Introduction
“Your labs show that you have kidney disease.”
No one wants to hear this at the doctor’s office. It comes as a surprise to many people like you, especially if you haven’t been alerted about any kidney issues in the past.
If you are newly diagnosed with chronic kidney disease (CKD) and freaking out, first I want to say that I hear you.
A new diagnosis is scary. Your feelings and your fears are valid. You should take the time you need to process this news.
However, one of the best ways to combat fear and anxiety is education.
Oftentimes, fear and anxiety is largely “fear of the unknown.” Once you’re in a clearer headspace and feel ready to begin learning, it’s time to approach this new diagnosis in a constructive manner.
It’s time to take your health by the reins and start learning how to tackle this beast!
How Kidney Disease Is Diagnosed
According to the National Kidney Foundation, “CKD is defined as abnormalities of kidney structure or function, present for >3 months, with implications for health.”
There are TWO criteria your doctor considers when diagnosing kidney disease. One of the following two markers must be present for >3 months in order to diagnose.
- Blood test showing eGFR <60 (more about eGFR in a bit)
- Other markers of damage such as albuminuria (protein leaking in the urine), urine sediment abnormalities, abnormal kidney biopsy, structural abnormalities detected by imaging, or history of kidney transplantation
If you’re looking at your lab results and thinking “hey! My eGFR was low for a couple months. Why didn’t my doctor say anything until now?” — this is why.
One low eGFR result doesn’t necessarily mean you have kidney disease. Multiple low results will establish a trend and lead to a diagnosis.
What is eGFR?
eGFR stands for estimated glomerular filtration rate. Essentially, this is an estimate of how well the kidneys are filtering. If your doctor says, “your kidneys are functioning at 50%” what they mean is, your eGFR is around 50. The eGFR is used to diagnose your stage of kidney disease.
Where does the term “glomerular filtration rate” come from?
Kidneys filter the blood. That is their main job. The name of the unit that does the filtering is the glomerulus (plural: glomeruli). Therefore, the glomerular filtration rate is the rate at which the kidneys filter, i.e. how efficiently they clear waste from your blood.
eGFR is calculated with a formula. The most common eGFR formula is based on a blood test called creatinine. Checking the creatinine, then using creatinine to calculate an eGFR, is an indirect way of measuring kidney function.
Stages of Kidney Disease
There are 5 stages of kidney disease. Stage 1 is the earliest stage which indicates little to no kidney damage. Stage 5 is later stage kidney disease and significant kidney damage. Stage 5 is also referred to as “end stage kidney disease”.
This chart explains how eGFR corresponds to the stage of CKD.
Looking at this chart you might feel a little confused about exactly what it means, especially if your eGFR is greater than 60. That’s okay, it can be very difficult to understand these news numbers and labs. Let’s discuss more in-depth and review what these different stages mean.
Stage 1-2 Kidney Disease (eGFR of 60 or Higher)
It is not too common to recieve a CKD diagnosis at stages 1 or 2.
Recall from above that stage 1 corresponds with an eGFR of 90 or higher. Additionally, stage 2 corresponds with an eGFR 60-89.
Stage 1-2 is often considered “normal kidney function”. How can someone have CKD if their labs are normal?
It’s important to know that an eGFR of 60-89 ALONE (or an eGFR >90, for that matter) does NOT indicate kidney disease.
Remember the diagnosis criteria: either a low eGFR (<60) or other signs of kidney damage (such as protein leaking), present for >3 months.
Creatinine (the blood test used to calculate eGFR) can be sensitive to things like hydration and changes in muscle mass. Sometimes a “low” eGFR may appear on your lab results, but it doesn’t necessarily mean you have CKD.
Here’s an example. One time I got my annual labs drawn while I was somewhat dehydrated. My eGFR was 86. That doesn’t indicate kidney disease. It just means I was dehydrated when I got my labs done.
Had the eGFR been 86 for several months in a row PLUS some other indication of kidney damage (like protein leaking in the urine), that could result in a kidney disease diagnosis.
Patients who receive a diagnosis of CKD at stages 1 or 2 will have some other indicator of altered kidney function: protein leaking into the urine, abnormal kidney imaging, or abnormal kidney biopsy.
Often, people diagnosed at stages 1-2 have kidney disease due to a genetic disease or an autoimmune condition.
Stage 3a-5 Kidney Disease (eGFR of 59 or Lower)
Stages 3a-5 mean that signs of reduced kidney function have appeared on your blood tests.
This is why many people recieve a diagnosis at stage 3 (or later) and say, “wait… stage 3? What about stage 1 and 2?”
It’s just due to the way kidney disease is classified and diagnosed.
Stage 3 or later means that reduced kidney function (eGFR <60) appears on your blood tests, with or without additional signs of damage, such as abnormal biopsy or protein in the urine.
In my experience working with kidney patients for the better part of the last decade, many providers will not begin to treat, address, or even discuss it with you until you’re in the later stages: stage 4 or 5.
Diagnosis at stage 4-5: unfortunately common
I recently worked with a patient whose labs showed stage 3 CKD for TEN YEARS. Although her labs remained somewhat stable during that time, and she had a low risk for progression (no protein leaking or other markers of damage), her healthcare team never even mentioned it.
It happens more than you might think. Many people find out they have kidney disease for the first time when they’re already at stage 4 or 5 (eGFR less than 30). At this point, your doctor might even tell you, “start preparing for dialysis.”
As a healthcare provider, this upsets to me. In what other situation does a person have an early-stage disease that we can treat and manage, only to have it brushed aside?
If this has been your experience, know you aren’t alone. Unfortunately, it happens way too often that patients aren’t alerted about changes in kidney function in a timely manner. This leads to formal diagnosis and treatment later than would be desirable.
Why this happens so often, I’m not quite sure.
But, you should feel somewhat comforted to know that no matter what stage of CKD you are in, it is NEVER too late to begin making diet & lifestyle changes that can help slow or delay further loss of kidney function.
8 Steps To Take With A New CKD Diagnosis
So, you know you have kidney disease. What next?
Understand Your Labs
To start, discuss your lab results with your doctor. Ask what BUN, creatinine, and GFR mean if the doctor has not thoroughly explained them. Ask what the normal numbers should be and what the doctor’s plan is to help improve these numbers.
Understand The Cause
Determine the cause of your kidney disease. There are many different things that can cause reduced kidney function, and the cause will determine how you treat it.
Was it diabetes? High blood pressure? Medication toxicity? A genetic disorder? An autoimmune disease? If your doctor has not explained to you what caused your reduction in kidney function – ask! This is very important information for you to know and understand.
Review Your Medications
Review your medications with your doctor to make sure they are kidney-safe.
Some medications, such as NSAIDS, promote kidney damage and should NOT be taken by people with reduced kidney function.
Stay Hydrated
Ensure you are staying well hydrated.
Did you know your body are over 70% water? Water is key for making sure all the microscopic processes in our bodies run smoothly?
A major job of the kidneys is to filter waste products from our bloodstream. If you are not well hydrated, it can inhibit proper kidney function and further cause stress to the damaged kidneys.
Most people with CKD (not on dialysis) need a minimum of 2-2.5 liters of water per day (defer to your doctor for guidance on this). IF YOU ARE ALREADY ON DIALYSIS: speak to the staff in your clinic for guidance. You may need to follow a fluid-restricted diet to prevent fluid overload.
Manage Your Blood Sugars
If your CKD was caused by diabetes, make diabetes management a priority. This may involve changes to your diet, exercise, or medication regimen.
Manage Your Blood Pressure
If your CKD is related to high blood pressure, take steps to achieve better blood pressure controll. Again, this can involve changes to your diet, your exercise routine, or your antihypertensive medications.
It’s important to note that even if high blood pressure was not the CAUSE of your kidney damage – blood pressure problems can also develop as a RESULT of kidney damage. The kidneys play a major role in blood pressure management. It is crucial to maintain good blood pressure control. You may even need medications to assist with this.
For people with CKD without blood pressure problems, it is common to start on a blood pressure medication, like lisinopril. These medications have been shown to protect kidneys and reduce protein leaking.
Learn About A Kidney Friendly Diet
Determine what kind of diet changes you may need to make. A renal dietitian can help you learn what’s right for you! Diet changes for CKD are very much based on YOUR lab results and your unique medical conditions (including the cause of your kidney damage).
For example, you may need to watch your dietary sodium (salt) intake more closely.
You may need to modify the type or amount of protein you eat. Many people benefit from reducing overall protein and/or swapping animal protein for plant proteins.
Some people may need to consider phosphorus or potassium content of foods, if their blood potassium and/or phosphorus levels are high. Not everyone with CKD automatically needs to worry about potassium or phosphorus. Be sure to check out my blog post The Truth About Potassium, Phosphorus, & CKD for more.
Other changed required may include:
- Modifying the type/amount of sugar in your usual diet
- Increasing your fruit/vegetable intake
- Increasing dietary fiber
To sum up the nutrition part, please know that a diet for CKD is not “one size fits all.” It looks different for each person.
Working with a dietitian is the best way to determine the exact right nutritional needs for you!
Consider Other Lifestyle Habits
Consider making adjustments to your various lifestyle habits. Things like sleep, smoking, physical activity, and stress all impact your health. How can these be improved, to help improve your overall health status?
Conclusion
I hope this information is helpful as you’re getting started. I know it can feel overwhelming, but remember – knowledge is power, and the more you understand your diagnosis, the better you can manage it.
For personalized help and guidance on what to eat for optimal kidney health, consult with a Board Certified Renal Dietitian (like me!). Major insurance plans are accepted and appointment take place via telehealth. You can also find me on Instagram and Facebook for additional tips every week – let’s connect! Until next time, be well. — Kate, Your Kidney Dietitian
