Diabetic nephropathy

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Diabetic nephropathy

Male urinary system

Pancreas and kidneys

Kimmelstiel-Wilson disease; Diabetic glomerulosclerosis; Diabetic kidney disease

Early stage diabetic nephropathy has no symptoms. Symptoms develop late in the disease and may be a result of kidney failure or eliminating high amounts of protein in the urine.

Symptoms may include:

• Fatigue
• Foamy appearance or excessive frothing of the urine
• Frequent hiccups
• General ill feeling
• Generalized itching
• Headache
• Nausea and vomiting
• Poor appetite
• Swelling of the legs
• Swelling, usually around the eyes in the mornings; general body swelling may occur with late-stage disease
• Unintentional weight gain (from fluid build up)

The first laboratory abnormality is a positive microalbuminuria test. This often means you have at least some damage to the kidney from diabetes. Damage at this stage may be reversible.

Most often, the diagnosis is suspected when a routine urinalysis shows too much protein in the urine (proteinuria) of someone with diabetes. This test may also show glucose in the urine, especially if blood sugar is poorly controlled.

High blood pressure may be present or develop rapidly. It may be difficult to control. Serum creatinine and BUN eventually may increase as kidney damage gets worse.

A kidney biopsy confirms the diagnosis. However, this test is not done if you have shown increasing protein in the urine over time and the presence of diabetic retinopathy during an eye exam. The biopsy may be done if there is any doubt in the diagnosis, and to study the extent of the disease.

This disease may also alter the results of the following tests:

• 24-hour urine protein
• Blood levels of phosphorus, calcium, bicarbonate, and potassium
• Hemoglobin
• Hematocrit
• Protein electrophoresis - urine
• Red blood cell (RBC) count

Review Date: 11/30/2006
Reviewed By: David M. Charytan, M.D., M.Sc., Department of Medicine, Division of Nephrology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.