Complaints & connections · borters.ch
Two numbers lead: the filtration rate and the protein in the urine — and the second is most often forgotten, although it says more about the future.
Also known as: CKD · chronic kidney disease
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The kidneys lose function over years, and so quietly that most people learn of it from a blood value. Symptoms are absent for a long time — the kidneys compensate until more than half the function is gone. That is exactly why this condition is a matter of numbers, and of two numbers: the estimated filtration rate from the creatinine, and the protein in the urine. The second is often forgotten, although it shows up earlier and says more about the future than the first. The two biggest causes are diabetes and high blood pressure, followed by kidney inflammation, cystic kidneys, repeated urinary infections, years of painkiller use and obstruction to outflow. The most important message of this dossier is that the course can be influenced, and considerably: well-controlled blood pressure, well-controlled sugar and the right medicines slow the decline so much that many people keep their kidneys for life. And one point you hold yourself: with fever, diarrhoea or vomiting and little to drink, some medicines are paused temporarily, because in that situation they put extra strain on the kidneys.
If only a single value is added, let it be this one. It changes treatment more often than the creatinine does.
Consistently controlled, it slows the decline more than anything else. The preferred medicines protect the kidneys as well — even if the creatinine rises slightly at first, which is expected.
Certain blood pressure and diabetes drugs and water tablets are stopped on such days on medical advice. Having this rule in writing prevents some of the sudden deteriorations.
Ibuprofen, diclofenac and relatives are the commonest avoidable harm here — as a gel too, briefly too, over the counter too.
Before CT scans and cardiac catheter procedures the kidney function belongs on the table so that precautions can be taken.
Less salt helps blood pressure and fluid balance. With protein it is about moderation, not abstinence — too little harms the muscles.
A severe course of malaria can damage the kidneys acutely; the values are therefore watched. Fever within three months of a malaria area belongs investigated the same day.
ACE inhibitors, sartans and SGLT2 inhibitors lower the pressure in the kidney filters and slow the loss measurably. They do not restore kidney function already lost. A slight rise in creatinine after starting is expected and no sign of harm — that is exactly where treatment is often stopped too early.
About one adult in ten has reduced kidney function, considerably more from seventy. The kidney has large reserves: symptoms usually appear only once more than half the function is gone — so it is found through the value, not through the feeling.
Symptoms come late. Waiting until something hurts means missing the years in which most can be achieved.
Persistently foaming urine is one of the few early signs and a reason to have the protein measured.
The two belong together and reinforce each other. Blood pressure that suddenly becomes harder to control can come from the kidneys.
The later signs, and all three so non-specific that they are put down to age.
When the kidneys no longer concentrate urine well, the volume shifts into the night. It is almost always blamed on the bladder or the prostate.
The estimated filtration rate. It also depends on muscle mass — in very slim and very muscular people it can mislead.
The value that is most often missing. It shows damage earlier than creatinine and helps decide which medicines make sense.
Rises as the kidneys weaken, and is the reason why certain medicines require a check.
The kidneys help steer blood formation. An anaemia that is otherwise unexplained belongs here — and it is treatable.
The kidney activates vitamin D — as function declines that succeeds less and less. This is why the already activated form is often prescribed here, and why it belongs in nephrological hands rather than self-management.
The one supplement that can become dangerous here: with declining kidney function potassium is no longer excreted, and too much disturbs the heart rhythm. Potassium salt as a salt substitute counts too.
Also the other way round: phosphate builds up and damages vessels and bone. Phosphate additives sit in processed cheese, cola and many ready meals — they are absorbed more completely than the natural phosphate in food.
The anaemia of kidney weakness has two parts: too little erythropoietin from the kidney and too little iron. The second can be measured and replaced — ferritin and transferrin saturation belong read together.
In kidney weakness the protein amount is set by stage, not by rule of thumb. Potassium- and phosphate-rich foods are limited according to the values — one of the areas where self-experiment can genuinely harm.
Here as a warning: with reduced kidney function many substances are cleared less well and build up. This applies to supplements as much as to medicines — the list belongs reviewed regularly.
Here as a warning: flushing teas are not intended with reduced kidney function. What flushes healthy kidneys can tip the water and potassium balance in sick ones — here the amount to drink is prescribed, not increased.
The one case where an old kidney remedy expressly does not belong: juniper berries irritate the kidney tissue and are not intended with kidney disease or in pregnancy.
Here as a warning: juniper counts as irritating to the kidney and is not intended with reduced kidney function. Essential oils taken internally generally do not belong with a sick kidney — that is where they are excreted.
The best-known case of harm from plant remedies concerned the kidneys — to be read in the TCM tool.