What Causes Diabetic Kidney Disease?

Diabetic kidney disease, also known as diabetic nephropathy, is one of the most common complications associated with diabetes. Onset of diabetic kidney disease usually occurs after several years of having diabetes. It is characterised by an increase in the amount of albumin, a protein, in the urine and a decrease in kidney function.

The exact cause of diabetic kidney disease is still unknown, but it is believed to be related to uncontrolled blood sugar levels in the bloodstream and other underlying conditions associated with diabetes, such as high blood pressure and high cholesterol.

When blood sugar levels remain high for extended periods of time, it can cause damage to the tiny blood vessels that normally filter the blood and help it to move through the body. Over time, this leads to reduced kidney function and can cause inflammation of the kidneys, as well as damage to other organs and systems in the body.

High blood pressure also plays a role in causing diabetic kidney disease as it can lead to a decrease in the filtration rate of the kidneys and ultimately cause damage to the vessels. In addition, those with poorly controlled diabetes are more likely to suffer from high cholesterol, which can also increase the risk of developing diabetic kidney disease.

There are also genetic factors that may play a role in the development of diabetic kidney disease. Those with a family history of the disease may be at increased risk if they suffer from diabetes as well.

To detect diabetic kidney disease as early as possible, people with diabetes should have regular kidney checks. These normally include a urine albumin:creatinine ratio (ACR) test and a blood test to estimate kidney function (eGFR).

Early Warning Signs You Shouldn’t Ignore

Diabetic kidney disease often causes no symptoms in its early stages, which is why regular blood and urine testing is important for people with diabetes. As kidney disease becomes more advanced, symptoms can include swollen ankles, feet or hands, tiredness, shortness of breath and needing to urinate more often, particularly at night. Persistent or worrying symptoms should be discussed with a GP.

Lifestyle Factors That Increase Risk

In addition to genetic and physiological factors, certain lifestyle choices can increase the risk of developing diabetic kidney disease.

Smoking

Smoking cigarettes promotes inflammation and constricts blood vessels, which can accelerate kidney damage in people with diabetes. Smoking is associated with an increased risk of kidney disease and its progression in people with type 1 or type 2 diabetes. Quitting smoking is one of the most important lifestyle changes a person can make to protect their overall health.

Obesity

Carrying excess weight can place additional strain on the kidneys and is associated with several risk factors for chronic kidney disease. Achieving and maintaining a healthy weight can form an important part of managing diabetes and protecting long-term kidney health.

Alcohol Consumption

Drinking too much alcohol can contribute to wider health problems and make diabetes more difficult to manage. Current UK guidance advises both men and women not to regularly drink more than 14 units of alcohol a week, ideally spread over three or more days.

High Protein Diets

People who have diabetes and chronic kidney disease may need individualised advice about protein intake. Current guidance does not recommend simply adopting a very low-protein diet, so significant dietary changes should be discussed with a healthcare professional or renal dietitian.

Preventing Progression

The onset of diabetic kidney disease cannot always be prevented, but good management can reduce the risk of progression and help slow further kidney damage. Keeping blood sugar well controlled, maintaining healthy blood pressure levels, and following appropriate diet and lifestyle advice can all help protect kidney health. Regular kidney checks can identify changes in ACR or eGFR before symptoms develop, allowing appropriate treatment and monitoring to begin earlier.

The best way to prevent the onset of diabetic kidney disease is to keep blood sugar levels under control and maintain control of other underlying conditions associated with diabetes, such as high blood pressure and high cholesterol. However, if you are already at risk for diabetic kidney disease, regular screening is important to catch any changes in kidney function before significant damage occurs.

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