When Kidney Disease Has No Warning Signs

Most people expect a serious illness to announce itself through pain, a visible change or another warning that something is wrong. Chronic Kidney Disease (CKD) often works differently.

Most people in the early stages of CKD have no symptoms, and many remain symptom-free until the disease is advanced. The Centers for Disease Control and Prevention estimates that as many as 9 in 10 U.S. adults with CKD do not know they have it. By the time symptoms such as fatigue, swelling or changes in urination appear, kidney function may already be significantly reduced.

That silence helps explain why some people first learn they have kidney disease during an emergency room visit or hospital stay. When CKD is not identified until it has progressed to kidney failure, kidney dialysis may need to begin urgently, before the patient has had time to learn about treatment choices or prepare physically and emotionally. The American Kidney Fund describes this experience as a “crash,” emergency or unplanned kidney dialysis start.

Testing is essential because feeling well does not necessarily mean the kidneys are healthy. Two routine tests provide important information: a blood test used to calculate the estimated glomerular filtration rate (eGFR) and a urine albumin-to-creatinine ratio (uACR), which can identify albumin that may indicate kidney damage.

Routine physicals provide an opportunity for patients to raise kidney health with their health care providers. Helpful steps include:

• Sharing a history of diabetes, high blood pressure, heart disease, previous kidney problems or kidney disease in the family.

• Asking whether both eGFR and uACR testing are appropriate based on individual risk factors.

• Requesting the actual test results and asking how they compare with results from previous visits.

• Discussing all prescription medicines, over-the-counter medicines, vitamins and supplements to determine whether they are safe for the kidneys.

• Asking when testing should be repeated and whether additional evaluation by a kidney specialist (a nephrologist) is needed.

The National Kidney Foundation offers a list of questions patients can bring to appointments, while the National Institute of Diabetes and Digestive and Kidney Diseases provides guidance on preparing for medical visits and monitoring kidney test results over time.

Knowing the risks creates an opportunity to identify CKD earlier, when treatment and monitoring may help protect remaining kidney function.