Looking after your kidneys is essential, especially when you have diabetes. Having healthy kidneys helps keep your body in good condition and improves your general wellbeing.

Form and function of your kidneys

Your kidneys are located underneath your rib cage, towards your back. They are two bean-shaped organs, each about the size of a fist.

Each kidney contains millions of nephrons (tiny filtering units), glomeruli (that act like a strainer), and a network of capillaries (tiny blood vessels). The glomeruli filter waste products and substances out of the blood, into tiny tubes called tubules. The substances the body needs are reabsorbed into the bloodstream and are reabsorbed via the renal veins. Urine is made with the waste and extra fluid the body does not need and is sent to the bladder through a tube called the ureter.

Your kidneys do some very important jobs, including:

• Cleaning the blood and getting rid of the waste and excess water, by making urine
• Keeping red blood cell counts, phosphorous and potassium levels normal
• Balancing body chemicals
• Keeping bones healthy and strong
• Helping to maintain blood pressure

How can you check the health of your kidneys?

There are three main tests to check kidney health.

1. Blood tests, in particular the estimated Glomerular Filtration Rate (eGFR), which indicates how well the kidneys are filtering. The eGFR helps to classify kidney disease into stages, more on this later.
2. Urine tests to check for a type of protein called albumin. Although it is normal to have a small amount of albumin in the urine, high levels are a sign of kidney damage and can cause scarring of your kidneys.
3. Blood pressure checks. High blood pressure similarly can cause kidney damage, due to damage to the many small blood vessels of the kidneys. Kidney disease also causes high blood pressure.

When things go wrong…

When kidneys get damaged we refer to this as nephropathy or kidney disease. End-stage kidney disease is referred to as renal failure.

Nephropathy can be roughly divided into two:

1. Acute Kidney Disease, which is the temporary loss of kidney function lasting less than three months.
2. Chronic Kidney Disease (or CKD), which is the most common form of kidney disease, and which occurs when the kidneys have been irreversibly damaged, over a period of three months or more.

The stages of CKD

As mentioned, CKD is divided into five stages – the more damaged your kidneys are, the less function they have. The stages of CKD are based on your blood pressure, the estimated glomeruli filtration rate (a blood test) and your urine’s albumin to creatinine ratio (ACR).

Stage of CKD	eGFR result	What it means
Early stage CKD	Stage 1	eGFR >90	Normal amounts or small to large amounts of albumin in the urine	No obvious symptoms
	Stage 2	eGFR 60-89	Normal amounts or small to large amounts of albumin in the urine	No obvious symptoms
Middle stages of kidney disease	Stage 3	eGFR 30-59	Kidneys don’t work as well as they should, albumin may be present in the urine in small amounts	You may start to feel unwell as the waste in your body increases and your blood pressure rises
	Stage 4	eGFR f 15-29	Kidneys are close to not working, albumin may be present in the urine in large amounts	You will likely have symptoms such as pain in your lower back and swelling of hands and feet
End-stage kidney disease	Stage 5	eGFR < 15	Kidneys are close to not working or have stopped working	Dialysis or kidney transplant is required

No matter what stage you are at, the goal at each level of kidney disease is to take steps to slow down or prevent any further damage.

You can live for many years with chronic kidney disease, but many people will experience a continued drop in their kidney’s ability to filter their blood and will eventually need kidney replacement therapy.

Chronic Kidney Disease

It is estimated that close to 30% of Australian adults have risk factors for the development of CKD, such as having diabetes or high blood pressure, the two main causes for chronic kidney disease.

Other factors that can increase your risk of developing kidney disease include:

• Smoking
• Obesity
• Having a family history of kidney disease
• Having an abnormal kidney structure
• Certain ethnic backgrounds

Treatment and prevention

As diabetes and hypertension are two of the main causes of CKD, managing these conditions is paramount to reducing the risk of developing CKD or in preventing further decline.

To prevent damage to the kidneys it is also important to eat healthy (and reducing your salt intake), do regular exercise, manage your cholesterol, maintain a healthy weight, and avoid smoking (to prevent damage to the tiny blood vessels in and around the kidneys).

For more information

Check out the Kidney Health Australia website https://kidney.org.au/resources or download the “looking after your kidneys” factsheet.

By Carolien Koreneff, CDE-RN, FADEA