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Symptoms of kidney diseases

Hello and welcome back.

As I had mentioned before, if someone has kidney problem, it could be 'Acute' or 'Chronic'. Most people with acute kidney problems have some symptom directly related to the kidney injury or they will already be in hospital for another illness. The ones I see in my outpatient clinic have slowly worsening renal function which we call Chronic Kidney Disease (CKD)

Allow me to inform you about the symptoms of chronic kidney disease (CKD) first since this is what I encounter most commonly in my outpatients. Symptoms might be slightly different depending on the stage of CKD -

Stage 1 CKD - This is the mildest form of the disease. Kidney function is between 90 - 100%. Patients are mostly asymptomatic or might have ankle swelling due to excessive proteinuria (protein leak from kidneys) or red discoloration of urine due to blood. They might complain of pain in case they have kidney stones or kidney infection.

Stage 2 CKD - Kidney function is between 60 - 90%. Once again symptoms are similar to stage 1 patients. Most patients are incidentally diagnosed on routine screening for another reason.

Stage 3 CKD - Kidney function is between 30 - 60%. These patients are again usually detected incidentally during screening or might present with swelling of legs, hypertension (high BP), pain in kidneys from stones etc.

Stage 4 CKD - Kidney function is between 15 - 30%. By the time patients reach stage 4, many patients start having some subtle symptoms which might be related to fluid accumulation in the body (ankle swelling, breathing difficulty, etc), erythropoietin hormone deficiency causing anemia (tiredness, weakness, breathing difficulty, etc), or accumulation of toxins in the body (tiredness, weakness, etc. However some patients might be remarkably asymptomatic!

Stage 5 CKD - Kidney function less than 15%. This is the last/ most severe stage. Most patients are symptomatic by the time they reach here. There will be accumulation of toxins and excess fluid which can cause tiredness, weakness, nausea, vomiting, weight loss, anemia, itching of the body, altered taste, loss of appetite, etc. These symptoms are all vague and not specific to kidney disease. Depending on the blood tests results and patient symptoms we decide when to start dialysis or advice transplantation. Most pateints with kidney function less than 10% will need dialysis or kidney transplant.

This brings us to symptoms of Acute Kidney Injury (AKI) where kidney function has deteriorated over a very short period of time (days to a couple of weeks). Usually patients are ill and already admitted in hospital or present to emergency department with various problems. They may have blood in urine (haematuria), pain whilst passing urine, frothy urine, reduced quantity of urine, etc. In addition if there has been accumulation of fluid and toxins due to non-functioning of the kidneys one can have vomiting, body swelling, breathing difficulty, etc. Any infection in the kidney or elsewhere can lead to fever.

I shall discuss about diagnosis of kidney disease in my next article.

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