Diabetes is the leading cause of kidney failure, making up 40 to 50 percent of all cases. People with type 1 diabetes are more likely to suffer severe kidney disease. However, if you have type 2 diabetes you are still at risk, especially if you also have hypertension. Type 2 diabetes makes up ninety percent of all diabetes cases and is more associated with high blood pressure.

Kidney disease in diabetes isn't inevitable. But, even when your diabetes is controlled, you can still develop chronic kidney disease and kidney failure.

How Does Diabetes Affect Your Kidneys

Your kidneys are essential to eliminating harmful toxins from your blood. These toxins enter your kidneys from the blood through small blood vessels or capillaries. In people with insulin-dependent or type 1 diabetes and type 2 diabetes, high blood glucose levels increase kidney function - including the amount of blood the kidney filters.

When your kidneys are overworked, it leads to kidney disease, or nephropathy. The capillaries don't effectively remove toxins, which start to build up. Another side effect of kidney disease in diabetes is that vital nutrients are eliminated in your urine. One of these nutrients is protein: a small amount in your urine is called microalbuminuria, and an excess amount is referred to as proteinuria. This is the first sign of deteriorating kidney function.

According to the American Diabetic Association (ADA), when you're first diagnosed with diabetes you'll likely have excess protein in your urine. It's usually temporary, and may occur if your blood pressure isn't under control, or your blood glucose has been high for a while before diagnosis.

Symptoms of Kidney Disease in Diabetes

Unfortunately, symptoms aren't very noticeable until there's been significant kidney damage, so you can't rely on them to determine if you're in the early stages of kidney disease. These symptoms include fatigue, fluid retention, inability to sleep, itchy skin, nausea or vomiting, shortness of breath, and weakness.

How to Prevent Kidney Disease in Diabetes

The ADA recommends the following strategies to reduce your risk of kidney disease when you have diabetes.

  • Control your blood glucose levels. Try to keep them as close to normal as possible, which can reduce your risk of kidney disease in diabetes by 35 to 56 percent.
  • Control your blood pressure. Have your pressure checked regularly and try to keep it in the normal range, which is 120/80 or lower.
  • Eat healthier and maintain a healthy weight. This helps you with both of the previous goals. Reduce your sugar, fat, salt and alcohol intake. Also, try to exercise at least 30 minutes a day five days a week.
  • Don't smoke. Long-term smokers have a 50 percent higher risk of progressive kidney disease.
  • Take a urine test. If you have diabetes you should have annual urine tests.
  • Take medications as prescribed. When high blood pressure can't be controlled by natural methods your doctor will likely recommend ACE inhibitors, which preserve kidney function.

Treatment of Kidney Disease in Diabetes

The prevention methods recommended above are also essential in treating kidney disease in diabetes, especially controlling hypertension. Even a small rise in your blood pressure can dramatically accelerate the rate at which kidney disease progresses. Other treatments include:

  • Urine tests. Your doctor will recommend frequent urine testing to check for both microalbuminuria and proteinuria.
  • A low-protein diet. Speak with your doctor to find out if this is an option for you. It should be done under supervision.
  • Dialysis. If you develop end-stage renal disease, you'll need to receive dialysis to remove toxins from your blood. There are two types of dialysis - hemodialysis and peritoneal dialysis. Hemodialysis removes waste from an artery and returns it to a vein. It's done two to three times a week and takes about three to five hours. Peritoneal dialysis filters toxins from the lining of your stomach and takes about 30 to 45 minutes and needs to be done four to five times a day.
  •  Kidney transplant. This option works better than dialysis; however, it's limited because you must wait for a match. Also, you need to take drugs so you don't reject the kidney.

If you have diabetes and kidney disease, discuss all your treatment options with your medical team so you understand the risks and the long-term effects involved.