If you have diabetes and you have been reading about complications, you have probably come across the terms diabetic nephropathy or diabetic kidney disease. It can sound frightening, but knowing about it early is actually your advantage. The kidneys give off quiet warning signals long before they are in serious trouble, and catching those signals means there is a lot that can be done.
How diabetes affects the kidneys
Your kidneys are packed with tiny blood vessels that filter waste from the blood. Over time, persistently high blood sugar damages these vessels, making them leak. The earliest sign of this leak is protein appearing in the urine, specifically a protein called albumin. At this stage, called microalbuminuria, there are usually no symptoms at all. If left unchecked, the leakage worsens, kidney filtration drops, and waste products build up in the blood.
Uncontrolled blood pressure, which is very common alongside diabetes, accelerates the process. So does smoking.
Early warning signs
In the early stages, there are usually no symptoms. That is why routine testing matters. As the disease progresses, you may notice the following.
- Swelling around the ankles, feet, or eyes, especially in the morning.
- Foamy or frothy urine, which suggests excess protein.
- Needing to urinate more frequently at night.
- Persistent fatigue or a general feeling of being unwell.
- Loss of appetite or a metallic taste in the mouth.
- Difficulty controlling blood pressure despite medication.
By the time these symptoms appear, the damage may be well advanced. The whole point of screening is to catch the problem before symptoms start.
Tests that catch it early
Two simple tests are the backbone of screening.
- Urine albumin-to-creatinine ratio (UACR): a spot urine test, no 24-hour collection needed, that detects tiny amounts of albumin. This is the earliest marker.
- Serum creatinine with estimated GFR (eGFR): a blood test that tells your doctor how well the kidneys are filtering. An eGFR below 60 sustained over three months signals chronic kidney disease.
Every person with diabetes should have both tests done at least once a year. If you have type 2 diabetes, screening should start from the time of diagnosis, since many people have had undetected high sugar for years before they are diagnosed.
What protects the kidneys
- Keeping blood sugar well controlled. Your HbA1c target, the three-month average, is set by your doctor based on your overall health.
- Blood pressure control. For most people with diabetes, a target below 130/80 is recommended, though your doctor may individualise this.
- Certain medications, particularly ACE inhibitors or ARBs, have a specific kidney-protective effect beyond just lowering blood pressure. Your doctor decides whether these are appropriate for you.
- Reducing salt in the diet. Indian meals can be high in salt from pickles, papads, and processed foods.
- Staying well hydrated and avoiding prolonged use of over-the-counter painkillers, which can stress the kidneys.
- Not smoking. Smoking constricts the small blood vessels in the kidneys and speeds up damage.
When to see a doctor
If you have diabetes and have not had your kidney function checked in the past year, now is the right time. If you notice persistent swelling, frothy urine, or worsening fatigue, do not wait for your next scheduled appointment. If your blood pressure is climbing despite medication, mention it at your next visit.
If you experience sudden, severe swelling with breathlessness, very little urine output, or confusion, that is an emergency. Call 108 or go to the nearest hospital immediately.
Living with a chronic condition like diabetes can sometimes feel heavy, and if that weighs on you, please know that support is available. You can reach the free national Tele-MANAS mental health helpline at any time on 14416 (or 1800-891-4416). If you or someone near you is in immediate danger, call 108 or go to the nearest hospital.
A word from our clinic
I am Dr. Rajiv Kumar, a diabetologist with 24 years of experience, practising at Prudent International Health Clinic in Viman Nagar, Pune. We routinely screen for diabetic kidney disease as part of your diabetes review and adjust your care plan when early signs are found. We are open all 7 days, 9 AM to 9 PM, with walk-ins welcome. Call or WhatsApp us on +91 70287 22200 to book a consultation. For current pricing, call the clinic on +91 70287 22200.
