Keep your kidneys 

Keep your kidneys 

NATIONAL INSTITUTES OF HEALTH 

National Diabetes Information Clearinghouse 

Prevent diabetes prob

Keep your kidneys he

NATIONAL INSTITUTES OF HEALTH 

National Diabetes Information Clearinghouse 
iv

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

What should I do each day to stay healthy 

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

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

How can I prevent diabetes 

kidney problems? .......................................

How can my doctor protect my kidneys 

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

How can diabetes hurt my kidneys? 

What can I do if I have kidney problems 

.........

caused by diabetes?....................................

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

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

Will I know if I start to have kidney problem

How can I find out if I have 

kidney problems? .......................................

Pronunciation Guide ..................................

For More Information ...............................

More in the Series ......................................

Acknowledgments ......................................
Too much glucose in the blood for a long 

cause diabetes problems. This high blood 

also called blood sugar, can damage many 

the body, such as the heart, blood vessels

kidneys. Heart and blood vessel disease c

to heart attacks and strokes. You can do 

prevent or slow down diabetes problems. 

This booklet is about 

kidney problems caused by 

diabetes. You will learn 

the things you can do each Kidne

day and during each year 

to stay healthy and prevent 

diabetes problems. 

Ureters 

Your kidneys a

bean-shaped o

the size of you

are located jus

rib cage, near 
y 

Follow the healthy eating pla

you and your doctor or dietit

worked out. 

Be active a total of 30 minu

days. Ask your doctor what 

are best for you. 

Take your medicines as dire

Check your blood glucose ev

Each time you check your b

glucose, write the number in 

record book. 

Check your feet every day f

blisters, sores, swelling, red

sore toenails. 

Brush and floss your teeth e

Control your blood pressur

cholesterol. 

Don’t smoke. 

2 
The kidneys act as filters to clean the bloo

get rid of wastes and send along fi ltered fl 

The tiny fi lters in the kidneys are called g

When kidneys are healthy, the artery brin

and wastes from the bloodstream into the 

The glomeruli clean the blood. Then was

extra fluid go out into the urine through t

Clean blood leaves the kidneys and goes 

the bloodstream through the vein. 

Ureter 

(wastes and fluid 

go out in urine) 

Vein 

(clean blood 

leaves the kidney) 

Artery 

(blood and wastes 

enter the kidney) ➔

➔

➔

G

(t

th

You have two kidneys. Your kidneys clean your 

make urine. This drawing shows a cross section 

*See page 14 for tips on how to say the words in 
y p

● Keep your blood glucose as close to no

you can. Ask your doctor what blood g

numbers are healthy for you. 

● Keep your blood pressure below 130/80 

prevent kidney damage. Blood pressure 

with two numbers separated by a slash. 

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

Ask your doctor what numbers are bes

you. If you take blood pressure pills ev

take them as your doctor tells you. Ke

your blood pressure under control will 

down or prevent damage to your eyes, 

blood vessels. 

Keep your blood pressure below 130/80. 

4 
• ACE (angiotensin converting enzym

inhibitor

• ARB (angiotensin receptor blocker) 

● Follow the healthy eating plan you wor

your doctor or dietitian. If you already 

kidney problems, your dietitian may su

cut back on protein, such as meat. 

● Have your kidneys checked at least onc

by having your urine tested for small am

of protein. This test is called the micro

test. 

● Have your blood tested at least once a 

creatinine. The result of this test shou

used to estimate your glomerular fi ltra

(GFR), a measure of kidney function. 

Pills can help you co

your blood pressure 

slow down kidney da
● Avoid taking painkillers regularly. Dail

pills like aspirin or acetaminophen can 

the kidneys. Taking a single dose of asp

day to protect the heart, however, shou

Taking acetaminophen for occasional p

also be safe. But if you are dealing with 

pain, such as arthritis, work with your d

find a way to control your pain without 

your kidneys at risk. 

● See a doctor right away for bladder or k

infections. You may have an infection i

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 belo

the ribs

How can my doctor protect my 

kidneys during special x-ray tes

X-ray tests using a contrast agent pose a r

your kidneys. If you need x rays, your doc

give you extra water before and after the x 

protect your kidneys. Or your doctor may 

order a test that does not use a contrast ag

6 
When the kidneys are working well, the t

in your kidneys, the glomeruli, keep prote

your body. You need the protein to stay h

High blood glucose and high blood pressu

damage the kidneys’ filters. When the ki

damaged, the protein leaks out of the kid

the urine. Damaged kidneys do not do a 

of cleaning out wastes and extra fluid. W

fluid build up in your blood instead of lea

body in urine. 

Kidney damage begins long before you no

symptoms. An early sign of kidney dama

your kidneys leak small amounts of a pro

albumin into the urine. But the only way 

about this leakage is to have your urine te

With more damage, the kidneys leak mor

more protein. This problem is called pro

More and more wastes build up in the blo

damage gets worse until the kidneys fail. 

Diabetic nephropathy is the medical term 

kidney problems caused by diabetes. Nep

affects both kidneys at the same time. 
➔

➔

Ureter 

(wastes and fl uid) 

Artery 

(blood and wastes) 

Vein 

(clean blood) 

➔

Unhealthy kidney 

Ureter 

(wastes, fluid, 

and protein) 

➔

➔

➔

Vein 

(blood with 

waste products) 

Protein 

Artery 

(blood and wastes) 

No 

leak

the 

kid

Pro

lea

the 

kid

8 
py 

Once you have kidney damage, you canno

it. But you can slow it down or stop it fro

worse by controlling your blood pressure

your ACE inhibitors or ARBs, and havin

kidney function tested regularly. Howeve

are pregnant, you should not take ACE in

or ARBs. 

Keeping blood pressure under control helps 

to keep your kidneys healthy. 
At first, you cannot tell. Kidney damage 

diabetes happens so slowly that you may 

sick at all for many years. You will not fe

even when your kidneys do only half the j

normal kidneys. You may not feel any sig

kidney failure until your kidneys have alm

stopped working. However, getting your 

blood checked every year can tell you how 

your kidneys are working. 

Once your kidneys fail, you may feel sick 

stomach and tired all the time. Your han

feet may swell from extra fluid in your bo

You may feel sick 

to your stomach 

when your kidneys 

stop working. 

10
One way to treat kidney failure is with dia

Dialysis is a treatment that does some of t

your kidneys used to do. Two types of dial

available (see page 12). You and your do

decide what type will work best for you. 

Dialysis is a treatment that takes waste products 

and extra fluid out of your body. 
machine that filters out the waste prod

extra fluid. The clean blood flows bac

arm. 

2. Peritoneal dialysis. In peritoneal dialy

belly is filled with a special fluid. The 

collects waste products and extra wate

your blood. Then the fluid is drained 

belly and thrown away. 

Another way to treat kidney failure is to h

kidney transplant. This operation gives y

kidney. The kidney can be from a close f

member, friend, or someone you do not k

You may be on dialysis for a long time. M

people are waiting for a new kidney. A n

must be a good match for your body. 

Will I know if I start to have 

kidney problems?

No. You will know you have kidney prob

if your doctor checks your blood for crea

and your urine for protein. Do not wait f

of kidney damage to have your blood and 

checked. 

12
Two lab tests can tell you and your doctor 

y p

your kidneys are working. 

● Each year, make sure your doctor chec

sample of your urine to see if your kidn

are leaking small amounts of protein ca

microalbumin. 

● At least once each year, your doctor sh

check your blood to measure the amou

creatinine. Creatinine is a waste produ

body makes. If your kidneys are not cl

waste products from your blood, they c

up and make you sick. Your doctor can 

creatinine level to check your GFR. G

for glomerular filtration rate. Results o

test tell you how well your kidneys are 

wastes from the blood. 
albumin (alBYOOmin) 

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) 

microalbumin (MY-kroh-al-BYOO-min) 

nephropathy (neh-FROP-uh-thee) 

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

proteinuria (proh-teen-YOO-ree-uh) 

14
Diabetes Teachers (nurses, dietitians, phar

and other health professionals)

To find a diabetes teacher near 

you, call the American Association

of Diabetes Educators toll-free 

at 1–800–TEAMUP4 (832–6874),

or look on the Internet at 

www.diabeteseducator.org and click on “F

Diabetes Educator.” 

Dietitians 

To find a dietitian near you, call the Ame

Dietetic Association toll-free at 1–800–8

or look on the Internet at www.eatright.o

click on “Find a Nutrition Professional.” 

Government 

The National Kidney and Urologic Dise

Information Clearinghouse (NKUDIC) 

of the National Institutes of Health (NIH

learn more about kidney problems, write 

NKUDIC, 3 Information Way, Bethesda

20892–3580, 1–800–891–5390; or see 

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

The National Kidney Disease Education 

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

about kidney problems, write or call NK

Kidney Information Way, Bethesda, MD 

1–866–454–3639; or see www.nkdep.nih.g

Internet. 
National Diabetes Information Clearin

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

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 20892–3560

Phone: 1–800–438–5383

Fax: 703–738–4929

Internet: www.ndep.nih.gov

American Diabetes Association 

1701 North Beauregard Street

Alexandria, VA 22311

Phone: 1–800–DIABETES (342–2383

Internet: www.diabetes.org

Juvenile Diabetes Research Foundatio

International

120 Wall Street

New York, NY 10005–4001

Phone: 1–800–533–CURE (2873)

Internet: www.jdrf.org

16 
The 

Prevent Diabetes Problems Series 

booklets that can help you learn more ab

to prevent diabetes problems. 

For free single copies of these booklets, w

fax, or email the 

National Diabetes Information Clearin

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

These booklets are also available at 

www.diabetes.niddk.nih.gov on the Intern
this publication: 

The National Diabetes Information Clea

thanks the people who helped review or fi 

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 G

System 

Atlanta, G

Ernestine 

 F.N.P., 

Kris Erns

Margaret 

Kay Man

For the In

Service 

Albuquer

Ruth Bea

Dorinda 

 C.D.E

Terry Fish

Lorraine 

 C.D.E

Red Lake

Charmain

B.S.N.

For the M

 Center 

Washingt

Resa Lev

For the Te

Counc

Texas De

Health 

Austin, T

Luby Gar

M.S., R

18
g

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

Internet: www.diabetes.niddk.nih.gov 

The National Diabetes Information Clearinghouse (

a service of the National Institute of Diabetes and D

and Kidney Diseases (NIDDK). The NIDDK is par

National Institutes of Health of the U.S. Departmen

and Human Services. Established in 1978, the Clear

provides information about diabetes to people with d

to their families, health care professionals, and the p

NDIC answers inquiries, develops and distributes pu

and works closely with professional and patient orga

and Government agencies to coordinate resources a

diabetes. 

Publications produced by the Clearinghouse are care

reviewed by both NIDDK scientists and outside expe

This publication is not copyrighted. The Clearingh

encourages users of this booklet to duplicate and d

many copies as desired. 

This booklet is also available at www.diabetes.niddk.n

This publication may contain information about medi

to treat a health condition. When this publication wa

the NIDDK included the most current information av

Occasionally, new information about medication is re

updates or for questions about any medications, pleas

U.S. Food and Drug Administration at 1–888–INFO–

(463–6332), a toll-free call, or visit their website at ww

Consult your doctor for more information. 
U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 08–4281 

February 2008