Diabetic kidney disease is diagnosed using tests that check how well your kidneys are working. These include a test that checks for a protein (albumin) in the urine. Another test checks how well your kidneys are filtering waste from your blood. This is called the estimated glomerular filtration rate (eGFR).

An albumin urine test can detect very small amounts of protein in the urine. This allows doctors to find kidney disease early. Starting treatment early can prevent further damage to the kidneys.

The eGFR is measured using a formula that compares a person's size, age, and sex to blood creatinine levels. As kidney disease gets worse, the eGFR number goes down.

When your doctor will start checking your kidney function depends on the type of diabetes you have. After testing starts, it should be done every year.^{footnote 1}

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The main treatment is medicine to lower your blood pressure and prevent or slow the damage to your kidneys. Medicines include:

• Angiotensin-converting enzyme inhibitors, also called ACE inhibitors.
• Angiotensin II receptor blockers, also called ARBs.

There are other steps you can take. For example:

• Keep your blood sugar levels within your target range.
• Work with your doctor to keep your blood pressure under control.
• Eat heart-healthy foods, and exercise regularly.
• Talk to your doctor or dietitian about how much protein is best.
• Limit your salt. This helps keep high blood pressure from getting worse.

As kidney damage gets worse, your blood pressure and cholesterol level rise. You may need to take more than one medicine to treat these problems. If damage becomes severe, you may need kidney dialysis or a transplant.

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• Take your medicines exactly as prescribed. It is very important that you take your insulin or other diabetes medicine as your doctor tells you. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Try to keep blood sugar in your target range.
  • Eat a variety of healthy foods and follow your meal plan to know how much carbohydrate you need for meals and snacks. Your doctor may restrict your protein. A dietitian can help you plan meals.
  • If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 2½ hours of moderate to vigorous exercise a week.
  • Check your blood sugar as often as your doctor recommends.
• Take and record your blood pressure at home if your doctor tells you to. To take your blood pressure at home:
  • Ask your doctor to check your blood pressure monitor. Your doctor can make sure that it is accurate and that the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.
  • Do not use tobacco products or use medicine known to raise blood pressure (such as some nasal decongestant sprays) before taking your blood pressure.
  • Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before taking a reading.
• Eat a low-salt diet to keep your blood pressure in your target range.
• Do not smoke. Smoking raises your risk of many health problems, including diabetic kidney disease. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Do not take ibuprofen, naproxen, or similar medicines, unless your doctor tells you to. These medicines may make kidney problems worse.
• If you get sick (throwing up, diarrhea, fever), you may need to stop taking some of your medicines until you are well again. Ask your doctor which medicines to pause when you are sick.

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