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Kidney Disease: Early Detection and Treatment

Many Americans know nothing about kidney disease—until it's too late.

"Unlike many diseases, kidney disease often has no symptoms until it is very advanced," says Andrew Narva, M.D., Director of the National Kidney Disease Education Program (NKDEP) a part of the NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

"For this reason and others, it is important for people to not only become aware of their risk, but also to learn about the steps they can take to keep their kidneys healthier longer. An important step is to get tested."

That testing is even more important for populations that are at higher risk for kidney disease, such as African Americans, adds Dr. Narva.

Your doctor can do very simple tests to check for kidney disease:

  • Measure the level of serum creatinine in your blood to estimate your glomerular filtration rate (GFR)
  • Measure the level of protein in your urine (increased levels of protein show your kidneys are not working right)
  • Check your blood pressure.

How can you tell if you are at risk for kidney disease? Ask yourself these questions:

  • Do you have diabetes (problems with your blood sugar)?
  • Do you have high blood pressure?
  • Do you have heart disease?
  • Did your mother, father, sister, or brother have kidney disease? (Kidney disease runs in families.)

If you answered "yes" to any of these questions, you are at risk for kidney disease. Now is the time to get tested.

Your health care provider will order two simple tests to check your kidneys—a blood test to check your glomerular filtration rate (GFR) and a urine test to check for protein.

  • GFR—A blood test measures how much blood your kidneys filter each minute, which is known as your GFR (glomerular filtration rate). This shows how well your kidneys are working. A GFR of 60 or higher is in the normal range. A GFR below 60 may mean you have kidney disease. You can't raise your GFR, but you can try to keep it from going lower.
  • Urine Protein—A urine test checks for protein in your urine, which can be a sign of kidney disease. Protein can leak into the urine when the filters in the kidneys are damaged. This test has several different names, including a check for "proteinuria," "albuminuria," or "microalbuminuria." It can also be called a "urine albumin-to-creatinine ratio."

Treating Kidney Disease

Kidney disease is usually a progressive disease, which means that the damage in the kidneys tends to be permanent and can't be undone. So it is important to identify kidney disease early before the damage is done. The good news is that kidney disease can be treated very effectively if it is caught in the early stages. This is very important, since kidney disease also makes your risks for heart disease and stroke higher.

"The good news is that kidney disease can be treated very effectively if it is caught in the early stages."

For people who have diabetes, monitoring blood glucose levels is very important. Your health care provider can help you find the right device for doing this if you are diagnosed with diabetes.

Controlling blood pressure is also very important for people with kidney disease. There are several types of medicine that help people keep their blood pressure in a healthy range. Two kinds of medicines, ACEi (angiotensin converting enzyme inhibitors) and ARBs (angiotensin receptor blockers) also help to protect the kidneys.

Kidney Failure: What Then?

If one or both kidneys fail completely and the damage can't be reversed, the condition is called kidney failure or end-stage renal disease (ESRD). When this occurs, your kidneys can no longer filter wastes well enough to keep you healthy. The symptoms for ESRD include fatigue, weakness, nausea, vomiting, and itching.

Treatments for kidney failure include dialysis or transplantation. There are two major types of dialysis:

  • In hemodialysis, blood is run through an external filter and the clean blood is returned to the body. Hemodialysis is usually done at a dialysis center three times a week.
  • Peritoneal dialysis uses the lining of your abdominal cavity (the space in your body that holds organs like the stomach, intestines, and liver) to filter your blood. This kind of dialysis is needed daily but it can be performed at home, while you sleep.

A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, and you no longer need dialysis.

Research on Progression of Kidney Disease

Many researchers are studying kidney disease. They are looking for ways to improve diagnosis, make treatments more effective, and make dialysis and transplantation work better. Several areas of research supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) hold great potential.

NIDDK is sponsoring a major study—the Chronic Renal Insufficiency Cohort (CRIC) study—to learn more about how kidney disease progresses. CRIC is following 3,000 adults for seven years. All study participants have mild to moderate kidney disease, and about half have diabetes.

Researchers think that some CRIC study participants' kidney function will decline more rapidly than others', and that some will develop cardiovascular disease while others won't. The goal of the study is to identify the factors linked to rapid decline of kidney function and development of cardiovascular disease.

A family sitting in a park

Photo: Corbis

Many people know family members who have diabetes or high blood pressure—the two leading causes of kidney failure. Diabetes and high blood pressure often run in African-American families. During National Kidney Month in March, start thinking about ways you can educate family members on steps they can take to keep their kidneys healthy. The free Family Reunion Health Guide, developed by the National Kidney Disease Education Program, contains everything you need to share this important information with your family. Call (866) 4-KIDNEY or visit

Winter 2008 Issue: Volume 3 Number 1 Pages 9 - 10