Most people don't find out that their kidneys are in trouble until they've already lost 60, 70, 80% of their kidney function. And by then, the damage is done. And here's what makes this so tricky.
Your kidneys have no pain receptors. They literally cannot tell you when something's wrong. But your body does give you some clues still.
And while none of these signs appear early, recognizing them as early as possible could mean the difference between slowing down the progress of the disease or ending up on dialysis. Hello, health champions. Today, we're going to talk about 10 different ways that you can tell if your kidneys are crying out for help.
And I'm actually going to make this 11 signs because there's 10 silent ones and one really loud one. And most of the damage goes unnoticed because like I said the kidney viscera the active portion the organ portion where the active cells are in the kidney they have no pain receptors. However, you can still experience pain from kidney related issues because the capsule, the renal capsule that surrounds the kidney tissue has pain receptors.
And the urtors, the little tubes that go from the kidneys and down to your bladder, they also have pain receptors. And I'm going to call the pain one number 11. I'm going to start with it because it's so different from all the others.
And this pain can have three different causes. The first one is kidney stones. So kidney stones is when you get little crystals, like little pieces that are almost like glass that develop inside the kidney tissue.
And while it's inside the kidney, you can't feel it because again, there are no pain receptors. But as soon as it leaves the kidney and goes out through that little tube called the urer, now you can have excruciating pain. And a lot of people will describe this as the worst pain they have ever experienced.
A lot of people will get cold sweats from the intensity of the pain. So that's another sign that can show up. Another characteristic of this pain is that it comes in waves.
And that's because the urer, the tube is trying to get rid of it. So it's squeezing, trying to move it forward, but because it's so sharp and there's a lot of friction, a lot of times it doesn't move much. So the urer stops squeezing intermittently and that's when the pain subsides at least partially for a while.
And another characteristic is that this pain migrates. It moves with the stone. So, in the beginning, you're going to feel it very high up, like right under the rib cage where the kidneys are located, but then as it moves down over a period of a few days, hopefully no longer, then the pain will move with the stone and it will end up often times in your groin.
Other things you will notice along with this is an urgency, meaning that you'll feel like you have to go all the time and more frequently than usual. That you have burning sensations upon peeing and very often there's going to be blood in the urine as well because these stones are very sharp and they can cut the urer on the inside. And sometimes with these kidney stones, you can also get nausea and vomiting.
And this is because there's a nerve called the vagus that comes all the way that's your cranial nerve that goes all the way down into your abdominal cavity and it innervates most of your abdominal organs. So just like when you get food poisoning and that chemical irritation irritates the visceral in the stomach and the vagus nerve and you end up with nausea and vomiting. Here you can also get that intense irritation of the nerves in the abdominal cavity.
And typically with stones, you're not going to get fever and chills. However, if that stone gets stuck and causes an obstruction now, you can get an infection associated with that stone and that can result in fevers and chills. And if that happens, this is a serious medical emergency that you need to take care of immediately.
The second thing that can cause kidney related back pain is a kidney infection. And what happens now is you will experience a deep aching pain. Not as sharp and intense as the kidney stone, but deep aching.
And this comes from the swelling from the inflammation. So you have more blood flow, you get a swelling of the kidney tissue and now that presses that expands the capsule and because of the infection and the inflammation, you will have fever and chills. And just like we talked about with kidney stones, you could get nausea and vomiting because the nerve irritation in that area is so intense in the vagus nerve that it can trigger nausea and vomiting.
So, if you get a kidney infection, you will definitely know that you are sick. You will be genuinely unwell and you'll have all the classic symptoms of a urinary tract infection such as urgency and frequency, burning on urination and cloudy and foul smelling urine. And the third way you can get pain is through PKD or polycystic kidney disease.
This one's not going to be as intense or aggressive, not as acute as the other two. And you will have a sensation of a heavy chronic pressurelike pain up in the kidney area. And here, what's going to happen is you have these cysts, these growths inside the kidney that are going to expand the entire kidney.
you get a swelling from that growth and that's going to cause a gradual stretching of that renal capsule of the enclosure and very often you'll end up with high blood pressure as well because the increasing pressure inside the kidney is going to trigger the blood vessels. So it'll push on the blood vessels and trigger the renin angiotensin system which is how the kidney regulates blood pressure and angiotensin means the tightening up of blood vessels. And this growth process can go on for many many years and you could end up with enormously large kidneys to the point where you have a feeling of fullness and bloating in that area.
So I wanted to go over back pain in some detail because it's very different from other kidney disease. Uh most kidney disease is going to be silent. So let's talk about those 10 silent signs.
And what they have in common is that unlike the acute stuff, none of them come on quickly and none of them are very early. You will often have significant loss of function. Like we said, 60 to 80% loss of kidney function before a lot of these symptoms occur.
So with all of the pain symptoms related to kidney like stones and infection, those are very acute. They come on quickly and they let you know immediately. And the tissue, however, is not really unhealthy.
So we want to think about that. A lot of times we don't distinguish between unhealthy and something that's under attack. And that's kind of like food poisoning.
If you have a healthy body and you eat something that's poisonous, then the correct response by the body is to get rid of it. It's supposed to give you intense vomiting and diarrhea because you're trying to get rid of it. But that doesn't mean that you are unhealthy.
that doesn't mean that there is degeneration going on. And the same thing with these kidney stones. Your body's job is to get rid of them.
And even if you feel absolutely horrible while it's happening, it doesn't mean that your body tissue is unhealthy. However, with all of the 10 silent ones, what's happening is you have a chronic gradual silent degeneration. So this goes on, it's chipping away at your kidney tissue, at your kidney function without letting you know.
And sign number one is fatigue and brain fog. So what happens is when you have decreased kidney function, when it's not able to eliminate toxins and filter things out, now you obviously have an increase in accumulation of waste products. And there's two in particular called ura and creatinine that will start building up in the bloodstream and your brain is very sensitive to these substances.
So what you're likely to notice then is cognitive sluggishness. Your cognitive function slows down. You will experience low energy and oftentimes difficulty concentrating.
Sign number two is puffy eyes and face in the morning. So what happens here is with kidney damage you can also experience loss of protein and this can happen very very slightly over a long long period of time but then as it gets more severe you can have significant loss of protein and one in particular is called albumin and that is your primary blood protein. It's there to thicken the blood.
And because blood pressure is higher, even normal blood pressure is higher than the surrounding tissues, if you didn't have anything to hold the liquid in, which the albumin does, sort of like a sponge, then the tendency would be to push the fluid out of the bloodstream, and we wouldn't be able to hold it. So, as we lose album, there'll be a tendency of leaking fluid into the surrounding tissue. And as this fluid shifts into the tissue, what we see, of course, is swelling.
And typically what would happen is during the day, if we're upright, then gravity is going to pull that fluid down toward your lower body, your lower extremity. But then at night, when you're laying out flat and gravity doesn't act anymore on your lower body than your face, now this fluid shifts and spreads out throughout the body. And that's where you will notice the fluid in your eyes and face in the morning.
And number three is swollen feet and ankles. And this is very similar to what we just talked about with the loss of protein, the albumin. But there's one more thing that makes this more significant.
And that is with the damaged kidney, you also can't get rid of the sodium. So there's two mechanisms with sodium retention. One is just insulin resistance which makes the kidneys hold on to more sodium.
But when the kidney is damaged now on top of that mechanism, it also can't get rid of the sodium the way it's supposed to. And just like albumin, sodium is something that holds water to it. In fact, it's the main thing that holds water.
So now with extra sodium, we're going to have water retention. And as we're upright during the day, we're going to have gravity pull it down to the lower extremity. And unlike what you notice in the eyes and the face, with the lower body, you will notice this is worse in the evening.
Sign number four is changes in urination. And there's a few different ways this can show up. One would be that you have more frequency, especially at night, called nocuria.
So, it's ideal to not have to get up at night at all, unless you just drink tons of fluids toward the end of the day in the evening. And as you get older, you might have to get up maybe once during the night, but you're not supposed to be have to get up like two, three, four, five times every night. And that is a problem that could indicate some kidney problems.
Another thing you could notice would be a reduced volume output that either overall total volume is less or that there is less each time you go. And you also want to try to pay attention and notice if your urine gets dark, cloudy, or if it changes smell, if you have a foul smell to it. And number five is foamy urine.
And here's something I'm going to spend a little extra time because this is very important that we understand. There's a lot of confusion about this. So if you have persistent foam or bubbles, if it makes a foam and the foam doesn't dissipate, if it doesn't go away, then that could mean that you have a lot of protein in there.
Urine typically is going to foam a little bit at first, but it's supposed to go away. But if it stays around then that is a sign of significant protein nura which means of course protein in the urine. And if you suspect that this might be the case then what you want to do is called an albumin to creatinine ratio test.
But here's important. I'm going to spend a little time on this. So the optimal level is that you have 0 to 29 milligram of albumin per gram of creatinine.
And creatinine is something that is constantly released in the body and the kidneys are very good at getting rid of it. It basically is supposed to clear out 100% of the creatinine in every pass. So very close to 100.
So that's a good reference that we can compare to. And albumin is not supposed to be in the urine at all or in extremely small amounts. So if that ratio goes up of albumin to creatinine, that's how we can tell if there's a problem.
And if the levels go a little bit above 29, between 30 to 300 mg per gram of creatinine, now we have what's called microalbin ura. And this is where there is detectable albumin in the urine. on a test we can detect it and it shows up long before there is a reduction in the filtration rate.
So a very standard test is to measure creatinine and then do a calculation and figure out what the glomeular filtration rate the E stands for estimated glomemeular filtration rate. And a lot of people will just look at the EGFR to see if there is a problem with the kidney. But if you understand this, then the albumin test, the micro albumin test can actually show up a problem of leaking kidneys long before that filtration rate changes.
And if the level goes over 300, now it's called macro, which means large amounts of albumin in the urine. But here's something that's super important to understand when we talk about this foamy urine that the albumin test is the earliest test that you can do to detect filtration problems of leakage in the kidneys. However, the foamy urine is a late sign.
So here's how it works. When we do this test, we said the optimal is between 0 and 29 milligrams and then between 30 to 300. It's called microalum minora.
However, there is still no visible foam. It has to breathe more. It has to get higher than that before it really starts foaming.
And above 300 now, we could start seeing some occasional foam, something that persists. And once we get over 500, now we have consistent noticeable foam. And then when the kidneys really get into trouble, it can get as high as 3,500 or even more.
And now we have a nefertic range, nefrotic syndrome where the kidneys are very close to failure. And with this much albumin, we're going to have a heavy persistent foam. And this is sort of the textbook picture that they're talking about when they're talking about foamy urine.
So foamy urine is a late sign still but the mechanism of albumin leaking is testable very very early. Number six is itchy and dry skin and with decreased filtration one of the things that start building up is phosphorus and phosphorus in the blood and sort of going out into the tissues that can trigger itching and dryness. And this also is something that would happen only in more advanced stages.
Now number seven is a big surprise to most people because they have no idea why anemia would be related to kidney function. Anemia can result in a cluster of symptoms and one would be feeling cold. Another one is shortness of breath.
And both of these have to do with lack of energy and lack of oxygen delivery. So if you don't have enough red blood cells in your bloodstream, that's called anemia. And the red blood cells of course are supposed to deliver oxygen to the tissues and we need the oxygen to make energy.
So if we don't have enough red blood cells now, we can't make the energy. So we start feeling cold. If we walk up some stairs and we get winded, that's because we can't make the energy for that extra effort.
And another thing we could notice is pale appearance that your skin gets really pale because it's the red blood cells that give you that rosy tone on your skin. And the kidneys have everything to do with anemia because they make a hormone called EPO or arythropitin. And the kidneys are the perfect place to do this because they receive more blood per organ weight than anything else in the body.
It's only 0. 5% of your body weight, but it receives 25% of your blood volume. And all of that blood actually filters through the active cells of the kidney tissue which is not like the heart because the heart cells receive very little of the blood that actually goes through the heart.
The heart is a pump and most of the blood is just flushing through the chambers of the heart. But the kidney actually tests it tastes all of that blood. So it's very good at sensing if there's a difference in oxygen levels.
So for example, if you spend any significant time at high altitude, like 10,000 feet above sea level, there's less oxygen. So your blood oxygen saturation is going to go down and the kidneys sense that and they make more EPO and you build up additional amounts of red blood cells so you can tolerate that thin air better. And number eight is high blood pressure.
And we already touched on this that the damaged kidney holds on to more sodium. It can't get rid of sodium the way it's supposed to. And like we said, the increased amount of sodium will hold on to more water, which will increase the volume of the blood inside the blood vessels.
So now obviously the blood pressure goes up. And in a healthy person with functioning kidneys and who is metabolically healthy, the increased pressure is going to push itself out naturally and self-regulate. But with insulin resistance, you hold on to extra sodium.
And with kidney damage, there's another mechanism that you hold on to more sodium. So this pressure mechanism called pressure diuresis where it self-regulates, it doesn't work. And then unfortunately one of the things that damage kidneys is high blood pressure.
So now we have a loop where we're creating even more damage to the kidneys. And once you have high blood pressure because of these mechanisms, the damaged kidney now a lot of times it's going to be more resistant to lifestyle changes like diet and exercise and meditation and also to medication. Number nine is metallic taste and ammonia breath.
And what happens here is that with the decreased kidney function, we're going to have an increase in the waste product ura. And then this ura gets broken down to ammonia by certain bacteria that you have in your mouth in your saliva. And this will result in a distinct metallic/ammonia taste or breath.
And what a lot of people will find is that brushing your teeth doesn't really help because you're always making some saliva and there's always going to be certain bacteria in your mouth that just keeps breaking down this ura and producing this metallic taste. And sign number 10 is poor sleep. And what happens is if you have this toxic buildup because the kidneys can't filter out and you also get some electrolyte imbalances because your kidneys can't regulate it properly.
Now these toxins and this electrolyte imbalance will disrupt your nervous system because your nervous system is very very sensitive to irritation and it's very dependent on a very precise balance of electrolytes. And if you stress out your nervous system now, it can't regulate your relaxation and your stress responses properly. So during the day, you have more sympathetic activity and during the night, you're supposed to have much more parasympathetic, which is your relaxation response.
But a disrupted or disturbed nervous system can't necessarily regulate these properly. So you end up with more stress and worse sleep. And another thing that can happen from the same mechanism of toxic buildup and electrolyte imbalance is something called restless legs where your legs feel like you have to move them.
It's like this tension, this irritation builds up. You get all jittery and of course if that happens during the night then that makes the sleep problem even worse. So here's what you want to do.
And this is ideally long before you ever have any of these symptoms because like we talked about over and over, most of these are silent and they take a long time to develop. Most of them are late stage symptoms. So we're really talking about prevention.
And the biggest bang for your buck, the absolute largest risk reduction you can do is to reduce your insulin resistance. Control your metabolic health. And you also want to of course reduce chronic inflammation, which is a lot related to diet and to insulin resistance, but it's also very much related to stress.
And one of the things that damage kidneys the most is blood pressure, high blood pressure. So you definitely want to make sure you control that and make sure that you hydrate properly but not excessively. So what you want to do is you go by the color of your urine.
It should be light straw color. If it's dark, you don't drink enough. If it looks like plain water, you're drinking too much.
So you don't have to go around with gallon jugs of water and drink all day long. But monitor the color of your urine and drink appropriately. And another smart thing to do is to avoid NSAIDs as much as possible.
These are the over-the-counter drugs that you buy, the cold pills and the headache pills. They're nonsteroidal anti-inflammatory drugs because they're very nephrotoxic. They're a big cause of kidney disease.
And now if you already have some science, you want to be a little bit more proactive and you want to get some tests done. So standard blood tests will measure your filtration rates. They will measure your bond, your blood, ura, nitrogen, and they will measure most of your electrolytes such as sodium, potassium, calcium, and phosphorus.
So these are going to be included with just about any standard blood test that you do. However, you also want to include not necessarily every time you get a blood test, but every few years. So, do it now and then do it every few years, an albumin creatinine ratio test.
And this would be a separate urine test, but they can collect that when they take your blood at the same time. And these, of course, would be a great thing to do even before you have signs. But then if you have signs then you also want to avoid high protein.
So a healthy kidney does not have a problem with protein unless you go on what's called a rabbit starvation diet where virtually all of your calories come from protein which is never healthy. But a damaged kidney has a little bit more problems. It can't get rid of minerals.
It can't get rid of toxins. And it has a little bit harder time processing protein also. And the good thing to keep in mind is that most medications are synthetic versions of things that exist in nature already in plants.
So some herbal supplements that they concentrate into herbal medication, so to speak, they can actually be potent enough to do some of the same damage that medications do. So they can be nephrotoxic. and make sure that you're aware of that before you start any new herbal regime.
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