Diabetic Nephropathy: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Diabetic Nephropathy?
A nephrologist, a doctor who treats kidney disease, treats diabetic nephropathy. An endocrinologist, a doctor who treats diabetes, often helps manage blood sugar too. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is diabetic nephropathy?
Diabetic nephropathy is kidney damage caused by diabetes. It is also called diabetic kidney disease. The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. When your kidneys are damaged, they cannot filter blood like they should, so wastes can build up in your body. Damage from diabetes usually happens slowly, over many years. About 1 out of 3 adults with diabetes has kidney disease.
Symptoms
Most people with diabetic kidney disease do not have symptoms. Kidney damage can begin 5 to 10 years before symptoms start. People with more severe, long-term kidney disease may have:
- Feeling tired most of the time.
- Swelling of the legs.
- Shortness of breath.
- Nausea and vomiting.
- Poor appetite.
- Headache.
- Itchy skin.
- An irregular heartbeat.
- Infections that come easily.
Causes and who gets it
High blood sugar, also called blood glucose, can damage the blood vessels in your kidneys. Many people with diabetes also have high blood pressure, which can damage the kidneys too. The kidneys have tiny filtering units called nephrons. Over time, they thicken and scar, and protein leaks into the urine. Having diabetes longer raises the chance of kidney damage. You are also more likely to have it if you have diabetes and:
- Smoke.
- Eat foods high in salt.
- Are not active.
- Are overweight.
- Have a family history of kidney failure.
African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.
How doctors diagnose it
Health care professionals use blood and urine tests to check for diabetic kidney disease. Your urine is checked for albumin, a protein that leaks when kidneys are damaged. A blood test shows how well your kidneys are filtering your blood. If you have diabetes, your provider also checks your kidneys with blood tests every year. Sometimes a kidney biopsy is ordered to confirm the diagnosis or look for other causes of kidney damage.
You should be tested every year if you have type 2 diabetes. You should also be tested every year if you have had type 1 diabetes for more than 5 years.
Treatment
When kidney damage is caught early, treatment can slow it. The best way to slow or prevent diabetes-related kidney disease is to try to reach your blood glucose and blood pressure goals. Healthy habits and taking your medicines as prescribed can help.
- Blood pressure medicines called ACE inhibitors and ARBs have been found to slow kidney damage in people with diabetes, high blood pressure, and kidney disease.
- ACE inhibitors and ARBs are not safe for women who are pregnant.
- Medicines called SGLT2 inhibitors are commonly recommended for people with chronic kidney disease. They can slow kidney damage and lower the risk of kidney failure. Your doctor decides if one is right for you.
- Stop smoking.
- Limit salt and sodium.
- Make physical activity part of your routine.
- Stay at or get to a healthy weight.
- Work with a dietitian to build a diabetes meal plan.
Pain medicines called NSAIDs, such as ibuprofen or naproxen, can damage the kidneys, more so when used every day. Ask your provider if there is another kind of medicine you can take instead. If the kidneys fail, a person needs dialysis or a kidney transplant.
When to see a doctor
Contact your provider if you have diabetes and have not had a urine test to check for protein. Swelling in the legs, shortness of breath, and constant tiredness can be symptoms of more severe, long-term kidney disease. Call 911 or go to the emergency room if you have chest pain, fainting, severe trouble breathing, or sudden confusion.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This kind of doctor can order your yearly urine and blood kidney tests, and help you work on your blood sugar and blood pressure goals.
Common questions
Does diabetic nephropathy always lead to kidney failure?
No, most people with diabetes and kidney disease do not end up with kidney failure. Kidney damage from diabetes can get worse over time, but you can take steps to slow it.
Can diabetic nephropathy be slowed down?
Yes, you can slow down kidney damage or keep it from getting worse. Controlling your blood sugar and blood pressure and taking your medicines as prescribed can help. Your doctor may also suggest a medicine called an SGLT2 inhibitor.
How do I know if I have diabetic nephropathy?
The only way to know is to get your kidneys checked, because most people have no symptoms. Doctors use a urine test for protein and a blood test of kidney function.
What causes diabetic nephropathy?
Diabetes causes it: high blood sugar over time can damage your kidneys. High blood pressure can add to the damage.
Sources
- NIDDK - Diabetic Kidney Disease
- National Kidney Foundation - SGLT2 Inhibitors
- MedlinePlus - Diabetes and kidney disease
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
