There are no symptoms in the early stages of diabetic nephropathy. The only sign of kidney damage may be small amounts of protein leaking into the urine (microalbuminuria). Normally, protein is not found in urine except during periods of high fever, strenuous exercise, pregnancy, or infection.

In people with type 1 diabetes, diabetic nephropathy usually develops 5 to 10 years after the onset of diabetes. People with type 2 diabetes may find out that they already have a small amount of protein in the urine (microalbuminuria) at the time diabetes is diagnosed, because they may have had diabetes for several years.

As diabetic nephropathy progresses, your kidneys cannot do their job as well. Your kidneys cannot clear toxins or drugs from your body as well. And your kidneys cannot balance the chemicals in your blood very well. You may:

* Lose more protein in your urine (macroalbuminuria, also known as overt nephropathy).
* Have higher blood pressure.
* Have higher cholesterol and triglyceride levels.

You may have symptoms if your nephropathy gets worse. These symptoms include:

* Swelling (edema), first in the feet and legs and later throughout your body.
* Poor appetite.
* Weight loss.
* Weakness.
* Feeling tired or worn out.
* Nausea or vomiting.
* Trouble sleeping.

If the kidneys are severely damaged, blood sugar levels may drop because the kidneys cannot remove excess insulin or filter oral medicines that increase insulin production, such as glipizide (Glucotrol) or glyburide (for example, Micronase).

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