Metabolic Syndrome and Cardiometabolic Health
Diabetes and Kidney Disease: Which Tests You Need
Written by Dr. Ajay V. Kaduskar, Diabetologist, Nagpur
MD (Medicine), PGDHSc (Diabetology), FEACD (The Netherlands)
Published · 4 min read
Quick answer
People with diabetes should have two tests at least once a year: a urine albumin-to-creatinine ratio (uACR) to detect protein leak, and a blood test for creatinine to calculate eGFR, which estimates kidney function. Type 2 diabetes screening starts at diagnosis. Early detection allows treatment that can slow or prevent kidney failure.
Diabetes is one of the leading causes of kidney disease worldwide. The danger is that damage starts quietly, with no pain or swelling, and by the time symptoms appear, a lot of kidney function may be lost. Two simple tests can catch it early.
How does diabetes damage the kidneys?
High blood sugar and high blood pressure harm the tiny filters in the kidneys (glomeruli). Over years, the filters leak protein into the urine and gradually lose their ability to clean the blood. This is called diabetic kidney disease. It often develops after 5 to 10 years of diabetes, but in type 2 diabetes it may already be present at diagnosis.
What are the warning signs?
Early kidney disease usually has no symptoms. Later signs include:
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Foamy urine
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Swelling of the feet, legs or face
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Tiredness and weakness
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Poor appetite or nausea
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Itching
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High blood pressure that is hard to control
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Reduced urine output
Do not wait for symptoms to be tested.
Which tests should you have?
1. urine albumin-to-creatinine ratio (uACR)
A spot urine sample (ideally the first morning sample) measures the amount of albumin, a protein, relative to creatinine.
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Below 30 mg/g: Normal
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30 to 300 mg/g: Moderately increased (formerly microalbuminuria)
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Above 300 mg/g: Severely increased
An abnormal result should be confirmed on two of three samples over three to six months, as fever, exercise, urine infection or high sugar can cause temporary rises.
2. eGFR (estimated glomerular filtration rate)
Calculated from serum creatinine, age and sex. It estimates how well the kidneys filter blood.
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90 or above: Normal
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60 to 89: Mildly reduced
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45 to 59: Mild to moderate reduction
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30 to 44: Moderate to severe reduction
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15 to 29: Severely reduced
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Below 15: Kidney failure
Some guidelines also use cystatin C for more precise estimates in selected people.
3. other tests
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Blood pressure at every visit
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Urine routine and microscopy
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Kidney ultrasound if needed
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Blood tests for potassium, haemoglobin and electrolytes
How often should you test?
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At diagnosis of type 2 diabetes
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At least once a year if results are normal
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More often, every 3 to 6 months, if kidney disease is present or progressing
How can you protect your kidneys?
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Keep HbA1c in your target range.
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Control blood pressure, usually below 130/80 mm Hg.
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Take kidney-protecting medicines if advised. ACE inhibitors or ARBs, SGLT2 inhibitors, finerenone in some patients and certain GLP-1 medicines have shown kidney benefits.
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Reduce salt and avoid excess protein supplements.
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Avoid painkillers such as ibuprofen, diclofenac and other NSAIDs unless prescribed.
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Stop smoking.
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Stay hydrated, unless told to limit fluids.
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Ask your doctor before using contrast dye, herbal products or new medicines.
When should you see a doctor?
See your doctor promptly if you notice swelling, foamy urine, reduced urine output, new high blood pressure or if your reports show a falling eGFR or rising uACR. You may need a kidney specialist (nephrologist) if eGFR is low or falling fast, or if protein loss is high.
What to remember
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Diabetic kidney disease is silent in its early stages.
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Test uACR and eGFR at least once a year.
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Good control of sugar and blood pressure protects the kidneys.
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Some medicines offer extra kidney protection.
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Avoid NSAID painkillers and check with your doctor before new medicines.
Two simple yearly tests can save your kidneys. Early action slows damage, and often keeps you away from dialysis. To get your kidney checks done, consult Dr. Ajay V. Kaduskar, a diabetologist at Niramay Clinics in Nagpur.
Sources and further reading
Frequently asked questions
The urine albumin-to-creatinine ratio (uACR) and the blood creatinine test with eGFR. They should be done at least once a year.
At diagnosis and then at least yearly if normal. If there is kidney disease, testing may be every 3 to 6 months.
Below 30 mg/g is normal. Values between 30 and 300 suggest moderately increased albumin, and above 300 suggests severe leak. Abnormal results should be repeated for confirmation.
Early damage can be slowed or sometimes improved with good control of sugar and blood pressure and protective medicines. Advanced damage is harder to reverse.
NSAIDs such as ibuprofen and diclofenac can harm the kidneys, particularly with diabetes, dehydration or existing kidney disease. Use them only if your doctor advises.
If your eGFR is low or falling quickly, you have significant protein leak, or kidney disease is advanced or unexplained. Your diabetologist will advise a referral.
Related reading
- Full guide: metabolic syndrome
- Fatty Liver and Diabetes: Why They Occur Together
- Diabetes and Heart Disease: The Metabolic Risk Link
- What Is Metabolic Syndrome? 5 Risk Factors Explained
- High Triglycerides, Diabetes and Obesity: What Is the Link?
If you would like advice suited to your own reports and medicines, you can book an appointment or visit Niramay Clinics in Dhantoli, Nagpur.
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