Question:
For many years, I’ve had some kidney problems and had to go on a very strict low-salt and low-protein diet. Recently, my urine test result showed more than 300mg per litre and high glucose content. What should I do to avoid kidney failure?
Answer:
Your recent urine result was actually a simple test for albuminuria (protein in the urine) to determine how damaged your kidneys are.
In the early stages of kidney disease, albumin is one of the first proteins to filter through the kidneys into the urine (because of its small molecular size). The presence of albumin in the urine is known as microalbuminuria, which may persist for months or years.
Microalbuminuria can be a prediction of kidney disease, especially when you’ve been diabetic for a long time. However, you can potentially reverse this problem with tight control on your blood sugar and blood pressure.
As your kidney damage progresses and you have larger amounts of albumin in your urine, your condition (microalbuminuria) changes to macroalbuminuria (also known as proteinuria or albuminuria). Macroalbuminuria may eventually lead to kidney failure, also commonly called as end-stage renal disease (ESRD).
How Chronic Kidney Disease (CKD) Happens
In the beginning, as your kidney’s renal tissue stops functioning, the kidney can still filter your body’s wastes at normal (or even increased) levels because the remaining tissues work harder to compensate. However, when creatinine (a waste product that comes from muscle activity that kidney can usually filter out of the blood) becomes high, it indicates that your kidneys aren’t working well anymore.
The Glomerular Filtration Rate (GFR) is the best way to measure how well your kidneys are functioning. The GFR is actually a math formula calculated using your age, race, gender, and serum creatinine level (which your doctor can get through a blood test).
If your GFR has been <60 mL/min/1.73 m2 for three months, you will be diagnosed with CKD.
There are 5 stages of CKD, which is determined by your GFR number. The lower your GFR is, the more serious your condition.
How to Manage Your Disease
At first, CKD sufferers may not have any symptoms except for proteinuria and increased blood creatinine. In the early stage, the kidneys won’t be able to concentrate your urine (yellow urine = concentrated urine) and as it progresses they won’t be able to remove phosphate, acid, and potassium from your body.
The early warning signs are:
- Oedema (swelling) – around the eyes (particularly in the morning), face, wrists, abdomen, thighs or ankles
- Foamy or frothy urine
- Bloody urine (haematuria)
- Urinating less often – with dark or coffee-coloured urine
- Urinating more frequently or in greater amount, especially at night (nocturia);
- Problems urinating – with burning sensation or abnormal discharge
- Mid-back pain – below the ribs, near the kidneys.
Other body systems and functions affected by CKD include:
- Hypertension
- Nerve damage
- Accumulation of potassium in the blood (hyperkalemia)
- Reduced phosphate excretion (hyperphosphatemia) associated with increased calcium excretion (hypocalcemia due to vitamin D3 deficiency)
- Hyperparathyroidism (a condition that affects the balance of calcium in your bloodstream and tissues)
- Other cardiovascular diseases
Your action plan after being diagnosed with CKD
1. Control your diet
- Limit your intake of fluids
- Eat a low-protein diet
- Restrict your intake of salt (sodium), potassium, phosphates, and other electrolytes.
- Alternatively, you need to get enough calories if you are losing weight.
- If a restricted diet still can’t help to reduce your phosphate levels, a phosphate binder (a drug) is recommended.
2. Control your blood sugar
- If you are diabetic, tight control of blood glucose is important as this reduces the risk of microalbuminuria by a third.
- In you already have microalbuminuria, the risk of progressing to albuminuria is reduced by half.
3. Control your blood pressure
- Lose weight
- Eat less salt
- Stop smoking and drinking
- Exercise regularly
To learn more about your kidneys and how to keep them healthy, see this cute little infographic here.
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