What Are The Different Stages of Diabetic Kidney Disease?.

Diagram of kidneys showing damage caused by diabetes.

The stages of Diabetic Kidney Disease (DKD), which is a complication of diabetes that affects kidney function over time, are important for understanding how the disease progresses and impacts health.


DKD stages are commonly based on the eGFR, which reflects the kidneys' filtering capacity. Here's a simplified overview of the stages:

Stage 1: Kidney damage with normal or high eGFR (>90 mL/min/1.73 m²). At this early stage, there may be signs of kidney damage in the presence of normal kidney function, indicated by protein in the urine or physical damage noted in imaging tests.

Stage 2: Mild reduction in eGFR (60-89 mL/min/1.73 m²). There might still be some signs of kidney damage, but the kidneys are generally still functioning well.

Stage 3: Moderate reduction in eGFR, which is subdivided into two stages:

Stage 3a: eGFR 45-59 mL/min/1.73 m².

Stage 3b: eGFR 30-44 mL/min/1.73 m². Symptoms might become more noticeable at this stage, such as swelling in the extremities or changes in urine output.

Stage 4: Severe reduction in eGFR (15-29 mL/min/1.73 m²). Kidney function is clearly impaired at this stage, and preparations for kidney replacement therapy, like dialysis or a transplant, might begin.

Stage 5: Kidney failure (eGFR <15 mL/min/1.73 m²) or end-stage renal disease (ESRD). At this final stage, the kidneys have lost nearly all their function, and dialysis or a kidney transplant is necessary to sustain life.

Each stage of Diabetic Kidney Disease requires a different approach to management, focusing on slowing progression, managing symptoms, and maintaining quality of life. It's critical for patients to work closely with their healthcare team to monitor their condition, make lifestyle adjustments, manage blood sugar and blood pressure, and treat any complications that arise.

Symptoms associated with each stage of Diabetic Kidney Disease (DKD)

Stage 1 and 2: Mild Kidney Damage

  • Symptoms: At these initial stages, symptoms are usually not present. However, subtle signs can include slightly elevated protein in urine and high blood sugar levels that may start to affect the kidneys.
  • Detection: Regular urine tests for albumin (a type of protein) can help detect kidney damage early, even when symptoms are not noticeable. 

Stage 3: Moderate Kidney Damage

  • Symptoms: As kidney function declines, symptoms may include swelling in the ankles and feet, increased urination, particularly at night, and high blood pressure.
  • Management: It's crucial to manage blood sugar and blood pressure to slow the progression of kidney damage. Annual checks of blood, urine, and blood pressure are recommended. 

Stage 4: Severe Kidney Damage

  • Symptoms: Symptoms become more evident and can include further swelling, fatigue, nausea, vomiting, and a loss of appetite. The body may retain more water and salt, leading to weight gain.
  • Treatment: A healthcare provider may prescribe ACE inhibitors or ARBs, which have been shown to slow the loss of kidney function, even in individuals with normal blood pressure. 

Stage 5: End-Stage Kidney Disease (ESRD)

  • Symptoms: In ESRD, the kidneys are no longer able to filter waste effectively. Symptoms can include itching, muscle cramps, especially in the legs, and changes in insulin need due to less breakdown by diseased kidneys.
  • Treatment: Treatment options include kidney transplantation, hemodialysis, and peritoneal dialysis.


Throughout all stages, it's essential to control diabetes and high blood pressure, treat urinary tract infections promptly, and avoid medicines that may damage the kidneys, such as NSAIDs. 

For individuals with diabetes, maintaining control of blood sugar levels has been shown to reduce the risk of progressing from microalbuminuria (small amounts of protein in the urine) to macroalbuminuria (larger amounts of protein), which can lead to ESRD.

Lastly, symptoms of kidney disease are often not specific and can include general feelings of illness such as loss of sleep, poor appetite, and difficulty concentrating. Therefore, regular medical check-ups are vital for early detection and management of DKD.

For detailed information and guidance, it is advisable to consult with healthcare providers.