What Are the Symptoms of Diabetic Nephropathy, a Type of Kidney Disease?

Over several years, diabetic nephropathy gradually progresses. In the early stages, there might not be any symptoms. Treatment could stop it from becoming worse and developing into more dangerous illnesses like end-stage renal disease.

One of the most frequent causes of chronic kidney disease (CKD) is diabetes. One in three diabetics go on to develop CKD.

One particular kind of chronic kidney disease (CKD) linked to a decrease in urine albumin content is diabetic nephropathy. Urine should be free of albumin if the kidneys are in good health.

You should be aware of these signs of diabetic nephropathy if you have the disease.

Diabetic nephropathy stages

Diabetic nephropathy is connected with five phases. They range from mild impairment of the kidneys to renal failure. Every stage could go on for several years.

Based on many blood tests, your estimated glomerular filtration rate (GFR) over three or more months determines the stage.

Your GFR, which is determined by measuring the quantity of waste product creatinine in your blood, shows how well your kidneys are filtering waste.

The phases of diabetic nephropathy are broken down as follows:
  • Stage 1: Although your kidneys are still functioning normally, there may be damage to them. Your kidney function is 90–100% if your GFR is at least 90%.
  • Stage 2: moderate loss of renal function accompanied by kidney injury. GFR: 60–89%.
  • Stage 3A: renal function loss ranging from mild to severe. GFR: 45–59%.
  • Stage 3B: Kidney function loss ranging from moderate to severe. GFR: between 30 and 44%.
  • Stage 4: severe impairment of renal function. GFR: 15–29%.
  • Stage 5: Kidney failure. GFR: 15% or less.
Urine albumin-creatinine ratio (uACR) is used to quantify kidney impairment, even though these phases show how effectively your kidneys are functioning. uACR is determined by a urine test.

Urine typically contains less than 30 mg/g of albumin. Regardless of GFR, if this number is higher, you may have renal disease.

Symptoms of diabetic nephropathy

Diabetic nephropathy manifests with the following symptoms at each stage or none at all.

Stage 1 diabetic nephropathy symptoms

Although your kidneys are beginning to work harder in stage 1, you most likely won't experience any symptoms.

Urine may be frothy depending on the amount of albumin present.

Stage 2 diabetic nephropathy symptoms

You are still not likely to experience any symptoms in stage 2 as your kidneys deteriorate and the amount of albumin in your urine increases.

Your elevated albumin level may be the cause of your frothy urine.

Stage 3 diabetic nephropathy symptoms

The majority of patients with stage 3 CKDs, such as diabetic nephropathy, are diagnosed. This stage is characterised by a greater decrease in kidney function, which may cause symptoms to start.

There are two divisions in this stage: kidney damage in stages 3A and 3B, respectively, ranging from mild to moderate to severe.

Symptoms of stage 3A could include:
  • Urinating more or less regularly
  • itchy or dry skin
  • decreased appetite
  • unintentional weight loss
  • fatigue
  • nausea
In addition to these signs, stage 3B may also cause you to feel as follows:
  • Your legs, arms, ankles, or feet may swell or become numb.
  • muscle aches and cramps
  • difficulty concentrating
  • shortness of breath
  • vomiting

Stage 4 diabetic nephropathy symptoms

In stage 4, symptoms tend to be common due to substantial loss of renal function.

In addition to the symptoms from the early phases, you might also feel like:
  • difficulty sleeping
  • breath with a fishy, ammoniac, or urine scent

Stage 5 diabetic nephropathy symptoms

Kidney failure in stage five may present with symptoms from earlier stages as well.

Additional signs of renal failure include:
  • drowsiness
  • seizures
  • coma
  • chest pain or pressure

What causes diabetic nephropathy?

Waste materials in our blood are filtered by our kidneys and then eliminated from our body through urine. Our blood contains vital elements such as red blood cells and protein.

People with type 1 and type 2 diabetes have high blood glucose (sugar) levels, which causes the kidneys to filter too much blood.

The kidneys' blood vessels may get damaged as a result of this additional labour over time, allowing albumin and other proteins to seep into the urine. Diabetic kidney disease may result from this.

How is diabetic nephropathy diagnosed?

The diagnosis of diabetic nephropathy is predicated on:
  • decline in GFR
  • elevated blood pressure
  • increased levels of albumin in urine
To diagnose diabetic nephropathy, medical professionals may carry out the following tests:
  • microalbuminuria urine test
  • creatinine blood test
  • blood urea nitrogen (BUN) blood test
  • glomerular filtration rate (GFR) blood test

Diabetic nephropathy treatment

Although diabetic nephropathy has no known cure, treatment with drugs and lifestyle modifications may be able to reduce the condition's progression.

A medical professional might recommend:
  • renal damage is slowed and the risk of kidney failure is decreased by finerenone (Kerendia).
  • blood pressure-lowering medications include angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors.
  • GLP-1 receptor agonists like metformin or other drugs to help regulate your blood sugar levels
  • SGLT2 inhibitors: a treatment for type 2 diabetes that slows the onset of chronic kidney disease
Adopting lifestyle practices like eating a diet high in foods high in nutrients and exercising frequently can also help you maintain the health of your kidneys.

Dialysis or a kidney transplant may be required if stage 5 diabetic nephropathy develops into kidney failure.

Life expectancy with diabetic nephropathy

Individuals with diabetic nephropathy have varying life expectancies depending on characteristics such as:
  • disease stage
  • coexisting health conditions
  • efficient therapy that reduces or eliminates kidney damage
  • lifestyle habits
According to a 2017 study involving 512,700 adults in Taiwan, adults with stages 1-3 diabetic CKD had a 16-year lower life expectancy than adults with diabetes without CKD or CKD without diabetes.

In the early stages of chronic kidney disease (CKD), obesity and insufficient physical activity were found to severely reduce the life expectancy of diabetics.

When to contact a doctor

If you have diabetes, get tested for signs of diabetic nephropathy and other kidney problems in your blood and urine once a year or more frequently as directed by your physician.

If you experience any of the following early signs of diabetic nephropathy, get in touch with a physician:
  • more or less frequent urination
  • itchy skin
  • foamy urine


Before you feel the signs of diabetic nephropathy, it could take a few years. You might already have moderate to severe renal damage by then.

Get regular testing for kidney abnormalities if you have diabetes, as the early stages of diabetic nephropathy typically show no symptoms.

Although diabetic nephropathy has no known cure, kidney damage can be prevented or slowed down with medication.

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