Kidney Problems: Types, Warning Signs and Tests

Types of kidney problems

Warning signs of kidney problems

Early CKD rarely causes symptoms. Signs that may point to a kidney problem include:

• Urine changes: foamy or bubbly urine (protein), pink, red or cola-colored urine (blood), passing much more or much less urine than usual, getting up often at night.
• Swelling (edema): around the ankles, feet, hands or eyes, because the kidneys are not removing salt and water, or protein is leaking out.
• Flank or back pain: under the ribs on one or both sides, typical of stones and infection rather than CKD.
• High blood pressure: both a cause and a result of kidney disease.
• Tiredness and weakness: from waste buildup and anemia.
• Itching, dry skin, muscle cramps, poor appetite, nausea and a metallic taste in later stages.
• Shortness of breath from fluid in the lungs.
• Trouble sleeping and concentrating.

These symptoms have many other causes, which is why testing is needed.

Who is at risk

The biggest risk factors for long-term kidney disease are:

• Diabetes: the leading cause of kidney failure. See diabetic nephropathy.
• High blood pressure: the second leading cause.
• Heart disease and obesity.
• Family history of kidney disease, including polycystic kidney disease.
• Age over 60.
• Black, Hispanic, Native American and South Asian ancestry, in part because of higher rates of diabetes and high blood pressure.
• Regular use of NSAIDs such as ibuprofen at high doses, and some other medicines.
• Past kidney injury, kidney stones or recurrent infections.

Tests that check your kidneys

CKD is staged by eGFR (stages 1 to 5) and by albuminuria level (A1 to A3). Stage 5, an eGFR below 15, is kidney failure.

Treatment depends on the problem

• Stones: pain relief, fluids, medicines to help passage, and procedures for larger stones.
• Infection: antibiotics.
• Acute kidney injury: fluids, treating the cause, stopping harmful medicines, and sometimes temporary dialysis.
• CKD: controlling blood pressure and blood sugar, ACE inhibitors or ARBs and SGLT2 inhibitors to slow progression, a lower salt diet, avoiding kidney-harming medicines, and treating anemia and bone problems. Advanced CKD may need dialysis or a kidney transplant.

Protecting your kidneys

• Keep blood pressure in your target range, often below 130/80 for people with CKD.
• Manage diabetes and get a yearly eGFR and urine ACR test if you have diabetes or high blood pressure.
• Limit salt and processed foods.
• Use NSAIDs only occasionally and at the lowest dose, and avoid them if you have CKD. Acetaminophen (paracetamol) is usually safer for the kidneys at label doses.
• Stay hydrated, especially if you have had kidney stones.
• Do not smoke.
• Ask your pharmacist to check doses of medicines that need adjusting for kidney function.

Frequently asked questions

What are the first signs of kidney problems?

Early chronic kidney disease usually causes no symptoms. The first signs are often found on tests: protein in the urine or a lower eGFR. When symptoms do appear, they include foamy urine, swelling of ankles or around the eyes, high blood pressure, and getting up at night to urinate.

How do I know if my back pain is my kidneys?

Kidney pain is felt higher and deeper than most back pain, under the ribs on one side, and does not change with movement. Kidney stones cause waves of severe pain, and kidney infection causes a steady ache with fever and urinary symptoms. Muscle pain is worse with movement.

Can kidney problems be reversed?

Acute problems such as stones, infections and many cases of acute kidney injury usually recover with treatment. Chronic kidney disease cannot be reversed, but its progression can often be slowed considerably with blood pressure and diabetes control and kidney-protecting medicines.

What color is urine with kidney problems?

Urine may be foamy (from protein), pink, red or brown (from blood), or very dark. In advanced kidney disease, urine may be pale and dilute. Color alone is not reliable, so a urine test is needed.

Who should get their kidneys checked?

Anyone with diabetes, high blood pressure, heart disease, obesity, a family history of kidney disease, or over age 60 should have a blood eGFR and urine ACR test, usually once a year or as advised by their doctor.