Conditions & Treatments

Diabetic Nephropathy (Kidney Disease)

Nephropathy is the deterioration of the kidneys. The final stage of nephropathy is called end-stage renal disease, or ESRD.

Diabetic Nephropathy (Kidney Disease)

What is diabetic nephropathy?

Nephropathy is the deterioration of kidney function. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD.

According to the CDC, diabetes is the most common cause of ESRD. In 2011, about 26 million people in the U.S. were reported to have diabetes, and more than 200,000 people with ESRD due to diabetes were either on chronic renal dialysis or had a kidney transplant. Both type 1 and type 2 diabetes can lead to diabetic nephropathy, although type 1 is more likely to lead to ESRD.

There are five stages of diabetic nephropathy. The fifth stage is ESRD. Progress from one stage to the next can take many years. 

What causes diabetic nephropathy?

Hypertension, or high blood pressure, is a complication of diabetes that is believed to contribute most directly to diabetic nephropathy. Hypertension is believed to be both a cause of diabetic nephropathy, as well as a result of the damage that is created by the disease. As kidney disease progresses, physical changes in the kidneys often lead to increased blood pressure.

Uncontrolled hypertension can make the progress toward stage five diabetic nephropathy occur more rapidly.

The high blood sugar associated with diabetes also causes damage to the kidney through many different and complicated pathways. Most of this damage is directed toward the blood vessels that filter the blood to make urine.

Can diabetic nephropathy be prevented?

The onset and progression of diabetic nephropathy can be slowed by intensive management of diabetes and its symptoms, including taking medications to lower blood pressure.

How can diabetic nephropathy be detected early?

You should have your urine tested at regular intervals to check for a protein called albumin. Normally, urine should not have any albumin. Having even a small amount of albumin in your urine is a sign that early kidney damage is present.

What is the treatment for diabetic nephropathy?

Specific treatment for diabetic nephropathy will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include any, or a combination of, the following:

  • Proper diet

  • Exercise

  • Strict monitoring and controlling of blood glucose levels, often with medication and insulin injections

  • Medication to lower blood pressure

  • Treatment of hypertension with either ACE inhibitors or angiotensin receptor blockers (ARBs) is especially effective in slowing the progression of diabetic kidney disease.

Treatment for ESRD often initially includes dialysis to cleanse the blood. Eventually, kidney transplant may also be a consideration.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Imaging

  • Adult Medicine Imaging
    The Adult Medicine Imaging Program at Massachusetts General Hospital Imaging offers a wide range of diagnostic exams and minimally invasive, image-guided treatments, all provided using leading-edge equipment and interpreted by specialty-trained radiologists.
MassGeneral Hospital for Children

  • Pediatric Endocrine Program and Diabetes Center
    The Pediatric Endocrinology Program and Diabetes Center at MassGeneral Hospital for Children is an international referral center for the management of pediatric diabetes and endocrine disorders in children and adolescents.
Transplant Center

  • Kidney/Pancreas/Islet Transplant Programs
    The Kidney/Pancreas/Islet Transplant Programs at Massachusetts General Hospital provide new and unique treatment options for patients with end-stage renal disease (kidney failure) and/or type 1 diabetes.
Diabetes Unit

  • Diabetes Self-Management Education and Support Program
    The Diabetes Self Management Education and Support (DSME/S) Program is an outpatient program designed for adults, children, and seniors with Type 1 or Type 2 Diabetes.
  • Diabetes Clinical Center
    The Mass General Diabetes Clinical Center is one of the oldest outpatient centers in the country dedicated to the comprehensive treatment of persons with diabetes, pre-diabetes, and associated disorders.
Nephrology Division

  • Center for Renal Education
    The Center for Renal Education provides education about Chronic Kidney Disease and its management and individualized plans of care that include nutritional counseling, blood pressure management, medication review and supportive services.
  • Resistant Hypertension Program
    The Resistant Hypertension Program specializes in the evaluation, diagnosis and management of patients with resistant or difficult to treat hypertension.
  • Chronic Ambulatory Peritoneal Dialysis (CAPD) Program
    The Peritoneal Dialysis Unit provides training and long term management for the patient who selects peritoneal dialysis as home therapy. Staffed by experienced peritoneal dialysis nurses, manual and automated home peritoneal dialysis is available.
  • Renal Associates Clinic
    Renal Associates provides services in general nephrology including diabetes, water and electrolyte disorders, kidney disease in pregnancy, urinary tract infections, and primary and secondary diseases of the kidney.
  • Polycystic Kidney Disease (PKD) Clinic
    The Polycystic Kidney Disease (PKD) Clinic at Massachusetts General Hospital specializes in the diagnosis and management of cystic kidney diseases.

Overcoming Barriers to Care

Massachusetts General Hospital develops model diabetes program to help close the gap in care.

Mass General experts discuss diabetes

Our physicians discuss the education, management and prevention of diabetes, a condition affecting nearly 24 million adults and children in the United States.

Kidney Health Q&A with Winfred W. Williams, MD, of the Mass General Transplant Center

Nephrologist Winfred W. Williams, MD, explains why the kidneys are important, what causes kidney disease and how to keep the kidneys healthy.

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Departments and Centers at Mass General have a reputation for excellence in patient care. View a list of all departments.