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Kidney disease occurs when the kidneys cannot function properly. There is no one type of “kidney disease”. Rather, a number of different conditions can cause disease and/or a loss in kidney function, and they have different signs and symptoms depending on how they affect the kidneys. These various causes fall into one of three main groups: Decreased blood flow to the kidney (“pre-renal”) prevents the kidneys from performing their functions and over time, can damage the kidneys. Decreased blood flow can happen very quickly and can be caused by conditions such as shock, severe dehydration and sepsis. It can also develop slowly over time as a result of heart failure and liver failure, for example


Conditions can affect the kidney itself (“renal”) causing damage and/or impaired function. Some examples include:
  • Diabetes
  • High blood pressure (hypertension)
  • Autoimmune diseases such as lupus or Goodpasture syndrome, or other abnormal immune responses
  • Infection—for example, if left untreated, urinary tract infections (UTIs) can spread to the kidneys
  • Injury, trauma
  • Toxins-- heavy metals and ethylene glycol, for example
  • Medications—examples include non-steroidal anti-inflammatory drugs (NSAIDS) and other analgesics (pain killers), certain antibiotics
  • Some contrast dyes used for imaging procedures
  • Severe damage to muscles (rhabdomyolysis)
  • Congenital forms of renal disease (those present at birth), including failure of the kidneys to form or develop normally
  • Polycystic kidney disease--a group of disorders characterized by multiple fluid-filled spaces or sacks within the kidneys
Blockage of drainage from the kidney (“post-renal”) can increase pressure within the kidneys and also prevent the kidneys from functioning. As with decreased blood flow, an ongoing obstruction can also damage the kidneys. Obstruction of drainage can be due to conditions such as
  • Tumours
  • Kidney stones
  • Enlargement of the prostate, such as benign prostatic hyperplasia (BPH)
Some of these causes can affect all functions of the kidney, and depending on the duration, occur in one of three main ways:
  • Acute kidney injury (AKI) is the rapid loss of kidney function. It may be recognized when a person suddenly produces urine much less frequently and/or has a dramatic increase in the level of waste products in the blood that the kidneys normally filter out. AKI is often the result of trauma, illness, or a medication that damages the kidneys. It is common in people who are already hospitalized, such as those who are critically ill and in the intensive care unit. If the damage caused by AKI persists, it can eventually progress to chronic kidney disease. An older name for AKI is “acute renal failure (ARF).”
  • Chronic kidney disease (CKD) is the loss of a significant degree of kidney function gradually over time. According to the National Kidney Foundation, 30 million American adults have CKD and millions more are at increased risk. In some cases, CKD is preventable or, if detected early enough, treatable to prevent or delay progression to end-stage renal disease.
  • End-stage renal disease or ESRD is the total or near-total loss of kidney function and is permanent. Treatment with dialysis or kidney transplantation is the only option at this stage of kidney disease to sustain life.
Some causes of kidney damage initially affect only one part of the kidney, particularly the glomerulus (which filters the blood to let water and small molecules pass into the urine but retains cells and large molecules such as proteins). Glomerular damage often presents in one of three main ways:
  • Proteinuria refers to increased amounts of protein in the urine. With mild damage, the glomeruli lose their ability to retain protein, which can be detected in the urine. If the body can compensate for the protein loss, there are few to no symptoms.
  • Nephrotic syndrome occurs with more severe damage to the glomeruli, although the nature of the damage (and the cause) can vary. Large amounts of protein (especially one protein called albumin) are lost in the urine, exceeding the body’s ability to compensate. Because albumin is important for maintaining the right amount of water in the blood, patients with nephrotic syndrome often have an accumulation of fluid in their bodies causing swelling (oedema).
  • Glomerulonephritis (nephritic syndrome) can also reflect severe damage to the glomeruli. Severe inflammation and damage affect kidney function, causing high blood pressure and fluid accumulation, and decreasing urine production. Smaller amounts of protein and some blood (red blood cells) also leak into the urine.
Tumours of the kidney often do not have any effect on kidney function but are detected as a mass in the kidney by imaging studies or felt by the patient, family, or healthcare practitioner. Blood and/or protein may be present in the urine. Three major tumours that arise in the kidney are:
  • Renal cell carcinoma is cancer that develops in the kidney in adults.
  • Wilms tumour is cancer that develops in the kidney in children, often between the ages of 2 and 5.
  • Transitional cell carcinoma is cancer that develops most commonly in the bladder, but may develop in the lining of the ureters (the tubes between the kidney and the bladder) or rarely within the kidney itself.


Urine for a CKD screening or ACR can be collected over 4 hours, or overnight. The first-morning sample is the most valuable because it is more concentrated and more likely to yield abnormal results. As you start to urinate, let some urine fall into the toilet, then collect a sample of urine in the container provided. Before a test, tell VisitHealth’s medic about any health condition you have.


Chronic kidney disease (CKD) can progress silently over many years, with no signs or symptoms or with ones that are too general for a person to suspect as related to kidney function. Routine lab tests done during a health examination can help detect early warning signs of kidney disease such as:
  • Blood in the urine (hematuria) and/or protein in the urine (proteinuria)
  • Decreased estimated glomerular filtration rate (eGFR) and elevated creatinine and urea (blood urea nitrogen or BUN), which are early signs of kidney dysfunction.
Other signs and symptoms may include:
  • Swelling or puffiness, particularly around the eyes or in the face, wrists, abdomen, thighs or ankles
  • Urine that is foamy, bloody, or coffee-coloured
  • A marked decrease in the amount of urine
  • Problems urinating, such as a burning feeling or abnormal discharge during urination, or a change in the frequency of urination, especially at night
  • Mid-back pain (flank), below the ribs, near where the kidneys are located
  • High blood pressure (hypertension)
As kidney disease worsens, additional signs and symptoms may include a combination of the following:
  • Feeling itchy
  • Tiredness, loss of concentration
  • Loss of appetite, nausea and/or vomiting
  • Numbness in hands and feet
  • Darkened skin
  • Muscle cramps
  • Gout
Acute kidney injury (AKI) is a sudden loss of kidney function and can be fatal. It requires prompt treatment. Symptoms may include:
  • Urinating less frequently
  • Fluid retention, causing swelling in the legs, ankles or feet
  • Drowsiness, fatigue
  • Shortness of breath
  • Nausea
  • Confusion
  • Seizures or coma
  • Chest pain


Increased creatinine levels in the blood suggest kidney disease or other conditions that affect kidney function.

Low blood levels of creatinine are not common, but they are also not usually a cause for concern. They can be seen with conditions that result in decreased muscle mass.

If albumin is undetectable in the urine, it is an indication that kidney function is normal.

Moderately increased albumin levels found in both initial and repeat urine tests indicate that a person is likely to have early kidney disease. Very high levels are an indication that kidney disease is present in a more severe form.


The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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