Diabetic Nephropathy: When should one seek medical advice?

By  , Expert Content
Dec 22, 2011

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Diabetic nephropathy is a kidney disease or damage caused by diabetes. Currently, it is a leading cause of chronic renal failure in adults and a major cause of sickness and death in diabetics. Research has shown that the kidney damage starts a few years after the onset of diabetes and progresses slowly. Most people with initial stages of kidney disease do not have any symptoms. The symptoms usually start 5 to 10 years after the kidney damage starts. Hence, many cases are diagnosed when the kidney damage is severe.

Diabetic nephropathy:
When to consult your doctor

Screening for diabetic nephropathy: Experts recommend regular evaluation for kidney disease or diabetic nephropathy in people with diabetes. These tests are done to find signs of kidney problems in the early stages. According to experts, urine tests to detect a protein called albumin in diabetics should be done at least once every year. Healthy kidney allows minimal amount of albumin to be excreted in the urine (less than 150 mg in a 24-hour collection). Urine test can detect small amounts of albumin in urine (the test is called test for microalbuminuria). If 150-300 mg of albumin is present in a 24-hour collection, the test is considered positive. Presence of excessive protein in urine (more than normal amount) is often a sign of kidney damage.

Screening for microalbuminuria or diabetic nephropathy is done in a urine sample. Screening for microalbuminuria can be carried out in the urine sample:

  • Timed urine collections over a 24-hour period.
  • Urine collected for 4 hours or overnight.
  • Random 'spot-urine' sample.

In a 24-hour urine collection, if <150 mg of albumin is present, it is considered normal. If the level is between 150-300 mg, it is considered microalbuminuria and if it is more than 300 mg it is considered as macroalbuminuria.

Twenty-four-hour and timed urine collection is difficult and can have errors in collecting sample or recording time. Hence, many experts prefer spot-urine method to detect microalbuminuria. In a spot urine sample, the albumin-to-Creatinine ratio is assessed to diagnose diabetic nephropathy. As kidney disease is a common complication of diabetes, regular checking of urine for albumin (protein) is recommended. The time frame for checking for protein in the urine depends on the type of diabetes you have (table 1).


Microalbumin testing in urine in people with diabetes

Type of diabetes

When to start yearly testing

Type 1 diabetes

After you have had diabetes for 5 years.

Type 2 diabetes

When you are diagnosed with diabetes.

Diabetes in children

After the age of 10 and after your child has had diabetes for 5 years.


Consult a doctor if you have any of the following symptoms:

Some symptoms that may occur in diabetic people with kidney disease include:

  • Poor or loss of appetite.
  • Fatigue or feeling tired most of the time.
  • Malaise or general ill feeling.
  • Headache, nausea and vomiting.
  • Swelling of the legs.
  • High blood pressure (risk of kidney damage increases progressively with increase in blood pressure).

If you have symptoms suggestive of kidney disease, your doctor will recommend blood and urine tests.


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