What brought you here
Diabetes and your kidneys
Diabetes is the most common reason kidneys fail in this country. It's also one of the most treatable — provided somebody is watching the right test at the right time.
What high blood sugar does to a filter
Each kidney holds around a million tiny filtering units, each one a knot of very small blood vessels. Blood sugar that runs high, year after year, thickens and stiffens those vessels. They filter less precisely, and the first thing that slips through is a protein called albumin.
This is slow. It usually takes years, and it causes no symptoms at all while it's happening — no pain, no change in your urine you'd notice, nothing you'd feel.
The test that finds it first
A urine albumin-to-creatinine ratio detects small amounts of albumin long before creatinine rises or eGFR falls. That gap is measured in years, and it is the most valuable window you get.
If you have diabetes, this test and an eGFR should be done at least once a year. It's a simple urine sample. If it hasn't been done recently, it's a reasonable thing to ask for.
There is more to do about it than there used to be
Blood sugar and blood pressure control remain the foundation. What has changed is that several medication classes are now used specifically to protect kidney function in people with diabetes — a real shift from managing the diabetes and hoping the kidneys follow.
Which of them fit you depends on your kidney function, your other conditions, and what you already take. That's a conversation to have with a physician who can see the whole picture, and it's one worth having early.
Worth a prompt call
- Swelling in your legs or face that has come on over days or weeks.
- A noticeable drop in how much you're urinating.
- Blood sugars that have become much harder to control than usual.
- A creatinine or eGFR that changed sharply rather than gradually.
What happens next
What we look at
- Urine albumin and eGFR together, and the trend across every past result we can get.
- Blood pressure, with a specific target rather than a general one.
- Your medication list — both what's protecting your kidneys and what may need its dose adjusted as function changes.
- Whether anything other than diabetes is contributing, since the two often travel together.
- A follow-up interval that matches your actual risk instead of a default.
Questions people ask us about this
Does everyone with diabetes end up with kidney disease?
No. Many people with diabetes never develop significant kidney disease, and among those who do, the course varies enormously. Blood sugar control, blood pressure control, and being monitored regularly all change that outcome substantially.
My sugars are well controlled. Do I still need a kidney check?
Yes — an annual urine albumin test and eGFR are recommended regardless, because kidney changes can begin quietly even when the numbers you watch look good. Finding it early is what makes it manageable.
What should my A1c be?
For most adults the target is under 7%, but it's genuinely individual — age, how long you've had diabetes, kidney function, and how you respond to low blood sugar all shift it. Your own target is a conversation, not a rule.
Not sure whether you need a kidney specialist?
Call and ask. Our staff will tell you whether this is something we should see, what your plan requires, and what to bring. A real person answers, and the whole staff speaks Spanish.