Diagnosis
Kidney disease FAQs
Nephrologist Andrew Bentall, M.D., answers the most frequently asked questions about kidney disease.
Living with diabetes is difficult, thinking about what you eat. But controlling the sugar levels are really important for helping kidney function and specifically slowing down any damage to the kidneys. Newer drugs that have come out in the last couple years can help with this, as well as working with your primary care physician or endocrinologist with your current therapies to get better sugar control.
We really want to help your health and so losing weight can be a key component to reducing your risk of progressing with kidney disease. Reducing calorie intake, which is either smaller portions, less snacking in between meals, and then thinking about burning calories with increasing your exercise, are great steps forward in starting that journey towards weight loss.
We look to get blood pressure less than 130 systolic, that's the top number. And less than 80 diastolic, that's the bottom number, on blood pressure readings. There are a number of different drugs that we can use to do this. And this will help both with your cardiovascular health, but slowing down any kidney disease progression over time as well.
There are two different types of dialysis: hemodialysis, which is done through cleaning the blood through a machine, which you attend a dialysis center three times a week for about four hours each time. It can be done at home in certain circumstances. Or peritoneal dialysis, where fluid gets put into your tummy, takes out the toxins and is drained. And that can be done either during the day or overnight on a machine. The benefits and risks of these are individualized, as some people are able to do the treatment at home or need to go to a treatment center for this. It also depends on your location and how close the nearest dialysis centers are.
The kidney transplant works in the same way as your own kidneys do, with the blood coming through the transplant, filtering it and the urine coming out. The kidney transplant is protected by the anti-rejection medication, so your body doesn't attack it. And we leave your own kidneys in because they eventually shrivel down and don't function anymore. You don't want more surgery than you need.
For a kidney transplant at the moment, taking anti-rejection drugs is an everyday, lifelong occurrence. These can come with side effects. But current research is looking to try and minimize or come off anti-rejection drugs with specific research protocols at the moment.
We really want to partner with you to get the best outcomes for you, so that chronic kidney disease doesn't affect you as much as it can. Controlling your blood pressure and therefore monitoring that at home, taking your medications regularly, and letting us know about side effects is a really important part in partnering and helping you to have a good quality of life living with chronic kidney disease.
Kidney biopsy
Kidney biopsy
During a kidney biopsy, a healthcare professional uses a needle to remove a small sample of kidney tissue for lab testing. The biopsy needle is put through the skin to the kidney. The procedure often uses an imaging device, such as an ultrasound transducer, to guide the needle.
To diagnose chronic kidney disease, a healthcare professional needs to assess your risk of the condition. They might ask you about your symptoms, including any changes in your urinary habits. You also might be asked about your personal or family history of kidney disease. Your healthcare professional also may ask about a history of other conditions, such as diabetes, high blood pressure, and autoimmune or inherited diseases. They also typically review with you any medicines you take.
Your healthcare professional is likely to examine your body. The exam may check for problems with the heart or blood vessels. A neurological exam also is common.
For kidney disease diagnosis, you also might need certain tests and procedures. These can help show how serious your kidney disease is. Your health care professional may refer to this as staging the disease. Tests might include:
- Blood tests. Kidney function tests look for the level of waste products in your blood. Waste products include creatinine and urea.
- Urine tests. Checking a sample of your urine can reveal signs of chronic kidney disease. Urine tests also could provide clues about what's causing your kidney disease. Having protein, called albumin, and blood present in the urine could be a sign of kidney disease.
- Imaging tests. Your healthcare professional might use ultrasound to view your kidneys. Ultrasound can show the structure and size of the kidneys. Other imaging tests might be used in some cases.
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Removing a sample of kidney tissue for testing. Your healthcare professional might recommend a kidney biopsy. A biopsy is a procedure to remove a sample of kidney tissue for testing in a lab. It uses a long, thin needle that is inserted through the skin and into a kidney. The biopsy sample is sent to a lab for testing. In the lab, tests can help reveal what's causing a kidney problem.
A kidney biopsy is usually done when the cause of kidney disease isn't clear, especially if kidney function is quickly declining and there's a lot of protein in the urine.
Results from these tests can help your healthcare team make a treatment plan.
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Treatment
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Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure. Even in that case, treatment is still needed to preserve kidney function for as long as possible.
Treatment for chronic kidney disease usually aims to help manage symptoms, reduce complications and slow the progress of the disease. If your kidneys become badly damaged, treatment for end-stage kidney disease might be needed.
Treating the cause
Your healthcare team will work with you on ways to slow down the progress of your kidney disease and help manage what's causing it. Treatment options vary and depend on the cause. For instance, your treatment may aim to lower high blood pressure or manage diabetes. But kidney damage can continue to worsen even after an underlying condition has been controlled.
Slowing progression of kidney disease
No matter what causes kidney disease, there are certain things you can do to protect the kidneys and slow down the rate of kidney function getting worse. These include:
- A low-salt diet. People with kidney disease should avoid adding extra salt to foods and limit how much salt, also called sodium, they have each day to around 2,000 milligrams.
- Blood pressure management. High blood pressure can develop or get worse with kidney disease. Do regular checks of your blood pressure at home. Aim to keep blood pressure at 130/80 or less. Eating the right foods, getting regular exercise and blood pressure medicines can help maintain blood pressure management.
- A lower protein diet. Eating less protein can reduce how hard your kidneys need to work to get rid of the extra waste. A registered dietitian can suggest ways to lower how much protein you have while still eating a healthy diet with enough calories.
- Certain blood pressure medicines. Taking an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin 2 receptor blocker (ARB) has been shown to protect the kidneys. These drugs are blood pressure medicines used in people with heart disease.
- Certain diabetes medicines. Drugs called SGLT2 inhibitors were designed for treating diabetes, but later on showed promise for protecting the kidneys and the heart. These medicines are most often helpful for people who have mild to moderate kidney disease and especially for those who have protein in their urine.
Treating complications of chronic kidney disease
Kidney disease complications can be managed to make you more comfortable. Treatments might include:
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Lower high blood pressure. People with kidney disease can have worsening high blood pressure. Your healthcare professional might have you take medicines to lower your blood pressure. Often, people need to take more than one medicine to lower their blood pressure. This might include an ACE inhibitor or ARB, along with a diuretic. A diuretic also is called a water pill, and it helps lower blood pressure by removing extra fluid from the body.
High blood pressure medicines can at first decrease kidney function and change electrolyte levels. So, you might need frequent blood tests to check your condition.
- Lessen swelling. Chronic kidney disease is one cause of fluid buildup in the body, which can lead to leg and ankle swelling or shortness of breath. Diuretic medicines can help maintain the balance of fluids in the body and reduce swelling.
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Treat anemia. Treatment might focus on helping the body make more red blood cells. This might lessen fatigue and weakness from anemia. Anemia happens when you don't have enough healthy red blood cells to carry oxygen to the body's tissues.
A shot containing a hormone called erythropoietin may be used to treat anemia. A condition known as iron-deficiency anemia also is common in people with kidney disease. Iron-deficiency anemia can develop after starting on the erythropoietin shots to treat anemia. When this happens, you need to take iron pills or in some cases, have an iron infusion given through a vein.
- Reduce heart disease risk. If you have high cholesterol, your healthcare professional might recommend medicines called statins. Statins can help lower cholesterol. People with chronic kidney disease often have high levels of bad cholesterol, which can raise the risk of heart disease. A healthy diet and regular exercise also are important.
- Prevent bone disease. Calcium and vitamin D supplements help prevent weak bones and lower the risk of broken bones. Your care team may recommend a low phosphorus diet. You also might take medicine known as a phosphate binder. This medicine is taken with meals and can lower the amount of phosphate in the blood and protect blood vessels from damage by calcium deposits. Calcium deposits are sometimes called calcifications.
- Treat acid buildup. If acid buildup causes a substance known as bicarbonate to drop in your blood, your healthcare professional may recommend taking sodium bicarbonate, or baking soda pills. Eating less animal protein also may help.
Your healthcare professional might recommend regular follow-up testing. Follow-up testing makes it possible to check if kidney disease is getting worse. In many cases, starting treatment earlier can help prevent severe complications.
Preparing for kidney failure
Kidney transplant
Kidney transplant
During kidney transplant surgery, the donor kidney is placed in your lower abdomen. Blood vessels of the new kidney are attached to blood vessels in the lower part of your abdomen, just above one of your legs. The new kidney's urine tube (ureter) is connected to your bladder. Unless they are causing complications, your own kidneys are left in place.
Complete or near-complete kidney failure may happen when the kidneys can't keep up with waste, fluid and salt clearance on their own. When this happens, family members of the person with kidney failure might notice that symptoms get worse. They may include:
- Poor appetite.
- Lack of energy.
- Poor sleep.
- Mental decline.
- Daily nausea.
Lab tests might show very low kidney function and high potassium in the blood. When this happens, you have end-stage kidney disease.
Treatment options for kidney failure in end-stage kidney disease include:
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Kidney transplant. A kidney transplant is surgery to place a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. You don't need to be on dialysis to have a kidney transplant.
A kidney transplant is considered the best treatment for kidney failure, but not everyone can have a kidney transplant. Having a kidney transplant requires a full and detailed evaluation process. After a transplant, you'll need to take medicines to keep your body from rejecting the new organ. The medicines need to be taken for the rest of your life.
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Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. There are two forms of dialysis. In hemodialysis, a machine filters waste and excess fluids from your blood. Hemodialysis usually is done in a dialysis center for 3 to 4 hours three times a week. In some cases, people may qualify to do hemodialysis themselves at home.
In peritoneal dialysis, a thin tube is placed with a minor surgery into your stomach area. Clean fluid slowly fills that space and remains there. The fluid is called dialysis solution. A natural membrane in the stomach area is used as the filter. The dialysis solution absorbs waste and excess fluids. After a few hours, the dialysis solution is drained from the body, carrying the waste with it. This type of dialysis happens at home. Most people can use a machine called a cycler to do the fluid exchanges at night, while they sleep.
- Comprehensive medical management. For some who choose not to have dialysis or a kidney transplant, there is another option. You may choose care that focuses on treating symptoms and keeping you comfortable as kidney disease progresses to end of life. People with kidney failure don't survive long without dialysis or a transplant. Your care team may include an expert in palliative care, which is specialized medical care that focuses on comfort measures and quality of life in people with serious illnesses.
The kidney transplant and dialysis treatment options also are called kidney replacement therapy.
Kidney Disease: How kidneys work, Hemodialysis, and Peritoneal dialysis
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Lifestyle and home remedies
As part of the treatment for chronic kidney disease, your healthcare team might suggest that you follow a special diet. Careful choices about what to eat and drink can limit how hard the kidneys have to work.
Ask your healthcare professional for a referral to a registered dietitian. A dietitian can study your diet and suggest ways to make it easier on your kidneys.
Your personal situation, including how well your kidneys are working and your overall health, can affect what dietary changes you may need to follow. For example, you might need to:
- Avoid products with added salt. Lower the amount of sodium you eat each day by staying away from salty snack foods and other foods with added salt. These include many ready-made foods, such as frozen dinners and canned soups and vegetables. Processed meats and cheeses also tend to be high in salt.
- Choose lower potassium foods. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. Since many salt substitutes contain potassium, you may want to stop using them if you have kidney failure.
- Limit the amount of protein you eat. Your registered dietitian will estimate how many grams of protein you need each day. Based on that amount, your dietitian can make suggestions on what to eat. High protein foods include lean meats, eggs, milk, cheese and beans. Low protein foods include vegetables, fruits, breads and cereals.
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Coping and support
Receiving a diagnosis of chronic kidney disease may worry you. And making changes to your diet can be challenging and sometimes confusing. If you're feeling overwhelmed by your diagnosis, it might help to:
- Connect with other people who have kidney disease. Someone else who's going through the same thing as you can understand what you're feeling. They also can offer unique support. Ask your healthcare professional about support groups in your area. Or contact the American Association of Kidney Patients, the National Kidney Foundation or the American Kidney Fund. These organizations can help connect you with groups in your area.
- Stick to your usual routine as much as possible. Try to keep doing the activities you enjoy. Continue working if your condition allows. This can help you cope with feelings of sadness or loss that you might have.
- Be active most days of the week. If your healthcare professional says it's OK, keep up your activity level. Aim for at least 30 minutes of physical activity most days of the week. This can help with fatigue and stress.
- Talk with someone you trust. You might have a friend or family member who is a good listener. Or you may find it helpful to talk with a faith leader or someone else you trust. Ask your healthcare professional for a referral to a social worker or counselor.
Preparing for your appointment
You may start by seeing the healthcare professional who provides your primary care. If lab tests show that you have kidney damage, you might be referred to a nephrologist. A nephrologist is a doctor who specializes in kidney conditions.
What you can do
Before your appointment, it's a good idea to:
- Be aware of any restrictions before the appointment. When you make the appointment, ask if there's anything you need to do in advance, such as change your diet, so that you're ready for any tests you may need.
- Write down any symptoms you have, including any that may seem unrelated to your kidneys or urinary function, and when they started.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medicines, vitamins or supplements you take and how much you take.
- Consider bringing a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who comes with you may remember things that you missed or forgot.
- Write down questions to ask your healthcare team.
For chronic kidney disease, some basic questions to ask include:
- What's the level of damage to my kidneys?
- What kinds of tests do I need?
- What's causing my condition?
- Is my kidney function getting worse?
- Can the damage to my kidneys be undone?
- What next steps do you recommend?
- Are there alternatives to the treatment you're suggesting?
- What are the possible side effects of treatment?
- I have other health conditions. How can I best treat them together?
- How often do I need to have tests to see how well my kidneys are working?
- Do I need to eat a special diet?
- Can you refer me to a dietitian who can help me plan my meals?
- Where can I find more information?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
During your appointment, you may be asked questions, such as:
- When did you first start having symptoms?
- How have your symptoms changed over time?
- Have you been diagnosed with or treated for high blood pressure?
- Have you noticed changes in your urinary habits?
Dec. 09, 2025