best sugar management clinics in yelahanka The main effects of diabetic nephropathy include protein in the urine (foamy urine), swelling in the hands, feet, or ankles, and high blood pressure that is difficult to control. Other effects include fatigue, nausea, vomiting, and changes in urination patterns. If left untreated, it can lead to serious complications like cardiovascular disease and kidney failure requiring dialysis or a transplant.