Taking charge of kidneys

Written By Jasjot Bhullar

Hey friends, welcome to the blog. Today, I want to talk about chronic kidney disease (CKD).

Have you been told that you or someone you know has kidney disease? Do you wonder what it means for your health? Let me start with what our kidneys do, and you may understand all that kidneys can affect if they are working less than they are supposed to. The primary function of our kidneys is to remove waste from the body—waste that our body produces from the process of living. Three organs are primarily responsible for waste removal: our intestines (gut), liver, and kidneys. The liver deactivates toxins via enzymes, the gut physically removes waste from the food we consume, and the kidneys remove what the liver deactivated, regulating blood pH and electrolytes within tight limits where life is possible.

Functioning kidneys are vital to life.

This is not all, though; kidneys are also the primary regulator of blood pressure, regulating the production of key neurohormones that affect our heart, blood vessels, and adrenal glands. Blood pressure regulation by the kidneys is not well known, as I have come to realize as a kidney specialist. Most people associate blood pressure with the heart. The heart and kidneys work together to regulate blood pressure.

Wait! There is more. Vitamin D needs activation by the kidneys to help our bodies absorb more calcium and keep the bones strong. So, with the loss of kidney function, you can develop low calcium levels and weaker bones. Kidneys play an important role in keeping our hemoglobin/blood counts normal. They regulate a vital step in red blood cell formation. So, if you have lost your kidney function, it would cause you to become anemic. I am listing here some of the critical functions that, as a kidney specialist, I am trained to monitor and treat as needed for anyone with kidney disease.

What is the biggest challenge when it comes to kidney disease?

It is a lack of symptoms.

Most people expect their kidneys to “hurt” or associate mid to low back pain with kidney disease, which is not the case.

Let's address “kidney pain”.

Kidney pain, when experienced, is excruciating and usually brings people to the ER!

Common causes of kidney pain are kidney stones, kidney infection (urinary tract infection involving the kidney(s) - pyelonephritis), bleeding cysts in the kidneys (which may be experienced in Polycystic kidneys), rare but serious causes can be kidney infarction (sudden loss of blood flow to the kidneys). Kidney pain needs immediate assessment with imaging studies - CT scan or ultrasound, usually in the hospital setting, in addition to blood and urine tests.

So let's begin by talking about common symptoms of kidney disease.

  • Tiredness/fatigue

  • Burning on urination

  • Blood in the urine

  • Swelling in the legs or overall body

  • Shortness of breath

  • Nausea and vomiting

  • Loss of appetite

  • Numbness or tingling of the limbs

  • High blood pressure

  • Confusion, etc.

These symptoms are not very specific for chronic kidney disease, making it challenging to know whether you have kidney disease.

The only way to determine if your kidneys are not functioning at an appropriate level is through blood and urine tests.

The conditions with an increased risk of kidney disease are:

  • High blood pressure (Hypertension)

  • Diabetes Mellitus (high blood glucose/sugar levels)

  • Heart failure

  • Cirrhosis

  • Recurrent kidney stones

  • Recurrent urinary tract infections

  • Chronic NSAID use (Non-Steroidal Anti-Inflammatory Drugs)

  • Family history of End-Stage Kidney Disease - dialysis or kidney transplantation

  • Solid organ transplantation

  • Cancer/malignancy

  • Chemotherapy

  • Critical illness

  • Recurrent acute kidney failure

  • Autoimmune disease like “Lupus”

  • Aging

However, some conditions can cause kidney disease on their own. Keeping a close watch for these is key to staying ahead of them. This is where having a good primary care doctor/provider is needed.

Anyone at risk of kidney disease needs to get a blood and urine test at least yearly.

What can you do?

  • Get yearly physical exams and labs, which include blood and urine tests

  • Stay on top of your health by tracking your general well-being. This includes weight monitoring, sleep tracking, addressing new symptoms when they don’t resolve quickly, and not relying on over-the-counter (OTC) meds to self-manage your health.

  • Keeping track of your diet

  • Avoiding alcohol and tobacco use

  • Physical activity tracking

  • Mental health tracking: Journaling, mindfulness activities, etc.

  • Questions to ask your doctor - PCP or Nephrologist (kidney specialist)

    • What is my kidney function or eGFR (estimated Glomerular Filtration Rate) based on your lab results?

    • Is my urine test normal?

    • If my kidney function/eGFR is lower than 60, do I have a referral to a Nephrologist (kidney specialist)?

    • If my urine tests are abnormal, do I have a referral to a Nephrologist (kidney specialist)?

What lab tests do you need to assess your kidneys?

  • Basic Metabolic Panel (BMP) or Comprehensive Metabolic Panel (CMP) or Renal Function Panel/ Test (RFP/T)

  • Urinalysis

  • Urine protein: creatinine, urine microalbumin: creatinine

Blood tests give us essential information about your kidney function - eGFR, something you can look up yourself.

Image 1:

Example of the eGFR lab report can be found on BMP, CMP, or RFP.

What is a normal eGFR (estimated Glomerular Filtration Rate)?

Normal eGFR is 120mL/min. This number is calculated taking into account your age, sex, and serum creatinine level.

Stages of chronic kidney disease (CKD): based on the eGFR value, there are five stages of CKD.

  • Stage 1: eGFR 90 to 120 mL/min

  • Stage 2: eGFR 60 to 90 mL/min

  • Stage 3: eGFR 30 to 60 mL/min. Stage 3 is further divided into two sub-stages: 3a (eGFR 45 to 60 mL/min) and 3b (eGFR 30 to 45 mL/min); these stages can be further characterized by the amount of protein or albumin in the urine.

  • Stage 4: eGFR 15 to 30 mL/min

  • Stage 5: eGFR < 15 mL/min. This stage is called End Stage Kidney Disease (ESKD) or End Stage Renal Disease (ESRD). At this stage, kidneys are not able to support life, and dialysis or a kidney transplant is needed to prolong life.

eGFR equals the filtration function of the kidneys; the lower the number, the worse the kidneys are functioning. Urine albumin, or total protein, is a sign of inflammation in the kidneys, which is frequently caused by common conditions such as high blood pressure or diabetes.

Urine tests can also reveal the presence of blood or white blood cells or crystals in the urine, which can all be helpful in investigating the cause of kidney disease.

Lower eGFR can improve and be maintained if irreversible kidney damage has occurred. It is necessary to follow up with a kidney specialist and continue to take care of your overall health.

Kidneys are affected by our diet, activity level, environment, sleep, psychological stressors, etc. The root cause of kidney problems can be linked to poor gut health, poor sleep, poor nutrition, and environmental toxins.

A personalized approach to optimal health through functional medical principles and a standard-of-care treatment plan is the best way to achieve long-lasting kidney well-being.

Stay tuned for more information related to kidney health.

Jasjot Bhullar