Last reviewed by Dr. Leena Joshi, MD, August 2026
Dr. Leena Joshi, MD is a board-certified nephrologist who treats diabetic kidney disease in Burlingame, Daly City, and San Mateo County. Diabetic kidney disease (diabetic nephropathy) is kidney damage caused by long-standing high blood sugar, and it is the leading cause of kidney failure. Dr. Joshi’s focus is early intervention: catching protein in the urine or a falling eGFR early, then using blood sugar control, blood pressure control, and kidney-protective medicines to keep as much function as possible. New patient appointments are typically available within days. Call (650) 355-5551.
What is diabetic kidney disease?
High blood sugar damages the tiny blood vessels that filter blood inside the kidneys. As the filters weaken, protein (albumin) leaks into the urine and waste builds up in the blood. The damage develops slowly over years and can happen in both type 1 and type 2 diabetes. It is usually found on a routine urine albumin test or a falling eGFR, often before there are any symptoms.
What are the signs of diabetic kidney disease?
- Protein or albumin in the urine on a routine test
- Foamy or bubbly urine
- Swelling in the legs, ankles, feet, or hands
- Rising blood pressure or blood pressure that is hard to control
- Increased urination, especially at night
- Fatigue, poor appetite, or nausea in later stages
How does Dr. Joshi manage diabetic kidney disease?
Dr. Joshi starts with kidney function labs and a urine albumin-to-creatinine ratio (ACR) to measure how much protein is leaking. Then she works on the four levers that slow damage: blood sugar targets set with your diabetes care team; blood pressure control using medicines that also protect the kidneys (ACE inhibitors or ARBs); newer kidney-protective medicines such as SGLT2 inhibitors, and for many patients GLP-1 medicines or finerenone; and a diet plan matched to your stage. She reviews every medication for kidney safety, monitors labs on a set schedule, and coordinates with your primary care doctor and endocrinologist so the plan is one plan, not three.
When should someone with diabetes see a nephrologist?
- A urine test shows albumin or protein
- Your eGFR is below 60, or is falling year over year
- You have had diabetes for more than five years and have never had kidney labs
- Your blood pressure stays high despite medication
- You have swelling, foamy urine, or unexplained fatigue
Related reading: the stages of diabetic kidney disease, kidney lab results explained, and chronic kidney disease treatment.
Frequently asked questions
Can diabetic kidney disease be reversed?
Established damage usually cannot be reversed, but with tight blood sugar and blood pressure control and kidney-protective medicines, progression can often be slowed or stopped. The earlier it is caught, the more kidney function can be kept.
How often should someone with diabetes see a kidney specialist?
Once kidney involvement is found (protein in the urine or a falling eGFR), Dr. Joshi typically sees patients every 3 to 6 months, adjusting the schedule to how stable the labs are.
What blood pressure goal should I aim for?
For most people with diabetes and kidney disease the target is below 130/80, but Dr. Joshi sets your goal individually based on your other conditions and how you tolerate medication.
What medications protect the kidneys in diabetes?
ACE inhibitors or ARBs, SGLT2 inhibitors, and for many patients GLP-1 medicines or finerenone. Dr. Joshi chooses based on your kidney function, blood sugar, heart health, and other medications.
Does diabetic kidney disease always lead to dialysis?
No. Many patients maintain adequate kidney function for years with proper management. Dr. Joshi monitors closely and discusses dialysis or transplant only if function falls to a level where they are needed.
What foods should be limited with diabetic kidney disease?
Sodium first, then depending on your stage, potassium, phosphorus, and protein. Dr. Joshi bases limits on your labs and can refer you to a renal dietitian.
Schedule an appointment
Dr. Leena Joshi, MD is a board-certified nephrologist with offices at 1750 El Camino Real, Suite 301, Burlingame and 1800 Sullivan Ave, Suite 507, Daly City. New patient appointments are typically available within days. A referral from your doctor is required; visits are by appointment only. Call (650) 355-5551.
This page is for general education and is not a substitute for medical advice. Always consult your physician about your specific situation.
Medically reviewed by Leena Joshi, MD.