Is early diabetic nephropathy reversible?

Written by Luo Han Ying
Endocrinology
Updated on March 10, 2025
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Diabetic nephropathy clinically mainly manifests as an increase in urine protein on routine urine tests. Thus, diabetic nephropathy can be classified into different stages. In the early stages, microalbuminuria appears, and at this early phase, diabetic nephropathy is actually reversible. However, if the condition progresses with significant proteinuria, it becomes difficult to reverse diabetic nephropathy through intervention treatments. Most clinical patients may experience a slight reduction in urine protein or maintain this condition long-term without further progression. However, some patients have already experienced an increase in creatinine levels by the time they reach this stage of diabetic nephropathy, making it particularly challenging to reverse the condition once creatinine levels rise. Therefore, for diabetic nephropathy, early detection and treatment are crucial, with the most important goal being the prevention of the disease's onset.

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Written by Zhou Qi
Nephrology
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How many years can a person with diabetic nephropathy live?

Diabetic nephropathy is divided into several stages, from mild to severe. In the early stage, patients only have an increased glomerular filtration rate and the proteinuria is not significant. As the disease progresses, the protein in the urine increases, eventually leading to renal failure and even developing into uremia. The entire process can last many years, with some patients experiencing it for up to ten years. In fact, when diabetic nephropathy progresses to its final stage, uremia, patients still have many treatment options, such as hemodialysis, peritoneal dialysis, or kidney transplantation, and even combined kidney and pancreas transplantation. Therefore, how long a patient can live depends on the patient's age, presence of cardiovascular and cerebrovascular diseases, and the choice of treatment methods, among other factors.

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Written by Zhou Qi
Nephrology
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Symptoms of stage four diabetic nephropathy

Stage four of diabetic nephropathy indicates the presence of significant amounts of urinary protein. At this stage, patients may exhibit symptoms of nephrotic syndrome, which means the total urinary protein quantification over 24 hours may exceed 3.5 grams, and the plasma albumin level may be lower than 30 grams per liter. Due to the large amount of protein leakage, patients may experience edema, presenting as swelling of the lower limbs or eyelids, or even severe generalized swelling. In addition to edema, patients may also have pleural and abdominal effusion, leading to pulmonary edema. Excessive fluid can overburden the heart, causing heart failure, which manifests as chest tightness, shortness of breath, and difficulty breathing, especially when the patient is active, these symptoms of chest tightness and shortness of breath become more pronounced.

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Nephrology
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Is diabetic nephropathy stage 3 reversible?

Patients with diabetic nephropathy actually have an irreversible condition. If a patient has developed mild to moderate proteinuria and entered stage three, it's generally because of long-term high blood sugar, oxidative stress, and an excess of glycation end products damaging the capillaries of the glomerulus, resulting in increased permeability and the occurrence of proteinuria. The damage that has already occurred cannot be reversed; however, patients still need active treatment to control their blood sugar and blood pressure in order to slow down the progression of diabetic nephropathy as much as possible. Stage three diabetic nephropathy is incurable, but treatment can slow the progression of the kidney disease, preventing the development from microalbuminuria to macroalbuminuria. Stage three refers to the early period of diabetic nephropathy, typically seen in diabetic patients who have had the disease for more than five years. It can feature a continuous increase in urinary albumin excretion rates. High filtration rates and long-term poor metabolic control may be reasons for the persistent microalbuminuria. During this stage, patients may experience a mild increase in blood pressure, and reducing blood pressure can decrease the excretion of microalbumin. During this period, strict control of blood sugar is necessary. Oral hypoglycemic drugs can be used for treatment, and it's crucial to regularly monitor fasting blood glucose, postprandial blood glucose, and glycated hemoglobin. Blood pressure should also be actively controlled, generally targeting a value of 130/80mmHg. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are preferred as they can lower blood pressure, reduce proteinuria, and have a protective effect on the kidneys, thus delaying the progression of kidney disease.

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Written by Zhou Qi
Nephrology
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How to reduce proteinuria in diabetic nephropathy.

A major clinical feature of diabetic nephropathy is the occurrence of proteinuria, which, if the condition continues to progress, can lead to kidney failure. Controlling proteinuria in the early stages of the disease is indeed very important. In terms of treatment, it is primarily necessary to use medications or insulin to control the patient's blood sugar, as hyperglycemia is the fundamental cause of diabetic nephropathy. Additionally, these patients often also have hypertension, necessitating the use of antihypertensive drugs to control blood pressure. When the patient's kidney function is not severely impaired, ACE inhibitors or ARBs can be the preferred choice of antihypertensive drugs, as they not only control blood pressure but also reduce proteinuria. However, if the patient's serum creatinine is significantly elevated, such as over 264 µmol/L, these drugs should no longer be used. (Medications should be used under the guidance of a doctor.)

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Written by Zhou Qi
Nephrology
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Does diabetic nephropathy require a biopsy?

Whether a patient with diabetic nephropathy needs a biopsy depends on the condition of the patient. Firstly, if the kidney disease is in the early stages and the blood creatinine level has not exceeded 256 micromoles per liter, a kidney biopsy can be considered. Otherwise, if the blood creatinine level exceeds 256 micromoles per liter, a biopsy is no longer meaningful since significant fibrosis and hardening of kidney tissue have already occurred. At this point, if it is unclear whether the proteinuria is caused by diabetes or another disease, a kidney biopsy can be considered to diagnose the cause and extent of glomerular damage, and to provide a basis for treatment.