How diabetes and hypertension damage the kidneys
In diabetes, high glucose damages the glomeruli, the filters of the kidneys, and makes them let albumin into the urine. The first sign is usually a slight rise in albumin (microalbuminuria), and later eGFR falls. In hypertension, high pressure thickens and narrows the kidney vessels and leads to nephrosclerosis. The two processes often coexist and accelerate each other (see diabetes and blood pressure).
Screening: why it is needed every year
People with diabetes or hypertension have the urine albumin/creatinine ratio and creatinine with eGFR checked at least once a year. A positive result is confirmed in 2 of 3 samples within three to six months, because fever, exercise and urinary infections can raise it temporarily. Screening detects damage before function falls and when intervention is most effective. For type 1 diabetes, screening begins some years after diagnosis.
Treatment
The basis is good control of glycemia (individualized HbA1c) and blood pressure (often below 130/80 mmHg, “13 over 8”). For albuminuria, the doctor chooses medicines that protect the kidneys and checks potassium and creatinine after starting. Some newer anti-diabetic medicines have proven benefit for the kidneys and heart; the choice is made by the doctor according to function. Other measures: reducing salt, stopping smoking, controlling lipids and weight.
Nonsteroidal anti-inflammatory drugs are avoided. When function falls, the dose of metformin and other medicines is reviewed. Tell the doctor about vomiting and diarrhea that cause dehydration.
What you can do yourself: home measurements and daily habits
Patients with diabetes or hypertension can greatly influence the course of kidney disease through regular follow-up. Measuring blood pressure at home with a validated device, seated after five minutes of rest, twice in the morning and twice in the evening for a week before the visit, gives a more reliable picture than a single measurement in the clinic. The target and the blood pressure medicines are set by the doctor; your records help adjust treatment. For glucose, as directed, self-monitoring or a sensor may be used, and HbA1c is checked every three to six months depending on stability.
Salt is reduced to about 5 g a day, which usually lowers blood pressure by a few mmHg and increases the effect of medicines against proteinuria. Diabetes also calls for attention to carbohydrate foods with a low glycemic index, regular activity and weight loss when overweight; a 5–10% weight loss clearly improves glucose and blood pressure. Smoking accelerates kidney and vascular damage. Avoid nonsteroidal anti-inflammatory drugs, because combined with blood pressure medicines and diuretics they can cause acute kidney injury (the “triple whammy”).
Some anti-diabetic medicines (for example metformin) are reviewed when eGFR falls and are stopped temporarily during dehydration; tell the doctor about vomiting and diarrhea. Foot care and an annual eye examination complete the protection, because small-vessel complications usually go together.
What the tests show and questions for the visit
Three indicators are read together: eGFR (how much the kidney filters), the urine albumin/creatinine ratio (how much damage there is in the filter) and blood pressure. Staging relies on the first two; preserved eGFR with raised albuminuria is not the same as reduced eGFR without albuminuria. Improvement of albuminuria with treatment is associated with a lower risk of progression, so it is followed as a target, not just a diagnosis.
Useful questions: what is my albuminuria and is it falling; which medicines have proven benefit for the kidneys and heart; what glucose and blood pressure targets do I have; which signs call for quick contact; when is the next check. Bring your measurement diary and the list of medicines.
Follow-up and services
Reviews are every 6 months to a year, or sooner when the doctor considers it reasonable: blood pressure, HbA1c, creatinine, eGFR, urine albumin, potassium and lipids. Eye and foot checks complete the assessment, because small-vessel complications often go together.
Care at Tirana Polyclinic: we offer nephrology consultation, 24-hour blood pressure monitoring, abdominal ultrasound and interpretation of tests. Dialysis and transplant are services of specialized centers outside the clinic.
Key sources
This information is educational and does not replace a visit to the doctor. Do not change your treatment without consulting your doctor. Updated: October 2026.