J Clin Invest. Clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Levin A, Stevens PE, Bilous RW, et al. KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease.

Kidney Int Suppl. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes [published correction appears in N Engl J Med.

N Engl J Med. Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.

Glycemic targets: standards of medical care in diabetes— Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA Clinical Guidelines Committee of the American College of Physicians.

Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians.

Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial [published correction appears in Lancet.

Groop PH, Cooper ME, Perkovic V, Emser A, Woerle HJ, von Eynatten M. Linagliptin lowers albuminuria on top of recommended standard treatment in patients with type 2 diabetes and renal dysfunction.

Groop PH, Cooper ME, Perkovic V, et al. Linagliptin and its effects on hyperglycaemia and albuminuria in patients with type 2 diabetes and renal dysfunction: the randomized MARLINA-T2D trial. Diabetes Obes Metab. Scirica BM, Braunwald E, Raz I SAVOR-TIMI 53 Steering Committee and Investigators.

Heart failure, saxagliptin and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial [published correction appears in Circulation. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes.

Fujita H, Morii T, Fujishima H, et al. The protective roles of GLP-1R signaling in diabetic nephropathy: possible mechanism and therapeutic potential.

Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. Palmer SC, Mavridis D, Nicolucci A, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis.

UK Prospective Diabetes Study UKPDS Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS 34 [published correction appears in Lancet. Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes.

Barnett AH, Mithal A, Manassie J, et al. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. Sarafidis PA, Bakris GL. Protection of the kidney by thiazolidinediones: an assessment from bench to bedside.

Heerspink HJ, Desai M, Jardine M, Balis D, Meininger G, Perkovic V. Canagliflozin slows progression of renal function decline independently of glycemic effects. J Am Soc Nephrol. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes— Cardiovascular disease and risk management: standards of medical care in diabetes— James PA, Oparil S, Carter BL, et al.

Whelton PK, Carey RM, Aronow WS, et al. J Am Coll Cardiol. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 [published correction appears in BMJ.

Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. Lv J, Perkovic V, Foote CV, Craig ME, Craig JC, Strippoli GF. Antihypertensive agents for preventing diabetic kidney disease.

Cochrane Database Syst Rev. The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria.

Haller H, Ito S, Izzo JL, et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy.

Currie G, Taylor AH, Fujita T, et al. Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol. Bolignano D, Palmer SC, Navaneethan SD, Strippoli GF. Aldosterone antagonists for preventing the progression of chronic kidney disease.

Menne J, Ritz E, Ruilope LM, Chatzikyrkou C, Viberti G, Haller H. The Randomized Olmesartan and Diabetes Microalbuminuria Prevention ROADMAP observational follow-up study: benefits of RAS blockade with olmesartan treatment are sustained after study discontinuation.

J Am Heart Assoc. Makani H, Bangalore S, Desouza KA, Shah A, Messerli FH. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials.

Bangalore S, Fakheri R, Toklu B, Messerli FH. Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials [published correction appears in BMJ.

Wanner C, Krane V, März W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis [published correction appears in N Engl JMed.

Fellström BC, Jardine AG, Schmieder RE, et al. Rosuvastatin and cardiovascular events in patients undergoing hemo-dialysis [published correction appears in N Engl J Med. Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH.

The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Lifestyle management: standards of medical care in diabetes— TODAY Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial [published correction appears in Diabetes Care.

Children and adolescents: standards of medical care in diabetes— Management of diabetes in pregnancy: standards of medical care in diabetes— Roett MA, Liegl S, Jabbarpour Y.

Diabetic nephropathy—the family physician's role. Am Fam Physician. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. search close.

PREV Jun 15, NEXT. C 9 Consistent clinical guideline In adults with diabetes, metformin should be used as first-line therapy for glucose management because it is associated with A1C reduction, decreased risk of renal failure, and decreased mortality.

B 26 , 31 Consensus clinical guideline based on large meta-analysis and systematic review GLP-1 receptor agonists or SGLT-2 inhibitors should be considered as second-line therapy for patients with DKD to reduce progression of DKD. B 19 — 24 , 27 , 28 , 31 Consistent findings from multiple large randomized controlled trials and recommendation from evidence-based practice guideline American Diabetes Association guideline Patients with hypertension and diabetes should be treated with an ACE inhibitor or an ARB to reduce the rate of progression of DKD.

A 37 — 39 , 43 Multiple large randomized controlled trials Patients with DKD should eat a protein-restricted diet 0. C 48 , 49 Large meta-analysis For women of reproductive age with diabetes, ACE inhibitor or ARB therapy should be initiated only after discussion of potentially teratogenic effects.

C 51 Expert-based clinical guideline. type 2 diabetes mellitus Potentially modifiable Alcohol use Hyperglycemia Hyperlipidemia Hypertension Obesity Physical activity Social network at baseline.

Screening and Diagnosis. GLYCEMIC CONTROL. BLOOD PRESSURE CONTROL. KATHRYN MCGRATH, MD, is a clinical assistant professor in the Department of Family and Community Medicine at Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pa.

mcgrath jefferson. Thorp ML. Diabetic nephropathy: common questions. Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. All Rights Reserved.

Individuals with type 2 diabetes mellitus should be screened for albuminuria at the time of diagnosis and annually thereafter. CKD is common in people with diabetes.

Approximately 1 in 3 adults with diabetes has CKD. Both type 1 and type 2 diabetes can cause kidney disease. Each kidney is made up of millions of tiny filters called nephrons.

Many people with diabetes also develop high blood pressure , which can damage kidneys too. You can help keep your kidneys healthy by managing your blood sugar, blood pressure, and cholesterol levels.

This is also very important for your heart and blood vessels—high blood sugar, blood pressure, and cholesterol levels are all risk factors for heart disease and stroke. If you have prediabetes, taking action to prevent type 2 diabetes is an important step in preventing kidney disease. You can do that by eating healthier and getting minutes of physical activity each week.

Find a program in your community or online. Skip directly to site content Skip directly to search. Español Other Languages. Diabetes and Chronic Kidney Disease Español Spanish Print. Minus Related Pages. Kidney Facts. Kidney diseases are the 9th leading cause of death in the United States.

Every 24 hours, people with diabetes begin treatment for kidney failure. How Diabetes Causes Kidney Disease Each kidney is made up of millions of tiny filters called nephrons. Tips To Keep Your Kidneys Healthy You can help keep your kidneys healthy by managing your blood sugar, blood pressure, and cholesterol levels.

Having a family history of kidney disease or belonging to certain ethnic groups eg, African American, Mexican, Pima Indian can increase your risk of diabetic kidney disease. Although you cannot do anything to change your family history, there are several factors that increase your risk of developing diabetic kidney disease that you can change and control.

These include:. DIABETIC KIDNEY DISEASE DIAGNOSIS. Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis.

The urine test is looking for a protein called albumin. If there is a very large amount of albumin in your urine, it means you have diabetic kidney disease. You may be told that you have "microalbuminuria" or "high albuminuria". That simply means that you have trace amounts of albumin in your urine, but it still means that you are at risk for getting diabetic kidney disease, assuming you do not have kidney disease caused by another condition.

See "Patient education: Protein in the urine proteinuria Beyond the Basics ". The same urine test that is used to diagnose diabetic kidney disease will also be used to monitor your condition over time. See 'Ongoing monitoring' below.

The key complication of diabetic kidney disease is more advanced kidney disease, called chronic kidney disease. Chronic kidney disease can, in turn, progress even further, eventually leading to total kidney failure and the need for dialysis or kidney transplantation.

DIABETIC KIDNEY DISEASE TREATMENT. People with diabetes often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important.

That's because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems. For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to:.

Most people with type 2 diabetes and kidney disease should be treated with a sodium-glucose co-transporter 2 SGLT2 inhibitor.

See 'SGLT2 inhibitors' below. Lifestyle changes — Changing your lifestyle can have a big impact on the health of your kidneys.

The following measures are recommended for everyone, but are especially important if you have diabetic kidney disease:. Blood sugar control — Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus.

See "Patient education: Glucose monitoring in diabetes Beyond the Basics ". A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months.

Even small decreases in the A1C lower the risk of diabetes-related complications to some degree. Managing your blood sugar involves lifestyle changes eg, diet and exercise as well as medications. Type 1 diabetes is treated with insulin. For type 2 diabetes, other medications are often used; some are not recommended for use in people with kidney problems, while others may help slow the progression of kidney disease.

Your doctors will work with you to determine what combination of medications is best for you. Managing high blood pressure — Many people with diabetes have hypertension high blood pressure.

Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye.

A health care provider can diagnose high blood pressure by measuring blood pressure on a regular basis. See "Patient education: High blood pressure in adults Beyond the Basics ".

The treatment of high blood pressure varies. If you have mild hypertension, your health care provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake.

These measures can sometimes reduce blood pressure to normal. See "Patient education: High blood pressure, diet, and weight Beyond the Basics ". If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several high blood pressure medications.

Your provider can discuss the pros and cons of each medication and the goals of treatment. See "Patient education: High blood pressure treatment in adults Beyond the Basics ". Blood pressure medications — All people with diabetic kidney disease need at least one medication to lower their blood pressure, and in most cases two medications are needed.

Several medications can be used for this purpose, but a medication known as an angiotensin-converting enzyme inhibitor abbreviated ACE inhibitor or a related drug known as an angiotensin receptor blocker ARB should be used because they limit the worsening of kidney disease.

ACE inhibitors and ARBs are particularly useful for people with diabetic kidney disease because they decrease the amount of albumin in the urine and can prevent or slow the progression of diabetes-related kidney disease. In fact, the kidney benefits of ACE inhibitors and ARBs are so robust that health care providers sometimes prescribe them for people with diabetic kidney disease who have normal blood pressure.

Still, despite their kidney-protecting abilities, ACE inhibitors and ARBs do have their downsides. For instance, ACE inhibitors cause a persistent dry cough in 5 to 20 percent of the people who take them, even up to 50 percent among Asian populations.

Some people get used to the cough; others find it so disruptive that they cannot continue taking an ACE inhibitor. For them, ARBs are often a good alternative, because ARBs do not cause a cough. In rare cases, you can have more serious side effects with ACE inhibitors and ARBs.

These include a condition called hyperkalemia, in which too much potassium accumulates in the blood. To monitor for these and other side effects, health care providers sometimes run blood tests soon after starting these drugs.

In some people, the medications will need to be stopped. SGLT2 inhibitors — In addition to the measures described above, some people with type 2 diabetes and kidney disease will get a medication called a sodium-glucose co-transporter 2 SGLT2 inhibitor. These medications lower blood sugar by increasing the excretion of sugar in the urine; they include canagliflozin brand name: Invokana , empagliflozin brand name: Jardiance , and dapagliflozin brand name: Farxiga.

Your health care provider can talk to you about whether you are a candidate for treatment with an SGLT2 inhibitor if you do not already take one ; this will depend on how advanced your kidney disease is and how much albumin is in your urine.

Ongoing monitoring — After beginning treatment and lifestyle changes to stall kidney disease, you will need to have repeat urine and blood tests to determine if urine albumin levels have improved.

If the urine albumin levels have not improved or your kidney function has worsened, your health care provider may need to adjust your medications or recommend other strategies to protect your kidneys. PREGNANCY AND DIABETIC KIDNEY DISEASE. If you have diabetes and are interested in getting pregnant, it is important to talk with your health care provider well in advance, especially if you have diabetic kidney disease.

Diabetes and its attendant problems can increase the risk of complications in pregnancy, especially in women with decreased kidney function. However, many women with mild diabetic kidney disease have normal pregnancies and healthy babies.

To ensure the best outcome with a pregnancy, the most important thing you can do is to keep your blood sugar and blood pressure under tight control. However, women who are pregnant or attempting to get pregnant should not take angiotensin-converting enzyme ACE inhibitors or angiotensin receptor blockers ARBs , as these drugs can cause birth defects.

Instead, other medications such as calcium channel blockers are used during pregnancy to keep the blood pressure in check. See "Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics ".

If the steps you need to take to protect your kidneys sound overwhelming, keep this in mind; controlling your blood sugar and blood pressure can help to reduce the risk or severity of several other debilitating diabetes complications, including:.

The same measures that are used in the treatment of diabetic kidney disease are also useful in preventing it.

That's true for the lifestyle choices mentioned above, as well as for the tight control of blood sugar levels and blood pressure. Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site www. Related topics for patients, as well as selected articles written for health care professionals, are also available.

Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.

In , the American College of Cardiology issued guidelines recommending the use of sodium-glucose cotransporter 2 SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists GLP-1RAs for people with type 2 diabetes and CKD.

These drugs may reduce the risk of CKD progression, cardiovascular events, or both. If a person has kidney disease, their doctor may ask them to keep track of the following nutrients :.

Water : Although essential, too much water or fluid may increase the risk of swelling and high blood pressure. Protein : For a person with kidney disease, protein can cause waste to build up in the blood, putting extra pressure on the kidneys.

Phosphorus : This occurs in many protein and dairy foods. Too much phosphorus can weaken the bones and put pressure on the kidneys. Potassium : People with kidney disease can have higher levels of potassium than is healthful, which can affect nerve cells.

Click here to learn more about the high potassium foods a person should avoid if they have kidney disease. This is crucial for lowering the risk of diabetes complications, such as kidney disease, cardiovascular disease, and diabetic neuropathy , which affects the nervous system.

These conditions, too, can lead to further complications. Managing blood sugar levels can also help prevent these from developing. If diabetic nephropathy progresses to ESRD, a person will need either dialysis or a kidney transplant.

They will usually need dialysis for the rest of their life or until a kidney transplant is available. Kidney dialysis is a procedure that typically uses a machine to separate waste products from the blood and remove them from the body.

Dialysis acts as a substitute for a healthy kidney. Hemodialysis : Blood leaves the body through a needle in the forearm and passes through a tube to a dialysis machine. The machine filters the blood outside the body, and the blood returns through another tube and needle.

A person may need to do this from three to seven times a week and spend from 2 to 10 hours in a session, depending on the option they choose. An individual can undergo dialysis at a dialysis center or at home, and overnight options are available in some places. Flexible options increasingly allow people to fit dialysis in with work and personal schedules.

Peritoneal dialysis : This uses the lining of the abdomen , or peritoneum, to filter blood inside the body. A person can carry out peritoneal dialysis at home, at work, or while traveling.

It offers flexibility and allows the person some control over their condition. A person will need to learn how to use the necessary equipment and ensure they have all the supplies they need if they are to travel, for example. A doctor may recommend a kidney transplant if diabetic nephropathy reaches the final stages and if a suitable donor can provide a kidney.

Finding a donor may take some time. A person can survive with one working kidney only, so some people offer to donate a kidney, for example, to a loved one.

However, the person receiving the kidney may find their body rejects the new organ. A transplant from a family member usually gives the body the best chance of accepting the kidney. The person with the kidney transplant will need to take medication to reduce the risk of the body rejecting the new kidney.

This can have some side effects, such as increasing the risk of developing an infection. Financial help is available for many people. Medicare and Medicaid usually cover treatment for kidney failure, according to the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK.

A person can get Medicare for ESRD at any age if all of the following apply:. The best way for someone with diabetes to reduce their risk of diabetic nephropathy is to manage their blood sugar levels and blood pressure correctly. Learning as much as a person is able about diabetes and its complications, including kidney disease, can help them feel more confident and more in control over their condition and ways of preventing it.

The outlook for people with diabetic nephropathy will depend on how well they manage their blood sugar and blood pressure levels and the stage at which they receive a diagnosis. The earlier treatment starts, the better the outlook. Treatment can delay or prevent the progress of diabetic nephropathy.

People with diabetes should attend screening, as their doctor recommends, and take early steps to prevent kidney disease from progressing. Learn more here about how the kidneys work.

Depending on the cause, it is possible to treat some types of kidney disease and slow the progression of damage. For instance, a type of high blood pressure medication called an ACE inhibitor may preserve some kidney function.

Certain dietary choices may reduce the work your kidneys must do. Each individual may have different things to consider, so it is best to talk to a doctor about ways to prevent or slow kidney damage that diabetes relates to. Deborah Weatherspoon, PhD, RN, CRNA Answers represent the opinions of our medical experts.

All content is strictly informational and should not be considered medical advice. Diabetic neuropathy is nerve damage that affects a range of nerves in the bodies of some people with diabetes.

It can lead to paralysis and might have…. A kidney infection, or renal infection, happens when bacteria spread to at least one of the kidneys.

What are the benefits of a foot massage for diabetic neuropathy? Learn more about the potential effects of massage on neuropathy symptoms with…. What symptoms might a person with diabetic neuropathy experience? Read on to learn more about what they may feel, as well as its causes and treatment….

Find out how long diabetic neuropathy takes to develop. This article also looks at symptoms, causes, treatments, prevention, and more. My podcast changed me Can 'biological race' explain disparities in health? Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us.

Medical News Today. Health Conditions Health Products Discover Tools Connect. Diabetic nephropathy or kidney disease. Medically reviewed by Deborah Weatherspoon, Ph.

What is it? Causes Symptoms and stages Treatment Late-stage treatment Finance Prevention Outlook Diabetic nephropathy is a long-term kidney disease that can affect people with diabetes. What is diabetic nephropathy? Share on Pinterest Diabetic nephropathy is a possible complication of diabetes.

Symptoms and stages. Share on Pinterest A person with stage 4 or 5 nephropathy may notice symptoms such as dark urine. Late-stage treatment options. Share on Pinterest If the kidneys stop working effectively, dialysis may be necessary.

Financial help. Q: Is it possible to reverse kidney damage once it starts? A: Depending on the cause, it is possible to treat some types of kidney disease and slow the progression of damage. Was this helpful?

How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.

Levin A, Stevens PE, Bilous RW, et al. KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes [published correction appears in N Engl J Med.

N Engl J Med. Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. Patel A, MacMahon S, Chalmers J, et al.

Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Glycemic targets: standards of medical care in diabetes— Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA Clinical Guidelines Committee of the American College of Physicians.

Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ismail-Beigi F, Craven T, Banerji MA, et al.

Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial [published correction appears in Lancet.

Groop PH, Cooper ME, Perkovic V, Emser A, Woerle HJ, von Eynatten M. Linagliptin lowers albuminuria on top of recommended standard treatment in patients with type 2 diabetes and renal dysfunction. Groop PH, Cooper ME, Perkovic V, et al.

Linagliptin and its effects on hyperglycaemia and albuminuria in patients with type 2 diabetes and renal dysfunction: the randomized MARLINA-T2D trial. Diabetes Obes Metab. Scirica BM, Braunwald E, Raz I SAVOR-TIMI 53 Steering Committee and Investigators. Heart failure, saxagliptin and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial [published correction appears in Circulation.

Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. Fujita H, Morii T, Fujishima H, et al. The protective roles of GLP-1R signaling in diabetic nephropathy: possible mechanism and therapeutic potential. Marso SP, Bain SC, Consoli A, et al.

Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. Palmer SC, Mavridis D, Nicolucci A, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis. UK Prospective Diabetes Study UKPDS Group.

Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS 34 [published correction appears in Lancet. Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes.

Barnett AH, Mithal A, Manassie J, et al. Efficacy and safety of empagliflozin added to existing antidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomised, double-blind, placebo-controlled trial.

Lancet Diabetes Endocrinol. Sarafidis PA, Bakris GL. Protection of the kidney by thiazolidinediones: an assessment from bench to bedside. Heerspink HJ, Desai M, Jardine M, Balis D, Meininger G, Perkovic V.

Canagliflozin slows progression of renal function decline independently of glycemic effects. J Am Soc Nephrol. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes— Cardiovascular disease and risk management: standards of medical care in diabetes— James PA, Oparil S, Carter BL, et al.

Whelton PK, Carey RM, Aronow WS, et al. J Am Coll Cardiol. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 [published correction appears in BMJ.

Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. Lv J, Perkovic V, Foote CV, Craig ME, Craig JC, Strippoli GF.

Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database Syst Rev. The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria.

Haller H, Ito S, Izzo JL, et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy.

Currie G, Taylor AH, Fujita T, et al. Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis.

BMC Nephrol. Bolignano D, Palmer SC, Navaneethan SD, Strippoli GF. Aldosterone antagonists for preventing the progression of chronic kidney disease.

Menne J, Ritz E, Ruilope LM, Chatzikyrkou C, Viberti G, Haller H. The Randomized Olmesartan and Diabetes Microalbuminuria Prevention ROADMAP observational follow-up study: benefits of RAS blockade with olmesartan treatment are sustained after study discontinuation.

J Am Heart Assoc. Makani H, Bangalore S, Desouza KA, Shah A, Messerli FH. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. Bangalore S, Fakheri R, Toklu B, Messerli FH.

Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta-analysis of randomized trials [published correction appears in BMJ.

Wanner C, Krane V, März W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis [published correction appears in N Engl JMed.

Fellström BC, Jardine AG, Schmieder RE, et al. Rosuvastatin and cardiovascular events in patients undergoing hemo-dialysis [published correction appears in N Engl J Med. Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis.

Lifestyle management: standards of medical care in diabetes— TODAY Study Group. Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial [published correction appears in Diabetes Care.

Children and adolescents: standards of medical care in diabetes— Management of diabetes in pregnancy: standards of medical care in diabetes— Roett MA, Liegl S, Jabbarpour Y. Diabetic nephropathy—the family physician's role. Am Fam Physician. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. search close. PREV Jun 15, NEXT.

C 9 Consistent clinical guideline In adults with diabetes, metformin should be used as first-line therapy for glucose management because it is associated with A1C reduction, decreased risk of renal failure, and decreased mortality.

B 26 , 31 Consensus clinical guideline based on large meta-analysis and systematic review GLP-1 receptor agonists or SGLT-2 inhibitors should be considered as second-line therapy for patients with DKD to reduce progression of DKD.

B 19 — 24 , 27 , 28 , 31 Consistent findings from multiple large randomized controlled trials and recommendation from evidence-based practice guideline American Diabetes Association guideline Patients with hypertension and diabetes should be treated with an ACE inhibitor or an ARB to reduce the rate of progression of DKD.

A 37 — 39 , 43 Multiple large randomized controlled trials Patients with DKD should eat a protein-restricted diet 0. C 48 , 49 Large meta-analysis For women of reproductive age with diabetes, ACE inhibitor or ARB therapy should be initiated only after discussion of potentially teratogenic effects.

C 51 Expert-based clinical guideline. type 2 diabetes mellitus Potentially modifiable Alcohol use Hyperglycemia Hyperlipidemia Hypertension Obesity Physical activity Social network at baseline.

Screening and Diagnosis. GLYCEMIC CONTROL. BLOOD PRESSURE CONTROL. KATHRYN MCGRATH, MD, is a clinical assistant professor in the Department of Family and Community Medicine at Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pa.

mcgrath jefferson. Thorp ML. Diabetic nephropathy: common questions. Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. All Rights Reserved. Individuals with type 2 diabetes mellitus should be screened for albuminuria at the time of diagnosis and annually thereafter.

In adults with diabetes, metformin should be used as first-line therapy for glucose management because it is associated with A1C reduction, decreased risk of renal failure, and decreased mortality. Consensus clinical guideline based on large meta-analysis and systematic review.

Before any appointment with a member of your diabetes treatment team, ask whether you need to follow any restrictions, such as fasting before taking a test. Questions to regularly review with your doctor or other members of the team include:.

Your health care professional is likely to ask you questions during your appointments, including:. Diabetic nephropathy kidney disease care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.

This content does not have an English version. This content does not have an Arabic version. Diagnosis Kidney biopsy Enlarge image Close. Kidney biopsy During a kidney biopsy, a health care professional uses a needle to remove a small sample of kidney tissue for lab testing.

Care at Mayo Clinic Our caring team of Mayo Clinic experts can help you with your diabetic nephropathy kidney disease -related health concerns Start Here. Kidney transplant Enlarge image Close. Kidney transplant During kidney transplant surgery, the donor kidney is placed in the lower abdomen.

Kidney Disease: How kidneys work, Hemodialysis, and Peritoneal dialysis. Request an appointment. By Mayo Clinic Staff.

Show references Diabetic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed May 24, Diabetic kidney disease adult. Mayo Clinic; Mottl AK, et al. Diabetic kidney disease: Manifestations, evaluation, and diagnosis.

Diabetes and chronic kidney disease. Centers for Disease Control and Prevention. Diabetic nephropathy. Merck Manual Professional Version. Goldman L, et al. Diabetes mellitus. In: Goldman-Cecil Medicine. Elsevier; Elsevier Point of Care. Clinical Overview: Diabetic nephropathy. De Boer IH, et al.

Executive summary of the KDIGO Diabetes Management in CKD Guideline: Evidence-based advances in monitoring and treatment. Kidney International.

Office of Patient Education. Chronic kidney disease treatment options. Coping effectively: A guide for patients and their families. National Kidney Foundation. Robertson RP. Pancreas and islet cell transplantation in diabetes mellitus. Accessed May 25, Ami T.

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