Nearly 85% of chronic kidney disease cases in people with diabetes are caused by diabetic kidney disease (DKD), making diabetes the leading cause of kidney failure nationwide. But according to ANC’s Dr. Maryyam Ali, who specializes in diabetic kidney disease, the most surprising part isn’t how common DKD is, it’s how early it starts, often silently, long before patients or their doctors notice a problem.
A Decade-Long Head Start
Research suggests kidney damage from diabetes can begin 10 to 15 years before creatinine, the standard blood marker doctors use to track kidney function, ever shifts out of the normal range. By the time creatinine rises, a patient may already be approaching stage 3 kidney disease. Dr. Ali points to a more sensitive early warning sign: urine protein. Even small amounts can signal that diabetes has already begun affecting the kidneys’ filtering system.
Well-controlled blood sugar can significantly delay this process, but it typically doesn’t prevent it altogether. The earlier treatment starts, the bigger the difference it can make. Dr. Ali compares it to adjusting an incline early on a ramp: a small change made early creates a much bigger shift over time than the same change made later, once damage has had years to build.
New Tools Are Changing the Outlook
The last several years have brought major advances in DKD treatment. Alongside longstanding options like ACE inhibitors and ARBs, newer medications such as SGLT2 inhibitors (Jardiance, Farxiga) and GLP-1 receptor agonists have shown real benefit for kidney outcomes, with current data favoring SGLT2 inhibitors as the more protective option for most patients. Encouragingly, diabetic kidney disease is the only kidney disease where early-stage damage can potentially be partially reversed through a combination of blood sugar control and medication, provided treatment begins before significant scarring sets in.
An Unexpected Warning Sign: Your Eyes
One of the most surprising insights from Dr. Ali: diabetic retinopathy, detected during a routine dilated eye exam, is a near one-to-one indicator of what’s happening inside the kidneys. Because retinal blood vessels are directly visible, changes there closely mirror changes happening in the kidneys’ own vessels, sometimes as reliably as a biopsy. The same holds true for hypertension, even patients with normal blood pressure readings at the doctor’s office can have hidden hypertension revealed through an eye exam. Despite this strong connection, referrals from eye doctors to nephrology remain uncommon, making it especially important for patients and primary care providers to ask the question directly.
Take the Next Step
If you have diabetes, ask your doctor about checking your urine protein and keep up with annual eye exams. Both may reveal what’s happening in your kidneys long before symptoms appear.
