People at risk for kidney disease can protect kidney function by treating diabetes, hypertension, losing weight, not smoking, and having regular screening tests.
The number of people with chronic kidney disease has doubled over the last decade. Experts attribute this rise, in part, to the increase in type 2 diabetes -- a condition that takes a toll on the kidneys. Uncontrolled hypertension also may play a role. Kidney disease, hypertension, and type 2 diabetes form a cluster of age-related conditions, and developing one puts you at risk for the others. More important, this cluster of conditions puts you at very high risk for cardiovascular disease. Even people in the early stages of chronic kidney disease are at a greatly increased risk for coronary heart disease.
Without treatment, kidney disease progresses and eventually leads to organ failure, which requires dialysis or a kidney transplant. Kidney failure -- also known as end-stage renal disease (ESRD) -- can be fatal. Most people with kidney disease are unaware that their kidney function is impaired because symptoms only appear after the kidneys have suffered significant damage. The high risk of heart disease is one more reason that early identification and treatment are essential.
Small declines in kidney function pose no health problems. In fact, it is possible to function well at half of normal kidney capacity, provided function remains stable. However, serious problems result in anyone with kidney disease whose functional capacity drops by more than half.
Early symptoms may include headache, fatigue, and dry, itchy skin. As more function is lost, people may need to urinate more (or less), lose their appetite, or experience nausea and vomiting. Sometimes the hands and feet swell, and fluid may back up in the heart and lungs, prompting heart failure -- or worsening it if it is already present. High blood pressure and anemia may also develop. These problems become serious when function declines to about 20%. ESRD is diagnosed at 10–15% of capacity; at this point dialysis or transplantation is necessary.
Essential Tests for Kidney Disease: Everyone should be screened for hypertension and diabetes -- and treated for these conditions if they are present -- to protect both the heart and the kidneys. But according to the National Kidney Foundation guidelines, people with diabetes, hypertension, or a family history of kidney disease are at high risk for kidney disease and require two additional laboratory tests: a urine test for extra protein (proteinuria) and a blood test for creatinine (a waste product created by normal muscle activity).
The urine test measures albumin, a protein that appears in urine when kidney function is impaired. Results of creatinine testing permit calculation of the glomerular filtration rate (GFR), an estimate of how efficiently the kidneys are functioning. Research is currently being conducted on the optimal interval for screening. Meanwhile, the American Diabetes Association recommends yearly urine and blood testing for most diabetes patients -- a good guideline for those in other high-risk groups. If kidney disease has already developed, testing should also be done every year -- or more often if GFR is below 60 mL/min, an indication of more advanced disease.
