Your kidneys are your body’s filter units. They work 24 hours a day to rid your body of the toxins that your body makes or takes in. Toxins from the blood enter the kidneys by crossing the walls of small blood vessels along its border. In people with nephropathy, these tiny blood vessels, called capillaries, are unable to filter out the impurities in your blood. They begin to leak,  allowing some of the waste products that should be removed to stay in your blood, and some of the proteins and nutrients that should remain in your blood to be lost in the urine. Symptoms of kidney disease usually occur after much kidney damage has already been done and may be subtle: fluid buildup, sleeplessness and tiredness, vomiting, or weakness.

Fortunately, damage can be detected early through a urine test for small amounts of protein.

When you first develop diabetes, you may have an excess of protein in your urine. This is usually a temporary condition.

Unchecked hypertension and a period of hyperglycemia before diagnosis could contribute to this condition. But the more obvious symptoms of kidney disease take a long time to appear. The kidneys have so much extra filtering ability that noticeable problems will not appear until 80 percent of the kidneys are damaged.

Not everyone with diabetes develops nephropathy. Severe kidney damage is more common in people with type 1 diabetes than in those with type 2. However, kidney damage can also result from high blood pressure, and many people with type 2 diabetes also have hypertension. Years of high blood pressure can damage the delicate filters in the kidneys, leading to less efficient removal of waste products from the blood. The good news is that there are steps you can take to reduce your risk of nephropathy.

Prevention
The most important thing you can do to prevent kidney damage is to keep your blood glucose levels close to normal. The DCCT showed that people in the intensive management group reduced their risk of kidney disease by 35 to 56 percent.

Another important step you can take is to keep your blood pressure in the target range. If your blood pressure is high, the delicate capillaries in your kidneys can become damaged.

Two things that you can do to lower high blood pressure are to keep a healthy body weight and to eat less salt. If kidney damage is advanced or if you cannot reduce your blood pressure with these steps,  you may need one or more medicines to lower blood pressure. ACE inhibitors and ARBs are blood pressure medications that also preserve kidney function.