Kidney disease

Your kidneys filter and remove waste and water from your bloodstream. The 2 most common causes of kidney disease are diabetes and high blood pressure as they damage parts of your kidneys.

Diabetes

When your blood sugar is raised, it causes damage to many blood vessels in your body, including the blood vessels in your kidneys. About 1 in 3 people with diabetes will end up with some kidney damage. Diabetic kidney disease is also called diabetic nephropathy.

High blood pressure

High blood pressure damages the small vessels that take blood to the kidney filters and can also damage the filters themselves. Read more about blood pressure and kidney disease.(external link)

Other causes

• Glomerulonephritis is a group of diseases that affects the filtering units in your kidneys.
• Polycystic kidney disease causes cysts to form in your kidneys. This is an inherited disease, which means that it is passed down from your parents.
• Lupus and other diseases that affect your body’s immune system can also affect your kidneys.
• Obstructions caused by abnormally shaped ureters, kidney stones, tumours or an enlarged prostate gland can affect your kidneys.
• Repeated urinary tract infections (UTIS) can also affect your kidneys.

You are at a higher risk of getting kidney disease if you:

• have diabetes
• have high blood pressure (hypertension) 
• have a body mass index (BMI) over 35
• have cardiovascular disease, such as coronary heart disease, cerebrovascular disease or peripheral vascular disease)
• have a family history of kidney disease
• take nephrotoxic medicines
• have some prostate conditions
• are Māori, Pacific Peoples or Indo-Asian
• are over 60 years of age. 

CKD is called a silent disease because it often causes no symptoms. It is not uncommon to lose up to 70% of kidney function before developing symptoms.

The first signs may be general and can include:

• tiredness
• poor appetite and weight loss
• muscle cramps
• a need to pee more often than usual
• pain or burning when peeing
• blood in your pee
• puffiness or swelling around your eyes and ankles.

One of the main ways kidney disease is diagnosed is by the presence of albumin in your pee (urine). Albumin is a protein found in your blood. A healthy kidney doesn’t let albumin pass from your blood into your urine. A damaged kidney lets some albumin pass into your urine. The less albumin in your urine, the better. Sometimes albuminuria is also called proteinuria.

Albumin in your pee is detected using a urine dipstick. Read more about albumin in the urine(external link). Having protein in your pee also increases your chance of having a heart attack, stroke and/or high blood pressure.

Other tests

• Blood tests – these measure blood levels of creatinine and urea. Both of these are normally excreted in your pee, but if your kidneys are not functioning properly, increased amounts can be found in your blood. Read more about kidney function blood tests.
• Renal imaging – this involves taking a picture of your kidneys using methods such as ultrasound, CAT scan or magnetic resonance imaging. These tests help work out if there are any unusual growths or blockages to the flow of pee.
• Renal biopsy – this is a hospital procedure in which a needle is inserted through your skin into your kidney. A small sample of kidney tissue is removed to be looked at under a microscope.

When kidney disease is detected early, changes to your lifestyle and what you eat can slow down the progress of kidney failure and prevent serious consequences. Kidney disease is classified into 5 stages based on how well your kidneys are working. Your treatment depends on what stage of kidney disease you have and what caused it in the first place.

Depending on your individual circumstances, treatment may include taking medicines to:

• reduce blood pressure
• keep diabetes well controlled
• reduce further damage to your kidneys

It could also include referral to a nephrologist (kidney specialist) or, in later stages, assessment for dialysis or kidney transplant.

Lifestyle changes can include:

• avoiding getting too thirsty
• contacting your healthcare provider if you have diarrhoea (runny poo), vomiting or other illness
• avoiding NSAIDs such as ibuprofen
• following a low-salt diet, and possibly a low-potassium diet if your potassium is high
• getting regular flu vaccinations
• telling your healthcare provider and pharmacist before you take any over‑the‑counter medicines or supplements.

Your healthcare provider may also talk to you about:

• getting support to quit smoking
• drinking less alcohol 
• doing more physical activity
• eating healthy food.

Here are some videos on exercising(external link) when you have chronic kidney disease from the Kidney Society. Read more about treatment options for chronic kidney disease(external link) and conservative treatment(external link).

Apps reviewed by Healthify

You may find it useful to look at some Diabetes apps, Heart failure apps, Heart rate apps, Blood pressure apps, Kidney disease apps, and Nutrition, exercise and weight management apps.

It is important to prevent your kidneys becoming damaged further.

• Have your blood pressure checked at least once a year.
• Have your blood sugar checked for diabetes.
• Don't smoke – there is no safe level of smoking and it damages your blood vessel walls.
• Check your cholesterol levels (high cholesterol damages blood vessels in you kidneys).
• Maintain your weight within a healthy range for your height with a well-balanced diet. Read more about chronic kidney disease and nutrition(external link).
• Regular exercise also helps control your weight
• Have an annual check-up with a GP. If you need a blood test, ask for your kidney function to be checked. Ask for your urine to be checked for blood, protein and sugar.
• Read more about how to protect your kidneys.
  

Kidney Health NZ has patient support centres(external link) around the country for people with kidney failure. These are run by trained volunteers who have experienced kidney failure in their own families/whānau, and who offer their time to talk and share stories.

Clinical resources

• Kidney Health NZ(external link) has a range of health professional guides, videos, calculators and eLearning resources.
• Slowing progression of renal dysfunction in patients with diabetes(external link)  BPAC, NZ, 2019
• The detection and management of patients with chronic kidney disease in primary care(external link)  BPAC, NZ, 2015
  Older articles from BPAC:
  • Making a difference in chronic kidney disease(external link) 
  • Should we still be measuring urea?(external link)
  • Drug monitoring – monitoring diuretics in primary care(external link)
• Peer group discussion – the detection and management of patients with chronic kidney disease in primary care(external link)  BPAC, NZ, 2015
• Clinical audit – testing renal function in elderly people(external link)  BPAC, NZ
• Chronic kidney disease (CKD) – management in general practice(external link)  Kidney Health NZ
• A decision aid for the treatment of kidney disease – a guide for health professionals about this tool (external link) Home Dialysis, Kidney Health NZ and Australia

Continuing professional development

Webinar: Kidney health for all(external link) Dr Andy Salmon, Medical Advisor KHNZ

This presentation covers:

Updates on CKD detection, management & guidelines covering World Kidney Day 2023 key themes:

• “Supporting the vulnerable”
  • CKD detection in high-risk groups
  • CKD management to slow progression
  • High-risk CKD – when to refer to renal services
• “Preparing for the unexpected”
  • Acute Kidney Injury
  • CKD complications

Video: Kidney Health For All Webinar

You can watch the video, answer questions and claim hours with a certificate. This video may take a few moments to load.

Chronic kidney disease by Carmel Gregan-Ford(external link) (Mobile Health, NZ, 2020)
Chronic kidney disease by Dr Chris Wood(external link) (The Goodfellow Unit, NZ, 2018)

Apps

Diabetes apps
Heart failure apps
Heart rate apps
Blood pressure apps
Kidney disease apps
Nutrition, exercise and weight management apps