What symptoms can I have?

Because the kidneys are very adaptable and are able to compensate for some loss of function, signs and symptoms may not appear until a large amount of irreversible damage has occurred.

Symptoms of CKD are often nonspecific which means they can be caused by other illnesses as well. 

Some symptoms of CKD might include:


Loss of appetite


Fatigue and weakness


Sleep problems - insomnia


Muscle twitches


An increased need to pee - particularly at night


Decreased mental sharpness and mood changes


Chest pain and/or shortness of breath


Swelling of feet and ankles


High blood pressure (hypertension)


Itchy skin


Blood in your pee


Feeling sick

If there are symptoms compatible with kidney disease, the doctor can ask the following questions to get more information about the history of the disease:


• How long have the symptoms existed?

• Are there any other illnesses (e.g. high blood pressure, diabetes)?

• Does anyone in the family have kidney disease?

• Have you taken medication or used contrast media for an imaging examination recently?


This is followed by a physical exam, including measurement of the blood pressure, blood tests and urine tests.


What kind of tests should I get if I want to know how well my kidneys are working?

The function of kidneys can be assessed by urine and blood tests. These tests can show how quickly body waste is being removed, and whether the kidneys are leaking abnormal amounts of protein, a sign of kidney damage. CKD patients need to go for these tests regularly so their doctor can monitor their kidneys’ function.



Understanding kidney testing:


There are a lot of different blood and urine tests that can provide information about your kidneys and overall health. We tried to summarize most of them and their relevance for you here:



Urine protein:


Damaged kidneys can leak protein into your urine. Persistent protein in the urine is usually an early sign of chronic kidney disease and can be detected with a simple urine test. With large amounts of protein in the urine you may notice that the urine is frothy or foamy in appearance


Different tests may be used to screen for proteins in the urine:


As a first step, an easy-to-perform urine strip test can provide valuable information about the presence of kidney disease. The test strips measure whether there is an abnormally high amount of protein in the urine. Any filtered protein is normally reabsorbed and kept in your body but when your kidneys are damaged protein leaks into your urine.


If this test result is abnormal, the urine is examined more closely in the laboratory with one of the following tests:

  Urine Tests
This is a routine test that can detect protein in the urine as well as red blood cells and white blood cells. These are not normally found in the urine and, if present, they may indicate kidney disease.
Microalbuminuria test is a sensitive test that can detect even small amounts of albumin (a type of protein) in the urine and be an early sign of kidney damage.
Urine Creatinine
Determines the concentration of creatinine in the urine. Another way of determining the level of kidney damage present.
Urine Protein-to-Creatinine Ratio
Allows to determine the amount of protein you excrete in the urine in a day
Albumin/creatinine ratio (ACR)

This test detects the amount of albumin (a type of protein) in the urine in a day. The American Diabetes Association recommends ACR as the preferred test for screening for even small amounts of albumin in the urine (this is called microalbuminuria)⁷.

Measurement of urine protein and albumin can be done as spot tests on a small sample or as tests on all the urine collected by a person for a full 24 hours. Though it is burdensome to collect urine for 24 hours this is sometimes needed to give the most accurate information on the kidney function.

Also, as part of the examination, your doctor should measure your blood pressure and order a blood test to measure the levels of glucose and creatinine in your blood. We will explain this further in the next section.

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  Blood Tests
Estimated Glomerular Filtration Rate (eGFR)

Using the blood creatinine concentration, age, body size and gender the doctor can calculate the eGFR for a patient. 

The eGFR is the best test available to estimate the kidney function and to define the stage of the disease. It also allows for the monitoring of the disease progression and to plan it’s treatment accordingly. 

Remember that the earlier the CKD is diagnosed the better the chances of slowing or stopping its progression.

The value of the eGFR decreases as kidney disease progresses: a lower eGFR score means that there is more damage to the kidneys and their function is lower.

eGFR can also be calculated using the concentration of another protein called cystatin C.

Serum Creatinine

The level of circulating creatinine in the blood is a marker for kidney function. Creatinine is a waste product from activities of muscle fibers, and is normally filtered and removed from the blood by the kidneys. When the kidneys function worsens the creatinine serum levels rise. 

Serum creatinine is also used in the eGFR calculation.

Cystatin C
Cystatin C is a protein that is produced by all the cells in the body that have a nucleus. Elimination from the circulation is done almost entirely by the kidneys which makes it a very good marker of how well the kidneys are working. Since the concentration of cystatin C in the blood is independent from muscle mass and gender (unlike creatinine), it's a more sensitive parameter for eGFR calculation.
Blood Urea Nitrogen (BUN)

A normal waste product from the breakdown of proteins in the food we eat and a byproduct of the body's metabolism, urea nitrogen is normally removed from the blood by the kidneys.

BUN levels rise when kidney function worsens. It can also rise or decrease depending on the amount of protein in your diet.

Serum Albumin

Albumin is a type of protein that normally circulates in the blood. It's made from the protein we consume in our diet. Usually, albumin is too big to be filtered by the kidneys but when the kidney damage is severe enough a patient may start losing albumin from the blood through the kidneys. Low levels of albumin may lead to several health problems including problems fighting infections. Since albumin attracts liquid and keeps it in the blood vessels, a low level of albumin might lead also to fluid retention and generalized swelling.

The level of albumin in the blood is also affected by the amount of protein in your diet.


Hemoglobin is the chemical compound of the red blood cells that carries the oxygen from the lungs to every cell in the body. 

The hemoglobin levels let your doctors know if you have anemia which is when the hemoglobin levels fall below normal values. Anemia can make you feel tired, with low energy, palpitations, agitated and may also increase the risk of infections²

TSAT and Serum Ferritin
TSAT and Serum Ferritin are ways to measure the amount of iron in your body and how it is being used and stored in your body. Iron is a fundamental component of hemoglobin and is integral for the correct development and functioning of your red blood cells as well as cellular energy production.
Parathyroid Hormone (PTH)
PTH is a hormone produced by the parathyroid glands that regulates the calcium and phosphate levels in the blood by its effects on the bones, kidneys and intestines.
Calcium is a mineral that is important for strong bones development. CKD patients may experience a loss of calcium due to defective kidney filtration which may lower calcium levels in the blood and lead to weaker bones and an increased risk of fractures.
Phosphorus metabolism can also be impaired in CKD patients leading to an increased phosphorus level in the blood. A high phosphorus level can lead to weak bones.
Potassium is a mineral in the blood that helps the heart and muscles work properly. A potassium level that is too high or too low may weaken the muscles and change your heartbeat, leading to potential life threatening situations. The more advanced the CKD is, the higher the potassium levels can get leading to a wide range of potential complications.
Total Cholesterol

Cholesterol is normally found in your blood. A high cholesterol level may increase your chance of having heart and circulation problems. For many patients, a good level for total cholesterol is below 200. If your cholesterol level is too high, your doctor may ask you to make some changes in your diet and increase your activity level. In some cases, medications to lower the cholesterol levels are also used.

In adults with newly identified CKD (including those treated with chronic dialysis or kidney transplantation), an evaluation with a series of exams is recommended to determine “the lipid profile” that involves measuring the level of cholesterol and other fatty substances in the blood. (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides)⁶

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1. Adapted from Findlay’s and Isles’ “Clinical Companion in Nephrology”, Springer Ed., 2015.

2. Adapted from “Comprehensive Clinical Nephrology”, 6th edition, Elsevier Ed., 2015. 

3. National Kidney Foundation

4. KidneyFund.org

5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1–150.

6. Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 259–305.

7. “Diabetic Nephropathy”, American Diabetes Association, Diabetes Care 2002 Jan; 25 (suppl 1): s85-s89.

8. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study, 2017.


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