Kidney Disease FAQs

If I have chronic kidney disease, when should my primary caregiver send me to a Nephrologist?  

When to be referred to Nephrologist depends on the level of kidney function you have, what has caused your kidney disease, how quickly your kidney disease is worsening, the comfort level of your primary caregiver dealing with and your any other medical conditions you may or may not have.  

The worse your kidney function and the more medical problems you have, the more important it will be for you to see a Nephrologist. Be sure to discuss in detail with your primary care to see if he or she feels the need to refer you to a Nephrologist. We feel that any patient with significant unexplained proteinuria (or protein in the urine) and or chronic kidney disease needs to see a Nephrologist for at least an initial evaluation.  

Does chronic kidney disease cause pain?

Most causes of chronic kidney disease do not cause pain.  Patients frequently present to the clinic with back pain and are concerned that this pain is related to their kidney disease. In fact, kidney disease causing back pain is very rare, and the vast majority of back pain has nothing to do with kidney function.  On occasion, patients may have urinary obstruction or stones that cause back pain. In other words, there are rare kidney and or other urinary problems which can cause back, flank and or lower abdominal pain.  These problems though typically do not cause significant chronic kidney disease. In other words, your back pain in all likelihood has nothing to do with your chronic kidney disease. 

If I am making urine, does that mean my kidney function is fine?

Not necessarily. The production of urine does not directly correlate with the level of kidney function you have.  In other words, urine production and the filtering action of the kidneys are not synonymous.  Even patients with the very little function may make a normal amount of urine. Unfortunately, the quality of this urine may be adequate. The reverse is typically not true, though if you are not making urine (or making very little urine), chances are your kidney function is very poor.  

How will I feel if my kidneys are failing?

You may feel fine until your kidney function is well below 20% of normal function. That is one of the many reasons why it is important to continue to follow up with your Nephrologist regularly if you do have significant chronic kidney disease.  Even if you feel well, you may be having progressive kidney function loss and or may be having complications from your kidney disease and not even know it.  

Once your kidney function drops below 15 - 20% of normal, most people begin to feel some symptoms of uremia (development of these symptoms can develop much earlier or later in the kidney disease process).  Uremia is the syndrome (or group of signs and symptoms) that develops with severe kidney disease.  The symptoms that develop can include but are not limited to fatigue; anorexia; nausea; dysgeusia (an abnormal taste sensation); hiccups; itching; insomnia; swelling of the lower extremities; shortness of breath; and even confusion as kidney function worsens. 

When should I begin to consider or prepare for dialysis?

Generally speaking, we at Nephrology Associates, P.C. follow what we call the 30 - 20 - 10 rule.  At 30% kidney function or less, we begin to discuss dialysis to include the various ways and setting in which to do dialysis, and possibly a meeting with an RN Dialysis educator to discuss this further.  At 20% function, we begin preparing for dialysis which includes deciding on the type of dialysis you have chosen to start with and prepping you for this modality.  And finally, at or around 10% function we complete the dialysis preparation work and begin to consider starting you on dialysis.  Again this will vary from patient to patient.