Physician Spotlight Articles
What health plans does Medicare offer?
Medicare has two main ways to get coverage—Original Medicare External link, which includes Part A External link and Part B External link, or a Medicare Advantage Plan External link, also called Part C. You can also choose to have prescription drug coverage through Medicare Part D External link.
Most people with kidney failure are not allowed to join a Medicare Advantage plan. However, beginning in 2021, the 21st Century Cures Act will allow people with ESRD to choose a Medicare Advantage plan instead of Original Medicare. Medicare Advantage plans may limit where you get care, but they cap out-of-pocket costs. With Original Medicare, there is no cap on out-of-pocket costs, but you can get care anywhere that Medicare is accepted.
You can find out more about the Medicare health plans by visiting Medicare.gov External link and searching on “ESRD,” then clicking on “Signing up for Medicare if you have ESRD.”
Other Medicare health plans are available that have special rules or are for specific groups of people. Medicare offers more information about these alternate plans online External link.
Learn more about Medicare benefits, rules, and coverage details at Medicare.gov External link or by calling 1-800-MEDICARE (1-800-633-4227; TTY: 1-877-486-2048).
When does Medicare coverage start for people with ESRD?
If kidney failure is the only reason you are signing up for Medicare, your Medicare start date will depend on the type of kidney failure treatment you receive. Find out more about when your Medicare coverage may start External link.
When does Medicare coverage end for people with ESRD?
If kidney failure is the only reason you have Medicare, your coverage end date will depend on whether you had a kidney transplant or dialysis treatment. Learn more about when your Medicare coverage will end External link.
Medicare coverage will not end if you are eligible because of age or disability.
Joint federal-state programs
You may also be able to get help paying for your kidney failure treatment from one or more programs that are run jointly by the Federal Government and state governments, including Medicaid and the Children’s Health Insurance Program (CHIP).
What is Medicaid?
Medicaid External link provides free or low-cost health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Each state runs its own Medicaid program based on rules set by the Federal Government. Medicaid may pay for services that Medicare does not.
What is the Children’s Health Insurance Program (CHIP)?
CHIP External link offers free or low-cost Medicaid to children whose parents earn too much for Medicaid but not enough to pay for a private health plan. CHIP is run by the states, based on federal rules. In some states, CHIP may cover pregnant women and parents. Find out if your family members qualify for CHIP through Healthcare.gov External link or your state’s Medicaid or CHIP agency External link.
Help paying for medicines
Talk with your health care team if you have trouble paying for your medicines, including asking about cheaper options. Your team may suggest other ways to cut your costs, such as using mail-order pharmacies or contacting local aid programs.
Key Terms
Some terms listed here have many meanings; only those meanings that relate to the financial and medical aspects of kidney failure and its treatment are included.
coinsurance: an amount a person may still need to pay after a deductible for health care. The amount is most often a percentage, such as 20 percent.
coordination period: if a person has more than one health plan, a coordination period is used to figure out which plan pays first and for how long. For example, if a person has an employer group plan and Medicare, the employer group plan is the first payer for the first 30 months the person is eligible for Medicare.
copay (or copayment): an amount a person may have to pay for health care. A copay is often a set fee. A person might pay $10 or $20 for a health care provider visit or prescription.
deductible: an amount a person must pay for health care or prescriptions before the health plan(s) will pay.
network: a group of health care providers that gives members a discount. Some plans pay for health care and prescriptions only if received from a network provider.
out of network: health care providers who are not in a plan’s network. In some health plans, health care and prescriptions cost more if received from these providers.
premium: an amount a person must pay periodically—monthly or quarterly—for Medicare, another health plan, or drug plan coverage.
social worker: a person who is trained to help people solve problems in their daily lives, especially people with disabilities or low incomes. A social worker may help with financial, employment, and emotional issues. Dialysis clinics and transplant centers must have a social worker with a Master of Social Work degree to help their patients.
Control your blood pressure
The most important step you can take to treat kidney disease is to control your blood pressure. High blood pressure can damage your kidneys. You can protect your kidneys by keeping your blood pressure at or less than the goal set by your health care provider. For most people, the blood pressure goal is less than 140/90 mm Hg.
Work with your health care provider to develop a plan to meet your blood pressure goals. Steps you can take to meet your blood pressure goals may include eating heart-healthy and low-sodium meals, quitting smoking, being active, getting enough sleep, and taking your medicines as prescribed.
Meet your blood glucose goal if you have diabetes
To reach your blood glucose goal, check your blood glucose level regularly. Use the results to guide decisions about food, physical activity, and medicines. Ask your health care provider how often you should check your blood glucose level.
Your health care provider will also test your A1C. The A1C is a blood test that measures your average blood glucose level over the past 3 months. This test is different from the blood glucose checks you do regularly. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. Stay close to your daily blood glucose numbers to help you meet your A1C goal.
How can I prepare for visits with my health care provider?
The more you plan for your visits, the more you will be able to learn about your health and treatment options.
Make a list of questions
It’s normal to have a lot of questions. Write down your questions as you think of them so that you can remember everything you want to ask when you see your health care provider. You may want to ask about what tests are being done, what test results mean, or the changes you need to make to your diet and medicines.
Take medicines as prescribed
Many people with CKD take medicines prescribed to lower blood pressure, control blood glucose, and lower cholesterol.
Two types of blood pressure medicines, ACE inhibitors and ARBs, may slow kidney disease and delay kidney failure, even in people who don’t have high blood pressure. The names of these medicines end in –pril or –sartan.
Many people need to take two or more medicines for their blood pressure. You may also need to take a diuretic, sometimes called a water pill. The aim is to meet your blood pressure goal. These medicines may work better if you limit your salt intake.
Know that your medicines may change over time
Your health care provider may change your medicines as your kidney disease gets worse. Your kidneys don’t filter as well as they did in the past, and this can cause an unsafe buildup of medicines in your blood. Some medicines can also harm your kidneys. As a result, your provider may tell you to
take a medicine less often or take a smaller dose
stop taking a medicine or switch to a different one
Your pharmacist and health care provider need to know about all the medicines you take, including OTC medicines, vitamins, and supplements.
Be careful about the over-the-counter medicines you take
If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include commonly used pain relievers and cold medicines that can damage your kidneys and lead to acute kidney injury, especially in those with kidney disease, diabetes, and high blood pressure.
Ibuprofen NIH external link and naproxen NIH external link are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.
What is high blood pressure?
Blood pressure is the force of blood pushing against blood vessel walls as your heart pumps out blood. High blood pressure NIH external link, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body.
What are the kidneys and what do they do?
Healthy kidneys filter about a half cup of blood every minute, removing wastes and extra water to make urine. The urine flows from each kidney to the bladder through a pair of thin tubes called ureters, one on each side of your bladder. Your bladder stores urine. Your kidneys, ureters, and bladder are part of your urinary tract system.
How does high blood pressure affect the kidneys
High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, including in the kidneys. The narrowing reduces blood flow.
If your kidneys’ blood vessels are damaged, they may no longer work properly. When this happens, the kidneys are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.
How common are high blood pressure and kidney disease?
Almost 1 in 2 U.S. adults—or about 108 million people—have high blood pressure.1
More than 1 in 7 U.S. adults—or about 37 million people—may have chronic kidney disease (CKD).2
What are the symptoms of high blood pressure and kidney disease?
Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches.
Early CKD also may not have symptoms. As kidney disease gets worse, some people may have swelling, called edema. Edema happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, ankles, or—less often—in the hands or face.
How do health care professionals diagnose high blood pressure and kidney disease?
High blood pressure
Blood pressure test results are written with the two numbers separated by a slash. The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats.
Medicines
Medicines that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), may be effective in slowing the progression of kidney disease.
Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care professional may prescribe a diuretic—a medication that helps the kidneys remove fluid from the blood—or other blood pressure medications NIH external link.
How can I tell if I have kidney disease?
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.
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.
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.
What is anemia?
Anemia NIH external link is a condition in which your blood has a lower-than-normal amount of red blood cells or hemoglobin. Hemoglobin is the iron NIH external link-rich protein that allows red blood cells to carry oxygen from your lungs to the rest of your body. With fewer red blood cells or less hemoglobin, your tissues and organs—such as your heart and brain—may not get enough oxygen to work properly.
How is anemia related to chronic kidney disease?
Anemia is a common complication of chronic kidney disease (CKD). CKD means your kidneys are damaged and can’t filter blood the way they should. This damage can cause wastes and fluid to build up in your body. CKD can also cause other health problems.
Anemia is less common in early kidney disease, and it often gets worse as kidney disease progresses and more kidney function is lost.
How common is anemia in CKD?
Anemia is common in people with CKD, especially among people with more advanced kidney disease. More than 37 million American adults may have CKD,1 and it is estimated that more than 1 out of every 7 people with kidney disease have anemia.2
Most people who have kidney failure—when kidney damage is so advanced that less than 15 percent of the kidney is working normally—also have anemia.3
Who is more likely to have anemia in CKD?
Your risk for anemia increases as your kidney disease gets worse.
People with CKD who also have diabetes are at greater risk for anemia, tend to develop anemia earlier, and often have more severe anemia than people with CKD who don’t have diabetes.4 People older than 60 are also more likely to have anemia with CKD.5
What are the complications of anemia in someone with CKD?
In people with CKD, severe anemia can increase the chance of developing heart problems because the heart is getting less oxygen than normal and is working harder to pump enough red blood cells to organs and tissues. People with CKD and anemia may also be at an increased risk for complications due to strokes NIH external link.
What causes anemia in CKD?
Anemia in people with CKD often has more than one cause.
When your kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells. With less EPO, your body makes fewer red blood cells, and less oxygen is delivered to your organs and tissues.
In addition to your body making fewer red blood cells, the red blood cells of people with anemia and CKD tend to live in the bloodstream for a shorter time than normal, causing the blood cells to die faster than they can be replaced.
People with anemia and CKD may have low levels of nutrients, such as iron, vitamin B12 NIH external link, and folate NIH external link, that are needed to make healthy red blood cells.
Blood tests
Health care professionals use blood tests NIH external link to check for signs of anemia or other health problems. Your health care professional will take a blood sample from you and send the sample to a lab to test.
How do health care professionals treat anemia in CKD?
Health care professionals first treat any underlying conditions that may be causing the anemia, such as an iron or vitamin deficiency. If your anemia is mild and you have few symptoms, you may not need treatment at first.
Treatments for anemia may ease your symptoms and improve your quality of life.
Your health care professional may refer you to a hematologist or a nephrologist, a health care professional who treats people with kidney problems or related conditions.
Iron
If you don’t have enough iron in your body, your health care professional may prescribe iron supplements, either as a pill or intravenous (IV) infusion. If you’re on dialysis, you may be given an IV iron supplement during your dialysis treatment. Iron supplements help your body make healthy red blood cells.
Vitamins
Your health care professional may ask you to take vitamin supplements such as vitamin B12 or folate—both needed to make healthy blood cells—if your body doesn’t have enough of these vitamins.
Definition & Facts
A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional.
Symptoms & Causes
You may have a kidney stone if you feel a sharp pain in your back, side, lower abdomen, or groin; or have blood in your urine. If you have a small stone that easily passes through your urinary tract, you may not have symptoms at all.
Diagnosis
Health care professionals use your medical history, a physical exam, and tests to diagnose kidney stones. The tests may also be able to show problems that caused a kidney stone to form.
Treatment
Health care professionals may treat your kidney stones by removing the kidney stone or breaking it into small pieces. You may be able to prevent kidney stones by drinking enough water, changing the way you eat, or taking medicines.
Eating, Diet, & Nutrition
If you have kidney stones, drink lots of water unless otherwise directed by a health care professional. You may be able to prevent future kidney stones by making changes in how much sodium, animal protein, calcium, and oxalate you consume.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Insti
Definition & Facts
Kidney infection is a type of urinary tract infection (UTI) that commonly begins in your bladder and moves upstream to one or both of your kidneys. In rare cases, kidney infections can lead to serious health problems, but quick treatment prevents most complications.
Symptoms & Causes
Symptoms of kidney infection can vary depending on your age and may include chills, fever, and painful urination. A kidney infection is caused by bacteria or viruses that infect your bladder and move upstream to infect one or both of your kidneys.
Diagnosis
Health care professionals use your medical history, a physical exam, and tests to diagnose kidney infection. Depending on your age, sex, and response to treatment, they will use certain tests to diagnose kidney infection.
Treatment
Doctors may treat your kidney infection by prescribing antibiotics. Make sure to take all of your medicine, even if you start to feel better.
Eating, Diet, & Nutrition
If you have a kidney infection, drink lots of liquids to help flush bacteria from your urinary tract. If you have kidney failure, you should not drink this much liquid. Talk with your health care professional about how much liquid is right for you.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What are simple kidney cysts?
Simple kidney cysts are fluid-filled sacs, or cysts, that can form in one or both of your kidneys. You can have just one cyst or you can have many. Simple kidney cysts are usually round or oval in shape. They can range from the size of a pea to the size of a golf ball.
Simple kidney cysts are usually harmless. Simple kidney cysts don’t enlarge the kidneys, replace their normal structure, or cause reduced kidney function like cysts do in people with polycystic kidney disease (PKD). PKD is a genetic disorder that can cause chronic kidney disease.
How common are simple kidney cysts
In one large study, about 1 in 10 people had simple kidney cysts. In people age 50 and older, nearly 1 in 5 people had simple kidney cysts.1
Who is more likely to develop simple kidney cysts?
Simple kidney cysts are more common in older people, and men are more likely to develop simple kidney cysts than women.2 In one study, men were twice as likely to have simple kidney cysts.1
What are the symptoms and complications of simple kidney cysts?
As people age, simple kidney cysts tend to grow bigger and grow in number. However, simple kidney cysts usually don’t cause symptoms or additional health problems.
In rare cases, simple kidney cysts can become large enough to
press on your bones or other organs, causing pain or discomfort
block blood or urine flow through the kidneys or the ureters
become infected, causing fever, pain, and tenderness
burst, causing pain or blood in the urine, also called hematuria
cause high blood pressure
Talk with your health care professional if you have any of these symptoms. Health care professionals can treat simple kidney cysts that cause symptoms or other health problems.
How do health care professionals diagnose simple kidney cysts?
Simple kidney cysts usually don’t cause symptoms, so health care professionals often find simple kidney cysts when they are performing an imaging test for another reason. Health care professionals may use imaging tests and lab tests to rule out other, more serious problems, including some kidney cancers. If you are diagnosed with a simple kidney cyst, you usually don’t need further testing or treatment.
Imaging tests
A specially trained technician performs imaging tests at a health care professional’s office, an outpatient center, or a hospital, and a radiologist or nephrologist reviews the images. A health care professional may use a computed tomography (CT) scan NIH external link or magnetic resonance imaging (MRI) NIH external link if he or she needs more information to confirm your diagnosis.
You don’t need anesthesia NIH external link for these tests, but a health care professional may give you light sedation if you have a fear of small spaces and need an MRI.
Ultrasound. An abdominal ultrasound NIH external link can find simple kidney cysts by creating images of your kidneys. Ultrasound uses a device called a transducer, which bounces safe, painless sound waves off your organs to create an image or picture of their structure.
CT scan. CT scans can show cysts and tumors in the kidneys. A CT scan uses a combination of x-rays and computer technology to create images of your urinary tract. Although a CT scan without contrast medium is the most common way to view your urinary tract, a health care professional may give you an injection of contrast medium. Contrast medium is a dye or other substance that makes structures inside your body easier to see during imaging tests. For a CT scan, you’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays.
MRI. Like CT scans, an MRI can show cysts and tumors but provides more detailed pictures. MRI machines use radio waves and magnets to produce detailed images of your organs and soft tissues without x-rays.
How do health care professionals treat the complications of simple kidney cysts?
Health care professionals usually don’t treat simple kidney cysts that aren’t causing symptoms. However, you may be asked to have regular ultrasounds to watch your simple kidney cysts for signs of change or problems.
Health care professionals will treat simple kidney cysts that cause symptoms, such as pain, or that block the flow of blood or urine. Some studies suggest that draining or removing the cysts may help with high blood pressure related to simple kidney cysts.3 Researchers are not exactly sure how or why this works.
Sclerotherapy. Sclerotherapy is used to drain cysts. Using ultrasound as a guide, a health care professional inserts a long needle through your skin and into the cyst. The health care professional drains the cyst and injects an alcohol solution. The solution hardens the area inside the cyst so it’s less likely to fill with fluid again. This procedure is usually performed at an outpatient center using local anesthesia.
Surgery. If a cyst is large, you may need laparoscopic surgery. The surgeon drains the cyst and then removes or burns away its outer tissue. For this procedure, you may need general anesthesia in a hospital. You may need to stay in the hospital for 1 or 2 days.
Clinical Trials for Simple Kidney Cysts
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions
What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and are at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.
References
[1] Terada N, Arai Y, Kinukawa N, Yoshimura K, Terai A. Risk factors for renal cysts. BJU International. 2004;93(9):1300–1302.
[2] Rule AD, Sasiwimonphan K, Lieske JC, Keddis MT, Torres VE, Vrtiska TJ. Characteristics of renal cystic and solid lesions based on contrast-enhanced computed tomography of potential kidney donors. American Journal of Kidney Diseases. 2012;59(5):611–618.
[3] Zerem E, Imamović G, and Omerović S. Simple renal cysts and arterial hypertension: does their evacuation decrease the blood pressure? Journal of Hypertension. 2009;27(10):2074–2078.
Last Reviewed June 2019
What is PKD?
Polycystic kidney disease is a genetic disorder that causes many cysts to grow in the kidneys. PKD cysts cause high blood pressure and problems with blood vessels in the brain and heart. Cysts in the liver can also occur with PKD.
Autosomal Dominant PKD
Autosomal dominant PKD is often not diagnosed until later in adulthood. For this reason, health care providers often call autosomal dominant PKD “adult PKD.” In many cases, PKD does not cause signs or symptoms until cysts are half an inch or larger.
Autosomal Recessive PKD
Autosomal recessive PKD is a rare genetic disorder that affects the liver as well as the kidneys. The signs of autosomal recessive PKD frequently appear in the earliest months of life, even in the womb, so health care providers often call it “infantile PKD.”
Eating, Diet, & Nutrition for PKD
PKD may require changes in what you eat to control blood pressure. Following a healthy eating plan can help lower blood pressure. A health care provider may recommend the DASH eating plan, which focuses on fruits, vegetables, whole grains, and foods lower in sodium.
What is immunoglobulin A (IgA) nephropathy?
IgA nephropathy, also known as Berger’s disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues. IgA is an antibody—a protein made by the immune system to protect the body from foreign substances such as bacteria or viruses. Most people with IgA nephropathy receive care from a nephrologist, a doctor who specializes in treating people with kidney disease.
How does IgA nephropathy affect the kidneys?
IgA nephropathy affects the kidneys by attacking the glomeruli. The glomeruli are sets of looping blood vessels in nephrons—the tiny working units of the kidneys that filter wastes and remove extra fluid from the blood. The buildup of IgA deposits inflames and damages the glomeruli, causing the kidneys to leak blood and protein into the urine. The damage may lead to scarring of the nephrons that progresses slowly over many years. Eventually, IgA nephropathy can lead to end-stage kidney disease, sometimes called ESRD, which means the kidneys no longer work well enough to keep a person healthy. When a person’s kidneys fail, he or she needs a transplant or blood-filtering treatments called dialysis.
What causes IgA nephropathy?
Scientists think that IgA nephropathy is an autoimmune kidney disease, meaning that the disease is due to the body’s immune system harming the kidneys.
People with IgA nephropathy have an increased blood level of IgA that contains less of a special sugar, galactose, than normal. This galactose-deficient IgA is considered “foreign” by other antibodies circulating in the blood. As a result, these other antibodies attach to the galactose-deficient IgA and form a clump. This clump is also called an immune complex. Some of the clumps become stuck in the glomerulus of the nephron and cause inflammation and damage.
For some people, IgA nephropathy runs in families. Scientists have recently found several genetic markers that may play a role in the development of the disease. IgA nephropathy may also be related to respiratory or intestinal infections and the immune system’s response to these infections.
How common is IgA nephropathy and who is more likely to get the disease?
IgA nephropathy is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure.1
IgA nephropathy can occur at any age, although the first evidence of kidney disease most frequently appears when people are in their teens to late 30s.2 IgA nephropathy in the United States is twice as likely to appear in men than in women.3 While found in people all over the world, IgA nephropathy is more common among Asians and Caucasians.4
What are the signs and symptoms of IgA nephropathy?
In its early stages, IgA nephropathy may have no symptoms; it can be silent for years or even decades. Once symptoms appear, the most common one is hematuria, or blood in the urine. Hematuria can be a sign of damaged glomeruli. Blood in the urine may appear during or soon after a cold, sore throat, or other respiratory infection. The amount of blood may be
visible with the naked eye. The urine may turn pink or the color of tea or cola. Sometimes a person may have dark or bloody urine.
so small that it can only be detected using special medical tests.
Another symptom of IgA nephropathy is albuminuria—when a person’s urine contains an increased amount of albumin, a protein typically found in the blood, or large amounts of protein in the urine. Albumin is the main protein in the blood. Healthy kidneys keep most proteins in the blood from leaking into the urine. However, when the glomeruli are damaged, large amounts of protein leak out of the blood into the urine.
When albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Too much fluid in the body may cause edema, or swelling, usually in the legs, feet, or ankles and less often in the hands or face. Foamy urine is another sign of albuminuria. Some people with IgA nephropathy have both hematuria and albuminuria.
Urine Tests
Dipstick test for albumin and blood. A dipstick test performed on a urine sample can detect the presence of albumin and blood. The patient provides a urine sample in a special container in a health care provider’s office or a commercial facility. A nurse or technician can test the sample in the same location, or he or she can send it to a lab for analysis. The test involves placing a strip of chemically treated paper, called a dipstick, into the patient’s urine sample. Patches on the dipstick change color when albumin or blood is present in urine.
Urine albumin-to-creatinine ratio. A health care provider uses this measurement, which compares the amount of albumin with the amount of creatinine in a urine sample, to estimate 24-hour albumin excretion. A patient may have chronic kidney disease if the urine albumin-to-creatinine ratio is greater than 30 milligrams (mg) of albumin for each gram (g) of creatinine (30 mg/g). This measurement is also called UACR.
Blood Test
A blood test involves having blood drawn at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood a patient’s kidneys filter each minute—a measurement called the estimated glomerular filtration rate (eGFR). Depending on the results, the test can indicate the following:
eGFR of 60 or above is in the normal range
eGFR below 60 may indicate kidney disease
eGFR of 15 or below may indicate kidney failure
How is IgA nephropathy diagnosed?
Currently, health care providers do not use blood or urine tests as reliable ways to diagnose IgA nephropathy; therefore, the diagnosis of IgA nephropathy requires a kidney biopsy.
A kidney biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs a kidney biopsy in a hospital or an outpatient center with light sedation and a local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the kidney. A pathologist—a doctor who specializes in examining tissues to diagnose diseases—examines the kidney tissue with a microscope. Only a biopsy can show the IgA deposits in the glomeruli. The biopsy can also show how much kidney damage has already occurred. The biopsy results can help the health care provider determine the best course of treatment.
Control Blood Pressure and Slow Progression of Kidney Disease
People with IgA nephropathy that is causing high blood pressure may need to take medications that lower blood pressure and can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications—angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—have proven effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. A person may also need beta-blockers, calcium channel blockers, and other blood pressure medications.
Remove Extra Fluid
A health care provider may prescribe a diuretic, a medication that helps the kidneys remove extra fluid from the blood. Removing the extra fluid can improve the control of blood pressure. Taking a diuretic along with an ACE inhibitor or an ARB often increases the effectiveness of these medications.
Lower Blood Cholesterol Levels
People with IgA nephropathy may develop high blood cholesterol levels. Cholesterol is a type of fat found in the body’s cells, in blood, and in many foods. People who take medications for high blood cholesterol levels can lower their blood cholesterol levels. A health care provider may prescribe one of several cholesterol-lowering medications called statins.
How can a person prevent IgA nephropathy?
Researchers have not found a way to prevent IgA nephropathy. People with a family history of IgA nephropathy should talk with their health care provider to find out what steps they can take to keep their kidneys healthy, such as controlling their blood pressure and keeping their blood cholesterol at healthy levels.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What is diabetic kidney disease?
Diabetic kidney disease is a type of kidney disease caused by diabetes.
Diabetes is the leading cause of kidney disease. About 1 out of 3 adults with diabetes has kidney disease.1
The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. Your kidneys also help control blood pressure and make hormones that your body needs to stay healthy.
What are other names for diabetic kidney disease?
Diabetic kidney disease is also called DKD, chronic kidney disease, CKD, kidney disease of diabetes, or diabetic nephropathy.
What increases my chances of developing diabetic kidney disease?
Having diabetes for a longer time increases the chances that you will have kidney damage. If you have diabetes, you are more likely to develop kidney disease if your
blood glucose is too high
blood pressure is too high
African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.
How can I tell if I have diabetic kidney disease?
Most people with diabetic kidney disease do not have symptoms. The only way to know if you have diabetic kidney disease is to get your kidneys checked.
Health care professionals use blood and urine tests to check for diabetic kidney disease. Your health care professional will check your urine for albumin and will also do a blood test to see how well your kidneys are filtering your blood.
How can I keep my kidneys healthy if I have diabetes?
The best way to slow or prevent diabetes-related kidney disease is to try to reach your blood glucose and blood pressure goals. Healthy lifestyle habits and taking your medicines as prescribed can help you achieve these goals and improve your health overall.
Reach your blood glucose goals
Your health care professional will test your A1C. The A1C is a blood test that shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you may do yourself. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months.
The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.
To reach your A1C goal, your health care professional may ask you to check your blood glucose levels. Work with your health care team to use the results to guide decisions about food, physical activity, and medicines. Ask your health care team how often you should check your blood glucose level.
Control your blood pressure
Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.
Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.
Take medicines as prescribed
Medicines may be an important part of your treatment plan. Your health care professional will prescribe medicine based on your specific needs. Medicine can help you meet your blood glucose and blood pressure goals. You may need to take more than one kind of medicine to control your blood pressure.
How can I cope with the stress of managing my diabetes?
Managing diabetes isn’t always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress NIH external link.
Does diabetic kidney disease get worse over time?
Kidney damage from diabetes can get worse over time. However, you can take steps to keep your kidneys healthy and help slow kidney damage to prevent or delay kidney failure. Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. However, most people with diabetes and kidney disease don’t end up with kidney failure.
What is Kidney Failure?
Kidney disease can get worse over time and may lead to kidney failure. If less than 15 percent of your kidney is working normally, that’s considered kidney failure. You may have symptoms from the buildup of waste products and extra water in your body.
The more you know about kidney failure ahead of time, the better prepared you may be to make a treatment choice and take charge of your care.
Choosing a Treatment
Learn about kidney failure treatment options early. Three treatment options filter your blood— hemodialysis, peritoneal dialysis, and kidney transplant. A fourth option—conservative management—offers care without dialysis or transplant. Each treatment has pros and cons, and your choice will affect your daily life.
Hemodialysis
Hemodialysis is a treatment to filter wastes and extra water from your blood. A machine pumps your blood through a filter outside of your body and returns filtered blood to your body. You can have this treatment in a center—usually three times each week—or at home.
Peritoneal Dialysis
Peritoneal dialysis is a treatment for kidney failure that you can do at home. This type of dialysis uses the lining of your belly to filter wastes and extra fluid from your body.
Kidney Transplant
During transplant surgery, a healthy kidney from a donor is placed into your body. The new, donated kidney does the work that your two kidneys used to do. After your transplant, you will need to take medicines every day to make sure your immune
Conservative Management
Conservative management for kidney failure means that your health care team continues your care without dialysis or a kidney transplant. Treatment goals are to preserve kidney function and quality of life as long as possible and to plan for end-of-life care.
Eating Right
When you have kidney failure, what you eat and drink can help you maintain a healthy balance of nutrients, salts, and minerals in your body and make your treatments work better. Work with a dietitian to create your eating plan.
Urine Albumin-to-Creatinine Ratio (UACR)
The two key markers for chronic kidney disease (CKD) are urine albumin and estimated glomerular filtration rate (eGFR).
Assess urine albumin excretion yearly to diagnose and monitor kidney damage in patients with type 1 diabetes for five years or more or with type 2 diabetes.
More frequent monitoring may be indicated in patients with changing clinical status or after therapeutic interventions.
Use a spot urine albumin-to-creatinine ratio (UACR). UACR estimates 24-hour urine albumin excretion. Twenty-four-hour collection and timed specimens are not necessary.
Urine Albumin (mg/dL) / Urine Creatinine (g/dL) = UACR in mg/g ≈ Albumin excretion in mg/day
UACR is a ratio between two measured substances. Unlike a dipstick test for albumin, UACR is unaffected by variation in urine concentration.
Albuminuria1 is present when UACR is greater than 30 mg/g and is a marker for CKD.
Albuminuria is used to diagnose and monitor kidney disease. Change in albuminuria may reflect response to therapy and risk for progression. A decrease in urine albumin may be associated with improved renal and cardiovascular outcomes.
Estimated GFR
The two key markers for chronic kidney disease (CKD) are estimated glomerular filtration rate (eGFR) and urine albumin.
Calculate eGFR from stable serum creatinine levels at least once a year in all patients with diabetes.
eGFR is more accurate than serum creatinine alone. Serum creatinine is affected by muscle mass, and related factors of age, sex, and race.
eGFR is not reliable for patients with rapidly changing creatinine levels, extremes in muscle mass and body size, or altered diet patterns.
See if your lab reports eGFR routinely. If it does not, ask your lab to do so. You can also calculate can eGFR yourself by using NIDDK’s GFR calculators.
The first steps to eating right
Step 1: Choose and prepare foods with less salt and sodium
Why? To help control your blood pressure. Your diet should contain less than 2,300 milligrams of sodium each day.
Buy fresh food often. Sodium (a part of salt) is added to many prepared or packaged foods you buy at the supermarket or at restaurants.
Cook foods from scratch instead of eating prepared foods, “fast” foods, frozen dinners, and canned foods that are higher in sodium. When you prepare your own food, you control what goes into it.
Use spices, herbs, and sodium-free seasonings in place of salt.
Check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 percent or more means the food is high in sodium.
Try lower-sodium versions of frozen dinners and other convenience foods.
Rinse canned vegetables, beans, meats, and fish with water before eating.
Look for food labels with words like sodium free or salt free; or low, reduced, or no salt or sodium; or unsalted or lightly salted.
An example of a Nutrition Facts food label that shows a Percent Daily Value of 5 percent of sodium per serving.
Look for sodium on the food label. A food label showing a Percent Daily Value of 5% or less is low sodium. Also look for the amount of saturated and trans fats listed on the label.
Step 2: Eat the right amount and the right types of protein
Why? To help protect your kidneys. When your body uses protein, it produces waste. Your kidneys remove this waste. Eating more protein than you need may make your kidneys work harder.
Eat small portions of protein foods.
Protein is found in foods from plants and animals. Most people eat both types of protein. Talk to your dietitian about how to choose the right combination of protein foods for you.
Animal-protein foods:
Chicken
Fish
Meat
Eggs
Dairy
A cooked portion of chicken, fish, or meat is about 2 to 3 ounces or about the size of a deck of cards. A portion of dairy foods is ½ cup of milk or yogurt, or one slice of cheese.
Plant-protein foods:
Beans
Nuts
Grains
A portion of cooked beans is about ½ cup, and a portion of nuts is ¼ cup. A portion of bread is a single slice, and a portion of cooked rice or cooked noodles is ½ cup.
Step 3: Choose foods that are healthy for your heart
Why? To help keep fat from building up in your blood vessels, heart, and kidneys.
Grill, broil, bake, roast, or stir-fry foods, instead of deep frying.
Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
Trim fat from meat and remove skin from poultry before eating.
Try to limit saturated and trans fats. Read the food label.
Heart-healthy foods:
Lean cuts of meat, such as loin or round
Poultry without the skin
Fish
Beans
Vegetables
Fruits
Low-fat or fat-free milk, yogurt, and cheese
Learn more about heart-healthy eating NIH external link.
A photo of an older couple making a heart-healthy meal.
Choose heart-healthy foods to help protect your blood vessels, heart, and kidneys.
Limit alcohol
Drink alcohol only in moderation: no more than one drink per day if you are a woman, and no more than two if you are a man. Drinking too much alcohol can damage the liver, heart, and brain and cause serious health problems. Ask your health care provider how much alcohol you can drink safely.
The next steps to eating right
As your kidney function goes down, you may need to eat foods with less phosphorus and potassium. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood, and you can work with your dietitian to adjust your meal plan. More information is provided in the NIDDK health topic, Nutrition for Advanced Chronic Kidney Disease.
Step 4: Choose foods and drinks with less phosphorus
Why? To help protect your bones and blood vessels. When you have CKD, phosphorus can build up in your blood. Too much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break. High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain.
Many packaged foods have added phosphorus. Look for phosphorus—or for words with “PHOS”—on ingredient labels.
Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh meats without added phosphorus.
Foods Lower in Phosphorus
Fresh fruits and vegetables
Breads, pasta, rice
Rice milk (not enriched)
Corn and rice cereals
Light-colored sodas/pop, such as lemon-lime or homemade iced tea
Foods Higher in Phosphorus
Meat, poultry, fish
Bran cereals and oatmeal
Dairy foods
Beans, lentils, nuts
Dark-colored sodas/pop, fruit punch, some bottled or canned iced teas that have added phosphorus
Your health care provider may talk to you about taking a phosphate binder with meals to lower the amount of phosphorus in your blood. A phosphate binder is a medicine that acts like a sponge to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into your blood. Instead, your body removes the phosphorus through your stool.
Step 5: Choose foods with the right amount of potassium
Why? To help your nerves and muscles work the right way. Problems can occur when blood potassium levels are too high or too low. Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. Your food and drink choices can help you lower your potassium level, if needed.
What can I do to keep my kidneys healthy?
You can protect your kidneys by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure. The steps described below may help keep your whole body healthy, including your kidneys.
During your next medical visit, you may want to ask your health care provider about your kidney health. Early kidney disease may not have any symptoms, so getting tested may be the only way to know your kidneys are healthy. Your health care provider will help decide how often you should be tested.
See a provider right away if you develop a urinary tract infection (UTI), which can cause kidney damage if left untreated.
Make healthy food choices
Choose foods that are healthy for your heart and your entire body: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Eat healthy meals, and cut back on salt and added sugars. Aim for less than 2,300 milligrams of sodium each day. Try to have less than 10 percent of your daily calories come from added sugars.
Make physical activity part of your routine
Be active for 30 minutes or more on most days. If you are not active now, ask your health care provider about the types and amounts of physical activity that are right for you. Add more activity to your life with these tips to help you get active.
Aim for a healthy weight
The NIH Body Weight Planner is an online tool to help you tailor your calorie and physical activity plans to achieve and stay at a healthy weight.
If you are overweight or have obesity, work with your health care provider or dietitian to create a realistic weight-loss plan. View more weight control and physical activity resources to help you get and stay motivated.
Stop smoking
If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov External link.
Limit alcohol intake NIH external link
Drinking too much alcohol can increase your blood pressure and add extra calories, which can lead to weight gain. If you drink alcohol External link, limit yourself to one drink per day if you are a woman and two drinks per day if you are a man. One drink is:
- 12 ounces of beer
- 5 ounces of wine
- 1.5 ounces of liquor
Explore stress-reducing activities
Learning how to manage stress NIH external link, relax, and cope with problems can improve emotional and physical health. Physical activity can help reduce stress, as can mind and body practices such as meditation NIH external link, yoga NIH external link, or tai chi NIH external link.
Manage diabetes, high blood pressure, and heart disease
If you have diabetes, high blood pressure, or heart disease, the best way to protect your kidneys from damage is to
Keep blood glucose numbers close to your goal. Checking your blood glucose, or blood sugar, level is an important way to manage your diabetes. Your health care team may want you to test your blood glucose one or more times a day.
Keep your blood pressure numbers close to your goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Read more about high blood pressure NIH external link.
Take all your medicines as prescribed. Talk with your health care provider about certain blood pressure medicines, called ACE inhibitors and ARBs, which may protect your kidneys. The names of these medicines end in –pril or –sartan.
Be careful about the daily use of over-the-counter pain medications. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen NIH external link and naproxen NIH external link, can damage your kidneys. Learn more about over-the-counter medicines and your kidneys.
To help prevent heart attacks and stroke, keep your cholesterol levels in the target range. There are two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels, which can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels. A cholesterol test also may measure another type of blood fat called triglycerides.
What Is Chronic Kidney Disease?
Chronic kidney disease (CKD) means your kidneys are damaged and can’t filter blood the way they should. The main risk factors for developing kidney disease are diabetes, high blood pressure, heart disease, and a family history of kidney failure.
Causes of Chronic Kidney Disease
Diabetes and high blood pressure are the most common causes of kidney disease. Your health care provider 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.
Tests & Diagnosis
Testing may be the only way to know if you have kidney disease. Get checked if you have diabetes, high blood pressure, heart disease, or a family history of kidney failure. The sooner you know you have kidney disease, the sooner you can get treatment.
Managing Chronic Kidney Disease
You can take steps to protect your kidneys. The most important step you can take to treat kidney disease is to control your blood pressure. Healthy habits can also help you manage your kidney disease.
Eating Right for Chronic Kidney Disease
Eating the right foods can help keep your kidney disease from getting worse. Work with a dietitian to create a meal plan that includes foods that you enjoy eating while maintaining your kidney health.
Preventing Chronic Kidney Disease
You are at risk for kidney disease if you have diabetes, high blood pressure, heart disease, or a family history of kidney failure. If you have risk factors, get tested for kidney disease and protect your kidneys by making healthy food choices, being more active, aiming for a healthy weight, and managing health conditions that cause kidney damage.
What if My Kidneys Fail?
Kidney failure means that your kidneys have lost most of their ability to function. Work with your health care team and family to consider your options to replace your lost kidney function, such as dialysis or transplant. Choose a treatment that is right for you.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What is mineral and bone disorder in chronic kidney disease (CKD)?
Mineral and bone disorder in chronic kidney disease (CKD) is a disorder that can affect the bones, heart, and blood vessels of a person with CKD. Mineral and bone disease occurs when kidneys damaged by CKD can’t filter blood NIH external link and regulate hormones the way they should. The hormone levels and levels of minerals, such as calcium and phosphorus, then become imbalanced, leading to damage.
Does mineral and bone disorder have other names?
Mineral and bone disorder in CKD is also called CKD Mineral and Bone Disorder, or CKD-MBD.
The bone disease component of mineral and bone disorder is called renal osteodystrophy.
Why are hormones and minerals important?
Healthy bones continuously rebuild. Hormones and minerals help bones stay strong. If your hormones and minerals are out of balance, your bones can become weak and misshapen.
How common is mineral and bone disorder?
More than 37 million Americans—about 1 in 7 adults—are estimated to have CKD. Anyone with CKD is likely to have some level of mineral and bone disorder.1 As kidney function declines, mineral and bone disorder progresses. The disorder is almost always found in the more than 785,000 Americans who have kidney failure and are either on dialysis or had a kidney transplant.2
Slowed bone growth and bone deformities
Damaged kidneys must work harder to remove phosphorus from your body. Buildup of phosphorus is associated with less calcium in your blood and with the release of PTH by your parathyroid glands. PTH moves calcium out of your bones and into your blood. The loss of calcium can harm your bones.
What are the symptoms of mineral and bone disorder?
Adults with mineral and bone disorder may feel bone and joint pain. However, these symptoms may not appear until a person has had the disorder for many years.
In children, mineral and bone disorder is particularly serious because their bones are still developing and growing. Unlike adults, children can show visible bone changes from mineral and bone disorder in the early stages of CKD. For example, they may not grow as expected—a condition known as growth failure—or their bones may become weak from lack of calcium.
Eating, diet, and nutrition
Changing what you eat and drink can help treat mineral and bone disorder. Eating fewer foods that contain phosphorus is one of the most important steps to help you prevent bone disease and blood vessel calcification.
Most foods contain some phosphorus. However, most processed and packaged foods, such as lunch meats and canned or boxed foods, contain high levels. Food producers use phosphorus as a food preservative. If you have CKD or are on dialysis, avoid packaged foods containing ingredients that include the letters “PHOS.”
Medicines and supplements
Medicines protect your bones and blood vessels by restoring the proper balance of minerals and hormones. If your kidneys don’t make adequate amounts of calcitriol, your health care professional may prescribe a variety of medicines, such as
Dialysis
If your kidneys no longer filter wastes and extra fluids from your body, your health care professional might recommend dialysis. The two forms of dialysis are hemodialysis and peritoneal dialysis.
If you require dialysis, your health care team will monitor and adjust your nutrition, medicines, and supplements based on your ongoing blood tests. If you receive a kidney transplant, your team will reevaluate your nutrition and medicine.
Why is nutrition important for someone with advanced chronic kidney disease?
A person may prevent or delay some health problems from chronic kidney disease (CKD) by eating the right foods and avoiding foods high in sodium, potassium, and phosphorus. Learning about calories, fats, proteins, and fluids is important for a person with advanced CKD. Protein foods such as meat and dairy products break down into waste products that healthy kidneys remove from the blood.
As CKD progresses, nutritional needs change. A health care provider may recommend that a patient with reduced kidney function choose foods carefully.
What do the kidneys do?
The kidneys remove wastes and extra water from the blood and make urine. To keep the body working properly, the kidneys balance the salts and minerals—such as calcium, phosphorus, sodium, and potassium—that circulate in the blood. The kidneys also release hormones that help make red blood cells, regulate blood pressure, and keep bones strong.
What are the effects of CKD?
CKD usually takes a long time to develop and does not go away. In CKD, the kidneys continue to work—just not as well as they should. Wastes may build up so gradually that the body becomes used to having those wastes in the blood. Salts containing phosphorus and potassium may rise to unsafe levels, causing heart and bone problems. Anemia—low red blood cell count—can result from CKD because the kidneys stop making enough erythropoietin, a hormone that causes bone marrow to make red blood cells. After months or years, CKD may progress to permanent kidney failure, which requires a person to have a kidney transplant or regular blood filtering treatments called dialysis.
What is medical nutrition therapy (MNT)?
MNT is the use of nutrition counseling by a registered dietitian to help promote a medical or health goal. A health care provider may refer a patient to a registered dietitian to help with the patient’s food plan. Many insurance policies cover MNT when recommended by a health care provider. Anyone who qualifies for Medicare can receive a benefit for MNT from a registered dietitian or nutrition professional when a health care provider provides a referral indicating that the person has diabetes or kidney disease.
One way to locate a qualified dietitian is to contact the Academy of Nutrition and Dietetics at www.eatright.org External link and click on “Find a Registered Dietitian.” Users can enter their address or ZIP code for a list of dietitians in their area. A person looking for dietary advice to prevent kidney damage should click on “Renal (Kidney) Nutrition” in the specialty field. Dietitians who specialize in helping people with CKD are called renal dietitians.
Why is knowing about calories important for someone with advanced CKD?
As CKD progresses, people often lose their appetites because they find that foods do not taste the same. As a result, they consume fewer calories—important units of energy in food—and may lose too much weight. Renal dietitians can help people with advanced CKD find healthy ways to add calories to their diet if they are losing too much weight.
Why is knowing about protein important for someone with advanced CKD?
Protein is an essential part of any diet. Proteins help build and maintain muscle, bone, skin, connective tissue, internal organs, and blood. They help fight disease and heal wounds. But proteins also break down into waste products that must be removed from the blood by the kidneys. Eating more protein than the body needs may put an extra burden on the kidneys and cause kidney function to decline faster.
Health care providers recommend that people with CKD eat moderate or reduced amounts of protein. However, restricting protein could lead to malnutrition, so people with CKD need to be careful. The typical American diet contains more than enough protein. Learning about portion sizes can help people limit protein intake without endangering their health.
What is the right meat portion size?
Most people—with or without CKD—can get the daily protein they need by eating two 3-ounce servings of meat or meat substitute. A 3-ounce serving of meat is about the size of a deck of cards or the palm of a person’s hand.
A renal dietitian can help people learn about the amount and sources of protein in their diet. Animal protein in egg whites, cheese, chicken, fish, and red meats contain more of the essential nutrients a body needs. With careful meal planning, a well-balanced vegetarian diet can also provide these nutrients. A renal dietitian can help people with advanced CKD make small adjustments in their eating habits that can result in significant protein reduction. For example, people can lower their protein intake by making sandwiches using thinner slices of meat and adding lettuce, cucumber slices, apple slices, and other garnishes. The following table lists some higher-protein foods and suggestions for lower-protein alternatives that are better choices for people with CKD trying to limit their protein intake.
How does what I eat and drink affect my hemodialysis?
Your choices about what to eat and drink while on hemodialysis can make a difference in how you feel and can make your treatments work better.
Between dialysis treatment sessions, wastes can build up in your blood and make you sick. You can reduce waste buildup by controlling what you eat and drink. You can match what you eat and drink with what your kidney treatments remove.
Some foods cause wastes to build up quickly between your dialysis sessions. If your blood contains too much waste, your kidney treatment session may not remove them all.
How can I learn what I should eat?
Your dialysis center has a renal dietitian to help you plan your meals. A renal dietitian has special training in caring for the food and nutrition needs of people with kidney disease.
Use this information to help you learn how to eat right to feel right on hemodialysis. Read one section at a time. Then, review with your renal dietitian the sections marked “Talk with Your Renal Dietitian.”
What foods count as liquid and why?
Foods that are liquid at room temperature, such as soup, contain water. Gelatin, pudding, ice cream, and other foods that include a lot of liquid in the recipe also count. Most fruits and vegetables contain water, such as melons, grapes, apples, oranges, tomatoes, lettuce, and celery. When you count up how much liquid you have in a day, be sure to count these foods.
What is my dry weight?
Your dry weight is your weight after a hemodialysis session has removed all extra fluid from your body. Controlling your liquid intake helps you stay at your proper dry weight. If you let too much fluid build up between sessions, it is harder to achieve your dry weight. Your health care provider can help you figure out what dry weight is right for you.
Talk with Your Renal Dietitian
Even though you are on hemodialysis, your kidneys may still remove some fluid. Or, your kidneys may not remove any fluid at all. Work with your renal dietitian to set a goal for how much liquid you can have each day. Keep track of the liquids you drink and other foods you eat.
What do I need to know about potassium?
Healthy kidneys keep the right amount of potassium in your blood to keep your heart beating at a steady pace. Potassium levels can rise between hemodialysis sessions and affect your heartbeat. Eating too much potassium can be dangerous to your heart and may even cause death.
To control potassium levels, limit potassium-rich foods such as avocados, bananas, kiwis, and dried fruit. Choose fruits and vegetables that are lower in potassium. Have very small portions of foods that are higher in potassium, such as one or two cherry tomatoes on a salad or a few raisins in your oatmeal.
You can remove some of the potassium from potatoes by dicing or shredding them and then boiling them in a full pot of water.
What do I need to know about phosphorus?
Too much phosphorus in your blood pulls calcium from your bones. Losing calcium may make your bones weak and likely to break. Also, too much phosphorus may make your skin itch. Limiting phosphorus can be hard because foods that contain phosphorus, such as meat and milk, also contain the protein you need. You should be careful to eat enough protein; however, not so much that you get too much phosphorus. Processed and packaged foods contain especially high levels of phosphorus. You can also find phosphorus naturally in foods such as poultry, fish, nuts, peanut butter, beans, cola, tea, and dairy products. Usually, people on hemodialysis should only have a 1/2 cup of milk per day. Your renal dietitian will give you more specific information about phosphorus.
Talk with Your Renal Dietitian
Limiting phosphorus and getting enough protein can be difficult. See the “Talk with Your Renal Dietitian” section under the next section about protein.
More information is provided in the NIDDK health topic, Phosphorus: Tips for People with Chronic Kidney Disease.
What do I need to know about sodium?
Sodium is a part of salt. Sodium is found in many canned, packaged, frozen, and fast foods. Sodium is also found in many condiments, seasonings, and meats. Too much sodium makes you thirsty, which makes you drink more liquid.
Try to eat fresh, naturally low-sodium foods. Look for products labeled “low sodium,” especially in canned and frozen foods.
What happens during hemodialysis?
During hemodialysis, your blood goes through a filter, called a dialyzer, outside your body. A dialyzer is sometimes called an “artificial kidney.”
At the start of a hemodialysis treatment, a dialysis nurse or technician places two needles into your arm. You may prefer to put in your own needles after you’re trained by your health care team. A numbing cream or spray can be used if placing the needles bothers you. Each needle is attached to a soft tube connected to the dialysis machine.
What happens to my blood while it’s in the filter?
Blood enters at one end of the filter and is forced into many, very thin, hollow fibers. As your blood passes through the hollow fibers, dialysis solution passes in the opposite direction on the outside of the fibers. Waste products from your blood move into the dialysis solution. Filtered blood remains in the hollow fibers and returns to your body.
Can the dialyzer do everything my kidneys once did?
No. Hemodialysis can replace part, but not all, of your kidney function. Dialysis will help improve your energy level, and changes you make to your diet can help you feel better. Limiting how much water and other liquid you drink and take in through foods can help keep too much fluid from building up in your body between treatments. Medicines also help you maintain your health while on dialysis.
Dialysis center
Most people go to a dialysis center for treatment. At the dialysis center, health care professionals set up and help you connect to the dialysis machine. A team of health care workers will be available to help you. You will continue to see your doctor. Other team members may include nurses, health care technicians, a dietitian, and a social worker.
How do I find a dialysis center?
Your doctor, nurse, or social worker can help you find a dialysis center that’s convenient for you. Under Medicare rules, you have the right to choose the dialysis center where you’ll receive treatment. You may want to use Dialysis Facility Compare External link, which rates all dialysis centers according to quality. Your doctor will give your medical information to the dialysis center you choose.
Most large cities have more than one dialysis center to choose from. You can visit the centers to see which one best fits your needs. For example, you can ask about a center’s rules for laptop and cellphone use, as well as for having visitors. You may want the center to be close to your home to save travel time. If you live in a rural area, the closest dialysis center may be far from your home. If you’d have a hard time getting to the dialysis center, you may want to consider home dialysis treatments such as home hemodialysis or peritoneal dialysis.
Home hemodialysis
Home hemodialysis lets you have longer or more frequent dialysis, which comes closer to replacing the work healthy kidneys do—usually three to seven times per week, and with treatment sessions that last between 2 and 10 hours. Machines for home use are small enough to sit on an end table.
Better quality of life
Standard hemodialysis can make you feel tired or washed out for several hours after each treatment. People who have switched from standard hemodialysis to longer or more frequent hemodialysis report they feel better, with more energy, less nausea, and better sleep. They also may report a better quality of life.1
How do I prepare for hemodialysis?
Dialysis is a complex treatment that takes time to understand. Because most people don’t feel sick until shortly before starting dialysis, you’ll likely still feel well when your doctor first talks to you about getting ready for dialysis. No one wants to start you on dialysis before you need it, but it takes time to prepare for dialysis.
Vascular access surgery
One important step before starting hemodialysis treatment is having minor surgery to create a vascular access. Your vascular access will be your lifeline through which you’ll connect to the dialyzer. Dialysis moves blood through the filter at a high rate. Blood flow is very strong. The machine withdraws and returns almost a pint of blood to your body every minute. The access will be the place on your body where you insert needles to allow your blood to flow from and return to your body at a high rate during dialysis.
AV fistula
The best type of long-term access is an AV fistula. A surgeon connects an artery to a vein, usually in your arm, to create an AV fistula. An artery is a blood vessel that carries blood away from your heart. A vein is a blood vessel that carries blood back toward your heart. When the surgeon connects an artery to a vein, the vein grows wider and thicker, making it easier to place the needles for dialysis. The AV fistula also has a large diameter that allows your blood to flow out and back into your body quickly. The goal is to allow high blood flow so that the largest amount of blood can pass through the dialyzer.
AV graft
If problems with your veins prevent you from having an AV fistula, you may need an AV graft instead. To create an AV graft, your surgeon uses a man-made tube to connect an artery to a vein. You can use an AV graft for dialysis soon after surgery. However, you’re more likely to have problems with infection and blood clots. Repeated blood clots can block the flow of blood through the graft and make it hard or impossible to have dialysis.
Talk with your doctor
The first step is to talk with your doctor to find out whether you’re a candidate for a transplant. If you’re on dialysis, your dialysis team will also be part of the process. If you and your doctor think a kidney transplant is right for you, your doctor will refer you to a transplant center.
Get tested at a transplant center
At the transplant center, you’ll meet members of your transplant team. You’ll have tests to make sure you’re a good candidate for transplant.
Tests will include blood tests and tests to check your heart and other organs—to make sure you’re healthy enough for surgery. Some conditions or illnesses could make a transplant less likely to succeed, such as cancer that is not in remission, or current substance abuse.
You’ll also have tests to check your mental and emotional health. The transplant team must be sure you’re prepared to care for a transplanted kidney. You’ll need to be able to understand and follow a schedule for taking the medicines you need after surgery.
In a process called cross-matching, the transplant team tests the donor’s blood against your blood to help predict whether your body’s immune system will accept or reject the new kidney.
If a family member or friend wants to donate a kidney and is a good match, that person will need a health exam to make sure he or she is healthy enough to be a donor. If you have a living donor, you don’t need to be on a waiting list for a kidney and can schedule the surgery when it’s best for you, your donor, and your surgeon.
Testing and evaluation at the transplant center may take several visits over weeks to months.
Get on the waiting list
If your tests show you can have a transplant, your transplant center will add your name to the waiting list. Wait times can range from a few months to years. Most transplant centers give preference to people who‘ve been on the waiting list the longest. Other factors, such as your age, where you live, and your blood type, may make your wait longer or shorter.
A transplant center can place you on the waiting list for a donor kidney if your kidney function is 20 or less—even if you aren’t on dialysis. While you wait for a kidney transplant, you may need to start dialysis.
Have monthly blood tests
While you wait for a kidney, you’ll need monthly blood tests. The center must have a recent sample of your blood to match with any kidney that becomes available.
Have your kidney transplant
During kidney transplant surgery, a surgeon places a healthy kidney into your body. You’ll receive general anesthesia NIH external link before the surgery. The surgery usually takes 3 or 4 hours. Unless your damaged kidneys cause infections or high blood pressure or are cancerous, they can stay in your body. Surgeons usually transplant a kidney into the lower abdomen near the groin.
If you’re on a waiting list for a donor kidney, you must go to the hospital to have your transplant surgery as soon as you learn that a kidney is available.
If a family member or friend is donating the kidney, you’ll schedule the surgery in advance. Your surgical team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.
How will I feel after my transplant?
Many people report feeling much better right after having transplant surgery. For some people, it takes a few days for the new kidney to start working. You probably will need to stay in the hospital several days to recover from surgery—longer if you have any problems after the transplant. You’ll have regular follow-up visits with your nephrologist after leaving the hospital.
If you have a living donor, the donor will probably also stay in the hospital for several days. However, a new technique for removing a kidney for donation that uses a smaller cut may make it possible for the donor to leave the hospital in 2 to 3 days.
How do I know my new kidney is working?
Blood tests help you know your donor kidney is working. Before you leave the hospital, you’ll schedule an appointment at the transplant center to test your blood. The tests show how well your kidneys are removing wastes from your blood.
At first, you’ll need regular checkups and blood tests at the transplant center or from your doctor. As time goes on, you’ll have fewer checkups.
Your blood tests may show that your kidney is not removing wastes from your blood as well as it should. You also may have other symptoms that your body is rejecting your donor kidney. If you have these problems, your transplant surgeon or nephrologist may order a kidney biopsy.
What are the possible problems after a kidney transplant?
The donated kidney may start working right away or may take up to a few weeks to make urine. If the new kidney doesn’t start working right away, you’ll need dialysis treatments to filter wastes and extra salt and fluid from your body until it starts working.
What are the symptoms of transplant rejection?
Transplant rejection often begins before you feel any changes. The routine blood tests that you have at the transplant center will reveal early signs of rejection. You may develop high blood pressure or notice swelling because your kidney isn’t getting rid of extra salt and fluid in your body.
Your health care provider will treat early signs of rejection by adjusting your medicines to help keep your body from rejecting your new kidney.
Transplant rejection is becoming less common. However, your body may still reject the donor kidney, even if you do everything you should. If that happens, you may need to go on dialysis and go back on the waiting list for another kidney. Some people are able to get a second kidney transplant.
What is peritoneal dialysis and how does it work?
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum.
A few weeks before you start peritoneal dialysis, a surgeon places a soft tube, called a catheter, in your belly.
When you start treatment, dialysis solution—water with salt and other additives—flows from a bag through the catheter into your belly. When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities. While the dialysis solution is inside your belly, it absorbs wastes and extra fluid from your body.
How will I feel when the dialysis solution is inside my belly?
You may feel the same as usual, or you may feel full or bloated. Your belly may enlarge a little. Some people need a larger size of clothing. You shouldn’t feel any pain. Most people look and feel normal despite a belly full of solution.
CAPD doesn’t use a machine. You do the exchanges during the day by hand.
You can do exchanges by hand in any clean, well-lit place. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch television, or sleep. With CAPD, you keep the solution in your belly for 4 to 6 hours or more. The time that the dialysis solution is in your belly is called the dwell time. Usually, you change the solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up at night to do an exchange.
Automated peritoneal dialysis. A machine does the exchanges while you sleep.
With automated peritoneal dialysis, a machine called a cycler fills and empties your belly three to five times during the night. In the morning, you begin the day with fresh solution in your belly. You may leave this solution in your belly all day or do one exchange in the middle of the afternoon without the machine. People sometimes call this treatment continuous cycler-assisted peritoneal dialysis or CCPD.
Where can I do peritoneal dialysis?
You can do both CAPD and automated peritoneal dialysis in any clean, private place, including at home, at work, or when travelling.
Before you travel, you can have the manufacturer ship the supplies to where you’re going so they’ll be there when you get there. If you use automated peritoneal dialysis, you’ll have to carry your machine with you or plan to do exchanges by hand while you’re away from home.
How do I prepare for peritoneal dialysis?
Surgery to put in your catheter
Before your first treatment, you will have surgery to place a catheter into your belly. Planning your catheter placement at least 3 weeks before your first exchange can improve treatment success.
Although you can use the catheter for dialysis as soon as it’s in place, the catheter tends to work better when you have 10 to 20 days to heal before starting a full schedule of exchanges.
Your surgeon will make a small cut, often below and a little to the side of your belly button, and then guide the catheter through the slit into your peritoneal cavity. You’ll receive general or local anesthesia NIH external link, and you may need to stay overnight in the hospital. However, most people can go home after the procedure.
You’ll learn to care for the skin around the catheter, called the exit site, as part of your dialysis training.
Dialysis training
After training, most people can perform both types of peritoneal dialysis on their own. You’ll work with a dialysis nurse for 1 to 2 weeks to learn how to do exchanges and avoid infections. Most people bring a family member or friend to training. With a trained friend or family member, you’ll be prepared in case you have a sick day and need help with exchanges.
Use a transfer set to connect your catheter to the dialysis solution
A transfer set is tubing that you use to connect your catheter to the bag of dialysis solution. When you first get your catheter, the section of tube that sticks out from your skin will have a secure cap on the end to prevent infection. A connector under the cap will attach to any type of transfer set.
Use dialysis solution as prescribed
Dialysis solution comes in 1.5-, 2-, 2.5-, or 3-liter bags. Solutions contain a sugar called dextrose or a compound called icodextrin and minerals to pull the wastes and extra fluid from your blood into your belly. Different solutions have different strengths of dextrose or icodextrin. Your doctor will prescribe a formula that fits your needs.
What changes will I have to make when I start peritoneal dialysis?
Daily routine
Your schedule will change as you work your dialysis exchanges into your routine. If you do CAPD during the day, you have some control over when you do the exchanges. However, you’ll still need to stop your normal activities and take about 30 minutes to perform an exchange. If you do automated peritoneal dialysis, you’ll have to set up your cycler every night.
Physical activity
You may need to limit some physical activities when your belly is full of dialysis solution. You may still be active and play sports, but you should discuss your activities with your health care team.
What is acquired cystic kidney disease?
Acquired cystic kidney disease happens when a person’s kidneys develop fluid-filled sacs, called cysts, over time. Acquired cystic kidney disease is not the same as polycystic kidney disease (PKD), another disease that causes the kidneys to develop multiple cysts.
What are the differences between acquired cystic kidney disease and polycystic kidney disease?
Acquired cystic kidney disease differs from PKD in several ways. Unlike acquired cystic kidney disease, PKD is a genetic, or inherited, disorder that can cause complications such as high blood pressure and problems with blood vessels in the brain and heart.
What causes acquired cystic kidney disease?
Researchers do not fully understand what causes cysts to grow in the kidneys of people with CKD. The fact that these cysts occur only in the kidneys and not in other parts of the body, as in PKD, indicates that the processes that lead to cyst formation take place primarily inside the kidneys.2
What are the signs and symptoms of acquired cystic kidney disease?
A person with acquired cystic kidney disease often has no symptoms. However, the complications of acquired cystic kidney disease can have signs and symptoms.
Medical History
Taking a medical history may help a health care provider diagnose acquired cystic kidney disease. A health care provider may suspect acquired cystic kidney disease if a person who has been on dialysis for several years develops symptoms such as fever, back pain, or blood in the urine.
Imaging Tests
To confirm the diagnosis, the health care provider may order one or more imaging tests. A radiologist—a doctor who specializes in medical imaging—interprets the images from these tests, and the patient does not need anesthesia.
How is acquired cystic kidney disease treated?
If acquired cystic kidney disease is not causing complications, a person does not need treatment. A health care provider will treat infections with antibiotics—medications that kill bacteria. If large cysts are causing pain, a health care provider may drain the cyst using a long needle inserted into the cyst through the skin.
When a surgeon transplants a new kidney into a patient’s body to treat kidney failure, acquired cystic kidney disease in the damaged kidneys, which usually remain in place after a transplant, often disappears.
A surgeon may perform an operation to remove tumors or suspected tumors. In rare cases, a surgeon performs an operation to stop cysts from bleeding.
Eating, Diet, and Nutrition
No specific diet will prevent or delay acquired cystic kidney disease. In general, a diet designed for people on hemodialysis or peritoneal dialysis reduces the amount of wastes that accumulate in the body between dialysis sessions.
More information is provided in the NIDDK health topics, Eating & Nutrition for Hemodialysis and Nutrition for Advanced Chronic Kidney Disease in Adults.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.
What is amyloidosis?
Amyloidosis is a rare disease that occurs when amyloid proteins are deposited in tissues and organs. Amyloid proteins are abnormal proteins the body cannot break down and recycle as it does with normal proteins. When amyloid proteins clump together, they form amyloid deposits. The buildup of these deposits damages organs and tissues.
Amyloidosis can affect different organs and tissues in different people, and it can affect more than one organ at the same time. The symptoms and severity of amyloidosis depend on which organs and tissues are affected. Amyloidosis most frequently affects the kidneys, heart, nervous system, liver, and gastrointestinal tract.
How common is kidney-related amyloidosis?
Amyloidosis is rare. AL amyloidosis is the most common type of amyloidosis in the United States, and it affects approximately 40 out of every 1 million Americans.2 The other types of amyloidosis are even less common.
Who is more likely to develop kidney-related amyloidosis?
The risk factors for kidney-related amyloidosis depend on the type of amyloidosis.
AL amyloidosis
AL amyloidosis is most common in people over the age of 65, and the risk of developing AL amyloidosis increases as you get older.2
AA amyloidosis
AA amyloidosis is most common in people who have experienced a long-lasting infection or chronic inflammatory disorder.
LECT2 amyloidosis
LECT2 amyloidosis is most common in Hispanic adults, particularly those of Mexican descent.
Hereditary amyloidosis
Hereditary amyloidosis is more common in people who have a family member with the condition.
Dialysis-related amyloidosis
Risk of developing dialysis-related amyloidosis increases the longer you have been on dialysis, the older you are at the start of dialysis treatment, and the more your kidney function has declined.3
What are the complications of kidney-related amyloidosis?
Amyloid that builds up in the kidneys can damage the kidneys and affect the kidneys’ ability to filter blood. This damage can cause wastes to build up in your body, which may worsen kidney damage and lead to kidney failure.
What causes kidney-related amyloidosis?
Amyloidosis is caused by an abnormal folding of proteins. These proteins can clump together and form amyloid deposits. The deposits collect in organs and tissues and may lead to organ damage and health problems, including kidney disease. Experts have identified more than 30 different proteins that can form amyloid.4
AL amyloidosis
Plasma cells NIH external link—a type of blood cell made by stem cells NIH external link in your bone marrow NIH external link—can produce abnormal proteins that cannot hold their shape. These abnormal proteins clump together, causing AL amyloidosis.
AA amyloidosis
Long-lasting infections or chronic inflammatory conditions such as rheumatoid arthritis NIH external link, inflammatory bowel disease, familial Mediterranean fever NIH external link, and tuberculosis NIH external link can trigger a protein to build up and cause AA amyloidosis.
LECT2 amyloidosis
Researchers do not know exactly what causes the LECT2 protein to form amyloid.
Hereditary amyloidosis
Genetic mutations passed down in families can cause your body—most often, your liver—to produce amyloid proteins. The amyloid proteins collect in certain parts of your body, such as the kidneys, and cause damage. There are many different types of hereditary amyloidosis, each associated with a different gene mutation and type of protein.
Dialysis-related amyloidosis
Dialysis doesn’t remove enough of a protein called beta-2 microglobulin from the blood. Over time, this protein can build up and deposit in bones, joints, and tendons, leading to dialysis-related amyloidosis.
How do health care professionals diagnose kidney-related amyloidosis?
Health care professionals use your medical and family history, a physical exam, and one or more tests to confirm your diagnosis of amyloidosis, identify the type of amyloidosis, and determine treatment.
What tests do health care professionals use to diagnose kidney-related amyloidosis?
Your health care professional may use one or more of the following tests to diagnose amyloidosis.
What is diabetes insipidus?
Diabetes insipidus is a rare disorder that causes the body to make too much urine. While most people make 1 to 3 quarts of urine a day, people with diabetes insipidus can make up to 20 quarts of urine a day. People with this disorder need to urinate frequently, called polyuria. They may also feel thirsty all the time and drink lots of liquids, a condition called polydipsia.
Are diabetes insipidus and diabetes mellitus the same?
Diabetes insipidus is not the same as diabetes mellitus. Although both conditions can increase thirst, intake of liquids, and urination, they are not related.
In diabetes mellitus, the level of glucose in your blood, also called blood sugar, is too high. Your kidneys try to remove the extra glucose by passing it in your urine.
In diabetes insipidus, your blood glucose levels are normal, but your kidneys can’t properly concentrate urine.
How common is diabetes insipidus?
Diabetes insipidus is rare, affecting about 1 in 25,000 people worldwide.1
What are the complications of diabetes insipidus?
The main complication of diabetes insipidus is dehydration, which happens when your body loses too much fluid and electrolytes to work properly. If you have diabetes insipidus, you can usually make up for the large amount of fluids you pass in your urine by drinking more liquids. But if you don’t, you could quickly become dehydrated.
What causes diabetes insipidus?
Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your kidneys balance the amount of fluid in your body. Problems with a part of your brain that controls thirst can also cause diabetes insipidus. Specific causes vary among the four types of diabetes insipidus: central, nephrogenic, dipsogenic, and gestational.2
Central diabetes insipidus
In central diabetes insipidus, your body doesn’t make enough vasopressin, also called “antidiuretic hormone.” Vasopressin is produced in your hypothalamus, a small area of your brain near the pituitary gland. When the amount of fluids in your body falls too low, the pituitary gland releases vasopressin into your bloodstream. The hormone signals your kidneys to conserve fluids by pulling fluids from your urine and returning fluid to your bloodstream. But if your body can’t make enough vasopressin, the fluid may get flushed out in your urine instead.
Gestational diabetes insipidus
Gestational diabetes insipidus is a rare, temporary condition that can develop during pregnancy. This type of diabetes insipidus occurs when the mother’s placenta NIH external link makes too much of an enzyme that breaks down her vasopressin. Women who are pregnant with more than one baby are more likely to develop the condition because they have more placental tissue.3 Because the liver plays a role in curbing the enzyme that breaks down vasopressin, diseases and conditions that affect liver function also increase risk. Examples include preeclampsia NIH external link and HELLP syndrome NIH external link.
How do health care professionals treat diabetes insipidus?
The main way to treat diabetes insipidus is to drink enough liquids to prevent dehydration. But doing so can disrupt your regular lifestyle, including your sleep. Your health care professional may refer you to a specialist, such as a nephrologist or an endocrinologist for more specific treatments. Other treatments vary by cause.
Central diabetes insipidus
Health care professionals most often treat central diabetes insipidus with a man-made hormone called desmopressin NIH external link, which replaces the vasopressin your body is not making.2,6 You can take this medicine as a nasal spray, a pill, or a shot.
Nephrogenic diabetes insipidus
In some cases, nephrogenic diabetes insipidus may go away after treating its cause. For example, switching medicines or taking steps to balance the amount of calcium or potassium in your body may be enough to resolve the problem. Your health care professional may also prescribe a class of diuretic medicines called thiazides to help reduce the amount of urine your kidneys make.2,7 Other treatments can include nonsteroidal anti-inflammatory drugs or other types of diuretics.
What is an ectopic kidney?
An ectopic kidney is a kidney located below, above, or on the opposite side of the kidney’s normal position in the urinary tract. The two kidneys are usually located near the middle of your back, just below your rib cage, on either side of your spine.
An ectopic kidney usually doesn’t cause any symptoms or health problems, and many people never find out that they have the condition. If an ectopic kidney is discovered, it is usually found during a fetal ultrasound—an imaging test that uses sound waves to create a picture of how a baby is developing in the womb—or during medical tests done to check for a urinary tract infection or to find the cause of abdominal pain. Rarely does a person have two ectopic kidneys.
In the womb, a fetus’s kidneys first develop as small buds in the lower abdomen inside the pelvis. During the first 8 weeks of growth, the fetus’s kidneys slowly move from the pelvis to their normal position in the back near the rib cage. When an ectopic kidney occurs during growth, the kidney
Does ectopic kidney have another name?
When the kidney stays in the pelvis, it is called a pelvic kidney. If the kidney crosses to the other side of the body, it is called crossed renal ectopia.
What other health problems can an ectopic kidney cause?
An ectopic kidney usually doesn’t cause health problems, or complications, and may work normally. Most people are born with two kidneys, so if your ectopic kidney doesn’t work at all, your other kidney may be able to do the work both kidneys would have done. In rare cases, a nonfunctioning ectopic kidney must be removed. As long as the other kidney is working well, there should be no problems living with one kidney, also called a solitary kidney.
People who have an ectopic kidney are more likely to have vesicoureteral reflux (VUR). VUR is a condition in which urine flows backward from the bladder to one or both ureters, and sometimes to the kidneys. In some people, an ectopic kidney can block urine from correctly draining from the body or may be associated with VUR.
How do health care professionals diagnose an ectopic kidney?
Many people who have an ectopic kidney don’t discover it unless they have tests done for other reasons or the ectopic kidney was found during a prenatal ultrasound.
Health care professionals may use urinary tract imaging tests and lab tests to find out if you have an ectopic kidney and to rule out other health problems. If you have an ectopic kidney and it’s not causing symptoms or other health problems, you usually don’t need further testing or treatment.
Imaging tests
A specially trained technician performs imaging tests at an outpatient center or hospital, and a radiologist reviews the images.
Health care professionals use the following imaging tests to help diagnose and manage an ectopic kidney.
How do health care professionals treat an ectopic kidney?
Your health care professional may not need to treat your ectopic kidney if it isn’t causing symptoms or damage to your body or kidney. If tests show that you have a blockage or other potential complication in the urinary tract, your health care professional may suggest further follow-up or surgery to correct the abnormality.
Can I prevent an ectopic kidney?
No. Like many other birth defects, health care professionals don’t know what causes or how to prevent an ectopic kidney.
Clinical Trials for Ectopic Kidney
The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses.
What are the kidneys and what do they do?
The two kidneys are bean-shaped organs located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.
Blood enters the kidneys through arteries that branch inside the kidneys into tiny clusters of looping blood vessels. Each cluster is called a glomerulus, which comes from the Greek word meaning filter. The plural form of the word is glomeruli. There are approximately 1 million glomeruli, or filters, in each kidney. The glomerulus is attached to the opening of a small fluid-collecting tube called a tubule. Blood is filtered in the glomerulus, and extra fluid and wastes pass into the tubule and become urine. Eventually, the urine drains from the kidneys into the bladder through larger tubes called ureters.
How do glomerular diseases interfere with kidney function?
Glomerular diseases damage the glomeruli, letting protein and sometimes red blood cells leak into the urine. Sometimes a glomerular disease also interferes with the clearance of waste products by the kidney, so they begin to build up in the blood. Furthermore, loss of blood proteins like albumin in the urine can result in a fall in their level in the bloodstream. In normal blood, albumin acts like a sponge, drawing extra fluid from the body into the bloodstream, where it remains until the kidneys remove it. But when albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Fluid can accumulate outside the circulatory system in the face, hands, feet, or ankles and cause swelling.
How is glomerular disease diagnosed?
Patients with glomerular disease have significant amounts of protein in the urine, which may be referred to as “nephrotic range” if levels are very high. Red blood cells in the urine are a frequent finding as well, particularly in some forms of glomerular disease. Urinalysis provides information about kidney damage by indicating levels of protein and red blood cells in the urine. Blood tests measure the levels of waste products such as creatinine and urea nitrogen to determine whether the filtering capacity of the kidneys is impaired. If these lab tests indicate kidney damage, the doctor may recommend ultrasound or an x-ray to see whether the shape or size of the kidneys is abnormal. These tests are called renal imaging. But since glomerular disease causes problems at the cellular level, the doctor will probably also recommend a kidney biopsy—a procedure in which a needle is used to extract small pieces of tissue for examination with different types of microscopes, each of which shows a different aspect of the tissue. A biopsy may be helpful in confirming glomerular disease and identifying the cause.
What causes glomerular disease?
A number of different diseases can result in glomerular disease. It may be the direct result of an infection or a drug toxic to the kidneys, or it may result from a disease that affects the entire body, like diabetes or lupus. Many different kinds of diseases can cause swelling or scarring of the nephron or glomerulus. Sometimes glomerular disease is idiopathic, meaning that it occurs without an apparent associated disease.
The categories presented below can overlap: that is, a disease might belong to two or more of the categories. For example, diabetic nephropathy is a form of glomerular disease that can be placed in two categories: systemic diseases, since diabetes itself is a systemic disease, and sclerotic diseases, because the specific damage done to the kidneys is associated with scarring.
Autoimmune Diseases
When the body’s immune system functions properly, it creates protein-like substances called antibodies and immunoglobulins to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions.
Hereditary Nephritis—Alport Syndrome
The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss. Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function.
Sclerotic Diseases
Glomerulosclerosis is scarring (sclerosis) of the glomeruli. In several sclerotic conditions, a systemic disease like lupus or diabetes is responsible. Glomerulosclerosis is caused by the activation of glomerular cells to produce scar material. This may be stimulated by molecules called growth factors, which may be made by glomerular cells themselves or may be brought to the glomerulus by the circulating blood that enters the glomerular filter.
Diabetic nephropathy is the leading cause of glomerular disease and of total kidney failure in the United States. Kidney disease is one of several problems caused by elevated levels of blood glucose, the central feature of diabetes. In addition to scarring the kidney, elevated glucose levels appear to increase the speed of blood flow into the kidney, putting a strain on the filtering glomeruli and raising blood pressure.
Chronic Kidney Disease
Most forms of glomerular disease develop gradually, often causing no symptoms for many years. Chronic kidney disease (CKD) is the slow, gradual loss of kidney function. Some forms of CKD can be controlled or slowed down. For example, diabetic nephropathy can be delayed by tightly controlling blood glucose levels and using ACE inhibitors and ARBs to reduce proteinuria and control blood pressure. But CKD cannot be cured. Partial loss of renal function means that some portion of the patient’s nephrons have been scarred, and scarred nephrons cannot be repaired. In many cases, CKD leads to kidney failure.
What are kidney failure and end-stage renal disease?
Kidney failure is the acute or chronic loss of 85 percent or more kidney function. End-stage renal disease (ESRD), is kidney failure that is treated by dialysis or kidney transplant. Depending on the form of glomerular disease, kidney function may be lost in a matter of days or weeks or may deteriorate slowly and gradually over the course of decades.
Acute Renal Failure
A few forms of glomerular disease cause very rapid deterioration of kidney function. For example, PSGN can cause severe symptoms (hematuria, proteinuria, edema) within 2 to 3 weeks after a sore throat or skin infection develops. The patient may temporarily require dialysis to replace renal function. This rapid loss of kidney function is called acute renal failure (ARF). Although ARF can be life-threatening while it lasts, kidney function usually returns after the cause of the kidney failure has been treated. In many patients, ARF is not associated with any permanent damage. However, some patients may recover from ARF and subsequently develop CKD.
Kidney Failure
To stay alive, a patient with kidney failure must go on dialysis—hemodialysis or peritoneal dialysis—or receive a new kidney through transplantation. Patients with CKD who are approaching kidney failure should learn as much about their treatment options as possible so they can make an informed decision when the time comes. With the help of dialysis or transplantation, many people continue to lead full, productive lives with kidney failure.
Does anti-GBM disease have another name?
Anti-GBM disease is sometimes also called Goodpasture’s disease.1 Another related term is Goodpasture syndrome, a condition that also affects the kidneys and lungs but is not caused by anti-GBM antibodies.
How common is anti-GBM disease?
Anti-GBM disease is rare, with only about 1 in 1 million new cases being reported per year.1
Who is more likely to develop anti-GBM disease?
Anti-GBM disease most often affects men in their 20s and women in their 60s, but it can occur at any age.1 The condition can occur in children, but this is extremely rare.
What causes anti-GBM disease?
Researchers don’t fully understand the cause of anti-GBM disease. A combination of your genes and factors in the environment External link may put you at risk.
Genes
Some genetic traits that parents pass on to their children, while uncommon, may affect the risk for developing anti-GBM disease. For example, scientists have found a link between anti-GBM disease and human leukocyte antigen (HLA) NIH external link, a protein on the surface of cells that plays an important role in immune response.2 Some types of HLA may increase your risk of developing the disorder, while others may decrease this risk.
Clinical Trials for Anti-GBM Disease
The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
What are clinical trials for anti-GBM disease?
Clinical trials—and other types of clinical studies—are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.
What clinical studies for anti-GBM disease are looking for participants?
You can view a filtered list of clinical studies on [condition] that are federally funded, open, and recruiting at www.ClinicalTrials.gov NIH external link. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.
What is immunoglobulin A (IgA) vasculitis?
IgA vasculitis, formerly called Henoch-Schönlein purpura or HSP, is a disease that causes the antibody immunoglobulin A to collect in small blood vessels, which then become inflamed and leak blood. Nearly all people with IgA vasculitis develop a red or purple rash NIH external link. Some people with IgA vasculitis also develop problems with their gastrointestinal (GI) tract, joints, and kidneys because of inflamed blood vessels in the intestines, joints, and kidneys. In rare cases, the lungs, nervous system, or other organs may be affected.
How common is IgA vasculitis?
IgA vasculitis is rare. The number of new cases of IgA vasculitis is approximately 3 to 27 cases per 100,000 in children and infants and fewer than 2 new cases per 100,000 each year in adults.1, 2
Who is more likely to develop IgA vasculitis?
IgA vasculitis is most common in young children between the ages of 4 and 7,3 but people of all ages can be affected.
You may be more likely to develop IgA vasculitis if you have a family history of the disease.
Are there long-term health problems from IgA vasculitis?
Most people recover from IgA vasculitis completely without treatment. The symptoms usually go away within a few weeks to months. The symptoms may return one or more times—usually within the first year—but typically go away again on their own.
The most common and serious long-term health problem caused by IgA vasculitis is CKD. Severe kidney damage is rare but, if it does occur, it may require aggressive treatment. Adults are much more likely than children to develop CKD.
How do health care professionals diagnose IgA vasculitis?
Health care professionals use your medical history, a physical exam, and lab tests to confirm your diagnosis of IgA vasculitis.
What tests do health care professionals use to diagnose or monitor IgA vasculitis?
Your health care professional may perform a skin or kidney biopsy, blood and urine tests, and sometimes an ultrasound of the kidneys or abdomen to confirm the diagnosis and monitor your health. In some cases, a kidney biopsy may be used to asses and monitor the severity of the disease. Depending on the organs affected, your health care professional may suggest other tests.
Skin biopsy
Your health care professional may obtain a skin biopsy to test for antibody deposits on your skin and confirm a diagnosis of IgA vasculitis. To do a skin biopsy, the health care professional removes skin cells from your body to examine under a microscope. You will be given a local anesthetic NIH external link so you don’t feel any pain.
Kidney biopsy
You may also need a kidney biopsy. A kidney biopsy can confirm the diagnosis of IgA vasculitis and provide information on the amount of kidney damage. Your health care professional will use the results of the kidney biopsy to help develop a treatment plan. The kidney biopsy is performed in a hospital with local anesthetic and, in some children, sedation.
Blood and urine tests
Your health care professional may use blood and urine tests to check the health of your kidneys. A urine sample can be used to determine whether there is blood or protein in your urine, which is a sign that the IgA vasculitis is affecting your kidneys. A blood test can check how well your kidneys are working.
Ultrasound
Depending on your symptoms, your health care professional may want you to have an ultrasound to check for GI or kidney problems.
Your health care professional will monitor your symptoms to determine if they are getting better. You may continue to have blood and urine tests to check your kidney function for at least 6 months after most of your symptoms disappear. Your health care professional will monitor you more closely if your tests show kidney damage, as this puts you at greater risk for developing CKD.
How do health care professionals treat IgA vasculitis?
There is no specific treatment for IgA vasculitis. The disease usually goes away on its own. However, your health care professional may suggest certain medicines to relieve symptoms such as abdominal pain, joint pain, and swelling. If your kidneys are involved, the treatment goal will be to prevent CKD.
If you are taking a medicine that may have caused the IgA vasculitis, you will stop taking that medicine.
How can I prevent IgA vasculitis?
Experts have not yet found a way to prevent IgA vasculitis. If your kidneys have been affected by the disease, treatments may be available to help prevent serious kidney problems. Talk with your health care professional about treatments, and follow the treatment plan your health care professional recommends.
How can my diet help prevent or relieve IgA vasculitis?
Diet and nutrition have not been shown to play a role in causing or preventing IgA vasculitis.
Clinical Trials for IgA Vasculitis
The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney disease. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
What is kidney dysplasia?
Kidney dysplasia is a condition in which the internal structures of one or both of a fetus’ kidneys do not develop normally while in the womb. During normal development, two thin tubes of muscle called ureters grow into the kidneys and branch out to form a network of tiny structures called tubules. The tubules collect urine as the fetus grows in the womb. In kidney dysplasia, the tubules fail to branch out completely. Urine that would normally flow through the tubules has nowhere to go. Urine collects inside the affected kidney and forms fluid-filled sacs called cysts. The cysts replace normal kidney tissue and prevent the kidney from functioning.
What are the kidneys and what do they do?
The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, which is composed of wastes and extra fluid. Children produce less urine than adults—the amount they produce depends on their age. The urine flows from the kidneys to the bladder through the two ureters, one on each side of the bladder. The bladder stores urine. The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to find a toilet soon. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder.
What causes kidney dysplasia?
Genetic factors can cause kidney dysplasia. Genes pass information from both parents to the child and determine the child’s traits. Sometimes, parents may pass a gene that has changed, or mutated, causing kidney dysplasia.
Genetic syndromes that affect multiple body systems can also cause kidney dysplasia. A syndrome is a group of symptoms or conditions that may seem unrelated yet are thought to have the same genetic cause. A baby with kidney dysplasia due to a genetic syndrome might also have problems of the digestive tract, nervous system, heart and blood vessels, muscles and skeleton, or other parts of the urinary tract.
A baby may also develop kidney dysplasia if his or her mother takes certain prescription medications during pregnancy, such as some used to treat seizures and high blood pressure. A mother’s use of illegal drugs, such as cocaine, during pregnancy may also cause kidney dysplasia in her unborn child.
How common is kidney dysplasia?
Kidney dysplasia is a common condition. Scientists estimate that kidney dysplasia affects about one in 4,000 babies.1 This estimate may be low because some people with kidney dysplasia are never diagnosed with the condition. About half of the babies diagnosed with this condition have other urinary tract defects.2
Who is more likely to develop kidney dysplasia?
Babies who are more likely to develop kidney dysplasia include those
whose parents have the genetic traits for the condition
with certain genetic syndromes affecting multiple body systems
whose mothers used certain prescription medications or illegal drugs during pregnancy
What are the signs of kidney dysplasia?
Many babies with kidney dysplasia in only one kidney have no signs of the condition. In some cases, the affected kidney may be enlarged at birth and may cause pain.
How is kidney dysplasia diagnosed?
Health care providers may be able to diagnose kidney dysplasia during a woman’s pregnancy using a fetal ultrasound, also called a fetal sonogram. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. Fetal ultrasound is a test done during pregnancy to create images of the fetus in the womb. A specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital, and an obstetrician or a radiologist interprets the images. An obstetrician is a doctor who specializes in pregnancy and childbirth. A radiologist is a doctor who specializes in medical imaging. The patient—in this case, the fetus’ mother—does not need anesthesia for this procedure. The images can show defects in the fetus’ kidneys and other parts of the urinary tract.
How can kidney dysplasia be prevented?
Researchers have not found a way to prevent kidney dysplasia caused by genetic factors or certain genetic syndromes. Pregnant women can prevent kidney dysplasia by avoiding the use of certain prescription medications or illegal drugs during pregnancy. Pregnant women should talk with their health care provider before taking any medications during pregnancy.
Eating, Diet, and Nutrition
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing kidney dysplasia.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What is lupus nephritis?
Lupus nephritis is a type of kidney disease caused by systemic lupus erythematosus NIH external link (SLE or lupus). Lupus is an autoimmune disease NIH external link—a disorder in which the body’s immune system attacks the body’s own cells and organs. Kidney disease caused by lupus may get worse over time and lead to kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant to maintain your health.
What do your kidneys do?
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.
Who gets lupus?
Lupus is much more common in women than in men and most often strikes during the child-bearing years. Nine out of 10 people who have lupus are women. Lupus is also more common in people of African or Asian background. African Americans and Asian Americans are about 2 to 3 times more likely to develop lupus than Caucasians.1 In the United States, 1 out of every 250 African American women will develop lupus.2
How common is lupus nephritis?
Kidney damage is one of the more common health problems caused by lupus. In adults who have lupus, as many as 5 out of 10 will have kidney disease. In children who have lupus, 8 of 10 will have kidney disease.3
Who is more likely to develop lupus nephritis?
African Americans, Hispanics/Latinos, and Asian Americans are more likely to develop lupus nephritis than Caucasians.4 Lupus nephritis is more common in men than in women.5
Urine Test
Your health care professional uses a urine sample to look for blood and protein in your urine. You collect the urine sample in a container in a health care professional’s office or lab. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when blood or protein is present. A high level of protein or a high number of red blood cells in the urine means kidney damage. The urine will also be examined under a microscope to look for kidney cells.
Blood Test
Your health care professional uses a blood test to check your kidney function. The blood test measures creatinine, a waste product from the normal breakdown of muscles in your body. Your kidneys remove creatinine from your blood. Health care professionals use the amount of creatinine in your blood to estimate your glomerular filtration rate (GFR). As kidney disease gets worse, the level of creatinine goes up.
Kidney Biopsy
A kidney biopsy is a procedure that involves taking a small piece of kidney tissue for examination under a microscope. A doctor performs the biopsy in a hospital using imaging techniques such as ultrasound or a computed tomography (CT) scan to guide the biopsy needle into the kidney. Health care professionals numb the area to limit pain and use light sedation External link to help you relax during the procedure.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.
What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov NIH external link.
What is the urinary tract?
The urinary tract is the body’s drainage system for removing urine, which is made up of wastes and extra fluid. For normal urination to occur, all body parts in the urinary tract need to work together, and in the correct order.
Kidneys. Two bean-shaped organs, each about the size of a fist. They are located just below your rib cage, one on each side of your spine. Every day, your kidneys filter about 120 to 150 quarts of blood to remove wastes and balance fluids. This process produces about 1 to 2 quarts of urine per day.
Ureters. Thin tubes of muscle that connect your kidneys to your bladder and carry urine to the bladder.
Bladder. A hollow, muscular, balloon-shaped organ that expands as it fills with urine. The bladder sits in your pelvis between your hip bones. A normal bladder acts like a reservoir. It can hold 1.5 to 2 cups of urine. Although you do not control how your kidneys function, you can control when to empty your bladder. Bladder emptying is known as urination.
How does urination occur?
To urinate, your brain signals the sphincters to relax. Then it signals the muscular bladder wall to tighten, squeezing urine through the urethra and out of your bladder.
How often you need to urinate depends on how quickly your kidneys produce the urine that fills the bladder and how much urine your bladder can comfortably hold. The muscles of your bladder wall remain relaxed while the bladder fills with urine, and the sphincter muscles remain contracted to keep urine in the bladder. As your bladder fills up, signals sent to your brain tell you to find a toilet soon.
Why is the urinary tract important?
The urinary tract is important because it filters wastes and extra fluid from the bloodstream and removes them from the body.
What affects the amount of urine you produce?
The amount of urine you produce depends on many factors, such as the amount of liquid and food you consume and the amount of fluid you lose through sweating and breathing. Certain medicines, medical conditions, and types of food can also affect the amount of urine you produce. Children produce less urine than adults.
How can you keep your urinary tract healthy?
You can help keep your urinary tract healthy by following some basic tips.
Drink enough fluids, especially water. If you’re healthy, try to drink six to eight 8-ounce glasses of fluid each day. You may need to drink more if you have kidney stones or bladder stones. At least half of your fluid intake should be water. You might need to drink less water if you have certain conditions, such as kidney failure or heart disease. Ask your health care professional how much fluid is healthy for you.
Clinical Trials
The NIDDK conducts and supports clinical trials in many diseases and conditions, including urologic diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
What is the urinary tract?
The urinary tract is the body’s drainage system for removing urine, which is made up of wastes and extra fluid. For normal urination to occur, all body parts in the urinary tract need to work together, and in the correct order.
Kidneys. Two bean-shaped organs, each about the size of a fist. They are located just below your rib cage, one on each side of your spine. Every day, your kidneys filter about 120 to 150 quarts of blood to remove wastes and balance fluids. This process produces about 1 to 2 quarts of urine per day.
Ureters. Thin tubes of muscle that connect your kidneys to your bladder and carry urine to the bladder.
Bladder. A hollow, muscular, balloon-shaped organ that expands as it fills with urine. The bladder sits in your pelvis between your hip bones. A normal bladder acts like a reservoir. It can hold 1.5 to 2 cups of urine. Although you do not control how your kidneys function, you can control when to empty your bladder. Bladder emptying is known as urination.
How does urination occur?
To urinate, your brain signals the sphincters to relax. Then it signals the muscular bladder wall to tighten, squeezing urine through the urethra and out of your bladder.
How often you need to urinate depends on how quickly your kidneys produce the urine that fills the bladder and how much urine your bladder can comfortably hold. The muscles of your bladder wall remain relaxed while the bladder fills with urine, and the sphincter muscles remain contracted to keep urine in the bladder. As your bladder fills up, signals sent to your brain tell you to find a toilet soon.
Why is the urinary tract important?
The urinary tract is important because it filters wastes and extra fluid from the bloodstream and removes them from the body.
What affects the amount of urine you produce?
The amount of urine you produce depends on many factors, such as the amount of liquid and food you consume and the amount of fluid you lose through sweating and breathing. Certain medicines, medical conditions, and types of food can also affect the amount of urine you produce. Children produce less urine than adults.
How can you keep your urinary tract healthy?
You can help keep your urinary tract healthy by following some basic tips.
Drink enough fluids, especially water. If you’re healthy, try to drink six to eight 8-ounce glasses of fluid each day. You may need to drink more if you have kidney stones or bladder stones. At least half of your fluid intake should be water. You might need to drink less water if you have certain conditions, such as kidney failure or heart disease. Ask your health care professional how much fluid is healthy for you.
Clinical Trials
The NIDDK conducts and supports clinical trials in many diseases and conditions, including urologic diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
- Why are the kidneys important?
Your kidneys remove wastes and extra fluid from your body. Your kidneys also remove acid that is produced by the cells of your body and maintain a healthy balance of water, salts, and minerals—such as sodium, calcium, phosphorus, and potassium—in your blood.Without this balance, nerves, muscles, and other tissues in your body may not work normally.How do my kidneys work?
Each of your kidneys is made up of about a million filtering units called nephrons. Each nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process: the glomerulus filters your blood, and the tubule returns needed substances to your blood and removes wastes.The glomerulus filters your blood
As blood flows into each nephron, it enters a cluster of tiny blood vessels—the glomerulus. The thin walls of the glomerulus allow smaller molecules, wastes, and fluid—mostly water—to pass into the tubule. Larger molecules, such as proteins and blood cells, stay in the blood vessel.The tubule returns needed substances to your blood and removes wastes
A blood vessel runs alongside the tubule. As the filtered fluid moves along the tubule, the blood vessel reabsorbs almost all of the water, along with minerals and nutrients your body needs. The tubule helps remove excess acid from the blood. The remaining fluid and wastes in the tubule become urine.How does blood flow through my kidneys?
Blood flows into your kidney through the renal artery. This large blood vessel branches into smaller and smaller blood vessels until the blood reaches the nephrons. In the nephron, your blood is filtered by the tiny blood vessels of the glomeruli and then flows out of your kidney through the renal vein.Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.
What is a solitary kidney?
If you have only one kidney, that kidney is called a solitary kidney. This condition is different from having a solitary functioning kidney, in which you have two kidneys and only one is functioning.
How common is a solitary kidney?
Globally, an estimated 1 in 2,000 babies1 are born each year with kidney agenesis and between 1 in 1,000 and 1 in 4,300 babies are born with kidney dysplasia. The estimates are probably low because some babies are never diagnosed with these conditions, particularly in countries where pregnant women do not routinely undergo prenatal ultrasounds.
Who is more likely to have a solitary kidney?
Men are more likely than women to be born with a solitary kidney and to receive donated kidneys. Women, however, are more likely than men to be living kidney donors.3
What are the symptoms of solitary kidney?
In general, people born with kidney agenesis or kidney dysplasia show no symptoms, lead full healthy lives, and may never discover they have a solitary kidney. Some people discover they have a solitary kidney by chance after having an x-ray, an ultrasound, or surgery for an unrelated condition or injury. A minority of people develop progressive loss of kidney function, and they can develop symptoms associated with chronic kidney disease.
Monitoring and controlling your blood pressure
High blood pressure NIH external link can damage blood vessels in your solitary kidney. If your kidneys’ blood vessels are damaged, they may no longer work properly. When this happens, the kidney is not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.
Can I prevent injury to my solitary kidney?
You should let your health care professional know if you have a solitary kidney to prevent injury from medicines or medical procedures. Certain sports may be more likely to injure the kidney. This risk is of particular concern with children, as they are more likely to play sports. Talk with your health care professional about the specific sport and ways to lessen the risk of injury. Loss of the remaining working kidney will result in the need for dialysis or a kidney transplant.
How does eating, diet, and nutrition affect a solitary kidney?
If you have a solitary kidney, you do not need to eat a special diet. However, you can keep your kidneys healthy by staying well hydrated, not taking too much salt, and not gaining excessive weight. If you have reduced kidney function, you may need to make changes to your diet to slow your kidney disease progression. Work with your health care professional or a registered dietitian to develop a meal plan that includes foods you enjoy eating while maintaining your kidney health.
What is renal tubular acidosis?
Renal tubular acidosis (RTA) occurs when the kidneys do not remove acids from the blood into the urine as they should. The acid level in the blood then becomes too high, a condition called acidosis. Some acid in the blood is normal, but too much acid can disturb many bodily functions.
How common is RTA?
RTA is a rare disease that is often misdiagnosed or undiagnosed,1 making it difficult to determine the true frequency in the general population.2
What are the complications of RTA?
Type 1 RTA
Untreated type 1 RTA causes children to grow more slowly and adults to develop progressive kidney disease and bone diseases NIH external link. Adults and children with untreated type 1 RTA may develop kidney stones because of abnormal calcium deposits that build up in the kidneys. These deposits prevent the kidneys from working properly.
Type 2 RTA
Untreated type 2 RTA may cause children to grow more slowly. In addition, type 2 RTA may cause rickets NIH external link5—a bone disease—and dental disease in both children and adults.6 A very low potassium level can develop during treatment of type 2 RTA with alkali.4
Type 4 RTA
In people with type 4 RTA, high levels of potassium in the blood can lead to muscle weakness7 or heart problems, such as slow or irregular heartbeats NIH external link and cardiac arrest NIH external link.
What are the signs and symptoms of RTA?
The major signs of type 1 RTA and type 2 RTA are low levels of potassium and bicarbonate—a waste product produced by your body—in the blood. The potassium level drops if your kidneys send too much potassium into your urine instead of returning it to the blood.
What are the causes of RTA?
Type 1 RTA
Type 1 RTA may be inherited. Researchers have identified at least three different genes that may cause the inherited form of the disease.2 People with sickle cell anemia NIH external link or Ehlers-Danlos syndrome, which are also inherited, may develop type 1 RTA later in life.
However, type 1 RTA may develop because of an autoimmune disease, such as Sjögren’s syndrome or lupus, that can affect many parts of the body. These diseases may interfere with the removal of acid from your blood.
Type 4 RTA
Type 4 RTA can occur when blood levels of the hormone aldosterone are low or when the kidneys do not respond to the hormone. Aldosterone directs the kidneys to regulate the level of sodium, which also affects the levels of chloride and potassium, in the blood.
How do health care professionals diagnose RTA?
Your health care professional will review your medical history and order blood NIH external link and urine tests NIH external link to measure the levels of acid, base, and potassium in your blood and urine. If your blood is more acidic than it should be and your urine is less acidic than it should be, RTA may be the reason, but a health care professional will need to rule out other causes.
How do health care professionals treat RTA?
For all types of RTA, drinking a solution of sodium bicarbonate NIH external link or sodium citrate will lower the acid level in your blood. This alkali therapy can prevent kidney stones from forming and make your kidneys work more normally so kidney failure does not get worse.
Infants with type 1 RTA may need potassium supplements, but older children and adults rarely do because alkali therapy prevents the kidneys from excreting potassium into the urine.
How can I prevent RTA?
Inherited types of RTA cannot be prevented,10 and most of the disorders that cause RTA are not preventable.
How does eating, diet, and nutrition affect RTA?
Researchers don’t yet know whether a diet low in acidic foods can have a positive effect on RTA.
Clinical Trials for Renal Tubular Acidosis
The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
What clinical studies for RTA are looking for participants?
You can find clinical studies on RTA at www.ClinicalTrials.gov NIH external link. In addition to searching for federally funded studies, you can expand or narrow your search to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.
What are renal artery stenosis (RAS) and renovascular hypertension (RVH)?
Renal artery stenosis (RAS) is the narrowing of one or both renal arteries. “Renal” means “kidney” and “stenosis” means “narrowing.” The renal arteries are blood vessels that carry blood to the kidneys from the aorta—the main blood vessel that carries blood from the heart to arteries throughout the body.
What are the kidneys and what do they do?
The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.
What causes RAS?
About 90 percent of RAS is caused by atherosclerosis NIH external link—clogging, narrowing, and hardening of the renal arteries.2 In these cases, RAS develops when plaque—a sticky substance made up of fat, cholesterol, calcium, and other material found in the blood—builds up on the inner wall of one or both renal arteries. Plaque buildup is what makes the artery wall hard and narrow.
How is RAS diagnosed?
A health care provider can diagnose RAS by listening to the abdomen with a stethoscope and performing imaging tests. When blood flows through a narrow artery, it sometimes makes a whooshing sound, called a bruit. The health care provider may place a stethoscope on the front or the side of the abdomen to listen for this sound. The absence of this sound, however, does not exclude the possibility of RAS.
Lifestyle Changes
The first step in treating RAS is making lifestyle changes that promote healthy blood vessels throughout the body, including the renal arteries. The best ways to keep plaque from building up in the arteries are to exercise, maintain a healthy body weight, and choose healthy foods. People who smoke should quit to help protect their kidneys and other internal organs.
Surgery
Although surgery has been used in the past for treatment of RAS due to atherosclerosis, recent studies have not shown improved outcomes with surgery compared with medication. However, surgery may be recommended for people with RAS caused by FMD or RAS that does not improve with medication. Different types of surgery for RAS include the following. The procedures are performed in a hospital by a vascular surgeon—a doctor who specializes in repairing blood vessels. Anesthesia is needed.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
Manage your medicines with help from your health care providers
At the pharmacy
The next time you pick up a prescription or buy an OTC medicine or supplement, ask your pharmacist how the product may affect your kidneys or react with other medicines you take.
Fill your prescriptions at only one pharmacy or pharmacy chain so your pharmacist can monitor your medicines and supplements, and check for harmful interactions between your medicines.
Be careful about using over-the-counter medicines
If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs include popular pain relievers and cold medicines that can damage your kidneys if you take them for a long time, or lead to acute kidney injury if you take them when you are dehydrated or your blood pressure is low.
Ibuprofen NIH external link and naproxen NIH external link are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.
Plan ahead to manage pain, flu, or other illness
Almost everyone gets sick once in a while. Your doctor or pharmacist can help you plan ahead to keep your kidneys safe until you get well. Prepare in advance so you know what to do if you have pain or a fever, diarrhea, nausea, or vomiting, which can lead to dehydration.
If blood pressure medicines help my kidneys, why all this extra caution?
In normal, everyday circumstances, taking your blood pressure medicines as prescribed helps protect your kidneys. However, certain situations, such as when you’re dehydrated from the flu or diarrhea, can lower the blood flow to your kidneys and cause harm.
Factors that can add up to cause harm
When you get sick from something like the flu or diarrhea, or have trouble drinking enough fluids, the blood pressure in your body may decrease. As a result, the pressure in your kidneys can be low, too.
In most cases, healthy kidneys can protect themselves. However, if you keep taking your blood pressure medicines when you’re dehydrated or have low blood pressure, your kidneys might have a hard time protecting themselves. The pressure within your kidneys might drop so low that your kidneys won’t filter normally.
Other ways to protect your kidneys
Read about what else you can do to keep your kidneys healthy. If you already have CKD, the steps you take to protect your kidneys also may help prevent heart disease—and improve your health overall.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.
How common is nephrotic syndrome?
Nephrotic syndrome is a combination of symptoms that can occur due to different causes. Among adults, the syndrome is most often caused by rare kidney diseases.
Who is more likely to develop nephrotic syndrome?
Nephrotic syndrome can affect children and adults of all ages.1
What causes nephrotic syndrome?
Many disorders can cause nephrotic syndrome, including diseases that affect only the kidneys and diseases that affect many parts of the body, such as diabetes and lupus NIH external link.
How do health care professionals diagnose nephrotic syndrome?
Your health care professional can diagnose nephrotic syndrome through urine tests. The urine tests show if you are losing too much protein in your urine.
Tests for diagnosing nephrotic syndrome
Urine dipstick test. This simple test checks for albumin in your urine. Having albumin in the urine is called albuminuria. You collect the urine sample in a container during a visit to a health care professional’s office or lab. A health care professional places a strip of chemically treated paper, called a dipstick, into the urine for the test. The dipstick changes color if albumin is present in the urine.
Tests for identifying the cause
Once nephrotic syndrome has been diagnosed, your health care professional will use tests to identify what caused it and check your kidney function. Tests for finding the cause of nephrotic syndrome can include3
Treating underlying causes
Other treatments vary, depending on underlying causes. In some cases, you may need to take medicines that suppress your immune system. For more on how health care professionals treat the underlying causes of nephrotic syndrome, see the NIDDK health topic Glomerular Diseases.
Once the cause has been treated, nephrotic syndrome may go away and kidney function returns to normal. Some patients may experience periods of remission followed by times when symptoms reappear. In some cases, nephrotic syndrome may lead to kidney failure.
Clinical Trials for Nephrotic Syndrome
The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
What clinical studies for nephrotic syndrome are looking for participants?
You can view a filtered list of clinical studies on nephrotic syndrome that are federally funded, open, and recruiting at www.ClinicalTrials.gov NIH external link. You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care provider before you participate in a clinical study.
What is Medullary Sponge Kidney?
Medullary sponge kidney, also known as Cacchi-Ricci disease, is a birth defect where changes occur in the tubules, or tiny tubes, inside a fetus’ kidneys.
In a normal kidney, urine flows through these tubules as the kidney is being formed during a fetus’ growth. In medullary sponge kidney, tiny, fluid-filled sacs called cysts form in the tubules within the medulla—the inner part of the kidney—creating a spongelike appearance. The cysts keep urine from flowing freely through the tubules.
Symptoms of medullary sponge kidney do not usually appear until the teenage years or the 20s. Medullary sponge kidney can affect one or both kidneys.
What causes Medullary Sponge Kidney?
Scientists do not fully understand the cause of medullary sponge kidney or why cysts form in the tubules during fetal development. Even though medullary sponge kidney is present at birth, most cases do not appear to be inherited.
How common is Medullary Sponge Kidney?
Medullary sponge kidney affects about one person per 5,000 people in the United States. Researchers have reported that 12 to 20 percent of people who develop calcium-based kidney stones have medullary sponge kidney.1
Who is more likely to develop Medullary Sponge Kidney?
Medullary sponge kidney affects all races and geographic regions. Among people who are more likely to develop calcium-based kidney stones, women are more likely than men to have medullary sponge kidney.2
Medical and Family History
Taking a medical and family history can help diagnose medullary sponge kidney. A health care provider will suspect medullary sponge kidney when a person has repeated UTIs or kidney stones.
Physical Exam
No physical signs are usually present in a patient with medullary sponge kidney, except for blood in the urine. Health care providers usually confirm a diagnosis of medullary sponge kidney with imaging studies.
Intravenous Pyelogram
In an intravenous pyelogram, a health care provider injects a special dye, called contrast medium, into a vein in the patient’s arm. The contrast medium travels through the body to the kidneys. The kidneys excrete the contrast medium into urine, which makes the urine visible on an x-ray. An x-ray technician performs this procedure at a health care provider’s office, an outpatient center, or a hospital. An intravenous pyelogram can show any blockage in the urinary tract, and the cysts show up as clusters of light.
Computerized Tomography Scans
Computerized tomography scans use a combination of x-rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the x-rays are taken. An x-ray technician performs the procedure in an outpatient center or a hospital. CT scans can show expanded or stretched tubules.
Ultrasound
Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital. Ultrasound can show kidney stones and calcium deposits within the kidney.
Curing an Existing Urinary Tract Infection
To treat a UTI, the health care provider may prescribe a medication called an antibiotic that kills bacteria. The choice of medication and length of treatment depend on the person’s medical history and the type of bacteria causing the infection.
Clinical Trials
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.
Hyponatremia (hi-poh-nay-tree-me-uh) is when the level of sodium in your blood is lower than normal.
Sodium is an important mineral that helps balance the amount of fluid (water) in your body. It also helps your nerves and muscles to work properly. When the sodium level in your blood is too low, extra water moves into your cells and makes them swell (get bigger). This can be dangerous, especially in the brain where there is not a lot of room to expand.
The kidney connection
Your kidneys play an active role in keeping your sodium and fluid levels balanced. People with more advanced stages of chronic kidney disease (CKD) may have a hard time balancing their fluid and blood sodium levels. This can lead to hyponatremia.
Signs and symptoms
Most people with mild hyponatremia may not have any symptoms. If symptoms are present, it is usually when the level of sodium in your blood goes very low or drops very fast. These symptoms can include:
- Nausea and/or vomiting
- Headache
- Muscle weakness, spasms (twitching), or cramps
- Low blood pressure
- Dizziness when standing up
- Low energy or fatigue
- Loss of appetite
- Restlessness or bad temper
More serious symptoms can happen in severe cases when the level of sodium in your blood is extremely low. These include:
- Altered mental status (severe confusion)
- Hallucinations
- Decreased consciousness
- Seizures
- Coma
Causes
The most common reason for hyponatremia is having too much fluid (water) in the body. This dilution (watering down) effect on the blood makes the amount of sodium seem low. Another common cause is when your body loses too much sodium in the urine and/or sweat.
Interesting fact: in most cases, hyponatremia (low blood sodium) is more closely related to how much fluid (water) is in your body than not getting enough sodium in your diet.
There are many reasons why your water and sodium levels can be out of balance. Some of the reasons that are more common for people living with kidney disease include:
- Acute kidney injury (AKI), advanced stages of chronic kidney disease (CKD), and kidney failure: the kidneys have trouble getting rid of extra fluid from the body which dilutes the blood
- Thiazide diuretics (water pills), such as hydrochlorothiazide (HCTZ) or chlorthalidone: can cause the body to get rid of too much sodium in the urine (especially at higher doses)
- Heart failure: extra fluid can build up in the body and dilute the blood
- Severe vomiting or diarrhea: can cause a lot of sodium and fluid loss
- Polydipsia (excessive thirst): can cause a person to drink too many fluids and dilute the blood
Other causes of hyponatremia that may not be directly related to kidney diseases include:
- Extreme hyperglycemia (very high blood sugar): extra fluid can build up in the blood to counteract the high level of sugar
- Cirrhosis (advanced liver disease): extra fluid can build up in the body and dilute the blood
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH): a medical condition where your body holds on to too much water and removes too much sodium in the urine
- Medications, such as some antidepressants, seizure medicines, or cancer medicines: may cause your body to hold extra water and/or lose too much sodium in urine or sweat
Complications
Hyponatremia that develops slowly over time and/or is only mildly decreased is not likely to cause complications, especially if treated promptly.
On the other hand, sudden hyponatremia (dramatic drop in less than 48 hours) and/or severely decreased sodium levels can cause serious problems if left untreated, including:
- rhabdomyolysis (life-threatening muscle breakdown)
- altered mental status (severe confusion)
- seizures
- coma
- death
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Diagnosis
Tests
A simple blood test is used to measure the level of sodium in your blood.
A normal blood sodium level is between 135 and 145 milliequivalents/liter (mEq/L). So, hyponatremia is when the level of sodium in your blood is below 135 mEq/L.
Remember, a low sodium level can be caused by many factors. So, your healthcare professional will likely order other tests and ask you questions about your medical history and recent routine to get a complete picture.
Other tests may include serum creatinine, glucose (sugar), potassium, carbon dioxide, triglycerides, and/or urine tests. When looked at together, your healthcare professional can provide you with custom guidance for resolving the issue.
Treatment
Treatment is based on the cause and severity of your hyponatremia.
Sodium levels falling just below 135 mEq/L may not warrant treatment – close follow-up and/or a recheck may be all that is needed. Prompt treatment is most important for people who have sudden hyponatremia (dramatic drop in less than 48 hours) and/or severely decreased levels.
Hyponatremia treatment is highly customized and requires medical supervision. Do not attempt any treatment approaches on your own without talking to your healthcare professional first.
Your healthcare professional may recommend one or more of the following treatment approaches:
- focus on the condition(s) causing the hyponatremia, like heart failure, cirrhosis, diabetes, or kidney failure
- lower the amount of liquids you eat and/or drink (also known as fluid restriction)
- adjust your medication dose and/or switch to a different medication (if the hyponatremia is a medication side effect)
- adjust your dialysis settings to take more fluid off with each session (if you are on dialysis)
- give a dose of sodium through your vein (intravenous or IV)
- add a medication that helps your body remove extra water while also holding on to sodium, such as tolvaptan or conivaptan (also known as aquaretics)
- add more salt (sodium) to your diet (not a common approach for people with kidney diseases)