- Our kidneys are as important to our health as our heart and lungs.
- They filter the blood to make urine, which allows the body to get rid of excess water, waste products (toxins) and salt.
- They also help control blood pressure and make chemicals (hormones) important for keeping bones and blood vessels healthy as well as red blood cells so they can carry oxygen as a fuel source around your body.
Where are they?
- Normally each person has 2 kidneys.
- They sit just under the rib cage in the middle of the back, one on each side of the spine.
- They are reddish brown in colour and shaped like kidney beans.
- Each kidney is about the size of a clenched fist.
How do healthy kidneys work?
- The main job of the kidneys is to clean the blood, remove waste from the blood .
- Every minute, about one litre of blood enters the kidneys through the kidney blood vessels.
- Each day the kidneys’ job is to clean approximately 190 litres (335 pints) of blood through about a million of mini filters per kidney (called nephrons) and 225 km (145 miles) of tubes.
- All the blood in the body would normally pass through the kidneys about 12 times per hour.
- On average the kidneys produce 2-3 litres of urine per day depending on how much fluid is drunk. In doing so, healthy kidneys remove water from the body.
Kidneys remove waste
- The kidneys remove waste products from the blood and ensure that there is the right balance of chemicals like salt (sodium), potassium and phosphorus in the body.
Kidneys produce hormones
The kidneys make 3 different hormones that:
- Help control blood pressure. People with kidney disease frequently have high blood pressure.
- Encourage the production of red blood cells, which prevents anaemia (called Erythropoietin or EPO). People with kidney disease may suffer from anaemia (a reduction in the number of cells in the blood which carry oxygen in the blood, i.e, red blood cells).
- Help maintain healthy bones (vitamin D). People with kidney disease may develop imbalance of calcium and phosphate and bone disease.
What happens when my kidneys don’t work so well?
When the kidneys are not working well or have failed you may experience some of the following:
- Extra fluid can build up in the body causing swelling of the ankles, shortness of breath and high blood pressure.
- You can have high blood pressure.
- Waste products build up in the body – usually gradually – and make you feel run down and unwell.
- Imbalance of chemicals can cause itchiness or dry skin, occasionally confusion, sickness or vomiting.
- Reduced hormone production may make you feel tired or have loss of concentration.
What can I do to keep healthy?
Keep a diary of how you feel and changes to your symptoms – tell your kidney team if anything changes.
Get regular health checks with your GP or kidney team.
Take your medication as prescribed or tell your team if you are having any problems with your medication.
Try to keep to a healthy diet – reduce salt, cholesterol, sugar and fat.
Try to have a variety fresh food where possible, or follow the advice from your dietician.
Try to keep active – keep as active as you can dependent on your mobility, walking, swimming, dancing or just moving around the house.
Try to stop smoking and limit your alcohol intake.
Read more to understand your kidney functions:
What is Chronic Kidney Disease? (CKD)
Chronic kidney disease means that your kidneys are damaged in some way and have lost some of their function:
- Such as filtering your blood of waste products.
- Removing excess fluid.
- Controlling your blood pressure.
- Keeping your bones healthy.
- Keeping your red bloods cells at a good level.
- Chronic means ongoing (persistent or long-term). It does not mean severe as some people think. You can have a mild chronic disease. Many people have mild CKD.
- Renal means relating to the kidney.
- Many people have kidney problems.
- About 1 in 10 people have some degree of CKD.
What causes it?
Kidney disease may be a quiet condition, by this we mean kidney function can fall to very low limits, without noticeable symptoms, but once recognised it is important for us to help you the patient understand your level and identify factors in your life that can be modified to help address the problem.
Three common causes in the UK, which probably account for about 3 in 4 cases of CKD in adults, are:
- Diabetes. Kidney disease can be a common complication of diabetes.
- High blood pressure. Untreated or poorly controlled high blood pressure is a very common cause of CKD. However, CKD can also cause high blood pressure, as the kidney works to keep the blood pressure stable.
- Ageing kidneys. About half of people aged 75 or more have some degree of CKD. In most of these cases, the CKD does not progress beyond the moderate stage unless other problems of the kidney develop, such as diabetic kidney disease.
Other less common conditions that can cause CKD include:
- Diseases of the glomeruli, these are the small filters in the kidney, glomerulonephritis.
- Renal artery stenosis; (narrowing of the blood vessels).
- Haemolytic uraemic syndrome; (This is rare but can develop post serious infections).
- Polycystic kidney disease; (cysts that develop on the kidneys).
- Blockages to the flow of urine.
- Drug-induced and toxin-induced kidney damage.
- Repeated kidney infections.
- This list is not complete and there are many other uncommon causes.
How do we measure it?
- A simple blood test can can estimate the % kidney function.
- This test is called the estimated glomerular filtration rate (eGFR).
- A normal eGFR is 90% or more.
- Sometimes your eGFR can varying from time to time, it can go up and down.
- It can be affected by other factors such as infections, dehydration and medications.
- Your urine will also be checked for protein, blood and infection.
Kidney Disease is often referred to in stages from 1 to 5.
The stage you are in will depend on the percentage of your kidney function.
Know your numbers! Apply for renal patient view, this will allow you to log on to your personal computer and see results from your hospital appointments with the renal team at Salford Royal.
Stages of Chronic Kidney Disease:
GFR Stage Description Plan
90% or over – 1 This would be a normal level of function but would include people with protein in their urine Managed by your GP.
60% to 89% – 2 Function is recognised as reduced, but perhaps more protein loss in the urine Managed by your GP.
30% to 59% – 3 At this level it is recognised your kidneys are not working so well, More tests or appointments may be required with your specialist.
15% to 29% – 4 This shows more marked changes in your kidney function have taken place. More frequent checks are needed.
Consider discussion of treatment options if function deteriorates further.
Less than 15 – 5 Approaching the need to commence a renal treatment. Treatment may be commenced where and if symptoms are occurring.
What are the symptoms of chronic kidney disease?
- Sometimes patients do not have any symptoms or changes to how they feel.
- Symptoms tend to develop when CKD becomes severe (stage 4) or worse.
- The symptoms at first tend to be vague and nonspecific, such as feeling tired, having less energy than usual, and just not feeling well.
- With more severe CKD, symptoms that may develop include:
A poor appetite.
Loss of concentration.
Dry, itchy skin.
Fluid retention which causes swollen feet and ankles.
Puffiness around the eyes.
A need to pass urine more often than usual.
Being pale due to lack of red blood cells (anaemia).
If the kidney function declines to stage 4 or 5 then various other problems may develop – for example, anaemia and an imbalance of calcium, phosphate and other chemicals in the bloodstream. These can cause various symptoms, such as tiredness due to anaemia and bone thinning or fractures due to calcium and phosphate imbalance.
What is the treatment for chronic kidney disease?
The aims of treatment are:
- To keep you as healthy and active as possible.
- Try to slow down any worsening of your kidneys.
- Plan for any future treatments you may need.
Treatment will include:
- Keeping your blood pressure within a safe target (130/60).
- Preventing your kidneys from leaking protein (proteinuria).
- Preventing you from getting anaemic (reduced red blood cells).
- Keeping your bones healthy.
- Keeping your heart healthy (preventing heart disease).
- Keeping any other health problems under control, such as diabetes.
- Keeping your blood levels within safe limits, such as potassium, urea and creatinine.
- You may need to have a variety of medications to as part of your treatment. These are often essential to treat your kidney disease.
- There are often lots of different medications that can be confusing or difficult to take.
- Make sure you ask what your medication is for and tell us if you are having any side effects or difficulties.
- Remember there are many other choices of medication if one particular doesn’t suit you – tell us.
What can you do to keep well?
- Talk to your kidney team and keep them well informed: They won’t know unless you tell them:
How you are,
How you feel,
Any concerns you have.
- Get regular health checks/ attend your appointments.
- Try to reduce salt in your diet, salt is often highest in processed foods, so try to eat fresh food as much as possible. Reduce intake of fatty foods, high sugar foods. Read more about eating well
- Take medication as prescribed and tell someone if you having problems with any medication.
- Try to be as active as you can dependent on your mobility, for some people this means going to the gym, running, cycling, swimming. For others it means walking, shopping, dancing or just being more active around the house.
- Try to stop smoking, limit your alcohol intake.
Where can I get more information?
- From your kidney care team.
- Other information leaflets- see you kidney care team.
- Patient education afternoons – see you kidney care team.
- Renal patient view.
Internet sites (click links to navigate to resources):
- Renal patient guide
- CKD resources on Patient.co.uk
- About CKD NHS choices
- CKD, Life Options materials
- Edren ( Edinburgh renal unit website)
- National Kidney Federation (NKF)
- British Kidney Patients Association ( BKPA)
Contact your local team
• Contact your Salford Royal nursing team 0161 206 1882
If you require further information, please tell us using the form below