Who is at risk for Chronic Kidney Disease (CKD)?
Anyone can get CKD but your risk is higher if you:

• Have diabetes and/or high blood pressure
• Have family members with kidney disease
• Are a member of certain ethnic groups (African Americans, Native Americans, South East Asians and Hispanics)
• Risk increases with age

What are the symptoms of CKD?
Most patients have no symptoms until they have severe loss of kidney function, generally less than 10-20% of normal. Symptoms may be vague and nonspecific and may include:

• Fatigue or loss of energy
• Loss of appetite
• Trouble sleeping
• Restless legs or leg cramps
• Itching or hiccups
• Swelling in the legs and/or the face

What are some common causes of kidney disease or damage and how are they treated?

• Diabetes and high blood pressure are the most common causes of chronic kidney disease. There is no specific treatment that reverses diabetic kidney disease or high blood pressure related kidney damage. Our goal is to prevent or slow down kidney damage. Good control of diabetes and high blood pressure as well as the use of medicines which protect the kidneys often stabilizes or slows down these forms of kidney damage especially if they are caught early.
• Polycystic kidney disease (PKD) is the most common inherited kidney disease and affects men and women equally. Hundreds of cysts typically replace normal kidney tissue over many years, resulting in loss of kidney function. The main treatments consist of good blood pressure control and medicines to protect the kidneys and close monitoring.
• Vasculitis is a disease in which blood vessels through out the body become inflamed and damaged by the immune system. When this happens in the blood vessels in the kidneys, they may leak blood or protein in the urine or not clean the blood well. Treatment usually consists of drugs which reduce immune system activity and inflammation.
• Glomerulonephritis refers to inflammation in the filters (or blood vessels or glomeruli) in the kidneys. Treatment consists of drugs which reduce immune system activity and inflammation.

How do you test kidney function?
A blood test called the Creatinine is the most common lab test used to indicate kidney function. Creatinine in the body is mostly made in muscles and is typically in the blood in very small and stable amounts throughout a lifetime. The creatinine rises when kidneys do not clean the blood well and therefore it can be used as an indicator of kidney function. The creatinine indicates the total function of both kidnenys.

Creatinines vary depending on sex (men typically have more muscle mass than women), age (we typically lose muscle mass as we age), race (certain races are known to have more muscle mass in general than others), and may change with weight gain or loss or with changes in exercise/activity level. Therefore an individual's creatinine must be interpreted taking these factors into account and a "normal creatinine " for one person may not be normal for another person. Another test called the GFR is calculated using the creatinine and takes into account age, sex and ethnic background. The GFR can be thought of as percent (%) of normal kidney cleaning. Thus a GFR of 50, represents 50% of normal kidney cleaning.

What are some other common kidney tests?

• The urine is another indicator of kidney health and in certain diseases may show protein, microscopic blood and /or allergic or inflammatory cells. If protein is present in the urine, it may be helpful to follow the amount of protein over time.
• 24-hour urine collections were done frequently in the past but are less commonly needed today to follow urine protein or amount of kidney function due to other testing alternatives. 24-hour collections are still helpful in certain diseases such as kidney stone evaluation and management.
• Pictures of the kidneys often reveal clues to the causes of kidney disease or damage and so an ultrasound (the test with a wand and cold jelly on the abdomen and back, no needles) is often requested. Depending on an individual's case, a CT scan, MRI or angiogram may also be recommended.
• Occasionally if a certain kidney disease is suspected or if the cause of kidney disease is unknown despite other testing, a kidney biopsy may be recommended. Kidney biopsies are typically done in the outpatient xray department of a hospital. Patients usually receive medicine to keep them relaxed and comfortable during the procedure but they are awake. Most patients can go home later the same day after a period of observation and monitoring for complications.

What are the stages of Kidney disease?
There are five stages of kidney disease, defined by the level of kidney cleaning (or GFR):

• Stage 1-Kidneys clean the blood normally but other indicators of kidney damage or stress are found, such as protein in the urine or scars on the kidneys or loss of one kidney.
• Stage 2-Kidneys cleaning at 60-90% of normal
• Stage 3-Kidneys cleaning at 30-60% of normal
• Stage 4-Kidneys cleaning at 15-30% of normal. At this level of function, an individual may start to experience symptoms of poor kidney function (such as fatigue or poor appetite) or may start to notice fluid build up in the ankles or higher blood pressure or have more problems with the build up of potassium or acid in the blood or become anemic (have a low blood count).
• Stage 5-Kidneys cleaning less than 15% of normal. This is also called End Stage Kidney Disease and generally indicates a person who needs dialysis or a kidney transplant in the near future.