Kidney disease is when your kidneys are not functioning as they should.

When kidney disease lasts for more than 3 months, it is called chronic kidney disease or CKD.

When the kidney is suddenly injured that is called acute kidney injury or AKI.

Waste isn’t removed
When you have chronic kidney disease, waste products and salts and water are not cleared from your body the way they should be. These waste products accumulate in your body.

Progression
Chronic kidney disease usually progresses slowly over time but how fast it progesses may be different from person to person.

Signs or symptoms may not be obvious
Often, few symptoms appear until kidney function is reduced to less than 15% of normal.

Other organs affected
The kidneys talk to many other body systems, including the heart, lungs, brain, blood, and skin. These too may be affected when there is kidney disease.

eGFR
A blood test called eGFR (estimated Glomerular Filtration Rate) tells you and your doctor how well your kidneys remove wastes from your body. Normal eGFR is over 100. An eGFR of less than 60 may be because of kidney disease.

Urine protein
Protein is natural in your body but is not normally found in the urine. A test can be done to check for protein in a urine sample. Too much protein could be a sign of damage to the kidney.

High blood pressure
High blood pressure may be a sign of kidney disease.

Ultrasound
A picture of your kidneys taken with an ultrasound machine can check the size of your kidneys and for cysts or kidney stones

Blood pressure
People with chronic kidney disease should discuss with their doctor the best blood pressure goal for them. For few patients, less than 130/80 is recommended as a treatment goal.

Medicines
Patients with chronic kidney disease should take regular medicines to slow progression of kidney disease.

Managing other complications
Patients with chronic kidney disease should be evaluated and treated for complications related to kidney disease such as anemia and mineral disorders.

Healthy Lifestyle
Patients with kidney disease should not smoke, should be physically active.

Managing your health
You are the most important member of the team. You should be an active member on our care team.

Learn about kidney health, ask questions, and talk regularly with us

Working with our team
You will work closely with our team to come up with the plan of care which will make you feel comfortable.

A registered dietician will work with you to set goals for your diet; a physical therapist will help you set goals for exercise and physical activity, and a social worker will help you locate and cope with your kidney disease.

What is the health of my kidney?

What is the cause of my kidney disease?

What type of changes in my diet will help protect my kidneys?

How will I know if my kidney disease is getting worse?

How frequently do I need to consult my nephrologist?

1. Keep fit, Be active

Keeping your body fit and active has many health benefits. This can help to maintain an ideal body weight, reduce your blood pressure and the risk of Chronic Kidney Disease.

2. Eat a healthy diet

This can help to maintain an ideal body weight, reduce your blood pressure, prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease.
Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day. This includes the salt already in your foods. To reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your salt intake if you prepare the food yourself with fresh ingredients.

3. Check and control your blood sugar

About half of people who have diabetes do not know they have diabetes. Therefore, you need to check your blood sugar level as part of your general body checkup. This is especially important for those who are approaching middle age or older. About 30 - 40% people who have diabetes develop kidney damage; but this can be prevented/ limited if the diabetes is well controlled. Check your kidney function regularly with blood and urine tests.

4. Check and control your blood pressure

About half of people who have high blood pressure do not know they have high blood pressure. Therefore, you need to check your blood pressure as part of your general body checkup. This is especially important for those who are approaching middle age or older. High blood pressure can damage your kidneys. This is especially likely when associated with other factors like diabetes, high cholesterol and Cardio-Vascular Diseases. The risk can be reduced with good control of blood pressure.

5. Adequate hydration / Take appropriate fluid intake

The right level of fluid intake for any individual depends on many factors including exercise, climate, health conditions, pregnancy and breastfeeding.
Normally this means 8 to 10 glasses, approximately 2 liters per day for a healthy person in a comfortable climate condition.
This needs to be adjusted when in severe climate condition. Your fluid intake may need to be adjusted if you have kidney or heart or liver disease. Consult your doctor on the appropriate fluid intake for your condition.

6. Don’t smoke

Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it can decrease their ability to function normally. Smoking also increases the risk of kidney cancer.

7. Don’t take over-the-counter anti-inflammatory/pain-killer pills regularly or Don't take any nephrotoxic drugs 

Common drugs such as non-steroidal anti-inflammatory (NSAIDS)/ pain-killer (e.g. drugs like ibuprofen) can harm the kidneys if taken regularly. If you have kidney disease or decreased kidney function, taking just a few doses can do harm to your kidneys. There are many other drugs also which can harm kidneys. You should never take any drug without consulting your doctor.

8. Get your kidney function checked if you have one or more of the following ‘high risk’ factors:

Diabetes, Hypertension, Obesity, Family history of kidney disease, Age more than 60 years

We have two kidneys, each about the size of an adult fist. They are located on either side of the spine just below the rib cage. Each kidney contains approximately one million filtering units called ‘Nephrons' in which the filter is called 'Glomerulus'. The kidneys are complicated and amazing organs that do many essential tasks to keep us healthy.

Functions of kidney :

• Purify blood by removing waste and toxins from the body


• Regulate fluid, electrolyte and acid-base balance in body


• Maintain haemoglobin by regulating the production of red blood cells


• Keep our bones healthy by regulating vitamin D, calcium and phosphorus homeostasis


• Release hormones that help regulate blood pressure. Kidney is one of the most important organs regulating blood pressure.

 

There are certain factors that can increase the chances of getting a kidney disease, but do not necessarily cause the kidney disease. These are called risk factors for kidney disease.
If you know the risk factors and ask your doctor for a regular kidney health checkup , you can help to detect kidney disease early and improve your outcomes.

Diabetes
Diabetes is the leading cause of kidney disease. Diabetes is a disease that causes your body to have trouble making or using insulin. When your body doesn’t use insulin the right way, too much sugar stays in your blood, which can lead to chronic kidney disease over time.

High blood pressure/ Hypertension
High blood pressure is one of the most common causes of kidney disease. High blood pressure means your heart is working too hard to pump your blood. When blood flows too forcefully through the tiny blood vessels in your kidneys, this can hurt these tiny vessels. Over time, this can lead to chronic kidney disease.

Family history of kidney disease
If you are related to someone who has chronic kidney disease, you are at greater risk of chronic kidney disease yourself. Diabetes and high blood pressure also run in families, and can increase your risk of getting kidney disease.

Race 
Due to genetics, people of certain races/ethnicities (e.g. African American) are at higher risk for having high blood pressure, diabetes, kidney disease.

Old age
Over time, the kidneys lose some function naturally and have less reserve to fight stressful conditions for kidneys. People, who are older than 60, are more likely to have kidney failure.

Systemic Diseases
Heart disease/ Cardiovascular disease, Cerebrovascular disease (Stroke), Liver cirrhosis, Renal stone disease, Recurrent urinary tract infections, Autoimmune conditions like SLE, RA etc.

Obesity
Being obese puts you at greater risk for the two biggest causes of kidney disease: diabetes and high blood pressure.  This means that being obese puts you at greater risk for kidney disease too.

Smoking
Smoking can cause high blood pressure, cardiovascular diseases. Smoking also causes blockages in your body’s blood vessels. When a blood vessel is blocked, your kidneys cannot get the blood flow they need, and this can cause damage, which can lead to chronic kidney disease. Smoking also accelerates the progression of kidney disease.

Having a history of acute kidney injury (AKI)
Acute kidney injury is when your kidneys stop working suddenly, over a short period of time. People who have had acute kidney injury before are more at risk for chronic kidney disease than people who have never had acute kidney injury.

Abnormal kidney structure

Medicine
Some nephrotoxic medications, such as over-the-counter pain medications (NSAIDS), may cause or worsen kidney disease.

In most cases, chronic kidney disease (CKD) is caused by other health problems that cause permanent damage to your kidneys little by little, over time. When you have damage in your kidneys, they may not work as well as they should. If the damage continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease or ESRD.

The two major causes of chronic kidney disease are diabetes and hypertension, which are responsible for up to 60-70% of the cases.

• Diabetes: Diabetes is the most common cause of CKD. It happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes.


• Hypertension: High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and CKD. Also, chronic kidney disease can itself cause high blood pressure.
  

Other conditions that affect the kidneys are:

• Glomerulonephritis (GN), a group of diseases that cause inflammation and damage to the kidney's filtering units.


• Interstitial nephritis, an inflammation of the kidney's tubules and surrounding structures.


• Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.


• CAKUT (Congenital Anomalies of the Kidney and Urinary tract): Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.


• Autoimmune disease: Lupus, rheumatoid arthritis and other autoimmune diseases that affect the body's immune system may also effect kidneys.


• Obstructive Nephropathy: Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.


• Repeated urinary infections.


• Some nephrotoxic drugs can cause CKD, especially some pain-killing drugs (analgesics) if taken over a long time.

Chronic kidney disease (CKD) is called a ‘Silent Disease’ as there are often no warning signs in initial period. As the kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until significant irreversible damage has occurred. It is not uncommon for people to lose up to 80 to 90 per cent of their kidney function before getting any symptoms. For CKD, it is said that “If you wait until you have symptoms to be tested, you have waited too long”. There are, however, some signs that may indicate reduced kidney function and it is important to take note of them.

Symptoms of kidney disease include:

• Changes in the amount and number of times urine is passed, need to urinate more often especially at night


• Changes in the appearance of your urine (for example, frothy urine, red urine)


• Blood in your urine


• Puffiness in your legs, ankles; puffiness around your eyes specially in morning


• Pain in your kidney area i.e. loin pain / flank pain


• Tiredness, fatigue, weakness


• Loss of appetite


• High blood pressure


• Difficulty sleeping, headaches, lack of concentration, decreased mental sharpness, forgetfulness


• Persistent itching


• Shortness of breath, chest pain


• Nausea and vomiting


• Bad breath and a metallic taste in your mouth


• Easy bruising, change in skin colour


• Muscle cramps


• Pins and needles in your fingers or toes


• More hypoglycemic episodes, if diabetic


• Decreased sexual desire

These symptoms are often nonspecific and may be caused by other illnesses. However, if they are related to kidney disease they may gradually worsen as kidney function declines.

If you believe you have any of these symptoms, talk to your doctor about your concerns. This is especially important if you have any risk factor for kidney disease. Your doctor is likely to monitor your blood pressure and kidney function with urine and blood tests during your clinic visits. Ask your doctor whether these tests are necessary for you. For CKD, it is said that “Knowing is half battle won.” With timely diagnosis and treatment, we can have good long term results.