Prevent diabetes problems

Keep your kidneys healthy

Number

3

in a

Series 

of 7

National Diabetes Information 

Clearinghouse

Prevent diabetes problems:

Keep your kidneys healthy

Contents

What are my kidneys and what do they do? .......... 1

How can diabetes affect my kidneys?..................... 2

What are blood pressure and high 

blood pressure? ........................................................ 3

How does high blood pressure affect my 

kidneys if I have diabetes?....................................... 4

What should my blood pressure be? ...................... 4

What are the symptoms of diabetic 

kidney disease?......................................................... 6 

How can I find out if I have diabetic 

kidney disease?......................................................... 8

What can I do if I have diabetic 

kidney disease?....................................................... 10

Eating, Diet, and Nutrition ................................... 11

How can x rays affect my kidneys? ....................... 14

What is kidney failure? .......................................... 14

What happens if my kidneys fail? ......................... 15

How does smoking affect my diabetes 

and kidneys? ........................................................... 19
How can I keep my kidneys healthy? ................... 20

Pronunciation Guide.............................................. 23

For More Information ........................................... 24

More in the Series.................................................. 28

Acknowledgments.................................................. 29
 1

What are my kidneys and what do 

they do?

Your kidneys are two bean-shaped organs, each 

about the size of a fist. They are located just below 

your rib cage, one on each side of your spine. 

Every day, your two kidneys filter about 120 to 

150 quarts of blood to produce about 1 to 2 quarts 

of urine. Urine flows from your kidneys to your 

bladder through tubes called ureters. Your bladder 

stores urine until releasing it through urination.

Ureters

Kidneys

Bladder
2 

How can diabetes affect my kidneys?

Too much glucose,* also called sugar, in your blood 

from diabetes damages your kidneys’ filters. If 

the filters are damaged, a protein called albumin,

which you need to stay healthy, leaks out of your 

blood and into your urine. Damaged kidneys do 

not do a good job of filtering wastes and extra fluid 

from your blood. The wastes and extra fluid build 

up in your blood and make you sick. 

*See the Pronunciation Guide for tips on how to 

say the words in bold type.

Diabetes is a leading cause of kidney disease. 

Diabetic kidney disease is the medical term for 

kidney disease caused by diabetes. Diabetic kidney 

disease affects both kidneys at the same time. 

If kidney disease runs in your family, you are 

also at risk for kidney disease. Talk with your 

family members about their medical history and 

your doctor about having your kidney function 

tested. 
 3

What are blood pressure and high 

blood pressure?

Blood pressure is the force of blood flow inside 

your blood vessels. Blood pressure is written with 

two numbers separated by a slash. For example, 

a blood pressure result of 130/80 is said as “130 

over 80.” The first number is the pressure in your 

blood vessels as your heart beats and pushes blood 

through your blood vessels. The second number 

is the pressure as your blood vessels relax between 

heartbeats. 

High blood pressure forces your heart to work 

harder to pump blood. High blood pressure can 

strain your heart, damage your blood vessels, 

and increase your risk of heart attack, stroke, eye 

problems, and kidney problems. 
4 

How does high blood pressure affect 

my kidneys if I have diabetes?

High blood pressure is the other leading cause of 

kidney disease in people with diabetes. High blood 

pressure also is a result of damage from kidney 

disease. If you have high blood pressure, your 

kidneys may already be damaged. Even a small 

rise in blood pressure can quickly make kidney 

disease worse. 

What should my blood pressure be?

Your blood pressure goal should either be below 

140/80 or 140/90 depending on whether you have 

kidney disease and how severe it is. Discuss your 

personal goal with your doctor. 
 5

Many people with diabetes have high blood 

pressure. However, keeping your blood pressure 

at your goal will help prevent damage to your 

kidneys, heart, brain, blood vessels, and other 

parts of your body. Meal planning, medicines, and 

physical activity can help you reach your blood 

pressure goal. 

Have your blood pressure checked at every 

health care visit. Ask your doctor if you need 

medicine to control your blood pressure. 

Medicine that helps control your blood pressure 

can slow progression of kidney disease.

Two types of blood pressure-lowering medicines, 

angiotensin-converting enzyme (ACE) inhibitors

and angiotensin receptor blockers (ARBs), have 

been found to slow progression of kidney disease 

in people with diabetes. 
6 

What are the symptoms of diabetic 

kidney disease?

In the early stages, diabetic kidney disease does 

not have any symptoms. Kidney disease happens 

so slowly that you may not feel sick at all for many 

years. You may not feel sick even when your 

kidneys do only half the job of healthy kidneys. 

Only your doctor can tell if you have kidney 

disease by checking the protein, or albumin, level 

in your urine at least once a year. 

The first symptom of diabetic kidney disease is 

often swelling in parts of your body, such as your 

hands, face, feet, or ankles. Also, large amounts 

of protein in your urine may cause urine to look 

foamy. Once your kidney function starts to 

decrease, other symptoms may include 

● increased or decreased urination

● feeling drowsy or tired

● feeling itchy or numb

● dry skin

● headaches

● weight loss
 7

● not feeling hungry

● feeling sick to your stomach 

● vomiting

● sleep problems

● trouble staying focused

● darkened skin

● muscle cramps

Kidney disease may 

cause you to feel sick 

to your stomach. 
8 

How can I find out if I have diabetic 

kidney disease?

The following tests can tell you and your doctor if 

you have diabetic kidney disease: 

● Blood pressure test. Your doctor will use 

a blood pressure cuff to check your blood 

pressure. You should have this test done at 

every health care visit. 

● Albumin and creatinine measurement. Your 

doctor will ask you for a sample of your urine 

to look for albumin. A high level of albumin in 

your urine may mean you have kidney disease. 

The urine sample is sent to a lab for a test that 

looks at the amount of albumin compared with 

the amount of creatinine, a waste product also in 

your urine. A urine albumin-to-creatinine ratio 

test result above 30 is a warning sign of kidney 

disease. You should have this test at least once 

a year.
 9

● Estimated glomerular filtration rate (eGFR) 

test. Blood drawn at your doctor’s office and 

sent to a lab can be tested to measure how much 

blood your kidneys filter each minute. If your 

kidneys are not filtering enough blood, you may 

have kidney damage or kidney failure. You 

should have this test at least once a year. The 

test results show the following:

•	eGFR of 60 or above is in the normal range

•	eGFR below 60 may mean you have kidney 

disease

•	eGFR of 15 or below may mean you have 

kidney failure

If your blood and urine test results show evidence 

of kidney damage or disease, your doctor may 

suggest more tests to help find out whether you 

have other health problems causing the damage. 

Other tests can include blood and urine samples 

for additional lab tests and imaging tests, or 

pictures, of your kidneys. Your doctor also may 

need to perform a biopsy, in which a small piece of 

tissue is removed from your kidney to look at with 

a microscope.
10 

What can I do if I have diabetic 

kidney disease?

Once you have diabetic kidney disease, you can 

slow it down or stop it from getting worse by 

watching your blood glucose and blood pressure 

numbers closely to keep them under control. 

If you have high blood pressure or protein in your 

urine, you can take an ACE inhibitor or ARB to 

control your blood pressure and reduce kidney 

damage. If you are pregnant, you should not take 

an ACE inhibitor or ARB.

See your doctor often. Have your urine and blood 

tested as your doctor advises to see how well your 

kidneys are working. You also may need to see a 

nephrologist—a doctor who specializes in kidney 

disease. 
 11

Eating, Diet, and Nutrition

Your dietitian or doctor may suggest a special 

eating plan for you. You may have to avoid a diet 

high in protein, fat, sodium, and potassium. 

● Cut back on protein, especially animal products 

such as meat. Damaged kidneys may fail to 

remove protein waste products from your blood. 

Diets high in protein make your kidneys work 

harder and fail sooner. 

● Avoid a high-fat diet. High-fat diets are high in 

cholesterol. Cholesterol is a type of fat found in 

your body’s cells, blood, and many foods. Your 

body needs some cholesterol to work the right 

way. For example, your body uses cholesterol to 

make certain essential hormones and maintain 

nerve function. However, your body makes all 

the cholesterol it needs. If you often eat foods 

that are high in cholesterol, or if high cholesterol 

runs in your family, extra cholesterol in your 

blood can build up over time in the walls of 

your blood vessels and arteries. High blood 

cholesterol can lead to heart disease and stroke, 

some of the biggest health problems for people 

with diabetes. 
12 

● Avoid high-sodium foods. Sodium is a mineral 

found in salt and other foods. High levels of 

sodium may raise your blood pressure. Some 

high-sodium foods include canned food, frozen 

dinners, and hot dogs. The amount of sodium 

is listed on the food label, so you can see which 

foods have the highest levels. Try to limit your 

sodium to less than a teaspoon a day, or about 

2,300 milligrams (mg) a day. If you have high 

blood pressure or are African American, middleaged, or older, aim for no more than 1,500 mg 

of sodium per day. Ask your doctor or your 

dietitian about how much sodium you can have.

● Ask your doctor about the amount of potassium 

you need. Potassium is a mineral that helps 

your heartbeat stay regular and muscles work 

right. Healthy kidneys keep the right amount of 

potassium in your body. However, if you have 

severe kidney damage, high levels of potassium 

may cause an abnormal heart rhythm or even 

make your heart stop, called cardiac arrest. 

Some high-potassium foods include apricots, 

bananas, oranges, and potatoes. 
 13

Read more about healthy eating and 

kidney disease in these publications at 

www.kidney.niddk.nih.gov:

● Eat Right to Feel Right on Hemodialysis 

● Nutrition for Advanced Chronic Kidney 

Disease in Adults

● Nutrition for Early Chronic Kidney Disease 

in Adults

● What I need to know about Eating and 

Diabetes
14 

How can x rays affect my kidneys?

X rays that use a special dye—known as contrast 

medium—to give a better picture of your organs 

can pose a risk to your kidneys. Contrast medium 

that is injected into your blood vessels is the type 

that can cause kidney damage. If you need x rays 

with contrast medium injected into your blood 

vessels, your doctor can give you extra fluids 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 contrast medium.

What is kidney failure?

Kidney failure, also called end-stage kidney disease 

or ESRD, means your kidneys no longer work well 

enough to do their job. You will need treatment to 

replace the work your kidneys have stopped doing. 
 15

What happens if my kidneys fail?

The two treatments for kidney failure are dialysis

and a kidney transplant. 

Dialysis

One way to treat kidney failure is with dialysis, 

which does some of the work your kidneys used 

to do. 

One form of dialysis, called hemodialysis, uses a 

machine to circulate your blood through a filter 

outside your body. If you choose hemodialysis, 

you should watch how much liquid you drink. 

Your dietitian will help you figure out how much 

liquid to drink each day. Extra liquid can raise 

your blood pressure, make your heart work harder, 

and increase the stress of dialysis treatments. 

Remember that many foods—such as soup, ice 

cream, and fruits—contain water. Ask your 

dietitian for tips on controlling your thirst.
16 

The other form of dialysis, called peritoneal

dialysis, uses the lining of your abdomen, or the 

area between your chest and hips, to filter your 

blood inside your body. 

You and your doctor will decide which type of 

dialysis will work best for you. 

Dialysis does some of the work your 

kidneys used to do. 
 17

Read more in these publications at 

www.kidney.niddk.nih.gov:

● Treatment Methods for Kidney Failure: 

Hemodialysis

● Treatment Methods for Kidney Failure: 

Peritoneal Dialysis

● Kidney Failure: Choosing a Treatment That’s 

Right for You

Kidney Transplant

Another way to treat kidney failure is to have a 

kidney transplant. This operation gives you a 

healthy kidney from a donor. 

A donor may be a living person. A living donor 

may be a blood relative, such as a parent, brother, 

sister, or child, or a close friend or nonblood 

relative, such as a spouse. A living kidney 

donation offers the best-quality kidney with the 

shortest wait time. Donating a kidney does not 

put the donor at risk for future health problems. 
18 

If you cannot get a kidney from a living donor, 

your name can be placed on the national waiting 

list for a deceased donor kidney, or a kidney 

that is taken from a person who has just died or 

suffered brain death. The wait for a deceased 

donor kidney is often longer than the wait for a 

living donor kidney. 

Both living and deceased donor kidneys should 

be a good match for your body.
 19

How does smoking affect my diabetes 

and kidneys?

If you already have kidney disease, smoking 

can worsen any blood vessel, heart, and kidney 

problems. Kidney cancer is also more common in 

smokers.

Smoking and diabetes are a dangerous mix. 

Smoking raises your risk for many diabetes 

problems. If you quit smoking, 

● you will lower your risk for heart attack, stroke, 

nerve disease, kidney disease, and amputation,

which is surgery to cut off a body part

● your cholesterol and blood pressure levels might 

improve 

● your blood circulation will improve 

If you smoke, stop smoking. Ask for help so that 

you don’t have to do it alone. You can start by 

calling 1–800–QUITNOW or 1–800–784–8669. 
20 

How can I keep my kidneys healthy? 

You can keep your kidneys healthy by taking 

these steps: 

● Keep your blood glucose numbers as close 

to your target as possible. Your doctor will 

work with you to set your target blood glucose 

numbers and teach you what to do if your 

numbers are too high or too low. 

● Keep your blood pressure numbers as close to 

your personal goal as possible. If you take blood 

pressure medicine, take it as your doctor advises. 

● Eat healthy meals and follow the meal plan that 

you and your doctor or dietitian have worked 

out. If you already have kidney disease, you may 

have to avoid a diet high in protein, fat, sodium, 

and potassium.

● If you choose hemodialysis, watch how much 

liquid you drink. Your dietitian will help you 

figure out how much liquid to drink each day. 
 21

● At least once a year, have these tests for kidney 

disease:

•	blood pressure test

•	albumin and creatinine measurement 

•	eGFR

● Have any other kidney tests your doctor thinks 

you need.

● Avoid taking painkillers often. Daily use of 

nonsteroidal anti-inflammatory drugs, such 

as the arthritis-type painkillers ibuprofen and 

naproxen, can damage your kidneys. If you are 

dealing with chronic, or long lasting, pain from a 

health problem such as arthritis, work with your 

doctor to find a way to control your pain without 

putting your kidneys at risk.
22 

● 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 urinate

•	urine that looks cloudy, reddish, or dark

•	fever or a shaky feeling

•	pain in your back or on your side below your 

ribs

● If you smoke, stop smoking.
 23

Pronunciation Guide

albumin (al-BYOO-min)

amputation (AM-pyoo-TAY-shuhn)

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

cholesterol (koh-LESS-tur-ol)

circulation (SUR-kyoo-LAY-shuhn)

creatinine (kree-AT-ih-neen)

dialysis (dy-AL-ih-siss)

glucose (GLOO-kohss)

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

inhibitors (in-HIB-ih-turs)

nephrologist (neh-FROL-uh-jist)

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

potassium (poh-TASS-ee-uhm)

sodium (SOH-dee-uhm)
24 

For More Information

To find diabetes educators (nurses, dietitians, 

pharmacists, and other health care providers), 

contact

American Association of Diabetes Educators 

200 West Madison Street, Suite 800 

Chicago, IL 60606 

Phone: 1–800–338–3633 

Internet: www.diabeteseducator.org 

To find dietitians, contact

Academy of Nutrition and Dietetics 

120 South Riverside Plaza, Suite 2000

Chicago, IL 60606–6995

Internet: www.eatright.org 

Click on “Find a Registered Dietitian.”

To learn more about kidney problems from 

diabetes, contact 

National Kidney and Urologic Diseases 

Information Clearinghouse 

3 Information Way

Bethesda, MD 20892–3580

Phone: 1–800–891–5390 

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: nkudic@info.niddk.nih.gov

Internet: www.kidney.niddk.nih.gov 
 25

National Kidney Disease Education Program 

3 Kidney Information Way

Bethesda, MD 20892

Phone: 1–866–4–KIDNEY (1–866–454–3639)

TTY: 1–866–569–1162

Fax: 301–402–8182

Email: nkdep@info.niddk.nih.gov

Internet: www.nkdep.nih.gov 

American Kidney Fund 

11921 Rockville Pike, Suite 300

Rockville, MD 20852

Phone: 1–800–638–8299

Internet: www.kidneyfund.org

National Kidney Foundation

30 East 33rd Street

New York, NY 10016–5337

Phone: 1–800–622–9010 or 212–889–2210

Fax: 212–689–9261

Internet: www.kidney.org
26 

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

www.yourdiabetesinfo.org
 27

American Diabetes Association

1701 North Beauregard Street

Alexandria, VA 22311

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

Email: askADA@diabetes.org

Internet: www.diabetes.org

JDRF

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
28 

More in the Series

The Prevent Diabetes Problems Series includes 

seven booklets that can help you learn more about 

how to prevent diabetes problems:

● Prevent diabetes problems: Keep your diabetes 

under control

● Prevent diabetes problems: Keep your eyes healthy

● Prevent diabetes problems: Keep your feet healthy

● Prevent diabetes problems: Keep your heart and 

blood vessels healthy

● Prevent diabetes problems: Keep your kidneys 

healthy

● Prevent diabetes problems: Keep your mouth 

healthy

● Prevent diabetes problems: Keep your nervous 

system healthy
 29

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. 

Acknowledgments

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. The National Diabetes 

Information Clearinghouse (NDIC) thanks 

Katherine R. Tuttle, M.D., F.A.S.N., F.A.C.P., 

of the National Kidney Foundation, Providence 

Sacred Heart Medical Center, and the University 

of Washington, School of Medicine, for reviewing 

the updated version of this publication.
30 

The NDIC also thanks the following 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 

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, D.C.

Resa Levetan, M.D.

For the Texas Diabetes 

Council

Texas Department of Health

Austin, TX

Luby Garza-Abijaoude, 

M.S., R.D., L.D.
 31

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

www.yourdiabetesinfo.org

The National Diabetes Education Program is a 

federally funded program sponsored by the U.S. 

Department of Health and Human Services’ 

National Institutes of Health and the Centers for 

Disease Control and Prevention and includes over 

200 partners at the federal, state, and local levels, 

working together to reduce the morbidity and 

mortality associated with diabetes.

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 

and, when taken as prescribed, the conditions they treat. 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 health care provider for more information.
NIH Publication No. 14–4281

February 2014

The NIDDK prints on recycled paper with bio-based ink.