Have Diabetes? Don't Ignore Your Kidney Health.

Diabetes and kidney health

Diabetes, which many people in Mombasa call sukari, means the level of sugar (glucose) in the blood is higher than it should be. Over many years, high blood sugar can damage the small blood vessels throughout the body, including the tiny filters inside the kidneys.

Many people with diabetes also have high blood pressure, which puts extra strain on the same filters. Together, diabetes and high blood pressure are the two most common causes of chronic kidney disease (CKD) worldwide. Not everyone with diabetes develops kidney problems, but the risk is high enough that regular kidney checks are a standard part of diabetes care.

What diabetic kidney disease means

Diabetic kidney disease is kidney damage linked to diabetes. Doctors may also call it "CKD in diabetes" or diabetic nephropathy. It usually develops slowly, and it usually shows up first in tests rather than as symptoms:

• Albumin in the urine. Damaged filters start letting albumin, a protein, leak into the urine. This is often the earliest sign.
• A falling eGFR. Over time the kidneys may filter less well, which shows as a lower eGFR on a blood test.

Some people have one of these signs without the other. Also, not every kidney problem in a person with diabetes is caused by diabetes. A doctor will think about other causes too, especially if results change quickly or there is blood in the urine. Like other forms of CKD, the changes need to last more than three months before CKD is diagnosed.

Kidney tests for people with diabetes

KDIGO and the American Diabetes Association recommend two tests for kidney screening in diabetes: a urine ACR and a blood creatinine with eGFR. Both are needed, because each one can pick up changes the other misses.

Urine albumin testing

The urine ACR (albumin to creatinine ratio) test uses a small urine sample, ideally the first urine of the morning. Comparing albumin with creatinine in the same sample corrects for how concentrated or dilute the urine is. Labs report ACR in mg/mmol or mg/g. An ACR of 3 mg/mmol (30 mg/g) or more is considered raised.

ACR can go up for a short time with hard exercise, fever, a urine infection, menstruation or very high blood sugar. For this reason, a raised result is usually confirmed with repeat tests over the following weeks to months before any conclusion is drawn.

Creatinine and eGFR

Creatinine is a waste product made by the muscles and cleared by the kidneys. The lab uses a validated equation to turn your creatinine result, together with your age and sex, into an eGFR (estimated glomerular filtration rate). eGFR estimates how well the kidneys are filtering. Creatinine on its own is not a diagnosis: reference ranges vary by lab, age, sex and muscle mass, so use the range printed on your own report. If a recent result was high, see high creatinine and diabetes.

How often kidneys are usually checked

KDIGO 2022 and the American Diabetes Association advise checking urine ACR and eGFR at least once a year in people with diabetes:

• Type 2 diabetes: starting from the time diabetes is diagnosed, because kidney changes may already be present.
• Type 1 diabetes: starting about five years after diagnosis.

If results are already abnormal, or if you have other risk factors, your doctor may advise testing more often. Your doctor will tell you what schedule suits you.

Protecting your kidneys

The details of care are always individual, but kidney protection in diabetes commonly involves keeping blood sugar and blood pressure within the ranges agreed with your doctor, not smoking, staying active and having regular tests.

In recent years, guidelines such as KDIGO 2022 have included newer medicine classes that may help protect the kidneys and heart in some people with diabetes and CKD. For example, a doctor may discuss a class of medicines called SGLT2 inhibitors, or certain blood pressure medicines. Whether any of these are suitable depends on your kidney results, your other medicines and your overall health. Please do not start, stop or change any medicine without speaking to your doctor.

When specialist assessment may be appropriate

Most people with diabetes have their kidneys checked by the doctor who manages their diabetes. Referral to a nephrologist (kidney specialist) is often considered when eGFR is low, when there is a large amount of albumin in the urine, when kidney function is falling quickly, when blood pressure is hard to control, or when the cause of kidney changes may not be diabetes. Your doctor will decide what applies to you. Read when to see a nephrologist.

Finding care in Mombasa

Urine ACR and creatinine tests are offered by many labs and hospital outpatient clinics in Mombasa. Many people with diabetes attend a diabetes clinic or see a physician, get their tests done at a lab, and bring the printed results back to the doctor. If you have diabetes and have never had a urine ACR test, it is reasonable to ask your doctor about one at your next visit. See kidney testing in Mombasa, or use find kidney care if you would like help identifying a verified provider on Mombasa Island, in Nyali, Bamburi, Likoni or Changamwe.

Frequently asked questions

Will diabetes definitely damage my kidneys?

No. Many people with diabetes never develop kidney disease. The risk is higher than in people without diabetes, which is why regular kidney tests are part of standard diabetes care.

I feel well. Do I still need kidney tests?

Yes, if you have diabetes. Early diabetic kidney disease usually causes no symptoms, so tests are the only way to find it. Guidelines advise a urine ACR and eGFR at least once a year.

Is a urine dipstick enough to check for albumin?

A standard urine dipstick can miss small amounts of albumin. The urine ACR test is the test recommended by KDIGO and the American Diabetes Association for kidney screening in diabetes.

My ACR was raised once. Does that mean I have kidney disease?

Not necessarily. ACR can rise for a short time after exercise, during an infection or fever, during menstruation or when blood sugar is very high. A doctor will usually repeat the test to confirm before drawing any conclusion.

This page explains what a test or condition involves. It is not a diagnosis and does not replace advice from a doctor who knows your history. Your results should be interpreted together with your symptoms, other tests and a clinical assessment. Medical disclaimer.