Diabetic kidney disease

Last reviewed: 22 Aug 2023
Last updated: 20 Sep 2023



History and exam

Key diagnostic factors

  • hypertension
  • signs of retinopathy
  • edema
More key diagnostic factors

Other diagnostic factors

  • poor vision
  • numbness of the lower extremities
  • pain of the lower extremities
  • constitutional symptoms (advanced disease)
  • foot changes
  • orthostatic hypotension
  • skin changes
  • muscular atrophy
  • pallor (as glomerular filtration rate declines)
  • bleeding tendency (advanced disease)
  • Kussmaul respirations (advanced disease)
Other diagnostic factors

Risk factors

  • sustained hyperglycemia
  • hypertension
  • family history of hypertension and/or kidney disease
  • obesity
  • smoking
  • physical inactivity
  • dyslipidemia
  • high protein, fat, and sodium intake
More risk factors

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urinary albumin to creatinine ratio (ACR)
  • serum creatinine with GFR estimation
  • kidney ultrasound
More 1st investigations to order

Investigations to consider

  • albumin excretion rate (AER)
  • CT abdomen
  • magnetic resonance angiography (MRA)
  • Doppler ultrasound
  • kidney biopsy
More investigations to consider

Treatment algorithm


type 1 diabetes with nephropathy: not on dialysis

type 2 diabetes with nephropathy: not on dialysis

on peritoneal dialysis or hemodialysis



David J. Leehey, MD, FACP
David J. Leehey

Professor of Medicine

Division of Nephrology

Loyola University Medical Center



Associate Chief of Staff for Clinical Affairs and Education

Veterans Affairs Hospital




DJL declares that he has no competing interests. DJL is an author of references cited in this topic.

Irfan Moinuddin, MD
Irfan Moinuddin

Assistant Professor of Medicine

Southern Illinois University School of Medicine




IM declares that he has no competing interests.

Peer reviewers

Rajiv Agarwal, MD

Professor of Medicine

Department of Medicine

Division of Nephrology

Indiana University School of Medicine




RA declares that he has no competing interests.

Merlin C. Thomas, PhD

Associate Professor

Baker IDI Heart and Diabetes Institute




MCT has received honoraria for speaking and educational sessions conducted by Sanofi-Aventis, Servier, Boehringer-Ingleheim, Abbott, Amgen, and Jansen-Cilag.

Damian Fogarty, BSc, MD, FRCP

Consultant/Senior Lecturer in Renal Medicine

Belfast City Hospital and Queen's University Belfast

Belfast City Hospital


Northern Ireland



DF has no share options, research support, or employment with pharmaceutical companies. He has received one-time speaking fees to cover his time preparing educational talks in the broad areas of diabetic nephropathy and chronic kidney disease, promoting early recognition and evidence-based or best practice management.

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