Diabetic nephropathy develops slowly over several years. There may be no symptoms in its early stages. Treatment may prevent it from progressing and leading to serious conditions, like end stage renal disease.

Diabetes is one of the most common causes of chronic kidney disease (CKD). About 1 in 3 people with diabetes develop CKD.

Diabetic nephropathy is a specific type of CKD associated with a loss of the protein albumin in your urine. With healthy kidneys, urine should contain no albumin.

These are the symptoms of diabetic nephropathy to know about if you have diabetes.

Diabetic nephropathy stages

There are five stages associated with diabetic nephropathy. They range from minor kidney damage to kidney failure. Each stage may last for several years.

The stage is determined by your estimated glomerular filtration rate (GFR) over 3 or more months, based on repeated blood testing.

Your GFR indicates whether your kidneys are properly filtering waste, estimated by the amount of the waste product creatinine in your blood.

Here’s a general breakdown of diabetic nephropathy stages:

Stage 1: You have possible kidney damage but your kidneys are still functioning normally. Your GFR is at least 90%, meaning your kidney function is 90–100%.
Stage 2: Kidney damage with a mild loss of kidney function. GFR: 60–89%.
Stage 3A: Mild to severe loss of kidney function. GFR: 45–59%.
Stage 3B: Moderate to severe loss of kidney function. GFR: 30–44%.
Stage 4: Severe loss of kidney function. GFR: 15–29%.
Stage 5: Kidney failure. GFR: 15% or less.

While these stages indicate how well your kidneys are functioning, damage to your kidneys is measured based on your urine albumin-creatinine ratio (uACR). A urine test determines uACR.

The typical amount of albumin in urine is below 30 mg/g. You may have kidney disease if this amount is higher, regardless of GFR.

Symptoms of diabetic nephropathy

Each stage of diabetic nephropathy has the following symptoms or lack of symptoms.

Stage 1 diabetic nephropathy symptoms

In stage 1, your kidneys are starting to work harder, but you probably won’t have any symptoms.

Depending on the amount of albumin in your urine, it may be foamy.

Stage 2 diabetic nephropathy symptoms

As your kidneys become damaged and your urine contains larger amounts of albumin, you are still unlikely to have any symptoms in stage 2.

Your urine may be foamy due to the increased level of albumin.

Stage 3 diabetic nephropathy symptoms

Most people with CKDs like diabetic nephropathy receive a diagnosis in stage 3. Symptoms may begin to appear in this stage due to the increased loss of kidney function.

This stage is divided in two: Stage 3A is mild to moderate kidney damage, and stage 3B is moderate to severe kidney damage.

Stage 3A symptoms may include:

In addition to these symptoms, you may experience the following in stage 3B:

Stage 4 diabetic nephropathy symptoms

Due to the severe loss of kidney function, symptoms are common in stage 4.

Along with the symptoms in the earlier stages, you may experience:

difficulty sleeping
breath that smells like urine, ammonia, or fish

Stage 5 diabetic nephropathy symptoms

The symptoms of stage 5, which is kidney failure, may include symptoms from the previous stages.

Other symptoms of kidney failure are:

What causes diabetic nephropathy?

Our kidneys filter waste products in our blood so they’re removed from our bodies through our urine. Protein, red blood cells, and other important substances remain in our blood.

The high levels of glucose (sugar) in the blood of people with type 1 and type 2 diabetes cause the kidneys to filter an excess amount of blood.

Over time, this extra work can damage the blood vessels in the kidneys, causing them to leak albumin and other proteins into the urine. This can lead to diabetic nephropathy.

How is diabetic nephropathy diagnosed?

A diabetic nephropathy diagnosis is based on:

decline in GFR
increased levels of albumin in urine
elevated blood pressure

Doctors may perform the following tests to diagnose diabetic nephropathy:

Learn more about diagnosing diabetic nephropathy.

Diabetic nephropathy treatment

There’s no cure for diabetic nephropathy, but treatment with medications and lifestyle strategies may help slow its progress.

A doctor may prescribe:

finerenone (Kerendia), which slows kidney damage and lowers the risk of kidney failure
angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to help lower blood pressure
metformin, GLP-1 receptor agonists, or other medications to help control your blood sugar level
sodium-glucose transport protein 2 (SGLT2) inhibitors to treat type 2 diabetes and to delay progression of CKD

Lifestyle strategies, such as prioritizing kidney-healthy foods and getting regular exercise, may also help your kidneys stay healthy.

If diabetic nephropathy progresses to kidney failure in stage 5, dialysis or a kidney transplant may be necessary.

Learn more about treating diabetic nephropathy.

Life expectancy with diabetic nephropathy

The life expectancy for people with diabetic nephropathy depends on factors like:

disease stage
coexisting health conditions
lifestyle habits
effective treatment that slows or stops kidney damage

A 2017 study including 512,700 adults in Taiwan suggests that the life expectancy of those with stages 1–3 diabetic CKD was 16 years fewer than the adults with diabetes without CKD and those with CKD without diabetes.

Researchers noted that low physical activity and obesity significantly lowered the life expectancy of those with diabetes in the early stages of CKD.

When to contact a doctor

If you have diabetes, visit a doctor each year or as often as a doctor recommends to test your blood and urine for evidence of diabetic nephropathy or other kidney diseases.

Contact a doctor if you notice any of the early symptoms of diabetic nephropathy, such as:

foamy urine
more or less frequent urination
itchy skin

Frequently asked questions about diabetic nephropathy

Here are answers to some frequently asked questions about diabetic nephropathy and diabetes in general.

How do you know if diabetes is affecting your kidneys?

Because most people don’t have symptoms in the early stages of kidney disease, it’s important to have regular blood and urine tests to check how well your kidneys are functioning.

What is the first sign of diabetic nephropathy?

Foamy urine is one of the earliest symptoms of diabetic nephropathy. In later stages, as toxic wastes increase in your kidneys, you may experience symptoms like less or more frequent urination, itchy skin, nausea, or swelling in your legs or arms.

How long does it take for diabetes to damage kidneys?

According to the National Kidney Foundation, people with type 1 diabetes experience some change in their kidney function within 2–5 years of diagnosis. Serious kidney disease develops within 10–30 years in 30–40% of people with type 1 diabetes. The time frame for type 2 diabetes is similar, but kidney disease typically starts at an older age than for type 1.

If you have diabetes, the Centers for Disease Control and Prevention (CDC) recommends getting regular blood and kidney tests to check your kidney function.

Can you reverse kidney damage from diabetes?

If your kidneys are already damaged due to diabetes, the damage cannot be reversed. However, there are ways to slow additional loss of kidney function.

Takeaway

It may take several years before you begin to experience the symptoms of diabetic nephropathy. By then, you may already have moderate to severe kidney damage.

Because the early stages of diabetic nephropathy usually have no symptoms, it’s important to get regular testing for kidney problems if you have diabetes.

Although there’s no cure for diabetic nephropathy, with treatment, damage to your kidneys may be slowed or stopped.

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