As we all know every human body has two kidneys, which are primarily responsible for filtering the blood free of the nitrogenous waste products like urea, creatinine, acids, etc. (all of which are products of metabolism in the body) and produce urine.
Millions of people are living with various types of kidney diseases and most of them don’t even have the faintest idea about it. This is why kidney disease is often known as a ‘Silent Killer’ as most people do not feel any difference until the disease is advanced. While people get their blood pressure, sugar and cholesterol levels checked on a regular basis, they fail to get a simple creatinine test done in their blood, to detect any unidentified kidney problems. According to the Global Burden Disease (GBD) study in 2015, chronic kidney disease (CKD) is ranked as the eighth leading cause of mortality in India.
There are a number of warning signs of a kidney disorder, however, most of the time these are ignored or confused with alternative pathologies (because of their non-specific nature). Therefore, one has to be very watchful and should get the confirmatory tests (including blood, urine, and imaging) done at the earliest appearance of any sign of a kidney disorder. One should visit a Nephrologist and clarify his/her doubts. But if you have hypertension, diabetes, obesity, metabolic syndrome as one calls it in today’s age, or Coronary Artery Disease, and/or a family history of the same or a family history of kidney failure or even if you’re older than 60 years of age, it is advisable to get kidney tests done on a regular basis.
While the only definitive way to diagnose a kidney disease is to get confirmatory tests done, here are some early warning signs of kidney disease:
- One of the early signs is the appearance of swelling over the ankles, feet or legs: One will start to notice edema at these sites which pits on applying pressure and is termed as pitting edema. As the kidney function begins to fall there is sodium retention which causes swelling in your shin and ankles. In short, any person noting new-onset pedal edema should get an immediate evaluation of his/her renal function after visiting a nephrologist.
- Periorbital Edema: It denotes swelling or puffiness around eyes caused by the accumulation of fluid in the cells or tissues. It is one of the earliest signs of a kidney disorder. It is especially prominent in individuals where there is a leakage of a significant amount of protein via the kidney. Loss of protein from the body decreases the intravascular oncotic pressure and leads to extravascular accumulation of fluid in various sites like around the eyes.
- Weakness: Early fatigability is almost always a universal symptom of kidney disease. As renal dysfunction progresses this symptom becomes more and more prominent. One may feel more tired or exhausted than on normal days and will be unable to perform more strenuous activities, thus requiring rest more often. This is largely due to the accumulation of toxins and impurities in the blood, resulting from poor kidney function. Being a non-specific symptom it is often ignored by most of the people and not thoroughly investigated.
- Decreased appetite: Secondary to the accumulation of toxins like urea, creatinine, acids, the appetite of an individual is suppressed. Also, as kidney disease advances, there is a change of taste, often described as metallic by the patients. If one gets the feeling of early satiety in spite of barely having anything during the day, it should raise alarm bells in one’s mind and one should get his or her renal function evaluated.
- Early morning nausea and vomiting: Another one of the earliest signs of worsening renal function in the presence of early morning nausea, which is often classically described as hitting the person when he or she goes to the bathroom in the morning for brushing his or her teeth. It also contributes to the poor appetite of the individual. At end-stage renal failure, the patient tends to have multiple episodes of vomiting and complete loss of appetite.
- Anemia: Haemoglobin level starts to fall, one might look pale, without any apparent site of blood loss from the body. It is one of the common complications of kidney disease. This can also cause weakness and fatigue. The cause of anemia is multifactorial which includes low Erythropoietin levels (Erythropoietin being synthesized in the kidney), low iron levels, toxin accumulation causing bone marrow suppression to name a few.
- Changes in urine frequency: One has to keep a very careful watch on his or her urine output. For instance, the urinary output may decrease or you may feel the need to urinate more often, especially at night (termed as nocturia). It can be a warning sign and may indicate that the kidney filtering units are damaged or in the process of being damaged. Sometimes this can also be a sign of some urinary tract infection or enlarged prostate in men. Thus, a change (increase or decrease) in the urine output should be reported immediately to your nephrologist.
- Foamy urine or blood in urine: Excessive frothiness in the urine indicates the presence of protein in the urine (which under normal circumstances should be negligible). When the filtering mechanism of the kidney has been or is being damaged, protein, blood cells start to leak out into the urine. In addition to signaling kidney disease, blood in the urine can indicate tumors, kidney stones or any kind of infection. Also, pus associated with urine along with fever or chills can be serious and may again be a sign of a serious urinary tract infection. Thus changes in colour, consistency or nature of urine should be informed as early as possible to a kidney specialist.
- Dry and itchy skin: Dry and itchy skin can be a sign of advanced kidney disease. As the renal function falls, toxins tend to accumulate in the body leading to itchy, dry and foul-smelling skin.
- Backache or lower abdomen pain: Pain in back, side or below the ribs can be an early symptom of kidney disorder like renal calculus or pyelonephritis. Similarly, lower abdomen pain can be associated with bladder infection or stone in a ureter (the tube connecting the kidney and bladder). Such symptoms should not be ignored and investigated further by a routine imaging study like X-ray KUB or Ultrasound Abdomen.
- High Blood Pressure: A presenting sign of kidney disease may be high blood pressure. Any person being diagnosed with hypertension must have a detailed workup of renal functions and kidney imaging to rule out renal etiology of hypertension. As kidney function deteriorates there are sodium and water retention leading to high blood pressure. Symptoms of hypertension include headache, abdominal pain, visual blackouts and maybe the early presenting symptoms of kidney disease.
Recognition and awareness of warning signs and timely intervention can mean the difference between early detection and treatment of kidney disorder or kidney failure which could end up with dialysis, kidney transplant or even death.
Tips to Keep Your Kidneys Healthy:
There are several ways to reduce the risk of developing kidney disease. So, why do wait until your kidneys are diseased? Following are a few steps to look after the health of your kidneys:
- Drink plenty of water: This is the most common and simplest way to keep your kidneys healthy. Consuming plenty of water, especially warm water helps the kidneys clear sodium, urea and toxins from the body.
- Low sodium/salt diet: Keep your sodium or salt intake in control. This means you need to cut off packaged/restaurant foods too. Also, do not add extra salt to your food. Low salt diet decreases the load on the kidney and prevents the development of hypertension, hypertension-related disorders and also delays the progression of kidney disease.
- Maintain appropriate bodyweight: Eat healthily and keep your weight in check. Get your body cholesterol levels checked regularly to prevent the deposition of cholesterol in your renal arteries. Also, eliminate saturated fats/fatty fried foods from the diet and emphasize on having lots of fruits and vegetables daily. The load on the kidneys increase as the weight of an individual increase. Try to aim for a BMI of 24 or less especially in the Indian scenario.
- Check blood sugar levels regularly and keep them under optimal levels: Kidney damage in diabetic patients is very common and can be prevented if detected early. Therefore, it is advisable to keep a regular check on your blood sugar levels, avoid sweet food products and meet a physician if blood sugar (fasting or postprandial) levels or HBA1C are raised. Keep HBA1C levels under 6.0.
- Monitor blood pressure regularly and keep it under control: In case you have hypertension, take antihypertensives as advised by your doctor, maintain a healthy lifestyle and make necessary dietary changes. The normal blood pressure level is <120/80. High blood pressure can also cause kidney disorders besides leading to a stroke or heart attack.
- Get kidney function tests, and urine analysis is done regularly as a part of your annual checkup: As I mentioned before in case you have diabetes, hypertension, obesity or if you are over 60 years of age get kidney function tests, renal imaging, and Urine Analysis was done regularly. In case of even slightest protein detection in urine, make sure to visit your nephrologist. Diabetics should especially be watchful of this.
- Quit Smoking: Smoking is one of the important modifiable risk factors implicated in the progression of kidney disease. Even smoking 1 cigarette could further harm an already weakened kidney. Smoking is also a risk factor for Diabetes, Hypertension, CAD. Thus, one should stop smoking at once, which is quintessential not only for the kidneys but also for the overall health of the body.
- Maintain an active healthy lifestyle by doing moderate exercise around 45 minutes a day like jogging, cycling, swimming, playing racquet games at least 5 out of 7 days in a week, if not daily. Change your sedentary lifestyle, walk around in the office or take a stroll after lunch.
- Balance your lifestyle properly by taking a restful night’s sleep of at least 8 hours a day. A good night’s sleep is essential to remain healthy.
Dr. Sudeep Singh Sachdev, Senior Consultant – Nephrology, Kidney Transplant – Adult, Narayana Superspeciality Hospital Gurugram