Chronic kidney disease: early signs and the tests that find it

Your kidneys filter waste and extra fluid out of your blood. Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work as well as they should. Doctors diagnose it when kidney damage or reduced kidney function lasts for more than three months. “Chronic” simply means long-lasting.

The hard part is that CKD is usually silent at first. The NHS (the UK’s national health service) says many people with CKD have no symptoms, because it does not usually cause problems until it reaches an advanced stage. That is why simple blood and urine tests matter so much. Often CKD is only found when a routine blood or urine test done for another reason shows a problem.

What have studies in Bangladesh found?

Studies in Dhaka suggest CKD is common, especially in people with diabetes:

A community survey of 402 adults over 30 in a middle-income area of Dhaka, published in the journal Globalization and Health in 2014, found CKD in 94 people (about 26%, roughly 1 in 4). Most of them had early-stage disease, found through protein (albumin) in the urine.
A study of adults with type 2 diabetes at one urban hospital in Dhaka, published in 2021, found CKD in about 21% of them.

These studies looked at different groups and used different methods. They do not give a national figure and may not reflect the situation today. But they show that CKD is a real concern in Bangladesh.

Who is at higher risk?

According to the US Centers for Disease Control and Prevention (CDC), diabetes and high blood pressure are the two biggest causes of CKD. In the United States, about 1 in 3 adults with diabetes and about 1 in 5 adults with high blood pressure have CKD (CDC risk factors page and 2023 CKD fact sheet). The NHS says CKD is more common in people of south Asian origin and becomes more common with age. Other risk factors include:

Heart disease (including heart failure) or a past stroke
A family history of kidney failure or an inherited kidney disease
Being overweight, which raises the risk of diabetes and high blood pressure
Smoking
Older age
Kidney stones, an enlarged prostate, or conditions such as lupus
A past episode of acute kidney injury, meaning sudden damage that stops the kidneys working properly
Long-term, regular use of some painkillers called NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen, naproxen or diclofenac

If you take painkillers often, or take any regular medicine, talk to your doctor about it.

Early signs: what to look out for

In the early stages there are often no signs at all. MedlinePlus, from the US National Library of Medicine, says that in people with diabetes, kidney damage can begin 5 to 10 years before symptoms start. When symptoms do appear, they are often vague and easy to blame on something else. They can include:

Tiredness and a general feeling of being unwell
Poor appetite, or losing weight without trying
Swollen ankles, feet or hands, caused by fluid building up in the body (called oedema)
Needing to pass urine more often, especially at night
Blood in the urine
Itchy, dry skin
Muscle cramps
Feeling sick, or headaches
Shortness of breath
Trouble sleeping

These signs can be caused by many less serious conditions. The only way to know for sure is with blood and urine tests. If you have signs that last or worry you, see a doctor.

The tests that find CKD

CKD is diagnosed with simple blood and urine tests. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says the two key markers are eGFR and urine albumin.

Test	What it involves	What it tells you
Serum creatinine and eGFR	A blood test	Creatinine is a waste product. The lab uses it, along with your age and sex, to estimate the glomerular filtration rate (eGFR), which shows how well your kidneys filter blood. A lower eGFR means the kidneys are filtering less well.
Urine albumin-to-creatinine ratio (ACR or UACR)	A small urine sample	Albumin is a protein. A healthy kidney does not let albumin pass into the urine. Albumin in the urine can be a sign of kidney damage.
Routine urine test (urinalysis)	A urine sample	Looks for protein, blood or other changes. MedlinePlus notes that these changes can appear months to years before symptoms.
Other blood tests	A blood test	The doctor may check for problems that CKD can cause, such as anaemia (a low red blood cell count) and abnormal levels of calcium, potassium or phosphorus in the blood.

One abnormal result does not always mean CKD. Urine albumin can rise for a short time for other reasons, and a single eGFR result is only an estimate. CKD is usually diagnosed when the eGFR stays below 60 for more than three months, or when signs of kidney damage, such as albumin in the urine, last that long. Your doctor may repeat the tests to be sure.

What the stages mean

Doctors use your eGFR to describe the stage of CKD. A higher stage means more serious disease. Urine albumin results are also used to describe how severe it is.

Stage 1: eGFR 90 or above (normal), but other tests show kidney damage
Stage 2: eGFR 60 to 89, with signs of kidney damage
Stage 3a: eGFR 45 to 59
Stage 3b: eGFR 30 to 44
Stage 4: eGFR 15 to 29
Stage 5: eGFR below 15, also called kidney failure

A diagnosis of CKD is not a reason to panic. The NHS says CKD only progresses to kidney failure in around 2 in 100 people with the condition. The CDC says CKD can be treated, and the earlier treatment starts the better.

Warning signs that need urgent care

Go to the nearest hospital emergency department straight away if you or a family member has any of the following:

Passing very little urine, or none at all
Severe or worsening shortness of breath
Swelling of the legs, face or body that gets worse quickly
Confusion, unusual sleepiness or difficulty staying awake
A seizure (fit)
Chest pain, or a fast or irregular heartbeat
Vomiting that does not stop
Blood in the urine with fever or strong pain in the side or back

These can be signs of kidney failure, or of a sudden kidney problem that needs treatment the same day.

What treatment generally involves

The NHS says most people with CKD can control their condition with medicine and regular check-ups, and that finding it early may help stop it getting worse. Treatment generally focuses on the cause, such as controlling blood sugar and blood pressure. People with CKD have a higher risk of heart disease and stroke, so care also aims to protect the heart. Some medicines can affect the kidneys, so your doctor may check that the medicines you take are safe for your kidneys. In late-stage kidney disease, dialysis (a process that cleans the blood) or a kidney transplant may be needed. Your doctor will decide which treatment is right for you.

Which doctor should you see?

A general physician or medicine specialist is a good first step. They can order the basic blood and urine tests and look for other causes of your symptoms.
A nephrologist is a kidney specialist. You may be referred to one if your eGFR is low or falling quickly, if there is a lot of protein in your urine, or if the cause of your kidney disease is unclear.
An endocrinologist (a hormone and diabetes specialist) can help if your diabetes is hard to control.
A urologist treats problems of the urinary tract, such as kidney stones, an enlarged prostate or a blockage.
A paediatric nephrologist treats children with kidney problems.

You can also call Shasthya Batayon (16263), the government health call centre listed by the Directorate General of Health Services (DGHS), to get advice from a doctor 24 hours a day.

The key message

CKD often has no early warning signs. If you have diabetes, high blood pressure or another risk factor, do not wait for symptoms. Ask your doctor about a blood test (creatinine with eGFR) and a urine test (albumin). These simple tests can find kidney damage early, when treatment can do the most good.

Find a doctor

Browse Kidney Diseases doctors in Bangladesh on ratings.com.bd, with chambers and, where listed, visiting hours and phone numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above. It did not pass the automatic check, and an administrator chose to publish it; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.