Causes
Most chronic kidney disease in the United States is caused by diabetes and high blood pressure, which damage the kidneys' small blood vessels over many years. Common causes and risk factors include:- Diabetes: Persistently high blood sugar from diabetes injures the kidneys' filtering units and is the leading cause of kidney failure.
- High blood pressure: Uncontrolled blood pressure strains and scars the delicate vessels inside the kidneys.
- Glomerulonephritis: Inflammation of the kidneys' filtering units, which can follow infections or immune conditions.
- Polycystic kidney disease: An inherited condition in which fluid-filled cysts gradually replace normal kidney tissue.
- Blockage or repeated stones: Recurrent kidney stones, an enlarged prostate, or other urinary blockage can damage the kidneys over time.
- Long-term NSAID use: Regular use of pain relievers such as ibuprofen or naproxen can harm kidney function.
Symptoms
Early CKD rarely causes symptoms, which is why routine screening is so important for people with risk factors. As kidney function declines, people may notice:- Fatigue and trouble concentrating: Wastes build up in the blood, and reduced red blood cell production can cause anemia.
- Swelling: Puffiness in the ankles, feet, hands, or around the eyes from retained fluid.
- Foamy urine: A sign of protein leaking into the urine through damaged filters.
- Urinating more at night, poor appetite, nausea, muscle cramps, or itching: These tend to appear in later stages.
Diagnosis
CKD is diagnosed with two simple tests: a blood test that estimates the glomerular filtration rate (eGFR), a measure of how well the kidneys filter, and a urine test for albumin, a protein that leaks through damaged filters. Abnormal results persisting for at least three months confirm the diagnosis, and the findings are used to assign a stage from 1 (mild) to 5 (kidney failure). An ultrasound is sometimes ordered to look at kidney size and structure.Treatment
Treatment focuses on slowing progression and protecting the heart, since cardiovascular disease is the most common complication of CKD:- Blood pressure control: ACE inhibitors such as lisinopril or ARBs such as losartan lower blood pressure and reduce protein loss in the urine.
- SGLT2 inhibitors: Medications such as dapagliflozin and empagliflozin slow the loss of kidney function in many patients, with or without diabetes.
- Diuretics: Water pills such as furosemide help control swelling and blood pressure.
- Blood sugar control: Careful diabetes management protects the kidney function that remains.
- Kidney-safe habits: Limiting sodium, avoiding NSAIDs, staying hydrated, and not smoking.
- Treating complications: Anemia and mineral and bone problems, including secondary hyperparathyroidism, are monitored and treated as CKD advances.
Complications
Advanced CKD can lead to fluid overload, high potassium levels, worsening blood pressure, bone disease, and a substantially higher risk of heart attack and stroke. A minority of patients eventually progress to kidney failure, which is treated with dialysis or kidney transplant — but with modern therapy started early, most people with CKD never reach that point. People with CKD do best with regular lab monitoring and coordinated chronic-disease care. The internal-medicine team at Zimmer Medical Group screens for kidney disease as part of routine care and adjusts treatment early, when it makes the biggest difference.Protecting the Kidney Function You Still Have
Chronic kidney disease progresses slowly in most people, and the pace is not fixed. A short list of treatments and precautions changes it measurably, which makes the years after diagnosis, when nothing feels wrong, the most valuable time to act.
Know both of your numbers
The eGFR describes how much filtering capacity remains, and the urine albumin-to-creatinine ratio describes how much damage is leaking protein. Two people with the same eGFR can have very different outlooks depending on the albumin result, because albuminuria predicts both progression and cardiovascular risk. Ask for both values at each check and track them over time; our guide to understanding your eGFR explains what the stages mean and why the trend matters more than any single result.
The medications that slow the decline
An ACE inhibitor such as lisinopril or an ARB such as losartan reduces protein loss and slows progression in anyone with albuminuria, and it is continued through the small initial rise in creatinine that often alarms people. SGLT2 inhibitors such as dapagliflozin and empagliflozin slow kidney decline whether or not diabetes is present and are now recommended for most people with CKD. In type 2 diabetes, finerenone and semaglutide have also shown kidney protection. Taken together these can delay the need for dialysis by years.
Medications to avoid or adjust
Ibuprofen, naproxen, and other NSAIDs are the most common avoidable cause of kidney injury and should be replaced with acetaminophen for routine pain. Many antibiotics, gabapentin, and some diabetes drugs need lower doses as eGFR falls, and metformin is typically reduced below an eGFR of 45 and stopped below 30. Ask about a sick-day plan: during vomiting, diarrhea, or fever, temporarily pausing the ACE inhibitor or ARB, diuretic, SGLT2 inhibitor, and metformin prevents the sharp dehydration-related drop in kidney function that can become permanent. Tell any clinician ordering a CT with contrast that you have CKD.
Blood pressure and diet
Blood pressure control does more for the kidneys than any single diet change, with a target below 130/80 and lower where tolerated; the hypertension page covers home monitoring. Dietary advice is more targeted than people expect: sodium under 2,000 mg a day for everyone, moderate rather than high protein intake, and potassium or phosphorus restriction only when blood tests show a need. A plant-forward pattern is associated with slower progression, and blanket bans on bananas and tomatoes are unnecessary for most people at earlier stages.
When a nephrologist should be involved
Referral is recommended when eGFR falls below 30, albumin excretion exceeds 300 mg/g, function is declining quickly, the cause is unclear, or potassium and blood pressure become hard to manage. Gout, anemia, and recurrent kidney stones are common companions of CKD and are managed alongside it. Our genitourinary team coordinates that care. The NIDDK and the National Kidney Foundation publish stage-by-stage patient guidance.
If you have diabetes or high blood pressure and have not had a urine albumin test in the past year, schedule one.