Chronic Kidney Disease — What It Means and What We Can Do About It

If you have been told your kidney function is low, or that there is protein in your urine, this page explains what that means and what happens next.

What chronic kidney disease is

Chronic kidney disease means the kidneys have been working below normal, or leaking protein, for more than three months. It is common, it is usually silent in the early stages, and — this is the part patients are rarely told — it is very often controllable. Most people with CKD will never need dialysis.

How I assess it

Two numbers matter, and they matter together:

• eGFR, estimated from a blood creatinine. This tells us how much filtering capacity is left. The eGFR calculated from the creatinine is more informative than the raw number.
• Urine albumin-to-creatinine ratio (ACR), from a single urine sample. This tells us how much protein is leaking, which predicts how fast the disease will move.

A single abnormal result is not a diagnosis. I will usually repeat the tests before concluding anything.

What actually slows it down

• Blood pressure control, with the target individualised to you
• A kidney-protective blood pressure medicine (an ACE inhibitor or ARB) when there is protein in the urine
• SGLT2 inhibitors, which now have strong evidence for slowing progression in many patients with and without diabetes
• Blood sugar control if you are diabetic
• Sensible salt reduction, and avoiding the extreme protein restriction that some people are advised to try
• Avoiding avoidable kidney injury: NSAID painkillers, unsupervised contrast scans, some herbal and ayurvedic preparations

When to see me

Do not wait for symptoms. Come if your eGFR is falling, if there is persistent protein or blood in the urine, if your blood pressure is hard to control, or if you have diabetes with a rising ACR. Early referral gives us more to work with.

What a first visit looks like

I will go through your previous reports, examine you, and usually order a repeat blood and urine test plus an ultrasound. You will leave with a written plan, and we will agree how often you need to be seen — for many patients that is once every three to six months, not more.

Planning ahead

When kidney function declines further despite treatment, we plan early — discussing dialysis or renal transplantation well before either becomes urgent, so you have time to understand your options and make an informed choice.