getting worse and help with blood sugar control.

Develop healthy habits

Healthy lifestyle choices are key to meeting your blood glucose and blood pressure targets. Making these changes will help you maintain healthy kidneys.

• Stop smoking

• Consume a greater variety of fruits and vegetables

• Consult a dietician to establish a diabetic meal plan low in sodium

• Include physical exercise in your daily routine

• Maintain a healthy cholesterol level

• Sustain or achieve a healthy weight

• Get enough sleep: Aim for 7 to 8 hours every night.

Follow your physician's prescription

Medicines may play a critical role in achieving your blood glucose and blood pressure targets. Your healthcare provider will prescribe medication depending on your circumstances. You may need to take multiple medications to keep your blood pressure under control.

Tests for diabetic kidney disease

Doctors use various tests to diagnose diabetic nephropathy, including:

Kidney biopsy

Your doctor may prescribe a kidney biopsy to diagnose a suspected kidney issue. Sometimes called a renal biopsy, a kidney biopsy can help determine the severity of a kidney ailment or assess the effectiveness of therapy for kidney disease. 

A kidney biopsy involves the removal of a tiny sample of kidney tissue. A laboratory will examine the sample under a microscope for evidence of injury or illness. Typically, a doctor will conduct a kidney biopsy by puncturing the skin with a small needle. They will likely use an ultrasound to guide the needle into the kidney. This is called a percutaneous kidney biopsy.

Additionally, you may need a kidney biopsy if your kidney transplant is not functioning well. This determines whether the kidney impairment results from diabetes or other underlying conditions.

Urinary albumin test

Your physician can conduct a urinary albumin test to determine the amount of protein in your urine. Proteinuria is one of the early indications of diabetic nephropathy. 

Often, your doctor will do a urine dipstick test followed by albumin and creatinine measurements. They will request a urine sample from you and provide the correct container. The facility conducts on-site testing or sends the sample to a laboratory for examination. 

An albumin dipstick test determines the presence of albumin in your urine. A technician inserts a dipstick, a strip of chemically treated paper, into your urine sample. The dipstick changes color if it detects albumin in the urine.

Albumin-creatinine ratio

Healthcare professionals use this to quantify the albumin to creatinine ratio in your urine and approximate the quantity of albumin expelled within 24 hours. Creatinine is a waste product that your kidneys filter and eliminate in the urine. 

A urine albumin-to-creatinine ratio of more than 30 mg/g is considered abnormal.

Imaging tests

Your healthcare professional can use ultrasound and x-rays to image the size of your kidneys. They can also check for narrowing of the arteries leading to your kidneys, which may cause impaired kidney function.

Additionally, you may have CT scanning and magnetic resonance imaging (MRI) to check your kidneys' blood circulation. Further, your doctor may need imaging tests to rule out other causes of kidney injury, such as obstruction from kidney stones. If you were assigned male at birth, your prostate can also cause issues, which an imaging test will pick up.

Glomerular filtration rate (GFR)

A glomerular filtration rate (GFR) measures the amount of creatinine in a blood sample. This can determine the rate at which the kidneys filter blood. A low filtration rate implies that the kidneys are not functioning correctly.

How to manage diabetic kidney disease

Diabetes management is not always straightforward. It's natural to feel anxious, upset, or frustrated when living with diabetes. While you may understand how to keep healthy, you may struggle to maintain your strategy over time. 

Long-term stress may increase your blood glucose and blood pressure, but you can learn to manage your stress. Consider deep breathing, gardening, taking a stroll, doing yoga, meditating, engaging in a pastime, or listening to music.

Prevention of diabetic kidney disease

You can avoid diabetic kidney disease by maintaining your target blood glucose level. Strict blood glucose management minimizes the risk of microalbuminuria. Other studies² indicate that strict control may be able to reverse microalbuminuria.

People living with diabetes or hypertension can make efforts to prevent or decrease the progression of chronic kidney disease. Early identification is key to prioritizing blood sugar and blood pressure control. A healthy lifestyle and health education may prevent or postpone the progression of kidney disease.

Treatment of diabetic kidney disease

Diabetic nephropathy has treatment options. As your kidneys near failure, you will need more aggressive treatment.

Dialysis

When your kidneys stop functioning correctly, doctors use dialysis to eliminate waste products and excess fluid from the blood. Healthy kidneys filter the blood, eliminating hazardous waste materials and excess fluid and converting them to urine excreted from the body.

Your kidneys may be unable to cleanse your blood effectively. This can happen if your kidneys aren't functioning and you have a severe chronic renal disease, such as kidney failure. As a result, waste materials and fluids may accumulate to harmful proportions in your body. 

If left untreated, this may result in various unpleasant symptoms and death in the worst-case scenario. Before this stage, dialysis removes undesirable chemicals and fluids from the blood. Hemodialysis is where your blood is diverted to a machine for cleaning. 

During your dialysis treatment, you will have strict eating and drinking guidelines to follow to ensure the procedure works. Most people remain on dialysis for years with a lowered life expectancy, so it's crucial to interrupt the progression of DKD before it gets to this point. 

Medication

When preventive measures are ineffective, some medications may be able to reduce blood pressure. There are various types of blood pressure medications, but not all are equally beneficial for people with diabetes. Some of them increase blood glucose levels or disguise symptoms of hypoglycemia. 

Doctors often recommend that people with diabetes take blood pressure medications called ACE inhibitors or angiotensin receptor blockers (ARBs). ACE inhibitors or ARBs are helpful for most people with diabetes, hypertension, or renal disease. 

Recent research indicates that ACE inhibitors, such as captopril and enalapril, may decrease renal disease progression and reduce blood pressure. Indeed, these medications are beneficial even in patients who do not have hypertension.

Kidney transplant

A healthy donor kidney, either from a deceased donor, family member, or friend, restores your kidney function. It's a procedure with many risks. Your body can reject the kidney, you can develop a blood clot that blocks the kidney, and you could get an infection post-surgery. 

You also need to be on immunosuppressants for life to prevent your body from rejecting the kidney. They have many side effects, including increasing your risks of illness, such as infections and certain types of cancer. 

When should I see a doctor?

Consult your physician if you have any signs or symptoms of renal disease. If you have diabetes, contact your doctor annually or go for kidney function testing.

The lowdown

Type 2 diabetes can cause progressive kidney disease. Chronic kidney disease (CKD) often develops with only minor symptoms. Many people are unaware they have CKD until their condition deteriorates to where they need dialysis or a kidney transplant to survive. 

If you have diabetes, your doctor will regularly evaluate your kidneys via urine and blood testing. Routine testing is the most effective strategy to diagnose diabetic kidney disease in its earliest stages. Speak to your doctor if you're concerned about diabetes or kidney disease.