Chronic Kidney Disease: Early Warning Signs and Protective Steps
The kidneys filter roughly 180 litres of blood a day, regulate blood pressure and fluid balance, control electrolytes, activate vitamin D and stimulate red blood cell production. They also have enormous reserve, which is why chronic kidney disease can advance a long way before a person feels anything at all.
Why it is usually found late
Symptoms typically appear only when kidney function falls below about 20-25% of normal. By then, much of the damage is irreversible. Early detection is therefore entirely about testing people at risk, not about waiting for symptoms.
When symptoms do appear:
- Swelling of the ankles, feet or around the eyes
- Fatigue and reduced concentration
- Passing urine more often at night
- Frothy urine, which suggests protein loss
- Loss of appetite, nausea, a metallic taste
- Itching
- Muscle cramps
- Breathlessness
- Difficult-to-control blood pressure
The two tests that matter
eGFR
Estimated glomerular filtration rate, calculated from serum creatinine with age and sex. It estimates how much the kidneys are filtering.
- 90 or above: normal
- 60-89: mildly reduced
- 30-59: moderately reduced
- 15-29: severely reduced
- Below 15: kidney failure
Urine albumin-to-creatinine ratio
Often the earlier signal. Small amounts of albumin leaking into urine indicate damage to the filtering units before eGFR falls.
- Below 30 mg/g: normal
- 30-300: moderately increased
- Above 300: severely increased
Chronic kidney disease is defined by abnormalities present for at least three months, so a single result needs confirmation. A routine urine dipstick is far less sensitive than ACR and misses early disease.
Who should be screened, and how often
At least annually in:
- Diabetes, the leading cause of kidney failure in India
- Hypertension, the second leading cause
- Heart failure or established cardiovascular disease
- Family history of kidney disease
- Obesity
- Long-term use of NSAIDs
- Recurrent kidney stones or urinary infections
- A history of acute kidney injury
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What slows progression
Blood pressure control
Target is generally below 130/80 in people with kidney disease and protein in the urine. This is the single most effective intervention.
ACE inhibitors or ARBs
These reduce protein leakage and slow decline, and are first choice when albuminuria is present. Creatinine may rise slightly after starting, which is expected; a large rise needs review.
SGLT2 inhibitors
One of the most important developments of the last decade. Originally diabetes drugs, they now have strong evidence for slowing kidney disease progression both with and without diabetes.
Glucose control in diabetes
Reduces the onset and progression of diabetic kidney disease.
Avoiding kidney insults
- Regular NSAIDs such as ibuprofen and diclofenac and their combinations are a common, avoidable cause of kidney injury, particularly in dehydration or with existing disease
- Unregulated herbal and kidney cleansing products, some of which contain heavy metals or nephrotoxic compounds
- Repeated contrast scans without precautions
- Dehydration, especially in outdoor work in Indian summers
Diet
Excess salt worsens both blood pressure and protein leakage. Protein restriction is sometimes advised in advanced disease but should only be done under dietitian supervision, because malnutrition is itself dangerous. Potassium and phosphate restriction becomes relevant at later stages and must be individualised – general advice to eat more fruit can be harmful in advanced kidney disease.
What to expect at each stage
Early-stage disease is managed by controlling blood pressure, glucose and albuminuria, and is compatible with a normal life. Advanced disease requires planning: anaemia and bone mineral management, dietary supervision, and timely discussion of dialysis or transplantation. Those conversations go far better when they happen early rather than in a crisis.
When to see a doctor
- Swelling of the legs or face, particularly on waking
- Persistently frothy urine
- Blood in the urine
- Passing much less urine than usual
- Uncontrolled blood pressure despite treatment
- Nausea, itching and fatigue in someone with known kidney disease
This article is general health information. Kidney results should be interpreted by a doctor, and medication doses often need adjusting when kidney function is reduced.