In the kidney, urine is formed from waste substances and water that are passed from millions of tiny blood vessels into the drainage tubes. With diabetes, the walls of these blood vessels sometimes thicken until the waste substances and water can no longer pass out of the blood vessels to start forming urine. The kidneys have an enormous reserve capacity and most of the blood vessels have to be damaged before there is any noticeable effect.

Proteinuria

The earliest sign of kidney damage is protein in the urine, called proteinuria. This can be discovered with urine tests and everyone with diabetes should have his or her urine checked for protein at regular intervals. Nowadays, many clinics are testing urine for microalbuminuria, tiny amounts of protein which may indicate the earliest stages of diabetic kidney damage in people with insulin-dependent diabetes. In those with non-insulin dependent diabetes microalbuminuria may indicate an increased risk of heart or other blood vessel problems. If it is found in several samples but without urinary tract infection other kidney tests can be carried out. Proteinuria does not necessarily mean you have other kidney function problems but it does indicate the need to check for them. If you have high blood pressure it must be very carefully controlled and frequent checks must be made for urinary tract infection.

Cystitis

The commonest cause of proteinuria among people with diabetes is urinary tract infection, such as cystitis or bladder infection, pyelonephritis or kidney infection. A midstream urine sample is easily taken and will be sent to the laboratory for analysis so that appropriate antibiotics can be given. Non-diabetic men rarely have urinary tract infection but diabetic men may do so and it is common in women. The symptoms are a burning sensation on passing urine which may have blood in it or smell bad, and a very frequent desire to pass urine, although there may be little there to pass. Urinary tract infection may upset your glucose balance and so your blood glucose levels should be checked frequently.

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