With the development of proteinuria, the kidneys' ability to remove poisons from the blood deteriorates such that 5-10 years later the kidneys are almost completely unable to remove these poisons from the blood. There are many factors, some known and others not, that affect the individual risk of developing diabetic nephropathy. Given the relatively predictable nature of diabetic nephropathy , a kidney biopsy is usually not needed once the condition has been properly evaluated by assessing your history, examination, as well as blood and urine tests and a kidney ultrasound examination. If, however, there are unusual features, then further investigations may be needed to define the kidney condition, and this may well involve a biopsy. High blood pressure is almost always a problem that develops or worsens in diabetic nephropathy.
Diabetic nephropathy is also a sign of worsening blood vessel disease throughout the body.
Diabetic eye disease is usually present by this stage indicating damage to smaller blood vessels. The importance of good blood glucose control can not be stressed enough. Such control can prevent the development and slow the progression of diabetic nephropathy, as well as preventing the other complications of diabetes even if kidney failure has developed. This will involve discussion with doctors, nurses and dieticians to try and achieve the recommended target. The main question is what target to aim for in blood pressure control.