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Chronic Kidney Disease Q&A with Andrew S. Levey, MD, and Michelle M. Richardson, PharmD


Two Tufts Medical Center Division of Nephrology specialists answer your questions about chronic kidney disease.

Andrew S Levey, MD
Michelle M. Richardson

What is kidney disease?

Chronic kidney disease (CKD) is a general term to describe disease caused by changes in the kidneys or in the way they work that may lead to health problems.  About 10 percent of people in the United States have some form of CKD. At its most serious, CKD can lead to kidney failure, which may require treatment with dialysis and transplantation.  However, many people with CKD can avoid kidney failure and successfully control their disease with medications, diet and exercise and may never need dialysis or a transplant. Any patient with CKD is at risk of complications of the disease and needs to work closely with their doctor. Complications can include side effects from medications and medical procedures, high blood pressure, anemia, bone problems, damage to nerves and an increased risk for heart disease.

How do I know if I have kidney disease?

Most people with CKD do not have any symptoms. Instead CKD is usually detected during a routine medical check up or during evaluation for other symptoms.  CKD can be detected by two simple laboratory tests: a urine test for albumin and a blood test for creatinine. Albumin is a normal protein found in the blood that can leak into the urine when the kidney is damaged. Albumin in the urine is not harmful but is a sign of structural damage to the kidney.  A high level of albumin in the urine for more than three months indicates that a patient has CKD. Creatinine is a normal waste product made by muscle tissue that is excreted in the urine. Creatinine builds up in the blood when the kidney doesn’t work as well as it should. Creatinine is used to estimate the glomerular filtration rate (GFR) – the rate at which the kidneys filter the blood. Low levels of GFR for more than three months indicate that a patient has CKD.  People with serious kidney disease usually have some symptoms, including feeling more tired and having less energy than before, having trouble concentrating, having a poor appetite and having trouble sleeping. They may have muscle cramping at night along with swollen feet and ankles. They may have puffiness around their eyes, especially in the morning; they may have dry, itchy skin and may need to urinate more often, especially at night. These symptoms may be shared by other diseases though, so it is important to be tested by a doctor.

What causes CKD and who is at increased risk?

The most common causes of CKD are diabetes, high blood pressure, reactions to medications, autoimmune diseases, and urinary tract infections, stones or obstructions. People with these conditions are at increased risk and should be tested for CKD. In addition, people with arthritis who take regular doses of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen should be monitored for CKD. Other people at increased risk include those with heart disease, a family history of kidney failure, or those over age 60.

What can I do about preventing CKD?

If you have diabetes or high blood pressure, you should follow your doctor’s advice about controlling your weight, blood sugar and blood pressure through diet, exercise and medications and not smoking.  Maintaining a healthy lifestyle is good for everyone, particular those at risk for kidney disease.

If I have CKD, what can I do about preventing complications of CKD?

If you have CKD, be sure to follow your doctor’s advice about controlling your blood pressure and follow up regularly for measurements of blood pressure, urine albumin and blood creatinine.  If you have albumin in the urine, your doctor will usually recommend medications called “ACE inhibitors” or “ARBs” for high blood pressure.  If you have decreased GFR, you may need adjustment to doses of medications that are normally excreted by the kidney.  Always be sure to tell all your doctors that you have CKD, so they can be careful in ordering tests or medications for you.  It is a good idea to have all your prescriptions filled at one pharmacy and to let the pharmacist know that you have CKD.  Also, be sure to ask your physician or pharmacist before taking over-the-counter medications or herbal supplements.  Some of these medications may affect how well your kidney works.