Kidney disease diagnosis, treatment and link to high blood pressure

High blood pressure and kidney disease are two illnesses that often go hand-in-hand. High blood pressure (hypertension) damages blood vessels throughout the body, reducing the blood supply to organs such as the kidneys and making high blood pressure one of the leading causes of kidney disease. Your kidneys play an important role in keeping your blood pressure in a healthy range and someone diagnosed with kidney disease is at increased risk of high blood pressure.

What are the symptoms of kidney disease?

Chronic kidney disease (also known by its initials, CKD) is the term doctors use when your kidneys aren’t working as well as they should and as well as they used to. The term chronic means that your condition is unlikely to get better, however, this doesn’t necessarily mean that your kidney disease is making you very ill.

In fact CKD may only be having a minimal effect on your health. If you do notice any unusual symptoms (see below) even if they are fairly minor, speak to your GP. They will be able to organise tests to check on the health of your kidneys, and give you advice on what steps to take next.  

The symptoms of kidney disease vary depending on how severely you have this condition. For medical purposes kidney disease is divided into five stages.

Stages 1 to 3 are regarded as being minor, so you may only have mild symptoms, or no discernible symptoms at all. This can make detecting and diagnosing kidney disease difficult.

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Early symptoms of kidney disease include:

• going to the toilet to urinate more often than usual
• urine having a different smell and/or colour than usual
• feeling thirsty far more often than normal
• itchy skin
• swollen hands, legs or face
• feeling tired or unwell
• feeling sick
• developing anaemia, which will make you look pale.
• puffiness around your eyes, and also around your hands, feet and ankles

Your GP will need to carry out a blood test to confirm whether or not you have kidney disease.

Find out about other reasons you might be suffering from swollen fingers or swollen ankles.

Severe kidney disease

If your kidney disease becomes more severe, and reaches stages four or five, it will be more obvious that you have kidney problems.

The symptoms at these stages are more noticeable, and you are likely to be feeling less well than normal.

• You may also feel more tired, due to worsening anaemia (if you aren’t being treated for this).
• Your blood may contain lower levels of phosphate and calcium and other vital chemicals.

All of these changes can affect your health, and may cause bone-thinning, and even bone fractures.

If you have kidney disease and it progresses to stage four or five, it is vital that you keep seeing your doctor to have your condition treated.

Stage 5 is regarded as the final stage in kidney disease, and, if not treated, will be fatal. This is why it is so important to see your GP as early as possible.

Sneaky symptoms of bone issues

How is kidney disease diagnosed?

In its early stages, you can easily miss the fact that you have chronic kidney disease. This is because to start with, the symptoms are quite minor, and you may not notice them or may just ignore them as a minor inconvenience.

Your GP may not be aware that you have this condition, unless you are very specific about the new symptoms that you’ve noticed recently. Or they may spot the symptoms when they are checking your health for another condition.

It is important to recognise - and even make a note of - new symptoms and health problems that don’t go away. When spotted early, kidney disease can be treated, and your doctor can keep an eye on your condition, so that you can have appropriate treatment promptly. This can help to slow the progress of kidney disease. In some cases it may be possible to return your kidneys to their previous, healthy state.

To check whether you have kidney disease your doctor will probably carry out a blood test to find out if your kidneys are working well or not. This is to check your blood to see the amount of a waste product called creatinine, it contains.

Then, taking your personal details – age, ethnic group and whether you are male or female into account, they will calculate the amount of waste your kidney can filter in one minute (in millilitres). This is known as your glomular filtration rate, or GFR.

• Healthy kidneys (GFR Level stage 1), should be able to filter 90 mL/minute, or more.
• At stage 2, kidneys with a relatively low amount of damage should be able to filter 60 to 89 mL/min.
• By stage 3 this drops to 30 to 59mL/min.
• By Stage 4, where there has been a severe decrease in GFR, kidneys can only filter 15 to 29 mL/minute.
• Stage 5, the final stage, is when the kidneys are in established renal failure (ERF) and are only able to filter less than 15 mL/minute, or are being helped by dialysis.

When you have dialysis you are usually connected to a machine that filters your blood to remove the waste products. If this doesn’t happen these waste products can build up and make you ill.

If you have a low GFR this shows that your kidneys aren’t working at a healthy level. If these tests indicate that your kidneys are struggling, or may be affected by disease, you may need to have an ultrasound scan carried out on your kidneys, to get a clearer picture of any problems, and how damaged your kidneys may be.

People with high blood pressure are recommended to have their blood tested regularly, as are those with a family history of advanced chronic kidney disease (CKD), cardiovascular disease, protein and/or blood in their urine, for which there is no explanation.

Who is at risk of kidney disease due to high blood pressure?

Because of the way our blood pressure and our kidneys work, they affect each other. For example, someone who has high blood pressure is also more prone to developing kidney disease. And having kidney disease can increase your risk of having high blood pressure.

So high blood pressure is part of a vicious cycle. And there are some factors that out you at greater risk of developing high blood pressure. Being over 65, being overweight or obese, having a relative with high blood pressure, and being from African or Caribbean origins are some of the factors that put you at increased risk of high blood pressure, and kidney disease.

The advice from Blood Pressure UK, is that people with kidney disease are far more likely to have heart disease or to suffer a stroke, than they are to develop serious kidney problems, such as kidney failure. Their advice is to do your best to maintain a healthy heart and healthy blood vessels. Keeping your blood pressure at a safe and healthy level will help you do this.

Find out about stroke symptoms, prevention and treatments

Saga Health Insurance may be able to provide you with cover even if you already have high blood pressure (hypertension), subject to some simple health questions and an additional premium. Find out more.

How can I prevent kidney disease?

The first step you should take to avoid developing kidney disease is to look at the habits you can change to improve your health. So, if you smoke, do everything you can to give up.

Smoking is a serious health risk for your kidneys, as well as cardiovascular disease, such as stroke and heart disease, and cancer. You can get free advice on stopping smoking from your GP, the NHS website, and the NHS smoking helpline 0300 123 1044.

Your guide to stopping smoking

Eat a healthy diet – try to have at least five portions of fruit and vegetables a day (more if you can). Other elements of a healthy diet include dairy food (or non-dairy alternatives, if you can’t eat dairy products), potatoes, pasta, bread etc. protein packed foods, such as eggs, meat and fish, and beans.

Cut back on salt, sugar and saturated fat. Salt can raise your blood pressure, so cut back to a maximum of 6g (0.2 ounces) each day.

If you are overweight, lose weight – you can get help and from your GP on how to lose excess lbs. Being overweight is a risk factor for kidney disease, as it raises your blood pressure.

If you drink alcohol, keep an eye on how much you’re having. Alcohol can increase your blood pressure, so make sure you stay within safe limits. Don’t drink more than 14 units of alcohol a week (less, if you can), and spread this across three or more days.

Are you drinking more than you think?

Getting some exercise is important, because it helps to lower your blood pressure, which is good for your kidneys, as well as your heart – in fact, your whole body. If you haven’t exercise in a while, start gently. Walking is a good way to start, as you can do this at your own pace – and it’s free. Make sure you have supportive shoes, and ask someone to walk with you (it’s more fun, and can make you feel more confident if you’re a bit wobbly from lack of exercise).

Whether they’re on prescription, or bought over the counter, non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen and aspirin, can cause kidney disease if you take them for a long time, or take more than recommended. Talk to your GP about NSAIDs, and see if there is an alternative painkiller that they can prescribe for you.

How is kidney disease treated?

Chronic kidney disease involves a number of health problems that can vary from one person to another. So the medication you would take for this condition is generally specific to the conditions that caused your chronic kidney disease, and for the health problems you have as a result of those conditions.

Anaemia and kidney disease

This condition can be quite common in people who have kidney disease. Kidneys affected by disease don’t always make enough of a substance called erythropoietin (EPO), that triggers the production of red blood cells in the bone marrow. And this can cause anaemia, which can make you feel very tired, and can affect how well your body – especially your heart and brain – function.

Anaemia caused by a lack of erythropoietin can be treated with ESA, a genetically created version of EPO. These are usually given by injection, from once a week to once a month, depending on the patient’s needs.

High Blood Pressure (Hypertension) and kidney disease

It is vital to have high blood pressure treated, and successfully lowered, and especially so if you have chronic kidney disease. If high blood pressure isn’t treated it can cause stroke and heart attacks.

Because it also plays a part in controlling how much salt and water is in our bodies, it is linked to kidney disease and is common in people with this condition. Because high blood pressure can further harm kidneys that are already damaged, and can cause heart attack and stroke, it is vital to have this condition diagnosed and treated promptly.

There is a range of treatments available to treat hypertension, depending on what is causing it. These include ACE inhibitors, calcium channel blockers, diuretics and beta-blockers. Your GP or kidney specialist will prescribe the one most suitable for you.

Find out how to monitor your blood pressure

Saturated fat and cholesterol

There has, over recent years, been advice to steer clear of dietary cholesterol – found in milk, cheese and cream, animal fats, such as butter and margarine, and fatty meat and processed meat products, as well as some plant-based food such as coconut oil and palm oil. 

Foods high in saturated fats and too little unsaturated fats changes the way the liver handles cholesterol.

Advice from the charity Heart UK is that most people with raised cholesterol should eat low levels of saturated fat. Heart UK’s advice is to lower your saturated fat intake and to eat healthy calories from unsaturated fats and wholegrain foods. Sources of unsaturated fats include nuts, seeds, olive oil and oily fish.

UK Dietary Guidelines only recommend watching your cholesterol intake if you have a condition called familial hypercholesterolaemia, the same guidance that Heart UK also provides. 

Learn more about cholesterol

Dialysis for kidney failure

Dialysis is used to remove the extra fluids and waste from your blood if your kidneys are no longer working properly, and can no longer do this on their own. It is important that these excess fluids and waste are removed, as otherwise they can reach levels where they are dangerous to your health.

In fact, if you don’t have dialysis to clear these elements from your blood, you can become increasingly ill, and may eventually die as a result.

There are two types of dialysis. Haemodialysis is the type used most often. This involves having a needle inserted into your arm. Blood travels from your body, through the tube that is attached to the needle, and into a machine. This is where the filtering process happens, before the blood travels along another tube, back into your arm.

Peritoneal dialysis is a more complex treatment. A narrow tube – a catheter – is positioned into your abdomen through a small cut in your abdomen. Your medical team then pump fluid through the tube, and into your abdomen, also known as the peritoneal cavity.

This fluid travels through the many, very small blood vessels in this cavity, collecting the excess fluid and waste products that need to be removed. This fluid flows into a collecting bag after a few hours. It is replaced with fresh fluid, and the process starts again. Peritoneal dialysis has to be carried out every day, but you can have this treatment at home, and it may be possible to do this while you are asleep.

Kidney transplant

While having a kidney transplant may sound extreme, for some people it may be the only option if your kidneys are functioning at a very low level.

A kidney transplant can be a very effective way of delivering good treatment for someone who has advanced kidney disease.

However, there aren’t enough kidney donors, which means that you may have to wait some time before a healthy kidney becomes available. And during that time you may have to start, or continue with dialysis treatment. It may well be worth the wait, however. According to Kidney Research UK, having kidney transplantation can provide you with a better quality of life, and possibly a longer life too.

Not everyone with kidney problems can have kidney transplantation. It depends on whether you are fit enough to go through the operation and any difficulties that may happen as a result of having the transplant.

Your medical team – the kidney specialist (nephrologist), other specialists, your GP and you will discuss whether it is safe to carry out the kidney transplantation. This discussion will include looking at your overall health – whether you have a chest condition, or show any signs of heart disease – for instance.

If you are given the green light to go ahead with the transplant, you’ll have further tests on your health, and if all is well, you should be put on the waiting list for a transplant.

At this point your medical team are likely to start talking about the possibility of a live kidney donor among your family and friends. Having a kidney from a live donor means that once the kidney is transplanted into the recipient (you), it has a much better chance of surviving well than a transplant kidney from someone who has died. (As long as they are healthy, living donors can function well on just one kidney)

According to the National Kidney Federation (a leading kidney patient charity in the UK) more than half of transplant last over 10 years, and transplants make a great improvement to life with kidney failure.

However, you may have to wait some time for a donor kidney (unless a family member or friends offer to donate theirs). And if you have a rare blood group or other unusual circumstances, you may have to wait longer, and may not be able to find a suitable donor.

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