Diabetes can affect the kidneys long before symptoms appear. The good news is that kidney risk can often be identified early and addressed with glucose, blood pressure, lipid and kidney-protective treatment.
What Should Be Checked?
Two key tests are eGFR, estimated from blood creatinine, and urine albumin-to-creatinine ratio (UACR). Persistent albuminuria or reduced eGFR can indicate chronic kidney disease and should prompt structured follow-up.
Why UACR Matters
Urine albumin can increase before substantial loss of filtration. An abnormal result should generally be confirmed because temporary factors such as exercise, infection or marked hyperglycemia can affect urinary albumin.
How Treatment Has Changed
For people with type 2 diabetes and chronic kidney disease, ADA 2026 recommends an SGLT2 inhibitor with demonstrated kidney benefit in appropriate patients, and recommends a GLP-1 receptor agonist with demonstrated benefit for kidney and cardiovascular risk reduction. These benefits are not simply about lowering HbA1c.
Protect the Kidneys Every Day
- Maintain individualized glucose targets.
- Control blood pressure.
- Use kidney-protective medicines when indicated.
- Avoid unnecessary NSAID use and dehydration.
- Stop smoking.
- Monitor UACR and eGFR at appropriate intervals.
When Should You See an Endocrinologist?
See an endocrinologist when albuminuria is persistent, eGFR is declining, glucose control is difficult, multiple medicines are required, or treatment needs to be individualized around kidney disease.
Dr. Moxit Shah, DM Endocrinology, provides individualized diabetes and endocrine care at Vishuddha Endocrine Clinic, Ahmedabad. Read our Diabetes Management Guide for a broader overview.
Key Takeaways
- eGFR and UACR are central to kidney risk assessment in diabetes.
- Kidney-protective treatment may be appropriate even when HbA1c is already at target.
- Regular monitoring allows treatment to be adjusted before kidney disease becomes advanced.
References
- ADA Standards of Care in Diabetes—2026: Chronic Kidney Disease and Risk Management.
- ADA Standards of Care in Diabetes—2026: Pharmacologic Approaches to Glycemic Treatment.
Dr. Moxit Shah, DM Endocrinology
Vishuddha Endocrine Clinic
104-105, Elite Magnum, Bhuyangdev Cross Road, Ahmedabad, Gujarat 380061
Phone: +91 99799 92797
