"Doctor, I have had diabetes for 15 years. Recently, my ankles and feet have been swelling. The lab report says my eGFR is 45. Are my kidneys failing, doctor? Will I have to undergo dialysis?" 58-year-old Jayasena came to our clinic with great concern.
Mr. Jayasena suffers from Stage 3 of Diabetic Nephropathy, a condition caused by diabetes. After 10-15 years of diabetes, the kidneys' filtration system is damaged due to poor blood sugar control.
But there is no need to fear. By identifying this condition in stage 3, proper medical advice and medication can completely control further kidney failure and prevent the need for dialysis. Here is medical information about diabetic nephropathy and how to protect your kidneys.
What is diabetic kidney disease?
Diabetic nephropathy is damage to the kidneys caused by high blood sugar (glucose) levels over time. It is a risk factor for both type 1 and type 2 diabetes.
Our kidneys filter waste products and excess water from the blood and excrete them through urine. In addition, the kidneys produce hormones that help control blood pressure, produce red blood cells, and strengthen bones.
When blood sugar levels rise over time, the very fine blood vessels (glomeruli) in the kidneys are damaged. As a result, the kidneys lose their ability to filter blood, which can progress to kidney failure. In such a case, dialysis treatment or a kidney transplant is required to save the patient's life.
How to reduce the risk of kidney disease?
Diabetic kidney disease can be controlled or stopped from progressing if detected early. The following steps should be taken to protect your kidneys:
- Blood sugar control: Maintain blood glucose levels (especially HbA1c values below 7%) at the level recommended by your doctor.
- Blood pressure control: Keeping blood pressure below 130/80 mmHg is essential to protect the kidneys.
- Limit the use of painkillers: Completely avoid taking NSAID painkillers such as Ibuprofen, Mefenamic Acid (Ponstan), and Diclofenac (Olfen) obtained from pharmacies without medical advice (these are directly harmful to the kidneys).
- Diet: Follow a diet low in protein, sodium (salt), and potassium as directed by a doctor or nutritionist.
- Lifestyle changes: Quit smoking completely, control cholesterol levels, and engage in vigorous exercise daily.
🚨 Red Flags that indicate rapid kidney function decline
When kidney failure in a diabetic patient becomes severe, the following symptoms appear:
- Body swelling (Edema): Fluid accumulation and swelling evident in the ankles, feet, hands, and face.
- Changes in urine: Foamy urine (a sign of excessive protein excretion in the urine - Proteinuria) and changes in the frequency of urination.
- Severe fatigue and lethargy: Severe anemia caused by decreased production of the hormone erythropoietin by the kidneys.
- Nausea and vomiting: Nausea, vomiting, and loss of appetite are common symptoms of Uremia, which is caused by the accumulation of waste products such as urea and creatinine in the body.
- Shortness of breath: Shortness of breath caused by fluid accumulation in the lungs (pulmonary edema) or increased acidity in the blood.
🛠️ Action Steps to take to protect your kidneys
- Step 1: Every person with diabetes should have kidney tests (urine and blood tests) at least once a year.
- Sub-Action/Step 2: Take the special classes of medications prescribed by your doctor, such as ACE Inhibitors (e.g. Enalapril) or ARBs (e.g. Losartan), to control blood pressure (these medications control blood pressure while preventing further kidney damage).
- Step Three: Perform a urine microalbuminuria test and a blood creatinine test as directed by your doctor to calculate your eGFR.
- Step Four: If you are in stage 3 or 4 of diabetic kidney disease, see a nephrologist for clinical advice.
- Step Five: Maintain proper body weight and minimize the consumption of sweet, salty, and fatty foods.
📊 Five stages of diabetic kidney disease (eGFR Stages)
| Stage | eGFR value (mL/min/1.73m²) | Kidney function and medical advice |
|---|---|---|
| Stage 1 | More than 90 | Kidney damage is present but function is normal. Control sugar and blood pressure. |
| Stage 2 | 60 - 89 | Mildly decreased kidney function. Get tested annually. |
| Stage 3 | 30 - 59 | Moderately decreased kidney function. (Mr. Jayasena is here). See a specialist. |
| Stage 4 | 15 - 29 | Severely reduced kidney function. Preparing for dialysis or transplantation. |
| Stage 5 | Less than 15 | End-Stage Renal Disease (ESRD) requires dialysis or a transplant to survive. |
❓ Some other questions you may have (FAQ)
What is eGFR? How does it measure kidney function? ▼
eGFR (Estimated Glomerular Filtration Rate) is the rate at which the kidneys filter waste products. A normal person's eGFR is above 90, while a value below 60 indicates kidney disease.
How often should diabetic patients have their kidneys checked? ▼
Diabetics should have a urine microalbumin test and a serum creatinine test at least once a year.
Can diabetic kidney disease be completely cured? ▼
Although the damage to the kidneys cannot be completely reversed, proper control of blood sugar and blood pressure in the early stages (stages 1, 2, and 3) can completely stop the disease from worsening.
Why are NSAID painkillers harmful to the kidneys? ▼
Medications like Ibuprofen and Diclofenac reduce blood flow to the kidneys. Giving these medications to kidneys that are already weakened by diabetes can cause them to fail more quickly.
📖 Sources and Scientific References
- NHS (UK) Guidance on Diabetic Kidney Disease: NHS Chronic Kidney Disease Overview (Accessed 2026)
- NCBI Bookshelf Nephrology Review: Diabetic Nephropathy Pathophysiology and Management (StatPearls - NBK482200)
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