Prevent diabetes problems
�

Keep your kidneys healthy 

Number 

3

in a 

Series 

of 7 

U.S. Department 

of Health and 

Human Services 

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

 

Prevent diabetes problems:
�

Keep your kidneys healthy
�

U.S. Department 

of Health and 

Human Services 

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

 

Contents

What are diabetes problems?.................................. 1

What should I do each day to stay healthy 

with diabetes? ........................................................... 2

What do my kidneys do?.......................................... 3
�

How can I prevent diabetes 

kidney problems? ..................................................... 4
�

How can my doctor protect my kidneys 

during special x-ray tests?........................................ 6
�

How can diabetes hurt my kidneys? 

What can I do if I have kidney problems 

....................... 7

caused by diabetes?.................................................. 9
�

How will I know if my kidneys fail?...................... 10
�

What happens if my kidneys fail? ......................... 11
�

Will I know if I start to have kidney problems? ...... 13
�

How can I find out if I have 

kidney problems? ................................................... 13
�

Pronunciation Guide...............................................14
�

For More Information ........................................... 15
�

More in the Series.................................................. 18
�

Acknowledgments .................................................. 19
�
vi
�
What are diabetes problems? 

Too much glucose in the blood for a long time can 

cause diabetes problems. This high blood glucose, 

also called blood sugar, can damage many parts of 

the body, such as the heart, blood vessels, eyes, and 

kidneys. Heart and blood vessel disease can lead 

to heart attacks and strokes. You can do a lot to 

prevent or slow down diabetes problems. 

Ureters 

Kidneys 

Bladder 

Your kidneys are two 

bean-shaped organs about 

the size of your fist. They 

are located just below the 

rib cage, near your back. 

1 
What should I do each day to stay 

healthy with diabetes? 

Follow the healthy eating plan that 

you and your doctor or dietitian have 

worked out. 

Be active a total of 30 minutes most 

days. Ask your doctor what activities 

are best for you. 

Take your medicines as directed. 

Check your blood glucose every day. 

Each time you check your blood 

glucose, write the number in your 

record book. 

Check your feet every day for cuts, 

blisters, sores, swelling, redness, or 

sore toenails. 

Brush and floss your teeth every day. 

Control your blood pressure and 

cholesterol. 

2 

Don’t smoke. 
 

 

What do my kidneys do? 

The kidneys act as filters to clean the blood. They 

get rid of wastes and send along filtered fluid. 

The tiny filters in the kidneys are called glomeruli.* 

When kidneys are healthy, the artery brings blood 

and wastes from the bloodstream into the kidneys. 

The glomeruli clean the blood. Then wastes and 

extra fluid go out into the urine through the ureter. 

Clean blood leaves the kidneys and goes back into 

the bloodstream through the vein. 

Glomeruli 

(tiny filters in 

the kidney) 

Ureter 

(wastes and fluid 

go out in urine) 

Vein 

(clean blood 

leaves the kidney) 

Artery 

(blood and wastes 

enter the kidney) ➔

➔

➔

You have two kidneys. Your kidneys clean your blood and 

make urine. This drawing shows a cross section of a kidney. 

*See page 14 for tips on how to say the words in bold type. 

3 
 

 

 

 

How can I prevent diabetes 

kidney problems?
�

●	 Keep your blood glucose as close to your goal as 

you can. For many people, this level is as close 

to normal as possible. For others, a higher blood 

glucose goal may be better. Ask your doctor 

what blood glucose numbers are healthy for you. 

●	 Keep your blood pressure below 130/80 to help 

prevent kidney damage. Blood pressure is written 

with two numbers separated by a slash. For 

example, 120/70 is said as “120 over 70.” 

For some people, a higher blood pressure goal 

may be better. Ask your doctor what numbers 

are best for you. If you take blood pressure pills 

every day, take them as your doctor tells you. 

Keeping your blood pressure under control will 

also slow down or prevent damage to your eyes, 

heart, and blood vessels. 

Keep your blood pressure 

under good control. 

4 
●	 Ask your doctor if you should take pills to slow 

down kidney damage. Two kinds are available: 

• ACE (angiotensin-converting enzyme) 

inhibitor
�

• ARB (angiotensin receptor blocker) 

●	 Follow the healthy eating plan you work out with 

your doctor or dietitian. If you already have 

kidney problems, your dietitian may suggest you 

cut back on protein, especially animal products 

such as meat, milk, cheese, and eggs. 

●	 Have your kidneys checked at least once a year 

by having your urine tested for protein. This test 

is called the urinary albumin test. 

●	 Have your blood tested at least once a year for 

creatinine. The result of this test should be used 

to find your glomerular filtration rate (GFR), a 

measure of kidney function. 

Pills can help you control 

your blood pressure and 

slow down kidney damage. 

5 
●	 Have any other kidney tests your doctor 

thinks you need. 

●	 Avoid taking painkillers regularly. Daily use of 

pills like aspirin or acetaminophen can damage 

the kidneys. Taking a single dose of aspirin every 

day to protect the heart, however, should be safe. 

Taking acetaminophen for occasional pain should 

also be safe. But if you are dealing with chronic 

pain, such as arthritis, work with your doctor to 

find a way to control your pain without putting 

your kidneys at risk. 

●	 See a doctor right away for bladder or kidney 

infections. You may have an infection if you have 

these symptoms: 

•	�pain or burning when you urinate 

• a frequent urge to go to the bathroom 

• urine that looks cloudy or reddish 

• fever or a shaky feeling 

• pain in your back or on your side below the ribs 

How can my doctor protect my 

kidneys during special x-ray tests?
�

X-ray tests using a contrast agent pose a risk to 

your kidneys. If you need x rays, your doctor can 

give you extra fluid and medicine before and after 

the x rays to protect your kidneys. Or your doctor 

may decide to order a test that does not use a 

contrast agent. 

6 
How can diabetes hurt my kidneys? 

When the kidneys are working well, the tiny filters 

in your kidneys, the glomeruli, keep blood proteins 

inside your body. You need these proteins to stay 

healthy. 

High blood glucose and high blood pressure 

damage the kidneys’ filters. When the kidneys are 

damaged, proteins leak out of the kidneys into the 

urine. The urinary albumin test detects this loss of 

protein in the urine. Damaged kidneys do not do 

a good job of filtering out wastes and extra fluid. 

Wastes and fluid build up in your blood instead of 

leaving the body in urine. 

Kidney damage begins long before you notice any 

symptoms. An early sign of kidney damage is when 

your kidneys leak small amounts of a protein called 

albumin into the urine. But the only way to know 

about this leakage is to have your urine tested. 

With more damage, the kidneys leak more and 

more protein. More and more wastes build up 

in the blood. This damage gets worse until the 

kidneys fail. 

Diabetic kidney disease (DKD) is the medical term 

for kidney problems caused by diabetes. DKD 

affects both kidneys at the same time. 

7 
Healthy kidney 

No albumin, 

a protein, is 

leaking from 

the healthy 

kidney. 

Unhealthy kidney 

➔

➔

Ureter 

(wastes and fluid) 

Artery 

(blood and wastes) 

Vein 

(clean blood) 

➔

Ureter 

(wastes, fluid, 

and protein) 

➔

➔

➔

Vein 

(blood with 

waste products) 

Albumin 

Artery 

(blood and wastes) 

Albumin, a 

protein, is 

leaking from 

the healthy 

kidney. 

8 
What can I do if I have kidney 

problems caused by diabetes?
�

Once you have kidney damage, you can slow it 

down or stop it from getting worse by controlling 

your blood glucose and blood pressure. Taking an 

ACE inhibitor or an ARB is important for both 

controlling your blood pressure and reducing 

kidney damage. However, if you are pregnant, you 

should not take an ACE inhibitor or ARB. 

If you have diabetes, you should have your urine 

and blood tested regularly to see how well your 

kidneys are working. The test results should be 

given to you as your urine albumin and GFR 

results. 

Keeping blood pressure under control helps 

to keep your kidneys healthy. 

9 
How will I know if my kidneys fail? 

At first, you cannot tell. Kidney damage from 

diabetes happens so slowly that you may not feel 

sick at all for many years. You will not feel sick 

even when your kidneys do only half the job of 

normal kidneys. You may not feel any signs of 

kidney failure until your kidneys have almost 

stopped working. However, getting your urine and 

blood checked every year can tell you how well 

your kidneys are working. 

Once your kidneys fail, you may feel sick to your 

stomach and tired all the time. Your hands and 

feet may swell from extra fluid in your body. 

You may feel sick 

to your stomach 

when your kidneys 

stop working. 

10
�
 

 

 

 

 

What happens if my kidneys fail? 

One way to treat kidney failure is with dialysis. 

Dialysis is a treatment that does some of the work 

your kidneys used to do. Two types of dialysis are 

available (see page 12). You and your doctor will 

decide what type will work best for you. 

Dialysis is a treatment that takes waste products 

and extra fluid out of your body. 

11 
1.	�Hemodialysis. In hemodialysis, your blood 

flows through a tube from your arm to a 

machine that filters out the waste products and 

extra fluid. The clean blood flows back to your 

arm. 

2.	�Peritoneal dialysis. In peritoneal dialysis, your 

belly is filled with a special fluid. The fluid 

collects waste products and extra water from 

your blood. Then the fluid is drained from your 

belly and thrown away. 

Another way to treat kidney failure is to have a 

kidney transplant. This operation gives you a new 

kidney. The kidney can be from a close family 

member, friend, or someone you do not know. A 

new kidney must be a good match for your body. 

You may be on dialysis for a long time because 

many people are on a waiting list for a new kidney 

from donors they do not know. You are more 

likely to have a kidney transplant if you know 

someone who is able to donate a kidney to you. 

12 
Will I know if I start to have 

kidney problems? 

Not likely. You will know you have kidney 

problems if your doctor checks your blood for 

creatinine to measure your GFR and your urine 

for albumin. Do not wait until you feel ill to have 

your blood and urine checked for signs of DKD.

How can I find out if I have 

kidney problems? 

Two lab tests can tell you and your doctor how well 

your kidneys are working. 

● Each year, make sure your doctor checks a 

sample of your urine to see if your kidneys are 

leaking small amounts of albumin. 

●	 At least once each year, your doctor should 

check your blood to measure the amount of 

creatinine. Creatinine is a waste product your 

body makes. If your kidneys are not cleaning 

waste products from your blood, they can build 

up and make you sick. Your doctor can use your 

creatinine level to check your GFR. Results 

of this test tell you how well your kidneys are 

removing wastes from the blood. 

13 
Pronunciation Guide 

albumin (al-BYOO-min) 

angiotensin (AN-jee-oh-TEN-sin) 

artery (AR-tur-ee) 

creatinine (kree-AT-ih-neen) 

dialysis (dy-AL-ih-siss) 

glomerular (gloh-MAIR-yoo-lur) 

glomeruli (gloh-MAIR-yoo-ly) 

hemodialysis (HEE-moh-dy-AL-ih-siss) 

inhibitor (in-HIB-ih-tur) 

peritoneal (PAIR-ih-toh-NEE-uhl) 

14
�
 

For More Information 

Diabetes Teachers (nurses, dietitians, pharmacists, 

and other health professionals) 

To find a diabetes teacher near 

you, call the American Association 

of Diabetes Educators toll-free 

at 1–800–TEAMUP4 

(1–800–832–6874), or look on 

the Internet at www.diabeteseducator.org and click 

on “Find a Diabetes Educator.” 

Dietitians 

To find a dietitian near you, contact the American 

Dietetic Association at www.eatright.org and click 

on “Find a Nutrition Professional.” 

Government 

The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) is part 

of the National Institutes of Health (NIH). To 

learn more about kidney problems, write or call 

NKUDIC, 3 Information Way, Bethesda, MD 

20892–3580, 1–800–891–5390; or see 

www.kidney.niddk.nih.gov on the Internet. 

The National Kidney Disease Education Program 

(NKDEP) is part of the NIH. To learn more 

about kidney problems, write or call NKDEP, 

3 Kidney Information Way, Bethesda, MD 20892, 

1–866–454–3639; or see www.nkdep.nih.gov on the 

Internet. 

15
�
To get more information about taking care of 

diabetes, contact 

National Diabetes Information Clearinghouse 

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

Internet: www.diabetes.niddk.nih.gov 

National Diabetes Education Program 

1 Diabetes Way 

Bethesda, MD 20814–9692 

Phone: 1–888–693–NDEP (1–888–693–6337) 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: ndep@mail.nih.gov 

Internet: www.ndep.nih.gov 

American Diabetes Association 

1701 North Beauregard Street 

Alexandria, VA 22311 

Phone: 1–800–DIABETES (1–800–342–2383) 

Internet: www.diabetes.org 

16 
Juvenile Diabetes Research Foundation 

International 

26 Broadway, 14th Floor 

New York, NY 10004 

Phone: 1–800–533–CURE (1–800–533–2873) 

Fax: 212–785–9595 

Email: info@jdrf.org 

Internet: www.jdrf.org 

National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 

Internet: www.kidney.org 

17 
More in the Series 

The Prevent Diabetes Problems Series has seven 

booklets that can help you learn more about how 

to prevent diabetes problems. 

For free single copies of these booklets, write, call, 

fax, or email the 

National Diabetes Information Clearinghouse 

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

These booklets are also available at 

www.diabetes.niddk.nih.gov on the Internet. 

18
�
 

 

 

 

 

 

 

Acknowledgments 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. The National Diabetes 

Information Clearinghouse (NDIC) thanks the 

people who helped review or field-test the original 

version of this publication:
�

For the American 

Association of 

Diabetes Educators 

Lynn Grieger, R.D., C.D.E.
�

Arlington, VT
�

Celia Levesque, R.N., 

C.D.E. 

Montgomery, AL 

Teresa McMahon, 

Pharm.D., C.D.E. 

Seattle, WA 

Barbara Schreiner, R.N., 

M.N., C.D.E. 

Galveston, TX 

For the American 

Diabetes Association 

Phyllis Barrier, M.S., 

R.D., C.D.E. 

Alexandria, VA 

Linda Haas, Ph.C., R.N., 

C.D.E. 

Seattle, WA 

Kathleen Mahoney, 

M.S.N., R.N., C.D.E. 

Drexel Hill, PA 

Randi Kington, M.S., 

R.N., C.S., C.D.E. 

Hartford, CT 

For the Centers for 

Medicare & Medicaid 

Services 

Baltimore, MD
�

Jan Drass, R.N., C.D.E.
�

For the Diabetes Research 

and Training Centers 

Albert Einstein 

School of Medicine 

Norwalk Hospital 

Norwalk, CT 

Jill Ely, R.N., C.D.E. 

Sam Engel, M.D. 

Pam Howard, A.P.R.N., C.D.E. 

Indiana University 

School of Medicine 

Indianapolis, IN 

Madelyn Wheeler, M.S., 

R.D., F.A.D.A., C.D.E. 

VA/JDF Diabetes 

Research Center 

Vanderbilt School of 

Medicine 

Nashville, TN 

Ok Chon Allison, 

M.S.N., R.N.C.S., 

A.N.P., C.D.E. 

Barbara Backer, B.S. 

James W. Pichert, Ph.D. 

Alvin Powers, M.D. 

Melissa E. Schweikhart 

Michael B. Smith 

Kathleen Wolffe, R.N. 

For the Grady Health 

System Diabetes Clinic 

Atlanta, GA
�

Ernestine Baker, R.N.,
�

F.N.P., C.D.E. 

Kris Ernst, R.N., C.D.E. 

Margaret Fowke, R.D., L.D. 

Kay Mann, R.N., C.D.E. 

For the Indian Health 

Service 

Albuquerque, NM
�

Ruth Bear, R.D., C.D.E.
�

Dorinda Bradley, R.N.,
�

C.D.E. 

Terry Fisher, R.N. 

Lorraine Valdez, R.N., 

C.D.E. 

Red Lake, MN 

Charmaine Branchaud, 

B.S.N., R.N., C.D.E. 

For the Medlantic Research 

Center 

Washington, DC 

Resa Levetan, M.D. 

For the Texas Diabetes 

Council 

Texas Department of 

Health 

Austin, TX 

Luby Garza-Abijaoude, 

M.S., R.D., L.D. 

The NDIC also thanks Katherine R. Tuttle, M.D., F.A.S.N., F.A.C.P., of the Providence 

Medical Research Center, Sacred Heart Medical Center in Spokane, WA, and the University 

of Washington School of Medicine in Spokane and Seattle for reviewing the updated version 

of this publication. 

19 

 

 

 

 

 

 

 

National Diabetes 

Information Clearinghouse 

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

Internet: www.diabetes.niddk.nih.gov 

The National Diabetes Information Clearinghouse (NDIC) is 

a service of the National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK is part of the 

National Institutes of Health of the U.S. Department of Health 

and Human Services. Established in 1978, the Clearinghouse 

provides information about diabetes to people with diabetes and 

to their families, health care professionals, and the public. The 

NDIC answers inquiries, develops and distributes publications, 

and works closely with professional and patient organizations 

and Government agencies to coordinate resources about 

diabetes. 

This publication is not copyrighted. The Clearinghouse 

encourages users of this publication to duplicate and 

distribute as many copies as desired. 

This publication is available at www.diabetes.niddk.nih.gov. 

This publication may contain information about medications. 

When prepared, this publication included the most current 

information available. For updates or for questions about any 

medications, contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit 

www.fda.gov. Consult your doctor for more information. 
U.S. DEPArTmENT OF HEALTH 

AND HUmAN SErvICES 

National Institutes of Health 

NIH Publication No. 10–4281 

February 2010