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APRIL 2018 | Published by RCPA

Issue #079

Testing for and diagnosing kidney disease early – the silent disease

Testing for and diagnosing kidney disease early – the silent disease

Diagnosing kidney disease early is crucial, particularly considering it’s not uncommon for people to lose up to 90 percent of their kidney function before experiencing any symptoms. Chronic kidney disease (CKD) is called a ‘silent disease’ as there are often no warning signs.

According to Kidney Health Australia, some symptoms and signs may indicate reduced kidney function and it’s important to take note of them. These can include high blood pressure; changes in the amount and number of times urine is passed; changes in the appearance of urine; blood in urine; puffiness in legs, ankles or around the eyes; pain in the kidney area; tiredness; loss of appetite; difficulty sleeping; headaches; lack of concentration; itching; shortness of breath; nausea and vomiting; bad breath and a metallic taste; muscle cramps; and pins and needles.

Clinical Professor John Burnett, Consultant Chemical Pathologist at PathWest Laboratory Medicine, Royal Perth Hospital says, “These symptoms and signs are non-specific and could easily be attributed to stress or something else. As a result, there are an estimated 10% of Australians who already have kidney disease, but are unaware of this silent disease.”

“Unfortunately, once individuals begin to experience symptoms, they may already have end-stage kidney disease (ESKD). This is the most severe form of CKD; therefore, it’s important for people to be aware if they are susceptible to developing the disease,” says Professor Burnett.

CKD is categorised into 5 stages[1], with each stage related to the level of kidney function and kidney damage. For individuals with ESKD, kidney replacement therapy in the form of dialysis or kidney transplantation is usually required for survival.

“A third of adult Australians are at an increased risk of kidney disease due to other pre-existing conditions, such as high blood pressure, cardiovascular disease, diabetes or a family history of kidney failure. Obesity and smoking are also risk factors which impact the rates of kidney disease. It’s much more common in the elderly and is overrepresented amongst Aboriginal and Torres Strait Islander persons. In each of these cases, a GP should test the kidney function of these individuals more regularly.”

Chemical Pathologists can identify the first warning signs that something is wrong, using a simple blood test called the eGFR (estimated glomerular filtration rate) which picks up decreased kidney function.

“It’s not until an individual has a blood test or a urine test that a person will know if they have kidney disease. The eGFR is a means of looking at how well the kidney is functioning and excreting waste products. An eGFR that is greater than 60 is regarded as normal; however, if it’s less than 60, then you have kidney disease. Individuals who have levels of less than 15 may need to go onto dialysis or possibly have a transplant. A urine test can also be used to measure the urine albumin to creatinine ratio. Having higher than normal levels can be a sign of early kidney disease.”

Albumin is a protein that is present in large amounts in the blood. When kidneys are functioning properly, only a tiny amount of albumin leaks through into the urine, less than 30 mg/day. In kidney failure, large amounts of protein spill into the urine.

“Early detection of kidney disease is very important. People at increased risk for kidney disease should get tested, as early treatment with lifestyle measures and medications can benefit those with CKD,” says Professor Burnett.

[1] http://kidney.org.au/your-kidneys/detect/kidney-disease/stages-of-chronic-kidney-disease-787




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