The kidneys have substantial reserve. A person can lose the majority of kidney function before feeling anything at all, which is why chronic kidney disease is so often diagnosed at an advanced stage.
Two inexpensive tests detect it years earlier, and treatment at that point genuinely changes the trajectory.
What the Kidneys Do
Beyond filtering waste, the kidneys perform several functions whose failure explains the symptoms of advanced disease.
- Removing waste products and excess fluid
- Balancing sodium, potassium and acid levels
- Controlling blood pressure through fluid balance and hormones
- Producing erythropoietin, which stimulates red blood cell production
- Activating vitamin D for bone health
This is why kidney failure causes anaemia and bone disease as well as fluid overload, and why treatment involves more than just removing waste.
The Two Tests That Matter
Detection requires both. Each misses cases the other finds.
Serum creatinine and eGFR: creatinine is a waste product, and the estimated glomerular filtration rate calculated from it indicates filtering capacity. Note that creatinine depends on muscle mass, so a slim elderly woman can have significant kidney impairment with a creatinine still in the normal range. Always look at the eGFR rather than the creatinine alone.
Urine albumin to creatinine ratio: detects small amounts of protein leaking into urine. This is often the earliest sign of kidney damage and appears years before eGFR falls. A routine urine dipstick is not sensitive enough and misses early disease.
Ask specifically for the albumin creatinine ratio. It is frequently omitted from routine panels.
Who Should Be Screened
Screening is targeted at those with risk factors, since these account for most cases.
- Diabetes: annual screening from diagnosis, as it is the leading cause of kidney failure in India
- Hypertension: the second leading cause
- Family history of kidney disease
- Cardiovascular disease
- Obesity
- Age over sixty
- Recurrent kidney stones or urinary infections
- Long term use of anti inflammatory painkillers
- Previous acute kidney injury
- Autoimmune conditions such as lupus
Anyone with diabetes or hypertension should have both tests annually. This is one of the most commonly missed elements of chronic disease care.
The Stages
Chronic kidney disease is staged by eGFR and albumin level together.
- Stage 1 and 2: normal or mildly reduced filtering with evidence of damage such as protein in urine. Usually no symptoms
- Stage 3: moderately reduced. Some patients begin to develop anaemia and bone mineral changes
- Stage 4: severely reduced. Preparation for dialysis or transplant begins
- Stage 5: kidney failure, requiring dialysis or transplantation
Most patients diagnosed in stages 1 to 3 never progress to needing dialysis if managed well. That is the argument for early detection.
Symptoms Appear Late
When symptoms do appear, considerable function has usually already been lost.
- Fatigue and weakness, largely from anaemia
- Swelling of ankles, feet or around the eyes
- Passing urine more often at night
- Frothy urine, indicating protein
- Poor appetite, nausea and a metallic taste
- Itching
- Muscle cramps
- Difficulty concentrating
- Breathlessness from fluid overload
Nocturia and persistently frothy urine are among the earliest noticeable signs and are frequently dismissed.
What Slows Progression
Several interventions have strong evidence, and applied together they can substantially delay or prevent progression to dialysis.
- Blood pressure control, generally targeting below 130 over 80
- ACE inhibitors or ARBs, which reduce protein leakage and protect the kidney beyond their blood pressure effect
- SGLT2 inhibitors, which have transformed kidney protection in recent years, for both diabetic and non diabetic kidney disease
- Tight diabetes control
- Salt restriction, under five grams daily
- Avoiding anti inflammatory painkillers, which are a common and avoidable cause of decline
- Stopping smoking
- Weight reduction
- Treating anaemia and bone mineral disorder
SGLT2 inhibitors are worth asking about specifically, since the evidence has changed considerably and many patients on older regimens have not been reassessed.
Medications and Substances to Avoid
Several commonly used substances accelerate kidney damage, and this is a major avoidable cause of progression in India.
- Anti inflammatory painkillers such as ibuprofen and diclofenac, taken regularly. Paracetamol is generally safer
- Contrast dye for scans, which requires precautions in kidney disease. Tell the radiology team
- Certain antibiotics, which need dose adjustment
- Unregulated herbal and traditional preparations, some of which contain heavy metals or nephrotoxic compounds
- Excessive protein supplements
- Dehydration, particularly during illness or in hot weather
Herbal and alternative remedies deserve emphasis. A substantial number of kidney injury cases we see follow prolonged use of unregulated preparations taken for other conditions. Tell your doctor everything you are taking.
Diet in Kidney Disease
Dietary requirements change with the stage, and generic advice can be harmful.
- Salt: restricted at all stages
- Protein: moderated in later stages, but not restricted excessively, since malnutrition worsens outcomes
- Potassium: restricted only when blood levels are high. This affects many Indian staples including bananas, coconut water, tomatoes and potatoes
- Phosphate: restricted in later stages, limiting dairy, nuts and processed foods with phosphate additives
- Fluid: restricted only in advanced disease with fluid retention
Do not restrict potassium or fluid on your own initiative. Unnecessary restriction causes malnutrition and dehydration. This needs individualised guidance from our nephrology and dietetics teams based on your blood results.
If you have diabetes or high blood pressure, ask for an eGFR and a urine albumin creatinine ratio annually. Early kidney disease is silent and treatable, and most people diagnosed early never reach dialysis. Avoid regular anti inflammatory painkillers and unregulated herbal preparations.
Our nephrology department at T. Nagar assesses and manages chronic kidney disease.
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