If you have been living with diabetes for several years, you probably check your blood sugar and HbA1c regularly.
But when was the last time you checked your kidney health?
Diabetes can gradually damage the kidneys, sometimes without causing noticeable symptoms in the early stages. By the time obvious signs such as swelling, fatigue or changes in urination appear, kidney function may already have been affected.
This is why kidney screening should be considered an important part of long-term diabetes management, not something to think about only when symptoms begin.
According to the American Diabetes Association’s 2026 Standards of Care, both urinary albumin levels and estimated glomerular filtration rate, or eGFR, are important for identifying and monitoring chronic kidney disease in people with diabetes.
How Can Diabetes Affect the Kidneys?
Your kidneys act as sophisticated filters.
Every day, they filter blood, remove waste products and excess fluid, regulate electrolytes and help maintain several important functions within the body.
The kidneys contain millions of tiny filtering units.
When blood glucose remains high over a prolonged period, the small blood vessels involved in this filtering process can become damaged. Over time, the kidneys may become less efficient at filtering the blood.
High blood pressure, which commonly occurs alongside diabetes, can place additional stress on these delicate blood vessels.
This gradual kidney damage associated with diabetes is commonly referred to as diabetic kidney disease or diabetic nephropathy.
Diabetes is a recognised risk factor for chronic kidney disease, and persistent high blood glucose can contribute to kidney damage over time.
The Biggest Problem: Early Kidney Disease May Have No Symptoms
One of the most important facts people with diabetes should understand is this:
You may have early kidney damage and still feel completely normal.
You may not experience pain.
Your urine may appear normal.
Your energy levels may be unchanged.
And your blood sugar readings may not immediately tell you that your kidneys are beginning to be affected.
This is exactly why regular kidney testing matters.
Waiting until you develop symptoms can mean missing the opportunity to identify kidney disease earlier.
What Are the Early Signs of Diabetic Kidney Disease?
In its earliest stages, diabetic kidney disease often produces no noticeable symptoms.
As kidney disease progresses, some people may experience:
- Swelling of the feet or ankles
- Puffiness around the eyes
- Increased tiredness
- Changes in urination
- Foamy urine
- Difficulty controlling blood pressure
- Loss of appetite
- Nausea
- Muscle cramps
- Itching
- Shortness of breath in advanced disease
However, these symptoms can have many different causes.
They should not be used as a substitute for proper kidney investigations.
For a person with diabetes, regular screening can identify changes before symptoms become obvious.
Two Kidney Tests People With Diabetes Should Know
When people hear the words “kidney test,” they often think only about serum creatinine.
Creatinine is useful, but kidney assessment in diabetes usually involves looking at more than one measurement.
Two particularly important markers are eGFR and urine albumin-to-creatinine ratio, or UACR. NIDDK identifies urine albumin and eGFR as the two key markers used in the evaluation of chronic kidney disease.
1. What Is an eGFR Test?
eGFR stands for estimated glomerular filtration rate.
It is calculated using a blood test, typically based on serum creatinine along with other relevant factors, and gives an estimate of how effectively the kidneys are filtering blood.
A lower eGFR can indicate reduced kidney function.
However, a single abnormal eGFR result does not always mean someone has chronic kidney disease.
Doctors usually interpret the number together with previous results, urine tests and the patient’s overall medical condition.
Persistent reduction in eGFR over time is more significant than one isolated result.
2. What Is a Urine Albumin Test?
Healthy kidneys normally keep important proteins such as albumin in the bloodstream.
When the kidney’s filtering system begins to become damaged, small amounts of albumin can leak into the urine.
A test called the urine albumin-to-creatinine ratio, or UACR, helps detect this.
A UACR above 30 mg/g is considered albuminuria and can be a marker of chronic kidney disease.
Albumin in the urine can sometimes appear before a major decline in kidney filtration is detected.
This is why having a seemingly acceptable creatinine value alone does not necessarily mean kidney screening is complete.
How Often Should People With Diabetes Check Their Kidneys?
The appropriate testing frequency depends on diabetes type, duration, previous kidney results and other risk factors.
The ADA’s 2026 guidance recommends that albuminuria and eGFR be monitored regularly to identify chronic kidney disease and follow its progression. In people without established kidney disease, annual screening is commonly recommended in appropriate diabetes populations, while those with existing kidney disease may require more frequent monitoring.
Your diabetes specialist can determine how frequently you need testing based on your individual risk.
What Increases the Risk of Kidney Damage in Diabetes?
Not everyone with diabetes develops kidney disease.
However, certain factors can increase the risk of progression.
These include:
- Persistently high blood glucose
- High blood pressure
- Longer duration of diabetes
- Smoking
- High cholesterol
- Excess body weight
- Existing cardiovascular disease
- Previous evidence of albumin in the urine
- Poor adherence to diabetes treatment
This is why protecting your kidneys involves more than focusing on one laboratory result.
Kidney protection requires comprehensive diabetes management.
Does Good Blood Sugar Control Protect the Kidneys?
Maintaining glucose levels within an individualized target range is an important part of reducing the risk of diabetes-related complications.
Persistently elevated blood glucose can contribute to progressive damage to small blood vessels, including those in the kidneys.
However, kidney protection is not only about HbA1c.
Blood pressure management, cholesterol control, body weight, smoking cessation and appropriate medication can all influence kidney and cardiovascular risk.
This is why diabetes should be treated as a condition affecting the whole body rather than simply as “high sugar.”
Blood Pressure and Kidney Disease Are Closely Connected
Diabetes and high blood pressure often occur together.
High blood pressure can damage kidney blood vessels, while declining kidney function can also make blood pressure more difficult to control.
This creates a cycle that may accelerate kidney damage if not managed appropriately.
Certain blood-pressure medicines, including ACE inhibitors and angiotensin receptor blockers, may be recommended for appropriate patients with diabetes, hypertension and albuminuria because they can help slow kidney disease progression. Current ADA guidance strongly recommends these medicines in specific higher-risk kidney disease settings.
Medication choice should always be individualized by the treating physician.
Modern Diabetes Medicines Can Also Support Kidney Protection
Diabetes treatment has changed significantly over the last several years.
Today, some medicines are selected not only for their ability to lower glucose but also for their potential cardiovascular and kidney benefits in suitable patients.
Treatment may include different combinations of glucose-lowering medicines depending on kidney function, cardiovascular risk, HbA1c, body weight and other medical factors.
This is another reason why continuing the same diabetes prescription for years without reassessment may not always be appropriate.
As your health changes, your treatment plan may also need to change.
Can Diabetic Kidney Disease Be Reversed?
This depends on the stage and severity of kidney involvement.
Established chronic kidney damage cannot always be completely reversed.
However, early detection can make a major difference because appropriate treatment may help slow progression, reduce albumin leakage and protect remaining kidney function.
NIDDK notes that reduction in urine albumin can reflect treatment response and may be associated with improved kidney and cardiovascular outcomes.
The goal is therefore not to wait until severe kidney failure develops.
The goal is to identify kidney stress early enough to act.
Should You Stop Eating Protein if You Have Kidney Disease?
Patients sometimes receive conflicting advice after seeing an abnormal kidney report.
Some immediately stop eating protein.
Others start drinking excessive amounts of water because they believe it will “flush the kidneys.”
Neither approach should be followed blindly.
Nutrition requirements differ depending on:
- Stage of kidney disease
- Diabetes control
- Body weight
- Current protein intake
- Other medical conditions
- Medications
- Potassium and electrolyte levels
A diet that is appropriate for one person with diabetes and kidney disease may not be appropriate for another.
Dietary changes should therefore be discussed with your doctor and qualified dietitian.
When Should You See a Diabetes Specialist?
Consider discussing kidney evaluation with your diabetes team if:
- You have had diabetes for several years
- Your HbA1c has remained high
- You have high blood pressure
- Your urine report shows protein or albumin
- Your creatinine or eGFR has changed
- You notice swelling of the feet
- You have cardiovascular disease
- You have never undergone a urine albumin test
You should also seek medical evaluation if kidney test results are changing rapidly or symptoms such as significant swelling, breathlessness or reduced urine output develop.
Depending on the severity of kidney involvement, collaboration between a diabetologist and nephrologist may also be required.
Diabetic Kidney Care at M.V. Hospital for Diabetes, Chennai
At M.V. Hospital for Diabetes, Chennai, diabetes care focuses not only on lowering blood glucose but also on identifying and managing complications that can develop over time.
Regular evaluation of HbA1c, blood pressure, eGFR and urine albumin can help build a clearer picture of both diabetes control and kidney health.
Patients with early signs of diabetic kidney disease may benefit from individualized glucose management, blood-pressure control, nutrition guidance, medication review and continued monitoring.
If you have been living with diabetes for years but only check your sugar levels, it may be time to look at the bigger picture.
Your HbA1c tells you about glucose control.
Your eGFR and urine albumin can tell you something equally important: how well your kidneys are coping with diabetes.
Early screening gives you the opportunity to protect kidney function before serious symptoms appear.
