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HELPFUL LINKS   *   10 Symptoms of Kidney Disease   *   FAQs  *  HOW YOUR KIDNEYS WORK

Nephrology Associates of Kentuckiana, PSC provides care for all aspects of the prevention and treatment of kidney disease. We work in partnership with many national organizations which offer additional information on kidney disease and conditions.

National Kidney Foundation - Any information or questions not found on our website associated with your kidney can be found here as well as ways to donate.

American Heart Association - Hypertension is often associated with Chronic Kidney Disease. You can find information about hypertension as well as preventing and maintaining healthy heart and blood pressure at this site.

American Diabetes Association - many individuals who deal with Chronic Kidney Disease also live with diabetes. You may find more information on diabetes through this site.

Kentucky Organ Donor Affiliates - if you or a loved one is in need of a kidney transplant, you may find more information at this site as well as sign up to be a donor. This will answer all of your questions concerning donating and transplant.

Renal Patient Association - The American Association of Kidney Patients (AAKP) is a national non-profit organization founded by kidney patients for kidney patients. We strive to educate and improve the health and well-being of chronic kidney disease (CKD) patients, those on hemodialysis, peritoneal dialysis and transplant recipients.

Up-To-Date - This is a great site that will keep you up-to-date on the news of not only renal conditions, but other diseases and conditions you may be dealing with.


10 Symptoms of Kidney Disease

Many people who have chronic kidney disease don't know it, because the early signs can be very subtle. It can take many years to go from chronic kidney disease (CKD) to kidney failure. Some people with CKD live out their lives without ever reaching kidney failure.

Knowing the symptoms of kidney disease can help you get the treatment you need to feel your best. If you or someone you know has one or more of the following symptoms of kidney disease, or you are worried about kidney problems, see a doctor for blood and urine tests. Remember, many of the symptoms can be due to reasons other than kidney disease. The only way to know the cause of your symptoms is to see your doctor.

Symptom 1: Changes in Urination
Kidneys make urine, so when the kidneys are failing, the urine may change:

  • You may have to get up at night to urinate.

  • Urine may be foamy or bubbly. You may urinate more often, or in greater amounts than usual, with pale urine.

  • You may urinate less often, or in smaller amounts than usual with dark colored urine.

  • Your urine may contain blood.

  • You may feel pressure or have difficulty urinating.

Symptom 2: Swelling/bone pain
Failing kidneys don't remove extra fluid, which builds up in your body causing swelling in the legs, ankles, feet, face, eyes, and/or hands.  Some people with kidney problems may have pain in the back or side related to the affected kidney. Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause pain and even an increase in bone fractures.

Symptom 3: Fatigue
Healthy kidneys make a hormone called erythropoietin (a-rith'-ro-po'-uh-tin) that tells your body to make oxygen-carrying red blood cells. As the kidneys fail, they make less erythropoietin. With fewer red blood cells to carry oxygen, your muscles and brain become tired very quickly. This condition is called anemia, and it can be treated.

Symptom 4: Skin Rash/Itching
Kidneys remove wastes from the bloodstream. When the kidneys fail, the buildup of wastes in your blood can cause severe itching or bruising and pale skin.

Symptom 5: Metallic Taste in Mouth/Ammonia Breath
A buildup of wastes in the blood (called uremia) can make food taste different and cause bad breath. You may also notice that you stop liking to eat meat, or that you are losing weight because you just don't feel like eating.

Symptom 6: Nausea and Vomiting
A severe buildup of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.

Symptom 7: Shortness of Breath
Trouble catching your breath can be related to the kidneys in two ways. First, extra fluid in the body can build up in the lungs. And second, anemia (a shortage of oxygen-carrying red blood cells) can leave your body oxygen-starved and short of breath.

Symptom 8: Feeling Cold
Anemia can make you feel cold all the time, even in a warm room.

Symptom 9: Dizziness and Trouble Concentrating
Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to memory problems, trouble with concentration, and dizziness.

Symptom 10: Other symptoms

  • High blood pressure

  • Chest pain due to pericarditis (inflammation around the heart)

  • Bleeding (due to poor blood clotting)

  • Decreased sexual interest and erectile dysfunction

  • Disturbed sleep

  • Altered mental status (encephalopathy from the accumulation of waste products or uremic poisons)

  • Restless legs syndrome



Q: How can I find out if I am in the early stages of CKD?
A: More than 26 million Americans have chronic kidney disease (CKD) and most don’t know it. The National Kidney Foundation’s Kidney Early Evaluation Program (KEEP®) offers free screenings for those at risk–anyone 18 years and older with high blood pressure, diabetes or a family history of these conditions or kidney disease. The KEEP program is finding kidney disease at the earliest stage possible.

KEEP provides three simple tests that determine kidney function. Participants receive a comprehensive health risk appraisal, blood pressure measurement, blood and urine testing and the opportunity to discuss their health and review results with onsite clinicians. Learn more and find a free screening near you.   [TOP]

Q: Can anything be done to prevent recurring Urinary Tract Infections (UTI)?
A. You can help lessen the chance of recurring UTIs by recognizing signs and symptoms of a UTI and taking appropriate action to see your doctor early. You should follow your doctor's advice and take all prescribed antibiotics as ordered and drink plenty of fluids. You should empty your bladder frequently, especially at night before going to bed. New studies show that drinking cranberry juice daily or eating cranberry products may help. Cranberries contain certain compounds that may stop bacteria from attaching to the urinary tract wall.   [TOP]

Q: How common is Chronic Kidney Disease (CKC)?
A: Some 26 million Americans (13 percent of the U.S. adult population) suffer from CKD—a figure experts predict will rise due to high obesity rates (1/3 of all adults), the link between obesity, diabetes and high blood pressure (all risk factors) and the aging of the Baby Boom generation (since age is another risk factor for CKD). Young and middle-aged adults can also develop CKD.   [TOP]

Q: Can CKD be prevented?
A: Taking care of overall health helps protect kidney health. Wise practices include exercising regularly, low salt diet, controlling weight, monitoring blood pressure, cholesterol and glucose levels, not smoking, drinking moderately, avoiding non-steroidal anti-inflammatory drugs (NSAIDs) and getting an annual physical.   [TOP]

Q: What questions should I ask my doctor?
A: No two people are alike, so asking questions is the best way to find out about your health. On this Life Options website, you can download a Patient Interest Checklist that will help you figure out questions. You'll also find a few basic ideas below, and you can add your own. If you write your questions and show the list to your doctor, you may be more likely to get them answered. Write down the answers, too—or have a family member come along to help you remember the answers.

1. What percent of kidney function do I have now?
2. What is the cause of my kidney problem?
3. What are my lab test results right now?
4. What can I do to keep my kidneys working as long as possible?
5. What treatment is available for my symptoms? (List symptoms)
6. What are the next steps for my treatment?
7. Will I eventually need dialysis or a transplant, if so, how long might it be until I do?   [TOP]


Why Are the Kidneys So Important?
Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and reabsorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

* remove waste products from the body
* remove drugs form the body
* balance the body's fluids
* release hormones that regulate blood pressure
* produce an active form of vitamin D that promotes strong, healthy bones
* control the production of red blood cells   [TOP]

Where Are the Kidneys and How Do They Function?
There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule. When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body's needs, the final product being the urine we excrete.

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.   [TOP]

What Are Some of the Causes of Chronic Kidney Disease?
Chronic kidney disease is defined as having some type of kidney abnormality or "marker" such as protein in the urine, and having decreased kidney function for three months or longer.

There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Some kidney conditions are inherited (run in families).

Others are congenital; that is, individuals may be born with an abnormality that can affect their kidneys. The following are some of the most common types and causes of kidney damage.

Diabetes is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. This results in a high blood sugar level, which can cause problems in many parts of your body. Diabetes is the leading cause of kidney disease.

High blood pressure (also known as hypertension) is another common cause of kidney disease and other complications such as heart attacks and strokes. High blood pressure occurs when the force of blood against your artery walls increases. When high blood pressure is controlled, the risk of complications such as chronic kidney disease is decreased. (For more information about high blood pressure, click here.)

Glomerulonephritis is a disease that causes inflammation of the kidney's tiny filtering units called the glomeruli. Glomerulonephritis may happen suddenly, for example, after a strep throat, and the individual may get well again.However, the disease may develop slowly over several years and it may cause progressive loss of kidney function. (For more information on Glomerulonephritis, click here.)

Polycystic kidney disease is the most common inherited kidney disease. It is characterized by the formation of kidney cysts that enlarge over time and may cause serious kidney damage and even kidney failure. Other inherited diseases that affect the kidneys include Alport's Syndrome,primary hyperoxaluria and cystinuria. (For more information on Polycystic Kidney Disease, click here.)

Kidney stones are very common, and when they pass, they may cause severe pain in your back and side. There are many possible causes of kidney stones, including an inherited disorder that causes too much calcium to be absorbed from foods and urinary tract infections or obstructions. Sometimes, medications and diet can help to prevent recurrent stone formation. In cases where stones are too large to pass, treatments may be done to remove the stones or break them down into small pieces that can pass out of the body. (For more information on About Kidney Stones, and Diet and Kidney Stones, click here.)

Urinary tract infections occur when germs enter the urinary tract and cause symptoms such as pain and/or burning during urination and more frequent need to urinate. These infections most often affect the bladder, but they sometimes spread to the kidneys, and they may cause fever and pain in your back. (For more information about Urinary Tract Infections, click here.)

Congenital diseases may also affect the kidneys. These usually involve some problem that occurs in the urinary tract when a baby is developing in its mother's womb. One of the most common occurs when a valve-like mechanism between the bladder and ureter (urine tube) fails to work properly and allows urine to back up (reflux) to the kidneys, causing infections and possible kidney damage.

Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and "street" drugs such as heroin and crack can also cause kidney damage.    [TOP]

How is Chronic Kidney Disease Detected?
Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

1. Blood pressure measurement
2. A test for protein in the urine. An excess amount of protein in your urine may mean your kidney's filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
3. A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have. Access the GFR calculator.

It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:

* are older
* have diabetes
* have high blood pressure
* have a family member who has chronic kidney disease
* are an African American, Hispanic American, Asians and Pacific Islander or American Indian.

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.   [TOP]

Can Kidney Disease Be Successfully Treated?
Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. Unfortunately, the exact causes of some kidney diseases are still unknown, and specific treatments are not yet available for them. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. A great deal of research is being done to find more effective treatment for all conditions that can cause chronic kidney disease.   [TOP]

How is Kidney Failure Treated?
Kidney failure may be treated with hemodialysis, peritoneal dialysis or kidney transplantation. Treatment with hemodialysis (the artificial kidney) may be performed at a dialysis unit or at home. Hemodialysis treatments are usually performed three times a week. Peritoneal dialysis is generally done daily at home. Continuous Cycling Peritoneal Dialysis requires the use of a machine while Continuous Ambulatory Peritoneal Dialysis does not. A kidney specialist can explain the different approaches and help individual patients make the best treatment choices for themselves and their families.

Kidney transplants have high success rates. The kidney may come from someone who died or from a living donor who may be a relative, friend or possibly a stranger, who donates a kidney to anyone in need of a transplant. Learn more about organ donating at Kentuckiana Organ Donors.   [TOP]

What Are the Warning Signs of Kidney Disease?
Kidney disease usually affects both kidneys. If the kidneys' ability to filter the blood is seriously damaged by disease, wastes and excess fluid may build up in the body. Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

1. High blood pressure.
2. Blood and/or protein in the urine.
3. A creatinine and Blood Urea Nitrogen (BUN) blood test, outside the normal range. BUN and creatinine are waste that build up in your blood when your kidney function is reduced.
4. A glomerular filtration rate (GFR) less than 60. GFR is a measure of kidney function.
5. More frequent urination, particularly at night; difficult or painful urination.
6. Puffiness around eyes, swelling of hands and feet.   [TOP]

How Well Do Your Kidneys Work?
By Gerard J. Stanley, Sr., MD (from the National Kidney Foundation website)

The kidneys perform several important jobs including the removal of chemical and mineral impurities from the blood, balancing acid in the blood, and controlling body fluids. These delicate processes take place when blood flows through the kidneys. The kidneys also help to control your body’s production of red blood cells, regulate blood pressure, and help keep bones strong and healthy. Each kidney has about a million tiny nephrons. Each nephron has a group of tiny blood vessels called a glomerulus. The glomerulus is the small structure in charge of filtering and cleaning the blood as it flows through the kidney. The rate at which the glomerulus filters the blood is called the glomerular filtration rate or “GFR”.

The kidneys filter almost 200 quarts of blood every day and make approximately two quarts of urine as the waste product. When the kidneys don't work like they should, products in the blood which are supposed to be removed, like the blood urea nitrogen (BUN), and creatinine (Cr) stay in the blood and can be easily measured with a blood test. Other products that are supposed to stay in the blood, like proteins, end up in the urine and can be measured with a urine test.

The National Kidney Foundation (NKF) wants doctors to calculate, and patients to know, their GFR number. If your doctor has drawn blood to check your creatinine, he or she can very easily figure out your GFR. By calculating your GFR and checking urine protein, your doctor can tell if you may be in the early stages of chronic kidney disease, or CKD. If steps are not taken to slow the worsening of kidney function, the kidneys may eventually fail and either dialysis or kidney transplant would be needed to live.

The most frequent causes of kidney disease are poorly controlled diabetes and high blood pressure. Other common kidney diseases are glomerulonephritis, which causes inflammation and damage to the glomerulus, and polycystic kidney disease—an inherited disease that causes large cysts to form in the kidney. Another common but often overlooked cause of kidney disease, is the overuse of analgesics, or pain-relieving medicines, especially aspirin, acetaminophen (Tylenol), and non-steroidal drugs (NSAIDs) like ibuprofen, ketoprofen, and naproxen (Aleve). Because these drugs can be bought over the counter they can be quite easily taken in large amounts. These medicines can be toxic to the kidneys, causing permanent damage.

There are usually no symptoms in the early stages of kidney disease, but as it gets worse, you may have high BUN and creatinine on lab tests, nausea and vomiting, less appetite, weakness, extreme tiredness, itching, muscle cramps and anemia.

Warning signs of kidney disease:
1) high blood pressure
2) blood and/or protein in the urine
3) decreasing GFR
4) more frequent urination; pain or difficulty urinating
5) puffiness around eyes; swelling of hands, feet

You can do some things to reduce the risk of getting kidney disease or slow it from getting worse. Work with your doctor to start an “ACE Inhibitor” blood pressure medicine. ACEs have been found to help protect kidney function as well as lower blood pressure. People with diabetes should take an ACE to protect their kidneys even if they do not have high blood pressure. Keeping good control of blood sugar is important. If protein is found in the urine, working with a dietitian to control diabetes and eating a lower protein diet may be needed.

Staying physically fit is important for kidney function. Exercise helps kidney disease by improving muscle function, lowering blood pressure, lowering cholesterol, keeping a healthy body weight and improving your sleep. Start an exercise program with an activity that you like, such as walking, swimming, bicycling or dancing. “Start low and go slow” but try to exercise at least 30 minutes, three times a week. You should be able to talk to your exercise partner while working out, and you should feel completely recovered within one hour of your routine.

Pain-relieving medicine should be taken carefully and only when needed. Speak to your doctor if you need to take pain medicines for more than 10 days in a row because of a chronic pain problem such as arthritis. Avoid combination drugs that have acetaminophen, NSAIDs, and caffeine. Always drink six to eight glasses of water each day if you are taking these medicines.

Pay attention to the warning signs of kidney disease: 1) high blood pressure; 2) blood and/or protein in the urine; 3) decreasing GFR; 4) more frequent urination; pain or difficulty urinating 5) puffiness around the eyes; swelling of hands and feet.

Calculating your GFR is very easy and your doctor should do it at least once a year if you are at risk for getting kidney disease, and more often if you have kidney disease. For doctors and patients who are not familiar with how to calculate GFR, the National Kidney Foundation Web site has an online GFR calculator.   [TOP]


Comprehensive Renal Care Clinic
Anemia Management
Hypertension Management
Chronic Kidney Disease Education
Risk Factor Reduction
Use of Electronic Medical Record
Nutrition – Renal Vitamins


Is to provide the highest quality, most comprehensive and up-to-date care for patients with kidney disease in a courteous, respectful, and timely manner.


6400 Dutchmans Pkwy, Suite 250
Louisville, KY 40205
Phone: 502-587-9660
Fax: 502-540-5615

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