World Kidney Day: Are your kidneys okay? Dr Ganesh Prasad explains why early detection is important

Unlike the heart or brain, which show immediate symptoms like chest pain or paralysis, kidney disease can progress to severe stages without any noticeable symptoms, making early detection crucial for kidney health

Synopsis: On World Kidney Day, Dr. Ganesh S Prasad, a consultant nephrologist at Narayana Health City, discusses the importance of early kidney disease detection in the “Health For You” podcast. He explains that unlike the heart or brain, kidney issues often go unnoticed until they reach a severe stage. Dr. Prasad highlights the risks and steps to maintain kidney health throughout life

On World Kidney Day, the question we all need to ask is: Are your kidneys okay? Many people don’t think about kidney health until it’s too late—because unlike the heart or brain, the kidneys often fail silently. In this exclusive conversation, Dr Ganesh S Prasad, consultant nephrologist and transplant physician at Narayana Health City, in our podcast “Health For You” , breaks down why early detection is crucial, the biggest risk factors, and what simple steps can keep your kidneys functioning for life.

Q. Many people are unaware of kidney health until they are affected. Is that true?

A. Yes, that’s true. The kidneys are different from other vital organs like the heart and brain. If you have a heart attack, you will experience chest pain. If you have a brain stroke, you may have paralysis. These organs show immediate, visible symptoms. However, kidneys have a unique feature—even when a patient is in a severe stage of kidney disease, they may not experience any symptoms.

Q. Is that the theme of this year’s Kidney Day?

A. Yes, exactly. That’s why the theme is “Are Your Kidneys Okay?” It focuses on early detection.World Kidney Day aims to raise awareness about kidney health, as many people are unaware of kidney-related issues until they experience serious health problems.

Q. What are the common causes of kidney failure?

A. The most common causes of kidney failure are diabetes and hypertension. Long-term uncontrolled diabetes damages the kidney’s filtration system, leading to chronic kidney disease (CKD). Similarly, high blood pressure puts excessive strain on the blood vessels in the kidneys, reducing their function over time.

Other causes include:

Kidney stones – Recurrent or untreated stones can cause long-term damage.
Infections – Frequent urinary tract infections (UTIs) can affect kidney health.
Autoimmune diseases – Conditions like lupus can lead to kidney inflammation.
Excessive painkiller use – Overuse of NSAIDs (non-steroidal anti-inflammatory drugs) can harm kidney function.

Q. Are there any simple ways to check kidney health at home?

A. While medical diagnostics are essential for an accurate assessment, individuals can monitor their kidney health at home by paying attention to their medical history. As I said previously also, many patients with kidney disease will have hypertension. So, these are the two main signs. Any patient with diabetes and hypertension—they are at risk for kidney disease.

Apart from these two, patients with kidney stone diseases or patients who are getting recurrent urine infections—should suspect whether they have kidney disease and should consult a doctor. And any family history of kidney disease is also important.

Q. Are there any other symptoms that people can notice?

A. Other symptoms could be simple, generalised fatigue—it can also be a sign of kidney disease. Not being able to eat properly, their appetite is reduced. In severe renal failure, what we call “uremic gastritis,” the moment they see food, they will get a vomiting sensation. This happens in severe failure patients, not in the very early stages. In late stages there may be swelling of the legs as well.

Some patients in very early stages will identify froth in the urine because of protein leakage. If the protein leakage is very severe, they will see, after they go to the toilet, that there is froth.

Q. Are there any kind of kidney diseases that people are not aware of?

A. Many people are unaware of glomerular diseases, and unlike kidney damage caused by diabetes or hypertension, which is often irreversible, early detection of glomerular disease can lead to a complete cure. While some treatments may last for three to five years, patients can fully recover if diagnosed early. To identify and treat these conditions, doctors may conduct a kidney biopsy, where a small tissue sample from the kidney is analysed to determine the severity and appropriate treatment plan. This helps in providing the correct medication and assessing how long treatment is required, significantly improving kidney health in non-diabetic and non-hypertensive patients.

Q. Are there any specific tests that can tell us if our kidneys are ok?

A. Kidney disease has two tests which are the most important, and every high-risk patient should do them regularly.

Detection of protein in the urine—this is a very simple test, and it can be done at home as well. You don’t need any high-end sophisticated labs. We even teach children on how to do this test for their parents. There are dipsticks—you just have to use it like a pregnancy test is done. One just has to dip the stick in the urine and there will be a color change if you have a protein leakage. And then further tests, we can do what is the estimation, how much protein is there etc.

Second one is to check creatinine levels to see the function capacity of the kidney.

Q. How do you read creatinine levels?

A. The functional capacity of the kidneys is measured using creatinine. In a blood test, we check serum creatinine, which should normally be below 1.2 mg/dL. Based on creatinine levels, we can estimate how much kidney function remains.

Q. How do we explain the stages of Kidney disease?

A. We divide kidney disease into five stages: Stage 1, 2, 3, 4, and 5—based on the filtration capacity of the kidney.
A normal kidney filters approximately 90 mL per minute. The combined filtration capacity of both kidneys is 90 mL per minute, which is considered normal.

Stage 1: eGFR ≥90 mL/min (Normal kidney function but with signs of damage, such as protein in urine)
Stage 2: eGFR 60-89 mL/min (Mild loss of kidney function)
Stage 3a: eGFR 45-59 mL/min (Mild to moderate loss of kidney function)
Stage 3b: eGFR 30-44 mL/min (Moderate to severe loss of kidney function)
Stage 4: eGFR 15-29 mL/min (Severe loss of kidney function)
Stage 5: eGFR <15 mL/min (Kidney failure or end-stage renal disease, ESRD)
The classification is based on glomerular filtration rate (GFR), which is an important indicator of kidney function.

Q. How many months once should people go for kidney health tests?

A. For general monitoring, these tests should be done at least once a year or every six months, depending on risk factors.

For patients already diagnosed with kidney disease, testing should be done every three months.

We are now seeing type 2 diabetes even in 13- to 14-year-olds due to childhood obesity. A few decades ago, type 1 diabetes was the only form seen in children. However, now, even 13- to 14-year-olds are developing type 2 diabetes. So, regular diabetes screening is a must. Everyone above 18 years of age, as long as they are eligible for a test, should undergo diabetes screening.

Q. What are the early warning signs of kidney disease that people often overlook?

A. Most kidney diseases do not show symptoms in the early stages. That’s why regular screening is crucial. However, some subtle signs people often overlook include:
Fatigue – Feeling unusually tired, even after adequate rest.
Loss of appetite – Not feeling hungry or experiencing nausea when seeing food.
Swelling in the legs and feet – Due to fluid retention.
Frequent urination – Especially at night.
Frothy or foamy urine – A sign of protein leakage in the urine.
Persistent high blood pressure – Could indicate kidney dysfunction.
Unexplained weight loss – In severe kidney disease cases.

In later stages, symptoms become more pronounced, such as vomiting, severe swelling, and extreme weakness. But 90 percent of kidney patients remain asymptomatic in the early stages, which is why regular testing is essential, especially for high-risk individuals.

Q. Is there a specific level of blood sugar that leads to kidney damage, or does any uncontrolled diabetes pose a risk?

A. There is no fixed blood sugar level that suddenly causes kidney damage. The risk is cumulative—the longer blood sugar remains above the recommended range, the higher the chance of kidney damage.
For example:
If blood sugar is consistently around 160-180 mg/dL, kidney damage may occur over 5-6 years.
If blood sugar is extremely high, around 300-400 mg/dL, kidney damage can happen within 3 years.
Even if sugar levels are around 180-200 mg/dL, kidney damage can still occur, but it may take 6-7 years.
So, it is not about one particular number. Any prolonged period of uncontrolled diabetes, even if it’s moderately high, can lead to kidney damage. This is why strict sugar control is essential to protect kidney health.

Q. Is there a specific diet that helps improve kidney health? Are there foods that are particularly good or bad for the kidneys?

A. There is no specific diet that can improve kidney health, but there are dietary habits that can prevent kidney damage.

The biggest enemy of kidney health is salt.
Excess salt intake can increase blood pressure, which is harmful to the kidneys.
The daily recommended salt intake should be less than 5 grams per day.

Water intake is important.

At least 2.5 to 3 liters of water per day is necessary to keep the kidneys hydrated and prevent kidney stone formation.
There is no single “superfood” that improves kidney function.

However, following a diet that helps control blood sugar and blood pressure will help protect kidney health.
So, rather than focusing on specific foods to improve kidney health, the focus should be on avoiding high salt intake, staying hydrated, and maintaining overall metabolic health.

Q. There is a lot of debate about how much water a person should drink daily. Some people follow extreme water intake practices, like drinking 7–11 liters a day. Is this dangerous?

A. Yes, excessive water intake can be dangerous. There is a condition called psychogenic polydipsia, where people consciously drink excessive amounts of water, thinking it is beneficial for weight loss or overall health. Drinking too much water can dilute the urine excessively, reducing the kidney’s ability to concentrate it.

Over time, this can lead to an electrolyte imbalance, particularly low sodium levels (hyponatremia) in the body. Severe hyponatremia can cause symptoms like nausea, confusion, seizures, and even coma.

The ideal daily water intake should be around 2.5 to 3 liters per day for most people. Drinking more than 5 liters per day without medical need is unnecessary and could be harmful.

Q. How can kidney disease be prevented?

A. Prevention is key when it comes to kidney disease, especially for people with risk factors like diabetes, high blood pressure, and a family history of kidney issues. Here are some essential steps to protect kidney health:

Control Blood Sugar and Blood Pressure: These are the two biggest causes of kidney disease. Keeping them in check reduces the risk of damage.
Stay Hydrated: Drinking at least 2.5 to 3 liters of water per day helps maintain kidney function and prevents kidney stones.
Limit Salt Intake: Excess salt increases blood pressure, which puts strain on the kidneys. Less than 5 grams (one teaspoon) of salt per day is recommended.
Eat a Balanced Diet: Avoid processed foods, red meat, and excessive protein intake. Eat more fruits, vegetables, and whole grains.
Avoid Overuse of Painkillers: NSAIDs like ibuprofen can damage kidneys when taken frequently.
Regular Check-ups: Those with diabetes, hypertension, or a history of kidney disease should get kidney function tests (creatinine, urine protein) at least once or twice a year.

By following these steps, we can significantly reduce the risk of kidney disease and maintain overall health.

Q. Can kidney disease be reversed?

A. In the early stages (Stage 1 and 2), kidney disease can be managed and progression slowed if the cause—like diabetes or high blood pressure—is controlled. However, from Stage 3 onward, complete reversal is unlikely. Early detection, lifestyle changes, and proper treatment are key to preventing further damage. In Stage 5, dialysis or transplant becomes the only option.

Q. What about kidney stones? Why do some people keep forming them?

A. Kidney stones are a common problem, but their formation varies from person to person. Some people have a higher tendency to develop stones repeatedly due to factors like genetics, diet, hydration levels, and metabolic conditions. The primary reason for kidney stone formation is poor water intake, which leads to concentrated urine and the buildup of minerals that form stones. Other factors include high intake of oxalate-rich foods (such as spinach, nuts, and chocolate), excessive salt consumption, and underlying medical conditions like hyperparathyroidism or recurrent urinary tract infections. Proper hydration, dietary changes, and medical evaluation can help reduce the risk of recurrent kidney stones.

Q. What is CKDu, and why is it important?

A. CKDu stands for Chronic Kidney Disease of Unknown Origin. It is a type of kidney disease where the exact cause is not clearly identified. In India and across the world, significant research is being conducted to understand its causes and risk factors.
One example is Uddanam nephropathy, a condition seen in specific regions like the Uddanam area of Andhra Pradesh, particularly in the Godavari districts and Vizianagaram. The Andhra Pradesh government has been funding extensive research to study this issue. Similarly, in Tamil Nadu, around places like Pandreri, certain populations are at high risk of developing kidney disease.

Q. What are the possible causes of CKDu?

A. Researchers suspect multiple factors contribute to CKDu. Some of the key reasons being investigated include:

Climate change: Tropical countries with extreme heat and humidity may increase the risk of kidney damage.
Use of agrochemicals: Excessive exposure to pesticides and other agricultural chemicals may be toxic to the kidneys.
Dehydration and heat stress: People working in hot conditions without adequate hydration may develop kidney damage over time.

While research is ongoing, it is clear that environmental and occupational factors play a crucial role in CKDu.

Q. With summer approaching, what steps can people take to protect their kidney health?

A. Staying hydrated is one of the most important steps to protect kidney health, especially in hot and humid climates. However, people should be mindful of what they drink. Many individuals consume sugary drinks like Pepsi, Coca-Cola, and artificial fruit juices, thinking they help with hydration. In reality, these beverages can worsen kidney problems by increasing uric acid levels and contributing to conditions like gout.

Instead, it is recommended to:
Drink plenty of water throughout the day.
Opt for coconut water, which provides hydration and electrolytes without harmful sugars. Diagnosed with kidney disease, then avoid.
Avoid sugary sodas and artificial juices, which can negatively impact kidney function.

Q. If someone has a high creatinine level but no symptoms, can they ignore it?

A. No, ignoring a high creatinine level is a mistake. Many people assume they are healthy just because they do not feel any symptoms. However, an elevated creatinine level indicates that the kidneys are already under stress.

For example, if a person has a creatinine level of 1.5 or 1.6, they might think it’s not serious, but in reality, they could already be in stage 2 or stage 3 of chronic kidney disease (CKD). If their age is above 50, they are even more likely to be in stage 3.

This is the right time to see a kidney specialist (nephrologist) and start treatment to prevent further kidney damage. If the condition is ignored and creatinine levels continue to rise to 3 or 4, it becomes much harder to manage, and the person may eventually require dialysis.

Early detection and treatment can help slow down or even prevent the progression of kidney disease, making it crucial to take any creatinine increase seriously.

Q. What should the government do to improve kidney health awareness and prevention?

A. The government should focus primarily on preventive healthcare for kidney diseases. Early detection of kidney problems can help in preventing or even completely curing certain conditions. However, many people are unaware of kidney damage, its complications, and when they should get their kidneys checked.

To address this, the government should:
Run large-scale awareness campaigns about kidney health, similar to campaigns for heart disease or diabetes.
Educate the public on when and how to check kidney function, emphasizing routine screening for high-risk individuals.
Strengthen existing programs for organ donation awareness while also expanding efforts in early-stage kidney disease prevention.
Engage celebrities and well-known personalities who have suffered from kidney disease or undergone kidney transplants to advocate for kidney health.

Q. How can celebrity involvement improve kidney health awareness?

A. Celebrity influence plays a major role in public health awareness. Whenever a well-known person passes away due to a cardiac arrest, there is an immediate rush of people to hospitals for heart checkups. A recent example is the passing of Puneeth Rajkumar, which led to a surge in young people visiting cardiologists to check their heart health.

In contrast, when celebrities like Arun Jaitley, or Lalu Prasad Yadav underwent kidney transplants, there was no widespread discussion about kidney health. People acknowledged their kidney failure and transplants but did not feel the urgency to check their own kidney function.

The government should engage these celebrities or their families as campaigners for kidney health, similar to how cardiac health awareness is promoted. This will ensure that kidney disease prevention reaches the masses effectively.

Q. Is consuming non-vegetarian food or a high-protein diet harmful to the kidneys?

A. There is a common myth that eating non-vegetarian food or high-protein diets directly causes kidney disease, but this is not true for healthy individuals. However, for people who already have kidney disease, excessive protein intake can worsen kidney function.

For healthy individuals: A balanced diet, including protein from vegetarian and non-vegetarian sources, does not harm the kidneys.

For people with kidney disease: High protein intake can put extra stress on the kidneys, as they have to work harder to process and eliminate waste products from protein metabolism.

Doctors usually advise moderate protein intake for kidney patients, based on their stage of kidney disease.

(Edited by Ananya Rao)