CHRONIC KIDNEY DISEASE

Chronic kidney disease (CKD) means your kidneys are damaged and can’t filter blood the
way they should. The disease is called “chronic” because the damage to your kidneys
happens slowly over a long period of time. This damage can cause wastes to build up in your
body. CKD can also cause other health problems.

Your kidneys are located in the middle of your back, just below your ribcage.

The kidneys’ main job is to filter extra water and wastes out of your blood to make urine. To
keep your body working properly, the kidneys balance the salts and minerals—such as
calcium, phosphorus, sodium, and potassium—that circulate in the blood. Your kidneys also
make hormones that help control blood pressure, make red blood cells, and keep your bones
strong.

Kidney disease often can get worse over time and may lead to kidney failure. If your kidneys
fail, you will need dialysis or a kidney transplant to maintain your health.

The sooner you know you have kidney disease, the sooner you can make changes to protect
your kidneys.

More information is provided in the NIDDK health topic, The Kidneys and How They Work.

Watch a video about what the kidneys do. Ex ternal lin k

How common is CKD?

CKD is common among adults in the United States. More than 30 million American adults
may have CKD.1

Who is more likely to develop CKD?

You are at risk for kidney disease if you have
  Diabetes. Diabetes is the leading cause of CKD. High blood glucose, also called
blood sugar, from diabetes can damage the blood vessels in your kidneys. Almost
1 in 3 people with diabetes has CKD.1
 High blood pressure. High blood pressure is the second leading cause of CKD.
Like high blood glucose, high blood pressure also can damage the blood vessels in
your kidneys. Almost 1 in 5 adults with high blood pressure has CKD.1
 Heart disease. Research shows a link between kidney disease and heart disease.
People with heart disease are at higher risk for kidney disease, and people with
kidney disease are at higher risk for heart disease. Researchers are working to
better understand the relationship between kidney disease and heart disease.
 Family history of kidney failure. If your mother, father, sister, or brother has
kidney failure, you are at risk for CKD. Kidney disease tends to run in families. If
you have kidney disease, encourage family members to get tested. Use tips from
the family health reunion guide and speak with your family during special
gatherings.

Your chances of having kidney disease increase with age.1 The longer you have had diabetes,
high blood pressure, or heart disease, the more likely that you will have kidney disease.

African Americans, Hispanics, and American Indians tend to have a greater risk for
CKD.2 The greater risk is due mostly to higher rates of diabetes and high blood pressure
among these groups. Scientists are studying other possible reasons for this increased risk.

Watch a video about kidney disease risk . Ex ternal lin k

If you are at risk for kidney disease, learn ways to prevent kidney disease.

What are the symptoms of CKD?

Early CKD may not have any symptoms

You may wonder how you can have CKD and feel fine. Our kidneys have a greater capacity
to do their job than is needed to keep us healthy. For example, you can donate one kidney and
remain healthy. You can also have kidney damage without any symptoms because, despite
the damage, your kidneys are still doing enough work to keep you feeling well. For many
people, the only way to know if you have kidney disease is to get your kidneys checked with
blood and urine tests.

As kidney disease gets worse, a person may have swelling, called edema. Edema happens
when the kidneys can’t get rid of extra fluid and salt. Edema can occur in the legs, feet, or
ankles, and less often in the hands or face.

Symptoms of advanced CKD

 chest pain
 dry skin
 itching or numbness
 feeling tired
  headaches
 increased or decreased urination
 loss of appetite
 muscle cramps
 nausea
 shortness of breath
 sleep problems
 trouble concentrating
 vomiting
 weight loss

People with CKD can also develop anemia, bone disease, and malnutrition.

Does CKD cause other health problems?

Kidney disease can lead to other health problems, such as heart disease. If you have kidney
disease, it increases your chances of having a stroke or heart attack.

High blood pressure can be both a cause and a result of kidney disease. High blood pressure
damages your kidneys, and damaged kidneys don’t work as well to help control your blood
pressure.

If you have CKD, you also have a higher chance of having a sudden change in kidney
function caused by illness, injury, or certain medicines. This is called acute kidney injury
(AKI).

How can CKD affect my day-to-day life?

Many people are afraid to learn that they have kidney disease because they think that all
kidney disease leads to dialysis. However, most people with kidney disease will not need
dialysis. If you have kidney disease, you can continue to live a productive life, work, spend
time with friends and family, stay physically active, and do other things you enjoy. You may
need to change what you eat and add healthy habits to your daily routine to help you protect
your kidneys.
 People with kidney disease can continue to work, be active,
and enjoy life.

Will my kidneys get better?

Kidney disease is often “progressive”, which means it gets worse over time. The damage to
your kidneys causes scars and is permanent.

You can take steps to protect your kidneys, such as managing your blood pressure and your
blood glucose, if you have diabetes.

What happens if my kidneys fail?

Kidney failure means that your kidneys have lost most of their ability to function—less than
15 percent of normal kidney function. If you have kidney failure, you will need treatment to
maintain your health. Learn more about what happens if your kidneys fail.

References
[1] Centers for Disease Control and Prevention. National Chronic Kidney Disease Fact Sheet,
2017. National Chronic Kidney Disease Fact Sheet, 2017 (PDF, 1.32 MB) . Accessed June
External lin k

7, 2017.

[2] Race, ethnicity, and kidney disease. NIDDK website. www.niddk.nih.gov. Published June
13, 2017. Accessed June 13, 2017.

Causes of CKD
Diabetes and high blood pressure are the most common causes of chronic kidney disease
(CKD). Your health care provider will look at your health history and may do tests to find out
why you have kidney disease. The cause of your kidney disease may affect the type of
treatment you receive.
Diabetes
Too much glucose, also called sugar, in your blood damages your kidneys’ filters. Over time,
your kidneys can become so damaged that they no longer do a good job filtering wastes and
extra fluid from your blood.

Often, the first sign of kidney disease from diabetes is protein in your urine. When the filters
are damaged, a protein called albumin, which you need to stay healthy, passes out of your
blood and into your urine. A healthy kidney doesn’t let albumin pass from the blood into the
urine.

Diabetic kidney disease is the medical term for kidney disease caused by diabetes.

High blood pressure

High blood pressure can damage blood vessels in the kidneys so they don’t work as well. If
the blood vessels in your kidneys are damaged, your kidneys may not work as well to remove
wastes and extra fluid from your body. Extra fluid in the blood vessels may then raise blood
pressure even more, creating a dangerous cycle.

More information is provided in the NIDDK health topic, High Blood Pressure and Kidney
Disease.

High blood pressure can damage blood vessels

in your kidneys.

Other causes of kidney disease

Other causes of kidney disease include

 a genetic disorder that causes many cysts to grow in the kidneys, polycystic kidney
disease (PKD).
 an infection
 a drug that is toxic to the kidneys
 a disease that affects the entire body, such as diabetes or lupus . Lupus
NIH external link

nephritis is the medical name for kidney disease caused by lupus

  IgA glomerulonephritis
 disorders in which the body’s immune system attacks its own cells and organs,
such as Goodpasture syndrome
 heavy metal poisoning, such as lead poisoning NIH externa l link

 rare genetic conditions, such as Alport syndrome NIH external link

 hemolytic uremic syndrome in children

 Henoch-Schönlein purpura
 renal artery stenosis

Tests & Diagnosis

How can I tell if I have kidney disease?
Early kidney disease usually doesn’t have any symptoms. Testing is the only way to know
how well your kidneys are working. Get checked for kidney disease if you have

 diabetes
 high blood pressure
 heart disease
 a family history of kidney failure

If you have diabetes, get checked every year. If you have high blood pressure, heart disease,
or a family history of kidney failure, talk with your health care provider about how often you
should get tested. The sooner you know you have kidney disease, the sooner you can get
treatment to help protect your kidneys.

Get tested to find out if you have kidney

disease. Early treatment may help protect your kidneys.

What tests do doctors use to diagnose and monitor

kidney disease?
To check for kidney disease, health care providers use
  a blood test that checks how well your kidneys are filtering your blood, called
GFR. GFR stands for glomerular filtration rate.
 a urine test to check for albumin. Albumin is a protein that can pass into the urine
when the kidneys are damaged.

If you have kidney disease, your health care provider will use the same two tests to help
monitor your kidney disease and make sure your treatment plan is working.

Watch a video on how to check for kidney disease. External lin k

Blood test for GFR

Your health care provider will use a blood test to check your kidney function. The results of
the test mean the following:

 a GFR of 60 or more is in the normal range. Ask your health care provider when
your GFR should be checked again.
 a GFR of less than 60 may mean you have kidney disease. Talk with your health
care provider about how to keep your kidney health at this level.
 a GFR of 15 or less is called kidney failure. Most people below this level need
dialysis or a kidney transplant. Talk with your health care provider about your
treatment options.

GFR results show whether your kidneys are

filtering at a normal level.

You can’t raise your GFR, but you can try to keep it from going lower. Learn more about
what you can do to keep your kidneys healthy.

Creatinine. Creatinine is a waste product from the normal breakdown of muscles in your
body. Your kidneys remove creatinine from your blood. Providers use the amount of
creatinine in your blood to estimate your GFR. As kidney disease gets worse, the level of
creatinine goes up.

Urine Test for Albumin

If you are at risk for kidney disease, your provider may check your urine for albumin.

Albumin is a protein found in your blood. A healthy kidney doesn’t let albumin pass into the
urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your
urine, the better. Having albumin in the urine is called albuminuria.
 A healthy kidney doesn’t let
albumin pass into the urine. A damaged kidney lets some albumin pass into the urine.

A health care provider can check for albumin in your urine in two ways:

Dipstick test for albumin. A provider uses a urine sample to look for albumin in your urine.
You collect the urine sample in a container in a health care provider’s office or lab. For the
test, a provider places a strip of chemically treated paper, called a dipstick, into the urine. The
dipstick changes color if albumin is present in the urine.

Urine albumin-to-creatinine ratio (UACR). This test measures and compares the amount of
albumin with the amount of creatinine in your urine sample. Providers use your UACR to
estimate how much albumin would pass into your urine over 24 hours. A urine albumin result
of

 30 mg/g or less is normal

 more than 30 mg/g may be a sign of kidney disease

If you have albumin in your urine, your provider may want you to repeat the urine test one or
two more times to confirm the results. Talk with your provider about what your specific
numbers mean for you.

If you have kidney disease, measuring the albumin in your urine helps your provider know
which treatment is best for you. A urine albumin level that stays the same or goes down may
mean that treatments are working.