Large-print version 

Prevent diabetes problems: 

Keep your kidneys healthy
 

in a 

Series 

of 7 

Number 

3

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
 

How can my doctor protect my kidneys
 

What can I do if I have kidney problems
 

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

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

How can I prevent diabetes kidney problems?.................... 4
 

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

How can diabetes hurt my kidneys?.................................... 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?...................... 12
 

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
 

 

 

 

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. 

Don’t smoke.
 

2 
 

 

 

 

You have two kidneys. Your kidneys clean your blood and make 

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

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. 

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

 

 

Ureter 

(wastes and fluid 

go out in urine) 

Vein 

(clean blood 

leaves the kidney) 

Artery 

(blood and wastes 

enter the kidney) 

Glomeruli 

(tiny filters in 

the kidney) 

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 

 

Vein 

Ureter 

(wastes and fluid) 

Artery 

(blood and wastes) 

(clean blood) 

Vein 

(blood with 

Ureter 

(wastes, fluid, 

and protein) 

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. 

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. 

12 
 

	 	 	 	 	 	 		 	 	 	

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. 

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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. 10–4281L 

February 2010