Diabetes-Related Nephropathy (Diabetic Nephropathy): What It Is, Signs, Stages, and How It's Treated
Updated: 6 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Diabetes-related nephropathy, or diabetic kidney disease, is kidney damage caused by type 1 or type 2 diabetes, in which high blood glucose injures the kidneys' filtering units. It is the most common cause of kidney failure worldwide. Early stages have no symptoms, so regular urine and blood tests are essential. Managing diabetes and blood pressure can slow it.
What the research says
SGLT2 inhibitors lower the risk of kidney failure in type 2 diabetes. A meta-analysis of four trials with 38,723 people with type 2 diabetes found that SGLT2 inhibitors reduced the risk of dialysis, transplantation, or death from kidney disease (relative risk 0.67; 95% CI 0.52–0.86) and reduced acute kidney injury (relative risk 0.75), with benefit across levels of kidney function (PubMed: Neuen et al., Lancet Diabetes Endocrinol, 2019).
SGLT2 inhibitors and GLP-1 agonists both lower kidney failure risk, with different side effects. A network meta-analysis of 764 trials (421,346 adults with type 2 diabetes) found that both drug classes lowered the risk of kidney failure (high-certainty evidence); SGLT2 inhibitors caused genital infections, while GLP-1 receptor agonists might cause severe gastrointestinal events (low-certainty evidence) (PubMed: Palmer et al., BMJ, 2021).
People who already have kidney disease still benefit. In 27 studies of people with both type 2 diabetes and chronic kidney disease (up to 7,363 participants), SGLT2 inhibitors reduced the risk of a composite kidney outcome (hazard ratio 0.71; 95% CI 0.53–0.95), slowed the yearly decline in eGFR by about 1.35 mL/min/1.73 m², and lowered albuminuria (PubMed: Toyama et al., Diabetes Obes Metab, 2019).
What Is Diabetes-Related Nephropathy?
Diabetes-related nephropathy is a common diabetes complication that causes kidney damage. The word "nephropathy" simply means kidney disease or kidney damage. It is the most common cause of kidney failure in the world, and between 2 and 4 out of every 10 people with diabetes may develop it.
Each of your kidneys contains more than a million tiny filtering units called nephrons. Nephrons filter your blood and balance your body's fluids. Inside each nephron, clusters of blood vessels called glomeruli perform the first step of filtration. Extra glucose circulating in your bloodstream can damage the glomeruli and other parts of the nephron. When your kidneys stop working as they should, toxins that should leave your body in urine build up in your blood and tissues instead.
Term | What it means |
Diabetes-related nephropathy | The formal name used on this page |
Diabetic nephropathy (DN) | Traditional medical term, still widely used |
Diabetic kidney disease (DKD) | The same condition under a different name |
How Diabetes Damages the Kidneys
Over years, persistently high blood glucose injures the glomeruli and other nephron structures. Damaged nephrons leak protein into the urine (proteinuria) and gradually lose their ability to filter toxins. The buildup of waste products in the blood is what eventually produces symptoms such as swelling, fatigue, and nausea.
The Five Stages of Diabetes-Related Nephropathy
Healthcare providers stage diabetes-related nephropathy using the estimated glomerular filtration rate (eGFR), a calculation from a blood test that shows how well your kidneys filter blood. A normal eGFR ranges from 60 to over 100. An eGFR of 0 means the kidneys are not working at all. For a broader look at kidney disease, see Chronic Kidney Disease: What It Is, Its 5 Stages, Causes, and How It's Treated.
Stage | eGFR range | What it means |
Stage I | 90 or higher | Mild damage, but the kidneys still function normally. Considered normal if there is no other evidence of kidney disease |
Stage II | 60–89 | More damage than stage I, but the kidneys still function well. May be considered normal without other evidence of kidney disease |
Stage III | 30–59 | Mild or moderate loss of kidney function |
Stage IV | 15–29 | Moderate to severe loss of kidney function |
Stage V | Below 15 | The kidneys are nearing or at complete failure |
Symptoms and Signs
Symptoms of Diabetes-Related Nephropathy
Symptoms usually do not appear until the later stages. As the condition worsens, some of the first signs may include:
Swelling (edema), especially around the face, hands, and feet
Nausea and vomiting
Feeling very tired (fatigue)
Foamy urine
Trouble focusing or confusion
Dry or itchy skin
Muscle cramps
Excessive hiccups
A metallic taste in the mouth
Needing less insulin than usual
What Is the First Sign?
The early stages usually have no noticeable symptoms at all. The earliest detectable sign is protein in the urine (proteinuria), but you cannot see or feel it. It only shows up on a urine test (urinalysis), which is why routine screening is so important for anyone with diabetes.
Causes
Diabetes itself causes diabetes-related nephropathy. Both type 1 and type 2 diabetes can cause it, and type 2 is more common than type 1.
How Long Does It Take Diabetes to Damage the Kidneys?
It takes years for diabetes to cause kidney damage. Most people with type 1 diabetes develop some kidney damage within two to five years of a diabetes-related nephropathy diagnosis, and about 3 or 4 out of 10 people progress to a more severe stage within 10 to 30 years. Experts believe type 2 diabetes takes a similar amount of time to damage the kidneys. However, many people live with type 2 diabetes for a long time without realizing it because early symptoms are not obvious, which is why some people discover kidney damage shortly after being diagnosed.
Risk Factors
Anyone with type 1 or type 2 diabetes can develop diabetes-related nephropathy, but risk is higher for people who are Black, Native American, Alaska Native, First Nations, Polynesian, or Maori.
Risk factor | Why it matters |
Black, Native American, Alaska Native, First Nations, Polynesian, or Maori heritage | Higher baseline risk of developing the condition |
Family history of kidney disease | A biological family history raises risk |
BMI greater than 25 (overweight or obesity) | Higher body weight increases strain on the kidneys |
High blood pressure (hypertension) | Accelerates kidney damage |
High blood sugar (hyperglycemia) | The core driver of nephron damage |
High cholesterol (hyperlipidemia) | Contributes to blood vessel damage in the kidneys |
Tobacco use | Smoking damages blood vessels throughout the body, including the kidneys |
How Diabetes Affects the Urinary and Sexual Systems
Diabetes can affect the urinary system in several ways beyond nephropathy. It can cause more frequent urination, urinary incontinence (loss of bladder control), and nerve damage to the bladder so that it no longer signals the brain when it is filling, which can eventually cause bladder damage. Diabetes can also affect the nerves involved in sexual arousal, which may result in erectile dysfunction, vaginal dryness, or less intense or absent orgasm (anorgasmia).
How Doctors Diagnose Diabetes-Related Nephropathy
If you have diabetes, schedule regular visits with your healthcare provider to check your kidney health. If diabetes-related nephropathy is suspected, your provider may order one or more of these tests. Sometimes urine or blood tests alone are enough for a diagnosis; if results are unclear, imaging or a biopsy may follow.
Test | What it checks |
Urine tests | Dipstick testing for glucose, blood, protein, or other signs of kidney disease |
Blood tests | Measure how well your kidneys filter blood (eGFR) |
Imaging tests | Examine the kidneys and surrounding blood vessels |
Kidney biopsy | Directly looks for signs of disease or damage |
Screening Schedule for People With Diabetes
People with diabetes should keep regular appointments, which may be every three to six months or as your provider recommends, to monitor kidney health. About five years after your initial diabetes diagnosis, providers recommend annual testing for diabetes-related nephropathy. Kidney damage usually does not appear within the first 10 years of a diagnosis, and if you have had diabetes for more than 25 years without kidney damage, you are less likely to develop it.
Treatment and Management
Treatment depends on your stage, age, and overall health. Kidney damage cannot be reversed, but treating diabetes is the first step in treating diabetes-related nephropathy, and early diagnosis plus a consistent treatment plan can slow or even stop progression.
Lifestyle Changes
Habit | Recommendation |
Diet | Eat well-rounded foods high in fiber and low in fats and calories |
Exercise | At least 30 minutes of physical activity most days of the week |
Weight | Maintain a healthy weight for you |
Tobacco | Quit tobacco products completely |
Alcohol | Cut back on alcohol |
Blood pressure | Treat high blood pressure |
Medication caution | Avoid medications that may damage the kidneys, such as some nonsteroidal anti-inflammatory drugs (NSAIDs) |
Prescription Medications
Your provider may prescribe the following, depending on what needs to be managed:
Medication class | Purpose |
Metformin, SGLT2 inhibitors, GLP-1 agonists | Treat diabetes |
ACE inhibitors or ARBs | Treat high blood pressure and protect the kidneys |
Statins | Treat high cholesterol |
Treatment for Kidney Failure
If the condition reaches kidney failure or near-failure, treatment may include dialysis, which performs the functions of the kidneys, or a kidney transplant from a donor to take over the job of a failing kidney.
Questions to Ask Your Healthcare Provider
What tests do you recommend to diagnose diabetes-related nephropathy?
How advanced is my diabetes-related nephropathy?
Should I see a kidney specialist (nephrologist) or another specialist?
What lifestyle changes can I make to slow down or stop diabetes-related nephropathy?
What treatments or medications do you recommend?
How often should I schedule appointments?
Can you recommend any support groups?
Outlook and Prognosis
Diabetes-related nephropathy is a slow-moving condition. If you have it, kidney damage cannot be reversed, but an early diagnosis and following your treatment plan can slow it down or even stop it from advancing. Left untreated, it may progress to kidney failure, which may be fatal without treatment. The only treatment options for kidney failure are dialysis or a kidney transplant.
Receiving a diagnosis can be overwhelming, and shock, fear, sadness, anger, and uncertainty are all natural. Managing the condition requires day-to-day care, but many people with diabetes-related nephropathy live happy and healthy lives.
Key Takeaways
Diabetes-related nephropathy is kidney damage caused by diabetes and is the most common cause of kidney failure worldwide.
An estimated 2 to 4 out of every 10 people with diabetes may develop it.
The early stages have no symptoms. The first detectable sign is protein in the urine, found only on testing.
The condition is staged I through V based on eGFR, with stage V meaning kidney failure.
Kidney damage cannot be reversed, but treatment can slow or stop progression.
If diabetes has lasted more than 25 years without kidney damage, your risk of developing the condition drops.
Take the Next Step
If you have type 1 or type 2 diabetes, ask your healthcare provider about annual kidney screening at your next appointment. A simple urine and blood test can reveal kidney damage long before symptoms appear. Share this guide with anyone managing diabetes who may not realize their kidneys are at risk.
Frequently Asked Questions
1. What is diabetes-related nephropathy?
Diabetes-related nephropathy (also called diabetic nephropathy or diabetic kidney disease) is kidney damage caused by diabetes. High blood glucose damages the nephrons, the tiny filtering units in the kidneys. It affects 2 to 4 out of every 10 people with diabetes and is the most common cause of kidney failure worldwide.
2. What causes diabetes-related nephropathy?
Diabetes itself causes it. Persistently high blood glucose damages the glomeruli in the nephrons, which perform the first step of filtering blood. Both type 1 and type 2 diabetes can cause the condition, with type 2 being more common.
3. How many people with diabetes get diabetic kidney disease?
Between 2 and 4 out of every 10 people with diabetes may develop diabetes-related nephropathy. About 3 or 4 out of 10 people with the condition progress to a more severe stage within 10 to 30 years.
4. What are the first signs of diabetic nephropathy?
The earliest stages usually have no noticeable symptoms. The first detectable sign is protein in the urine (proteinuria), which can only be found through a urine test (urinalysis).
5. What are the later-stage symptoms of diabetic nephropathy?
As the condition advances, symptoms may include swelling around the face, hands, and feet; nausea and vomiting; fatigue; foamy urine; trouble focusing or confusion; dry or itchy skin; muscle cramps; excessive hiccups; a metallic taste in the mouth; and needing less insulin than usual.
6. What are the five stages of diabetic nephropathy?
The stages are based on eGFR (kidney filtering rate): Stage I (eGFR 90 or higher, mild damage), Stage II (60–89), Stage III (30–59, mild to moderate loss of function), Stage IV (15–29, moderate to severe loss), and Stage V (below 15, kidneys nearing or at complete failure).
7. What is eGFR?
Estimated glomerular filtration rate (eGFR) is a calculation from a blood test that shows how well your kidneys filter blood. A normal eGFR ranges from 60 to over 100, and an eGFR of 0 means the kidneys are not working at all. It is used to stage kidney disease.
8. Can diabetic nephropathy be reversed or cured?
No. Kidney damage from diabetes cannot be reversed. However, an early diagnosis combined with a consistent treatment plan, including managing blood sugar, blood pressure, diet, and weight, can slow down or even stop the condition from advancing.
9. How is diabetic nephropathy treated?
Treatment includes lifestyle changes (a high-fiber diet, daily exercise, a healthy weight, quitting tobacco, and limiting alcohol), medications for diabetes (metformin, SGLT2 inhibitors, GLP-1 agonists), blood pressure (ACE inhibitors or ARBs), and cholesterol (statins), plus avoiding kidney-damaging drugs such as some NSAIDs.
10. What happens if diabetic nephropathy reaches kidney failure?
Kidney failure may be fatal without treatment. The only treatment options are dialysis, which performs the functions of the kidneys, or a kidney transplant from a donor.
11. When should people with diabetes be tested for kidney disease?
Providers recommend annual testing starting about five years after the initial diabetes diagnosis. Regular checkups every three to six months, or as your provider recommends, monitor kidney health along the way. Kidney damage usually does not appear within the first 10 years of diagnosis.
12. Does long-term diabetes without kidney damage mean I'm safe?
Having diabetes for more than 25 years without kidney damage is a good sign, because you become less likely to develop diabetes-related nephropathy. Keep up with regular checkups regardless.
13. What is a nephron?
A nephron is a tiny unit inside each kidney that filters blood and balances the body's fluids. Each kidney contains more than a million nephrons. Inside each nephron, the glomeruli perform the first step of filtering blood, and these are the structures high glucose damages first.
References
Cleveland Clinic. Diabetes-Related Nephropathy. Cleveland Clinic. Jan. 5, 2026. https://my.clevelandclinic.org/health/diseases/24183-diabetic-nephropathy
Centers for Disease Control and Prevention. Living with Chronic Kidney Disease. CDC. Last updated May 15, 2024. https://www.cdc.gov/kidney-disease/living-with/
National Institute of Diabetes and Digestive and Kidney Diseases. How Is Diabetes Related to Urinary Tract and Sexual Problems? NIDDK. Last updated July 26, 2023. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/how-diabetes-related-to-urinary-tract-problems
National Kidney Foundation. Preventing Diabetic Kidney Disease: 10 Answers to Questions. National Kidney Foundation. https://www.kidney.org/kidney-topics/preventing-diabetic-kidney-disease-10-answers-to-questions
Kumar M, Dev S, Khalid MU, et al. The bidirectional link between diabetes and kidney disease: mechanisms and management. Cureus. 2023;15(9):e45615. doi:10.7759/cureus.45615. PMID: 37868469.
Neuen BL, Young T, Heerspink HJL, Neal B, Perkovic V, Billot L, et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019;7(11):845-854. doi:10.1016/S2213-8587(19)30256-6. PMID: 31495651.
Palmer SC, Tendal B, Mustafa RA, Vandvik PO, Li S, Hao Q, et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2021;372:m4573. doi:10.1136/bmj.m4573. PMID: 33441402.
Toyama T, Neuen BL, Jun M, Ohkuma T, Neal B, Jardine MJ, et al. Effect of SGLT2 inhibitors on cardiovascular, renal and safety outcomes in patients with type 2 diabetes mellitus and chronic kidney disease: a systematic review and meta-analysis. Diabetes Obes Metab. 2019;21(5):1237-1250. doi:10.1111/dom.13648. PMID: 30697905.
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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