Chronic Kidney Disease With No Symptoms? Yes

Q: I was diagnosed with type 2 diabetes almost two years ago. I thought I was doing OK, but recent urine and blood tests were abnormal. My doctor said I have an early stage of chronic kidney disease, most likely due to my diabetes. I am 45, significantly overweight, and don’t have any difficulty with urination. Is it possible to have a kidney problem without any symptoms?

A: Not only is it possible, it’s fairly common to have an early stage (there are five) of chronic kidney disease without any obvious symptoms. It’s a gradual process (months or years), resulting in a minimal—or sometimes progressive and permanent—loss of kidney function. While it’s not a pleasant diagnosis to hear, your physician was diligent in checking since you have two important risk factors: diabetes and obesity.

Our kidneys are amazing. They remove waste products and excess water from our blood while also playing a major role in controlling blood levels of minerals such as calcium, sodium and potassium. They also help to ensure that toxic byproducts of the foods, fluids, vitamins, supplements and medications we consume don't build up to dangerous levels in our bodies.

Even though our kidneys are very resilient and able to work when they are damaged or diseased, over time this takes a toll. As a result, a variety of symptoms may occur. These include but are not limited to:

• Unexplained fatigue and weakness
• Loss of appetite
• Nausea and vomiting
• Frequent hiccups
• Swelling of the legs and ankles
• Anemia and pale skin
• Muscle twitching and cramps
• Persistent itching and easy bruising
• Bone pain
• Erectile dysfunction and decreased libido
• Frequent urination, especially during the night
• Confusion and a change in mental status known as encephalopathy

And, to address your question regarding urination, most people—even in the face of deteriorating kidney function—have their usual production and output of urine. However, if kidney function continues to deteriorate without the proper diagnosis and treatment, kidney failure could occur and dialysis or transplant may be needed.

While chronic kidney disease isn’t as well-known as many other health concerns, it is a problem that is growing in numbers. In fact, the Centers for Disease Control and Prevention has estimated that 16.8 percent of adults ages 20 and older—roughly one in six—are affected by this condition. Risk factors include:

• Type 1 or 2 diabetes
• High blood pressure
• Obesity
• High cholesterol
• Heart disease
• Sickle cell disease
• Family history of kidney disease
• Multiple kidney infections and kidney stones
• Polycystic kidney disease
• Heroin abuse
• A decrease in the ability of urine to flow from the kidneys through the ureter(the tube leading from the kidneys to the bladder) from causes such as an enlarged prostate or a narrowing of the ureter due to strictures
• Liver disease
• Aging (almost 40 percent of adults 60 and older have some form of CKD)

Since you have been diagnosed with chronic kidney disease, you need to be especially careful with your medications. Whether over-the-counter, herbal, or prescription drugs, it is important to check with your physician or pharmacist prior to their use.

Specific categories that have the potential to cause further harm and need to be monitored include, but are not limited to:

• Pain relievers such as aspirin, acetaminophen, ibuprofen, naproxen, others
• Antacids containing magnesium and aluminum
• Fleets or other enemas containing phosphorus
• Anti-ulcer medications including cimetidine and ranitidine that require a decrease in dosage with this disease

Yet, there is lots of hope in your battle against CKD. While there is no cure, your physician (family doctor, internist, nephrologist) will most likely advise one or more of the following:

• Preventive measures (controlling high blood pressure, controlling blood sugar levels, decreasing weight, others)
• Early detection and periodic monitoring (urine tests, blood test including the estimated glomerular filtration rate, ultrasound of the kidneys, others)
• Dietary changes such as the restriction of protein, salt, potassium, phosphorus (found in many sodas)
• Medical treatment (diuretics, vitamin D, angiotensin receptor blocker, others)

Using those approaches, you have a good chance to slow, as well as treat, the progression and potential complications of chronic kidney disease.

For further information, and to find out if you are at risk for chronic kidney disease, speak with your physician. Also, please check out the National Kidney and Urologic Disease Information Clearinghouse at www.kidney.niddk.nih.gov as well as the National Kidney Foundation at www.kidney.org 

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)