diabetic nephropathy

The kidneys are the body's filtration plant, made of millions of microscopic sieves that clean the blood while keeping precious proteins inside. Years of high blood sugar clog and scar these tiny filters, so they begin to leak what they should hold back and fail at what they should let through — the slow ruin of diabetic nephropathy.

Diabetic nephropathy is progressive kidney damage caused by long-standing diabetes, driven by hyperglycemia, high pressure within the filtering glomeruli, and tissue scarring. Its earliest detectable sign is small amounts of the protein albumin in the urine (albuminuria); over time, protein loss increases, the filtration rate falls, and blood pressure tends to rise. It develops over many years and usually accompanies other microvascular complications such as retinopathy.

It is the single leading cause of chronic kidney disease and kidney failure worldwide, ultimately requiring dialysis or transplantation in advanced cases. Progression can be markedly slowed by tight control of glucose and blood pressure, by blocking the renin-angiotensin system with ACE inhibitors or ARBs, and increasingly by SGLT2 inhibitors, which protect the kidney beyond their glucose-lowering effect. Early screening with a urine albumin test is therefore central to diabetes care.