Many patients are puzzled by this: "My legs and feet aren't swollen, and my urination is fine. Why do I need to check my kidneys?"

Director Huang Xinwen explains that this is precisely the most dangerous characteristic of diabetic nephropathy: it is silent in the early stages, and by the time symptoms appear, the damage has often already progressed to the moderate or advanced stages.

20%-40%

。

Diabetic kidney disease refers to chronic kidney disease caused by diabetes. Approximately 20%-40% of diabetic patients in China develop this condition, and it has become the leading cause of uremia.

Even more concerning is that the mortality rate among patients with diabetic kidney disease is significantly higher than that of those without it.

01

Three Major Misconceptions That Are Quietly Damaging Your Kidneys

Director Huang Xinwen has observed in clinical practice that many diabetic patients, due to several deeply ingrained misconceptions, miss the optimal window for intervention, leading to irreversible deterioration of kidney function.

Misconception One: No Urine Protein, No Diabetic Nephropathy

"This is the most common misconception." Director Huang pointed out that in the early stages of diabetic nephropathy, routine urine test results for proteinuria may appear completely normal.

The truly sensitive "early warning signal" is the urine albumin-to-creatinine ratio (UACR). This indicator becomes elevated *before* abnormalities appear in routine urine protein tests and is key to detecting early kidney damage.

Misconception Two: No Lower Limb Edema, No Diabetic Nephropathy

Many patients believe that kidney disease necessarily comes with swelling. Director Huang corrects this: "Edema is a manifestation of late-stage kidney disease."

In the early and middle stages of the disease, although the kidneys are already damaged, the body's water metabolism can still compensate, so visible swelling does not occur. By the time swelling in both feet appears, kidney function may have already been lost by more than half.

Myth 3: Microalbuminuria has no symptoms and does not require treatment

"The detection of microalbuminuria means that diabetic nephropathy has already begun." Director Huang emphasized that the microalbuminuria stage is the "golden window period" for intercepting disease progression.

At this stage, although there are no discomforts, the kidney's filtration mesh (glomeruli) has already started to leak. Without intervention, it will continuously progress to macroalbuminuria and even renal failure.

02

How to catch the "subtle signs" of kidney damage?

Director Huang Xinwen explained that diagnosing diabetic nephropathy primarily relies on two core indicators:

Urine albumin-to-creatinine ratio (UACR): Evaluates the extent of glomerular damage.

Estimated glomerular filtration rate (eGFR): Assesses the "working efficiency" of the kidneys.

Based on UACR, diabetic kidney disease can be divided into three stages:

Stage A1 (normal to mildly elevated): UACR < 30 mg/g. Most patients in this stage are asymptomatic, and some may only exhibit transient microalbuminuria, which is easily overlooked.

Stage A2 (Moderate Elevation): UACR between 30-300 mg/g. Mild edema, elevated blood pressure, or foamy urine may occur but are often overlooked.

Stage A3 (Severe Elevation): UACR > 300 mg/g. Upon entering this stage, patients exhibit significant edema, hypertension, and substantial foamy urine. Renal function continues to decline, accompanied by symptoms of renal failure such as nausea, vomiting, and anemia.

UACR ≥ 30 mg/g

eGFR < 60 ml/min/1.73m²

Diagnostic Criteria: Clinical diagnosis of diabetic nephropathy can be made when UACR ≥ 30 mg/g and/or eGFR < 60 ml/min/1.73m² persists for more than 3 months.

Director Huang added, "Diabetic retinopathy is a 'sister disease' to diabetic nephropathy. If the microvessels in the eyes are already damaged, those in the kidneys are likely affected as well. Therefore, ophthalmologic examination findings can aid in the diagnosis of nephropathy."

03

Protect Your Kidneys: Implement These Six Defensive Measures Without Fail

Director Huang Xinwen points out that diabetic nephropathy currently lacks specific radical cures, with the core strategy focusing on "prevention" and "early treatment." He provides six practical kidney-protection guidelines:

1. Lifestyle Modifications Are the Foundation

Manage weight reasonably, adhere to a diabetic diet, quit smoking completely, and choose suitable exercises (such as walking or Tai Chi) to reduce the burden on the kidneys.

2. Scientific Management of Protein Intake

Protein intake should be neither excessive nor insufficient. Director Huang advises that diabetic kidney disease patients should keep their daily protein intake at approximately 0.8 grams per kilogram of body weight.

Protein should primarily come from high-quality sources like eggs, milk, and lean meats. For patients already on dialysis, intake may be appropriately increased. When necessary, supplementation with compound α-keto acid preparations may be considered under medical guidance.

3. Implementation of Individualized Blood Glucose Management

Blood sugar control targets are not one-size-fits-all. Based on factors such as age, disease duration, complications, and hypoglycemia risk, physicians should develop individualized glycemic control goals—a “one person, one plan” approach—to achieve stable sugar management and avoid extreme fluctuations.

4. Strict Management of Blood Pressure

<130/80 mmHg

Blood pressure is the direct force of blood flow impacting the kidneys. Maintaining blood pressure consistently below <130/80 mmHg over the long term can effectively slow the progression of kidney disease and reduce the risk of cardiovascular and cerebrovascular events.

5. Actively Correct Dyslipidemia

Blood lipid management is equally crucial for the health of kidney microvessels. Proper control of lipid levels helps improve the long-term prognosis of kidney disease.

6. Initiate and undergo regular kidney screenings as early as possible.

This is the most easily overlooked yet most critical point.

All patients with type 2 diabetes should undergo their first screening at the time of diagnosis.

Type 1 diabetes patients generally begin screening 5 years after diagnosis.

Screening Items: Check urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) at least once a year.

Once diagnosed, regular follow-up assessments should be conducted 1-4 times a year based on risk stratification.

Director Huang Xinwen finally gives a serious reminder:

When diabetic nephropathy progresses to end-stage renal failure, patients will face severe complications such as anemia, acidosis, and heart failure, and can only rely on dialysis or kidney transplantation to sustain life. This poses a tremendous physical, psychological, and financial burden on patients. Kidney damage is a “one-way street”—once it occurs, it is difficult to reverse. Do not wait until your body sends out alarms before taking action.