Can diabetic nephropathy cause blood in urine?

Written by Zhou Qi
Nephrology
Updated on May 28, 2025
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Generally speaking, diabetic nephropathy does not cause hematuria. The main site of damage in diabetic nephropathy is indeed the glomerulus. Prolonged hyperglycemia and metabolic disorders can lead to damage to the capillaries of the glomerulus. However, the main clinical characteristic of this damage is proteinuria, which causes glomerulosclerosis and may also lead to renal failure, but it is rare for patients to have red blood cells in their urine or to experience hematuria. Therefore, if a patient with diabetic nephropathy has visible hematuria, such as red or tea-colored urine, it is necessary to check for other causes beyond diabetes, such as urinary tract infections, urogenital system stones, tumors, etc., all of which can cause hematuria.

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Written by Zhou Qi
Nephrology
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Can diabetic nephropathy with swollen feet be treated?

Patients with diabetic nephropathy who experience swelling in their feet often have significant amounts of protein in their urine or may have already developed renal failure. While there are ways to manage foot swelling, the fundamental issues may not be resolved. For swelling, diuretics can be used to increase urine output. If diuretics are ineffective, hemodialysis may be employed to ultrafiltrate and remove excess fluid from the body and alleviate swelling. However, these measures only address the symptoms on the surface. For patients with diabetic nephropathy, the underlying causes are due to diabetes, oxidative stress, and high blood sugar states, which damage the kidneys. Currently, there is no specific clinical treatment for these fundamental issues.

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Written by Zhou Qi
Nephrology
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How to reduce proteinuria in diabetic nephropathy.

A major clinical feature of diabetic nephropathy is the occurrence of proteinuria, which, if the condition continues to progress, can lead to kidney failure. Controlling proteinuria in the early stages of the disease is indeed very important. In terms of treatment, it is primarily necessary to use medications or insulin to control the patient's blood sugar, as hyperglycemia is the fundamental cause of diabetic nephropathy. Additionally, these patients often also have hypertension, necessitating the use of antihypertensive drugs to control blood pressure. When the patient's kidney function is not severely impaired, ACE inhibitors or ARBs can be the preferred choice of antihypertensive drugs, as they not only control blood pressure but also reduce proteinuria. However, if the patient's serum creatinine is significantly elevated, such as over 264 µmol/L, these drugs should no longer be used. (Medications should be used under the guidance of a doctor.)

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Written by Zhou Qi
Nephrology
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Is diabetic nephropathy with facial swelling serious?

Patients with diabetic nephropathy who experience facial swelling should not use this symptom as a basis for judging the severity of their condition. Diabetic nephropathy is divided into five stages. The condition is relatively mild during the first three stages. By the fourth stage, patients begin to exhibit significant proteinuria, and by the fifth stage, they experience severe renal failure. Conditions in these last two stages are quite severe. However, patients might also experience facial swelling during the first three stages, and while the likelihood of facial swelling increases during the fourth and fifth stages, some patients in these stages might not show obvious edema. Therefore, it is difficult to determine the severity of the condition based solely on swelling. Patients need to undergo 24-hour urinary protein quantification and blood tests to assess kidney function in order to judge the severity of their condition.

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Written by Zhou Qi
Nephrology
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How should diabetic nephropathy patients drink water?

For any kidney disease, regardless of whether it is caused by diabetes or not, the patient's water intake needs to be carefully considered. Generally, a few key points should be adhered to: First, there should be no excess accumulation of water in the patient's body. The water intake should be excreted normally through the kidneys without accumulating too much water, as excessive accumulation can increase blood pressure and even lead to pulmonary edema or heart failure. Second, if the patient's urine output decreases, water intake should be limited but not excessively, to avoid affecting the blood supply to the kidneys. Ideally, urine output should be maintained between 1000 to 2500 milliliters. Water intake should depend on urine output; if urine output is high, the patient can drink more water, but if it is low, intake should be appropriately restricted. It's necessary to weigh oneself daily to monitor changes in weight; if a large amount of water accumulates, weight will gradually increase, and at this time, water intake should be restricted.

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Written by Hu Lin
Nephrology
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Early symptoms of diabetic nephropathy

The early symptoms of diabetic nephropathy primarily include the presence of microalbuminuria, which is characterized by an albumin excretion rate of 30 to 300 mg per 24 hours, or a ratio of albumin to creatinine in spot urine ranging from 30 to 300 mg/g. However, this value needs to be tested three times over six months, with at least two of these tests meeting the above criteria for a diagnosis. Additionally, in the early stages of diabetes, patients' blood pressure tends to be within the normal range, but there is a trend toward elevation. Some patients may experience changes in the diurnal rhythm of their blood pressure, and the glomerular filtration rate may slightly increase or remain within the normal range.