10 Early Warning Signs of CKD

How often do you think about your kidneys? Probably not very often. When your kidneys are functioning properly, it’s easy to forget what a key role they play in your health. But when your kidneys aren’t working as well as they should, your body will send you warning signals to let you know something is wrong. These warnings can be early indicators of chronic kidney disease.  

What is chronic kidney disease? 

Chronic kidney disease is the gradual loss of kidney function over time. The kidneys’ main job is to filter waste and extra water out of the blood to make urine. When the kidneys are functioning properly, they help maintain a balance of salt and minerals in the blood. They also release a hormone that helps regulate blood pressure. 

More than 37 million Americans have chronic kidney disease. However, many people with CKD aren’t aware they have it. That’s because the symptoms can often be attributed to other conditions. Sometimes, people may not experience any symptoms at all until later stages. Because symptoms usually go undetected, chronic kidney disease is often known as a silent disease. 

Since there is currently no cure for chronic kidney disease, it’s important to recognize and act upon any warning signs as soon as possible. Here are some early warning signs of chronic kidney disease to look out for. 

Changes in urination

Although urine issues are usually associated with the bladder, one of the earliest and most obvious signs of kidney issues is a change in urination. The kidneys cleanse the blood of toxins and remove waste products and excess fluid through urine. Any changes in urine, like frequency or appearance, can indicate that your kidneys aren’t doing their job.  

Changes in urination frequency and amount

The kidneys are made up of millions of filters known as nephrons. If the nephrons are damaged, you might feel the urge to urinate more often than usual, especially at night. This is known as nocturia. 

Nocturia is defined as needed to wake up at least once during the night to use the bathroom. You may also urinate more by volume, which is called polyuria. The severity of nocturia or nocturnal polyuria, may depend on age, co-morbidities and health history and research shows that up at 64% of people with CKD experience at least one of these conditions.   

Researchers have suggested the main causes of nocturia in CKD is osmotic diuresis, increased salt excretion and high volume of fluid ingestion. Osmotic diuresis is increased urination caused by an excess of urinary solute found in fluid that is filtered by the kidneys. The process of osmosis causes additional water to come into the urine which increases the amount.  

Another study found that the excretion of urinary sodium (salt) during the nighttime increased as kidney function declines. That may be because people with impaired kidney function consume excessive salt, and salt excretion is then carried over to the nighttime, resulting in nocturnal polyuria. Diet modifications like reducing salt and glucose intake, and limiting fluid intake near bed time,  can help reduce nocturia.  

Foamy urine

Low levels of protein in the urine are normal and aren’t noticeable. However, frothy or foamy urine can indicate an excess amount of protein, which is usually found in the blood. When the kidneys are functioning properly, they filter out protein, prohibiting it from passing through into the urine. If there is damage to the kidneys, they can’t filter proteins properly and it may leak out of the kidneys into your urine.  

Bloody urine

When the kidneys are functioning properly, they keep blood cells in the body when they filter waste from the blood to create urine. But when the kidneys’ filters have been damaged, blood cells can start to leak into the urine. Although blood in the urine can indicate chronic kidney disease, it can also be a sign of infection, tumors, or kidney stones. 

Fatigue

There are several reasons you might be feeling more tired than usual. You may not be getting enough sleep or poor-quality sleep. However, fatigue can also be caused by kidney disease. If your kidneys aren’t working the way they are supposed to, toxins and other impurities can build up in the blood. This can make you feel more tired than normal.  

The kidneys also secrete a hormone known as erythropoietin (EPO) that is responsible for telling the bone marrow to make more red blood cells when your blood oxygen levels are low. Kidney damage reduces your ability to make EPO, so your bone marrow doesn’t know it needs to make more red blood cells. This can cause you to become anemic, and one of the common symptoms of anemia is fatigue.  

Feeling cold

In addition to fatigue, anemia can cause you to feel cold even in warm temperatures. A low red blood cell count makes it difficult for oxygen to circulate throughout the body, especially to the limbs. If you have anemia related to chronic kidney disease, you may notice that your arms and legs feel cold often.  

Swelling in the ankles, hands, feet, or legs 

Our bodies are mostly water, and they need water to function. However, if conditions within our bodies have fallen out of balance, we can hold on to too much water. One of the kidneys’ jobs is to remove that excess fluid. If the kidneys are failing or damaged, they can’t remove extra fluid properly and it builds up in the body.  

Excess fluid that gets trapped in the body’s tissues is called edema. It is usually more noticeable in the ankles, legs, hands, and feet. However, it can affect any part of the body.  

Puffiness around the eyes 

Puffiness or swelling around the eyes can go hand in hand with protein in the urine as a warning sign of kidney disease. If you have puffiness around the eyes, it can mean that your kidneys are leaking large amounts of protein in the urine instead of keeping it in the body. 

Shortness of breathShortness of breath 

Shortness of breath is another symptom that can have multiple causes. When shortness of breath is caused by kidney issues, there are a couple of different factors. One is that the kidneys are not removing extra fluid, which can cause it to build up in the lungs. Another reason for shortness of breath is anemia. When there is a shortage of oxygen-carrying red blood cells, your body becomes oxygen-starved, which can leave you feeling like you can’t catch your breath.  

Decreased appetite 

Although a lack or loss of appetite can be attributed to several different conditions, it can also be an early indicator of kidney disease. If toxins build up in your body because your kidneys aren’t functioning properly, it can cause you to lose your appetite. You may get full quickly, feel full for longer periods of time after meals, or you might feel too sick or tired to eat.  

High blood pressure 

High blood pressure is one of the main causes of CKD and it can also be a sign of the disease. As kidney function deteriorates, sodium and water build up in the body causing blood pressure to rise. When this happens the kidneys release a hormone called renin, which regulates blood pressure. When the kidneys are not functioning properly, they are unable to release this hormone when salt levels get too high or too low causing a fluctuation in blood pressure.  

Muscle cramps 

When there is severe loss of kidney function, it can cause an imbalance in electrolytes such as sodium, calcium, or potassium. This imbalance can disrupt how the muscles and nerves work, resulting in muscle cramps.  

Pain in the lower back 

Your kidneys are located on either side of your spine in your lower back. If you feel pain in this area, it can be a sign of kidney problems. It can also be a sign that there is an infection or blockage of the kidneys. 

What should I do if I have early warning signs of CKD? 

While it can be easy to dismiss warning signs of chronic kidney, it’s important to talk to your doctor. The only way to diagnose kidney disease is through lab testing, a physical exam and a health history.  

There are two tests your doctor will order to determine if you have kidney disease, including blood and urine tests. 

A blood test for kidney disease measures the amount of creatinine in your blood. Creatinine is a waste product of creatine, which is a compound that provides energy to the muscles. When your muscles use energy, the tissue starts to break down, causing creatinine to be released into the bloodstream. Normal creatinine levels should be 0.7 to 1.3 mg/dL for males and 0.6 to 1.1 mg for females. If the levels are higher than that, it can be a sign that the kidneys are not working properly.  

stages of kidney disease
Photo credit: National Kidney Foundation

A urine test for kidney disease measures the amount of albumin in your urine. Albumin is a protein that can pass into the urine when the kidneys are damaged. When the kidneys are functioning properly, they don’t let any albumin pass into your urine. But when they are damaged, albumin can pass into the urine.  

Your doctor can measure the amount of albumin in your urine in two ways: 

  • Dipstick test—Your doctor will take a urine sample and place a strip of chemically treated paper, called a dipstick, into the urine. The dipstick will change color if there is albumin present.  
  • Urine albumin to creatinine ratio—Your doctor will measure and compare the amount of albumin and creatine in your urine sample. Your doctor will use this ratio to estimate how much albumin would pass into your urine in a 24-hour period. If your albumin result is 30 mg/g or less, that’s normal. If it is higher than 30 mg/g, it can be a sign of kidney disease. You may need to repeat the test to confirm the results.  

What if I’ve been diagnosed with chronic kidney disease? 

 The days after a diagnosis can feel overwhelming and it may be difficult to keep track of all the information you are learning about your disease. It can be helpful to write down questions you want to ask your doctor.  

You should keep track of your symptoms so you can let your doctor know if they are getting worse. If they are getting worse, especially symptoms like foamy or bloody urine, it may be a sign that your kidney disease is progressing. 

While there is no cure for kidney disease, treatment can help it from getting worse. Your doctor may also tell you to modify your diet and get more exercise. Decreased kidney function affects many different aspects of your health. Improving your diet and getting more exercise can help you manage some of the issues you might experience, such as low energy, muscle weakness, and high blood pressure. 

As you start your CKD journey, you may feel alone. But you’re not. At PatientsLikeMe, there are over 17,000 members who know what you’re going through. Join the conversation today to learn how to manage chronic kidney disease and get the support you need. 

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