How to Protect Your Kidneys

CKD means the kidneys are at least 40% less able to filter out wastes and water from the blood, and the damage is permanent. In time, CKD may lead to kidney failure, in which case dialysis (blood cleaning) or a kidney transplant is needed to support life.

The two most common causes of CKD are type 2 diabetes and high blood pressure. Among Americans with kidney failure, 75% have one or both of these problems. The rest have genetic diseases, infections, birth defects, kidney stones, or other causes.

If CKD is caught early, it may be possible to slow it down or even stop it. The National Kidney Foundation lists five stages of CKD. Each stage is based on the percent that the kidneys can filter, or “glomerular filtration rate” (GFR). GFR is not a blood test. It’s a formula used to figure out how well your kidneys are filtering your blood.

The stages of CKD are:

• Stage 1 – Kidney damage (protein in the urine) and normal GFR (>90)
• Stage 2 – Kidney damage and mild drop in GFR (60-89)
• Stage 3 – Moderate drop in GFR (30-59)
• Stage 4 – Severe drop in GFR (15-29)
• Stage 5 – Kidney failure: dialysis or kidney transplant needed (GFR <15)

Since kidneys clean the blood and make urine, blood and urine tests are a good way to check whether the kidneys are doing their job. If your blood or urine has high levels of substances the kidneys should filter out, something may be wrong. Knowing the names of your tests and what the results mean is a way for you to track your kidney function and see how you are doing over time. The two most common kidney function tests are creatinine (blood) and albumin (urine).

Creatinine

Creatinine is a waste product that forms each time you move a muscle. Healthy kidneys remove creatinine from the blood. A blood test can check your level—the more creatinine in your blood, the less work your kidneys are doing. When you know your level, you can find out your GFR on-line. Visit our online GFR calculator.

Albumin (protein)

Protein is a large molecule that is too big to fit through healthy kidney filters. If protein leaks into your urine, you may have a kidney problem. You may be able to see if you have large amounts of protein leaking—your urine may be bubbly or foamy. Smaller amounts (microalbuminuria) can be found with a dipstick or other test. If you are at risk for CKD, ask your doctor to test your urine for protein.

Most people with early CKD don’t have symptoms—or don’t know that they have them. Knowing what to watch for can help you to alert your doctor. Getting early treatment can help you feel your best and protect your kidneys.

Anemia

Red blood cells carry oxygen to all of the cells in your body. Anemia is a shortage of red blood cells that can start early in CKD. What do kidneys have to do with blood cells? Healthy kidneys make a hormone called erythropoietin (EPO) that tells your bone marrow to make red blood cells. As kidneys fail, they make less of the hormone.

With fewer red blood cells, you get tired much faster, even when you are doing routine tasks like climbing a flight of stairs or walking to the mailbox. Feeling very, very tired can be a symptom of anemia.

Other symptoms of anemia are:

• Muscle weakness
• Shortness of breath
• Pale skin, gums and fingernail beds
• Feeling dizzy or lightheaded
• Feeling cold all the time (when other people are not)
• Fuzzy thinking (memory problems or trouble focusing)
• Erectile dysfunction in men
• Changed periods in women
• Pica (a desire to eat ice or non-food items such as ice, dirt, laundry starch or clay)

Tell your doctor right away if you have any of these symptoms. Anemia can be treated with iron and injections of EPO. In just a few weeks, you can have your energy back—and getting your anemia treated can also protect your heart.

Sometimes people with CKD give up their jobs and go on disability because they are so tired. But disability pays much less than most jobs, and there is a six-month wait for checks to start. Once you leave a job, it can be hard to find a new one after you feel better. Don’t let this happen to you! If you think you have anemia, ask for a blood count and get treatment.

Edema (Swelling)

Failing kidneys remove less water. The extra water can build up in the legs, ankles feet, face, and/or hands (edema). Some people have trouble catching their breath due to extra fluid in the lungs. This may be mistaken for asthma. If you have high blood pressure, you may find that it is harder to control, even when you take your pills.

In early CKD, your doctor may suggest that you eat less salt in your diet and take drugs to help your kidneys remove more water (diuretics). These steps may help slow the rate of CKD and help your edema.

Changes in Urination

Kidneys make urine, and when the kidneys are failing the urine may change. Some changes you may notice include:

• Urinating more often
• Not urinating as much
• Making more—or much less—urine than usual
• Getting up at night to urinate
• Foamy or bubbly urine
• Blood in the urine or very dark urine that looks like tea or cola
• Pressure when urinating or trouble getting a flow started

Uremia (Buildup of Toxins in the Body)

Kidneys remove wastes from the blood. When the kidneys fail, wastes build up in the body (uremia). Symptoms of uremia include:

• Skin rash
• Itching
• Nausea and vomiting
• Loss of appetite for meats (protein)
• Metallic taste in the mouth
• Bad “ammonia” breath
• Weight loss (from loss of appetite)

Phosphorus is a mineral that is found in many foods (especially meats, dairy, beans, nuts, and whole grains). When it builds up in the body, it can cause itching. Your doctor may prescribe drugs called phosphate binders and ask you to eat less phosphorus in your diet to help relieve your itching.

Back or Flank (Side) Pain

Some people with kidney problems have pain in the back or flank on the side of the affected kidney. Polycystic kidney disease can also cause this type of pain.

Poor Growth (Children Only)

One of the early signs of CKD in children is poor growth.

To sum things up, most of these symptoms are not only found in CKD—they can occur with other health problems too. A doctor is the best person to check out all of your symptoms and order tests to find out if CKD is the cause. If you are at high risk for CKD due to high blood pressure, diabetes or a family history of CKD, the sooner you find out if you have a problem, the sooner you can take steps to treat it.

While most CKD can’t be cured, you can often slow down the disease and feel better. You may never get to kidney failure. Even if you have an early stage of CKD, work with your doctor to decide how often to have your kidney function tested—every three months, six months, or 12 months? You can also follow these simple steps to protect your kidney function for as long as possible:

Reduce the Stress on Your Kidneys

Give your kidneys a bit of a break by using the tips below:

• Drink lots of water to flush out wastes. Drinking water also helps lower the chances of kidney stones and infections.
• Keep your blood pressure in the target range. Weight control, exercise, and drugs can control blood pressure—and prevent or slow the risk of kidney failure. Also, blood pressure drugs in the ACE-inhibitor and ARB class help slow down a loss of protein in the urine and protect the kidneys. Blood pressure puts a lot of stress on your kidneys. If you have high blood pressure and any other kidney problem, treating your blood pressure will help protect your kidneys.
• If you have diabetes, keep your blood sugar in the target range. Weight control, exercise, medication, and tight control of blood sugar can prevent or slow the risk of kidney failure.
• Have blockages (e.g., narrowed arteries) treated. Sometimes blockages can be opened to help save function in a blocked kidney. If you think you have a blockage, ask your doctor what can be done about it.
• Take steps to prevent kidney stones if you are prone to them.
• Take steps to prevent infections if you are prone to them.
• Check with your doctor to see if there is a special diet you should be on such as low protein, low salt (sodium), and low phosphorus.

Avoid Known Kidney Toxins

• Limit use of over-the-counter or prescription painkillers that contain ibuprofen (Advil®, Motrin®), naproxen (Aleve®), or acetaminophen (Tylenol®). These non-steroidal anti-inflammatory drugs (NSAIDS) cause blood vessels in the kidneys to shrink, so less blood flow comes through. If you take any of these drugs often, be sure to tell your doctor. Taking these drugs with caffeine can also further harm the kidneys. Drinking a large glass of water when you take an NSAID can help your kidneys flush the drug out.
• Know your own drug allergies. Sometimes taking a drug that you are allergic to can damage the kidneys.
• Ask about a drug’s effects on the kidneys any time you take a new medication. Some antibiotics and chemotherapy drugs are known to be hard on the kidneys. If you know that your kidney function is less than normal, avoid these drugs if you can and see if your doctor can prescribe something else.
• Avoid X-ray dye tests or have your doctor take steps to protect your kidneys. Less toxic dye can be used (this costs more), the dye can be diluted, and it can be flushed out of your body with extra fluid. Some doctors prescribe a drug called Mucomyst ® to help protect the kidneys from the dye.
• Get a throat culture if you have a sore throat—and treatment if it is caused by Strep bacteria.
• Avoid use of street drugs. If you use them, know that they can harm your health and seek help to stop. Be honest with your doctor about what you are using so he or she can help treat you.
• Quit smoking. In people with CKD, research has linked smoking to an increase in the amount of protein in the urine. In smokers with diabetes, kidney disease may progress twice as fast . Get help to quit smoking and prolong your kidney function.

Other steps you take do to keep your kidneys working well for as long as possible include:

• Visit your doctor for check ups.
• Take all drugs as prescribed—in the right amount, at the right time.
• Tell your doctor about any herbs, supplements, or over-the-counter drugs you take. Just because some products are sold without a doctor’s prescription does not mean they are safe for people with less than normal kidney function.
• Follow any dietary limits as prescribed.
• Know your blood or urine test names and what the results mean.

Do Your Part

If you are at risk for kidney disease, there are many things you can do to help keep your kidneys working. With knowledge of the signs and symptoms of CKD and early treatment you can protect your kidneys and live long and well with CKD.