How to Detect Diabetic Kidney Disease Early and Strive for Reversal?

Approximately 20%–40% of patients with diabetes in China have diabetic kidney disease (DKD) — meaning at least 1 in every 5 people with diabetes develops DKD.
Diabetic kidney disease is the leading cause of end-stage renal disease and one of the main causes of disability and death in patients with diabetes.
How can patients with diabetes detect DKD early, receive active treatment, and avoid progression to dialysis?
Early detection of DKD cannot rely on symptoms
Many patients with diabetes believe:“I have no typical kidney symptoms such as backache, high blood pressure, or edema, so I definitely do not have DKD.”
In reality, in the early stage of DKD, patients usually feel no obvious abnormalities — only an increase in urinary microalbumin. This change is asymptomatic and can only be detected through laboratory tests.For this reason, early-stage DKD is easily overlooked, causing patients to miss the window for early intervention.
Intervention at this early stage offers a realistic chance of reversing DKD.By the time obvious symptoms appear, renal damage is already severe. Approximately 30% of patients may already have nephrotic syndrome, characterized by heavy proteinuria, hypoalbuminemia, edema, and dyslipidemia. As the disease progresses, hypertension worsens and marked edema develops. At this point, DKD is no longer reversible.
Patients will gradually develop declining renal function and renal failure, requiring dialysis or kidney transplantation to sustain life.
Therefore, early detection of DKD must not depend solely on symptoms.
Two screening tests to detect early DKD
The development and progression of renal damage in DKD are mainly marked by progressive decline in renal function and increased urinary microalbumin. Clinical diagnosis relies primarily on urinary albumin excretion rate and estimated glomerular filtration rate (eGFR).

Patients with type 2 diabetes should be screened for renal disease at diagnosis and at least annually thereafter.
Patients with type 1 diabetes typically develop DKD about 5 years after diagnosis, so annual screening can start 5 years after diagnosis.

Definition of abnormal urinary albumin excretion:

Normal albuminuria: Urinary albumin/creatinine ratio (UACR) < 30 mg/g
Microalbuminuria: 30 mg/g ≤ UACR ≤ 300 mg/g
Macroalbuminuria: UACR > 300 mg/g

An elevated urinary albumin excretion is defined as random urine UACR ≥ 30 mg/g.If UACR is repeated within 3–6 months and is elevated in 2 out of 3 tests, after excluding infection and other confounding factors, a diagnosis of albuminuria can be made.
After confirming DKD, the severity of renal damage can be further staged using eGFR.
Stages of renal impairment:

Stage 1: Kidney damage with normal eGFR ≥ 90 mL/(min·1.73 m²)
Stage 2: Kidney damage with mildly decreased eGFR 60–89 mL/(min·1.73 m²)
Stage 3a: Mildly to moderately decreased eGFR 45–59 mL/(min·1.73 m²)
Stage 3b: Moderately to severely decreased eGFR 30–44 mL/(min·1.73 m²)
Stage 4: Severely decreased eGFR 15–29 mL/(min·1.73 m²)
Stage 5: Renal failure, eGFR < 15 mL/(min·1.73 m²) or dialysis

Patients with diabetes can check their lab results to assess their kidney health.
Seek immediate medical attention if these 2 symptoms appear
Although early DKD is often asymptomatic, patients should still watch for subtle warning signs. If either of the following occurs, screening for DKD is urgently needed.

1. Fine, persistent foam in the urine
   Foamy urine caused by proteinuria:A layer of tiny bubbles resembling beer foam or beaten egg whites, which does not dissipate after 20 minutes. This is highly suggestive of proteinuria and a sign of kidney damage.
   Foamy urine not related to proteinuria:May occur with poor glycemic control, urinary tract infection, or rapid urination. These bubbles usually disappear within about 20 minutes and are not a cause for concern.
2. Facial swelling upon waking
   Marked facial edema in the early morning, making the face appear swollen, can be an early sign of DKD.
   If patients with diabetes develop either of these symptoms, they must see a doctor promptly for testing to confirm kidney involvement. Early diagnosis and timely treatment offer the best chance to reverse the condition.