If your toes are always cold, one reason could be poor blood flow — a circulatory problem sometimes linked to smoking, high blood pressure, or heart disease. The nerve damage of uncontrolled diabetes can also make your feet feel cold. Other possible causes include hypothyroidism and anaemia. A doctor can look for any underlying problems — or let you know that you simply have cold feet.
Foot Pain
When feet ache after a long day, you might just curse your shoes. After all, eight out of 10 women say their shoes hurt. But the pain that’s not due to sky-high heels may come from a stress fracture, a small crack in a bone. One possible cause: Exercise that was too intense, particularly high-impact sports like basketball and distance running. Also, weakened bones due to osteoporosis increase the risk.
Red, White, and Blue Toes
Raynaud’s disease can cause toes to turn white, then bluish, and then redden again and return to their natural tone. The cause is a sudden narrowing of the arteries, called vasospasms. Stress or changes in temperature can trigger vasospasms, which usually don’t lead to other health concerns. Raynaud’s may also be related to rheumatoid arthritis, Sjögren’s disease, or thyroid problems.
Heel Pain
The most common cause of heel pain is plantar fasciitis, inflammation where this long ligament attaches to the heel bone. The pain may be sharpest when you first wake up and put pressure on the foot. Arthritis, excessive exercise, and poorly fitting shoes also can cause heel pain, as can tendonitis. Less common causes include a bone spur on the bottom of the heel, a bone infection, tumor, or fracture.
Dragging Your Feet
Sometimes the first sign of a problem is a change in the way you walk — a wider gait or slight foot dragging. The cause may be the slow loss of normal sensation in your feet, brought on by peripheral nerve damage. About 30% of these cases are linked to diabetes. Nerve damage also can be due to infection, vitamin deficiency, and alcoholism. In many cases, no one knows what caused the nerve damage. Other possible causes for foot dragging include problems with the brain, spinal cord, or muscles.
Clubbed Toes
In clubbing, the shape of the toes (and often the fingers) changes. The nails are more rounded on top and curve downward. Lung disease is the most common underlying cause, but it also can be caused by heart disease, liver, and digestive disorders, or certain infections. Sometimes, clubbing runs in families without any underlying disease.
Swollen Feet
This is usually a temporary nuisance caused by standing too long or a long flight — especially if you are pregnant. In contrast, feet that stay swollen can be a sign of a serious medical condition. The cause may be poor circulation, a problem with the lymphatic system, or a blood clot. A kidney disorder or underactive thyroid can also cause swelling. If you have persistent swelling of your feet, see a physician.
Burning Feet
A burning sensation in the feet is common among diabetics with peripheral nerve damage. It can also be caused by a vitamin B deficiency, athlete’s foot, chronic kidney disease, poor circulation in the legs and feet (peripheral arterial disease), or hypothyroidism.
Sores That Don’t Heal
Foot sores that will not heal are a major warning sign for diabetes. Diabetes can impair sensation in the feet, circulation, and normal wound healing, so even a blister can become a troublesome wound. Those sores also are prone to infection. Diabetics should wash and dry their feet and check them for any wounds every day. Slow-healing of sores also can be caused by poor circulation from conditions such as peripheral artery disease.
Pain in the Big Toe
Gout is a notorious cause of sudden pain in the big toe joint, along with redness and swelling (seen here). Osteoarthritis is another culprit that causes pain and swelling. If the joint is rigid, it may be hallux rigidus, a complication of arthritis where a bone spur develops. Finally, turf toe is an ailment of athletes, particularly those who play on hard surfaces. It’s caused by an injury to ligaments surrounding the joint.
Pain in the Smaller Toes
If you feel like you’re walking on a marble, or if pain burns in the ball of your foot and radiates to the toes, you may have Morton’s neuroma, a thickening of tissue around a nerve, usually between the third and fourth toes. It is eight to 10 times more common in women than in men. It is caused by injury or too much pressure on the toes.
Itchy Feet
Itchy, scaly skin may be athlete’s foot, a common fungal infection. A reaction to chemicals or skin care products — called contact dermatitis — can cause itching, too, along with redness and dry patches. If the skin on itchy feet is thick and pimple-like, it may be psoriasis, an over-reaction of the immune system. Medicated creams can relieve the symptoms.
Claw Toe
This foot deformity can be caused by shoes that are tight and pinch your toes or by a disease that damages nerves, such as diabetes, alcoholism, or other neurological disorder. Your toes will be bent upward as they extend from the ball of the foot, then downward from the middle joint, resembling a claw. They may respond to stretching and exercises of the toes or you may need special shoes or even surgery.
Foot Spasms
A sudden, sharp pain in the foot is the hallmark of a muscle spasm or cramp, which can last many minutes. Overwork and muscle fatigue are common causes. Other causes include poor circulation, dehydration, or imbalances in potassium, magnesium, calcium, or vitamin D levels in the body. The changing hormone levels of pregnancy or thyroid disorders may play a role. If spasms are frequent or severe, see a doctor. Strengthening exercises can help with muscle fatigue.
Dark Spot on the Foot
We associate skin cancer with the sun, so we’re not as likely to check our feet for unusual spots. However, a melanoma, the most dangerous form of skin cancer, can develop in areas that are not regularly exposed to the sun. Melanoma can even appear beneath the nail, where it might look like a black spot.
Yellow Toenails
Your toenails tell a lot about your overall health. A fungal infection often causes thickened yellow toenails. Thick, yellow nails also can be a sign of an underlying disease, including lymphedema (swelling related to the lymphatic system), lung problems, psoriasis, or rheumatoid arthritis.
Spoon-shaped Toenails
Sometimes an injury to the nail or frequent exposure to petroleum-based solvents can create a concave, spoon-like shape. However, iron deficiency also can cause this unusual shape.
White Nails
Injury to the nail or illness anywhere in the body can cause white areas in the nails. If part or all of a nail separates from the nail bed (shown here), it can appear white — and may be due to an injury, nail infection, or psoriasis. If the nail is intact and most of it is white, it can sometimes be a sign of a more serious condition including liver disease, congestive heart failure, or kidney disease. Talk with your health care team about any concerns.
Pitting of the Nails
Pitting, or punctured-looking depressions in the surface of the nail, is caused by a disruption in the growth of the nail at the nail plate. It affects as many as half of people with psoriasis.
This project will raise awareness about prevention and provide training to community volunteers to act as health champions who will screen, treat, and share vital information on hypertension and diabetes through peers group, meetings, and through other health campaigns. We will provide medical screening, medications, nutritional supplements, and advice that will aid 5,000 people in Ibadan communities to cope with existing conditions and live a healthy lifestyle.
$10,000 total goal
$10,000 remaining
0 donors
0 monthly donors
Coming soon
Challenge
Nigeria has one of the highest rates of hypertension in the world, with studies showing rates between 30% and 45%. Hypertension accounts for about 25% of emergencies in Nigerian hospitals. Researchers recommend increased awareness and interventions for prevention and early detection of hypertension. This is particularly urgent in Oyo State. Even with early diagnosis, high cost of medication is forcing patients to seek an alternative to drugs or go without treatment.
Solution
Rays of Hope Support Initiative will Continue raising awareness and educating about Hypertension and Diabetes in underserved communities, expanding our reach to 5,000 people in at least five different communities Provide training to 10 volunteers, or “Health Champions” Provide medical screening, medications, and nutritional supplements to at least 400 of those with the greatest need Providing treatment to those with an existing condition can help reduce the rate of illness and death.
Long-Term Impact
ROHSI aims to reduce the prevalence of hypertension in Nigeria in the long-term. We will create partnerships with government health agencies and community development associations to bring awareness and treatment to more communities. We will get closer to our vision of a low prevalence of hypertension in Nigeria, but we can’t do it without your help!
Diabetes is a prevalent disease. However, it can still take many by surprise, and leave them struggling to pay medical bills.
With the complexities of the condition and the wide range of costs involved with treatment, having a financing plan is necessary. Health insurance is obviously one of the primary methods of assistance. But not everyone has the adequate coverage to cover
the costs – let alone the out-of-pocket cash to put on the counter every time out.
Opening a savings account, particularly one with high interest, could be a worthwhile investment toward consistently managing the disease today and into the future.
Diabetes at a glance
Type 1 Diabetes
A condition that keeps the body from producing enough insulin. Insulin shots are used to control blood glucose levels. Most diagnoses occur among children and young adults, which is why it is also referred to as juvenile diabetes.
Type 2 Diabetes
The most common form of the condition where the body doesn’t properly use insulin to convert sugar, starches and other food into energy.
Gestational Diabetes
Occurs when women experience high blood glucose levels during pregnancy. It’s usually easily managed and goes away after pregnancy.
Prediabetes
When blood glucose levels are higher than normal, but not high enough to be diagnosed as Type 2 diabetes. A large number of Americans are living with prediabetes (1 out of 3 adults). But taking early action to manage glucose levels can prevent diabetes from forming.
People who have diabetes are at higher risk of developing the following health conditions:
Blindness
Heart disease
Stroke
Kidney failure
Blindness
Loss of lower appendages (toes, feet, or legs)
Keep in mind – these conditions occur in the case of severe complications with the disease. With consistent attention to diet and other medical treatments (like most living with type 1 or type 2 diabetes undergo), these conditions are avoidable.
Diabetes by the numbers
According to a recent report from the Centers for Disease Control and Prevention (CDC), more than 100 million U.S. adults are now living with diabetes or prediabetes. Of that, only 12% were aware that they had it. And with approximately 1.5 million new cases being diagnosed every year, the need for education and financial support is clear.
Rates of diagnosis for the following ethnic groups
7.4% of non-Hispanic whites
8.0% of Asian Americans
12.1% of Hispanics
12.7% of non-Hispanic blacks
15.1% of American Indians/Alaskan Natives
Breakdown among Asian Americans:
4.3% diagnosed were Chinese
8.9% diagnosed were Filipinos
11.2% diagnosed were Asian Indians
8.5% diagnosed were identified as other Asian Americans
Breakdown among Hispanic adults:
8.5% diagnosed were Central and South Americans
9.0% diagnosed were Cubans
13.8% diagnosed were Mexican Americans
12.0% diagnosed were Puerto Ricans
Underreported deaths due to diabetes
Diabetes is one of the leading causes of death in the United States (seventh as of 2015). However, studies have found that it is also among the most underreported. According to the American Diabetes Association®, only 35% of people who died with diabetes had the disease listed on their death certificate. And of that number, only 10% had diabetes identified as the cause of death.
There are a number of possible reasons for the underreported rate. But a lot points to the lack of ability to pay for adequate diagnosis and proper medical treatment.
What specific costs will someone with diabetes have to address?
If you or your child are diagnosed with diabetes, or you’re told that you have prediabetes, management and prevention take center stage. While a lot involves diet and exercise, medication will inevitably have an effect on your finances as well.
According to the American Diabetes Association® (ADA), medical costs for a person with diabetes averages out to $16,750 per year (a total of $327 billion nationwide in 2017). Of that amount, $9,601 is attributed to treatment specifically for diabetes. That’s more than twice the medical cost for people without diabetes.
Of the $327 billion nationally, $237 billion was attributed to direct diabetes medical costs and $90 billion was attributed to indirect costs – absenteeism and reduced productivity at work. Understanding the different forms of diabetes treatment, as well as the direct and indirect costs, is important for wrapping your head around plans for financing.
Type
Treatments
Type 1 Diabetes
Diet
Exercise
Insulin therapy
Regular blood glucose tests/monitoring
Type 2 Diabetes
Diet
Exercise
Insulin therapy
Other medication
Gestational Diabetes
Diet
Exercise
Monitoring sugar intake
Monitoring the baby
Direct Medical Costs ($9,601/year)
Indirect Medical Costs ($90 billion nationally)
Prescription medication (30% of total cost)
Loss of productivity due to mortality ($20 billion nationally)
Hospital care (30% of total cost)
Inability to work as a result of diabetes ($40 billion nationally)
Routine doctor’s office visits (15% of total cost)
Reduced productivity while at work ($30 billion)
Other medications and supplies (25% of total cost)
Reduced productivity due to increased absences and loss of employment from diabetes ($6 billion)
Insulin
Insulin injections are one of the primary forms of medical treatment used to manage diabetes. Especially for those living with type 1 diabetes, who can’t produce insulin of their own, these types of injections are vital for survival. However, the cost for insulin has skyrocketed in recent years, leaving many in the position of having to choose between going into debt or cutting back on medication.
The average cost for insulin as of 2015: $100-$200 per month
An average cost for insulin as of 2018: $400-$500 per month
WIDELY USED INSULIN BRANDS AND INSULIN INJECTION TOOLS
Along with your normal doctor’s visits, diabetes screenings are an important part of the process for identifying the disease. Specifically, if you have been diagnosed, testing your blood glucose levels will become a regular part of your life. Much of the costs for medications involved should be covered by your health insurance. And there are a number of home testing devices you can invest in to help make things more convenient and cost-effective.
WIDELY USED DIABETES TESTING BRANDS AND OTHER MEDICATIONS
Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone (These drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication.)
Diabetes health expenditures according to group
Depending on whether you or your child has type 1 or type 2 diabetes, total expenditures can vary. Those who manage their condition at home, through diet, exercise, and home testing will have different averages than those needing regular appointments with specialists. According to the American Diabetes Association®, average total healthcare expenditures for diabetes treatment differ according to gender, race, and states with the highest populations of people diagnosed.
States with the highest population of people with diabetes
New York: $21 billion in healthcare expenditures
Florida: $24 billion in healthcare expenditures
Texas: $25 billion in healthcare expenditures
California: $39 billion in healthcare expenditures
Options for diabetes treatment financing
In a recent online survey of 500 adults with diabetes, more than half of the participants acknowledged the medical costs involved has had a negative impact on their finances. Many also admitted to going to “extreme lengths” to cover the costs. These lengths include accruing credit card debt, borrowing money from family or friends, and tapping into a savings or retirement account. Many may feel the need to take some extra financial risks because they don’t feel as supported as they’d like. Understanding your options will help you make the most informed choices.
Insurance
Government insurance, such as Medicare and Medicaid provides most of the financial assistance for diabetes care. The military also takes care of a good amount of costs for veterans. The remainder of the cost is covered by private insurance or out-of-pocket cash. According to the National Conference of State Legislatures, 46 states mandate that diabetes be covered under state insurance.
These states require coverage for diabetes treatment as well as equipment and supplies for home use (insulin, pumps, syringes, test meters). Four states do not have that same insurance mandate, however – Ohio, Alabama, North Dakota, and Idaho. Anyone with diabetes who live in any of those four states will most likely need to deal with a private insurer or explore other methods of financing.
Coverage from private insurers usually come through employer-sponsored group plans or individual health plans. Advisors would suggest going with employer-sponsored plans, because they offer higher protections due to being subsidized. On the other hand, if you are unemployed and venturing into the individual market, it may be difficult to find affordable coverage. The reason is that diabetes is considered a “high risk” disease. Insurance companies anticipate a high amount of claims, especially from those with pre-existing conditions. So it will be reflected in the pricing.
HSA
People who have diabetes but don’t have coverage that’s comprehensible enough for their needs may utilize a health savings account (HSA). An HSA is primarily useful for people with high deductibles (at least $1,350 individually, or $2,700 for family). Also, those who are a part of low-income families or don’t live in a “mandate state” may see this as a helpful tool. One big benefit of an HSA is that you take the money with you. There’s no “use it or lose it” policy like some other savings plans. Being able to set aside pre-taxed dollars to help pay for medical expenses can go along way when trying to manage diabetes.
FSA
Another way to set aside dollars for medical expenses is through a flexible spending account (FSA). An FSA is provided through your employer with a $2,650 limit. You can also use it to cover medical expenses for your spouse and dependents. One thing to keep in mind with FSA’s is that they do have an expiration period. You’re generally required to use the funds within your plan year. But your employer may offer extensions at their choosing. The benefit is, it can be used with any type of health plan. And diabetic supplies are eligible to be paid through FSA’s.
High interest savings account
If you’re not interested in dealing with your employer for coverage or a flexible spending account, a high interest savings account could be a good option to explore. It’s just like any other savings account, only with fewer restrictions. Not only are you saving for your medical needs, but your money is also making money. High interest savings accounts are opened through online banks – which means they don’t have to worry about maintaining branches all over the country. They can offer you higher interest rates, with the benefit of accessing your money whenever you want.
Unlike an HSA, a high interest savings account isn’t tied to a high deductible health plan with a dollar limit. And unlike an FSA, there’s no expiration date on when you can use your money. It removes any additional stress so you can concentrate on managing your condition properly. And as you earn interest, you can still take advantage of a number of outreach resources available for people with diabetes.
This condition can be a tough one to get a handle on, but it’s not insurmountable. Let your understanding of diabetes, your knowledge of its treatments, and your strategy for tackling costs work in your favor.
End-stage kidney disease is the final stage of chronic kidney disease. At this last stage, the kidneys are unable to work on their own, which means that a person either needs dialysis or a kidney transplant to stay alive. While a transplant is an ideal choice as it offers a cure, not everyone is a candidate for this surgery.
Even so, it’s critical to note that most people with chronic kidney disease do not end up needing dialysis.
This is because, with early care, a person can usually slow down the disease.
If you or a loved one are in the final stages of kidney disease, what can you expect, and what is it like to die from renal failure?
Definition of Chronic Kidney Disease
Your kidneys filter waste and water out of your bloodstream. When your kidney function declines, waste accumulates in the body, and this waste buildup can eventually lead to symptoms like severe nausea and vomiting, loss of appetite, and feeling sick and weak overall.
A loss of normal kidney function may occur suddenly (called acute kidney disease) or over a period of three or more months (called chronic kidney disease). Acute kidney disease has the potential to reverse itself. But in chronic kidney disease, kidney function gradually worsens with time.
There are five stages of chronic kidney disease, with the fifth stage representing end-stage kidney disease.
In other words, without a lifesaving measure like dialysis or a kidney transplant, a person would die within a week or so.
It’s important to note that a person’s kidney function tends to slowly get worse, although the rate at which kidney function declines and transitions from one stage to the next depends on many factors (for example, the underlying health condition that caused the kidney disease in the first place).
It can take many years or decades for renal failure to progress to the final stage of the disease.
Causes
There are many different causes of chronic kidney disease; the two most common are diabetes and high blood pressure.
Prolonged blockage of the urinary tract (for example, from a tumour or an enlarged prostate gland in men)
It’s important for a doctor to diagnose the “why” behind your kidney disease because he may be able to slow your disease down. For example, if high blood pressure is the culprit, then your doctor may be more aggressive with monitoring your blood pressure and keeping it within a normal range. Likewise, careful management of your blood sugars if you are diabetic, may slow the decline of your kidneys.
Diagnosis
There are a number of tests that a doctor may perform to properly diagnosis your chronic kidney disease, and some of these tests (for example, blood tests) will be repeated many times, even as you progress to the final stage.
Examples of tests that your doctor will perform to diagnosis and monitor your kidney function include:
Blood tests that measure your kidney function (for example, BUN and creatinine level) and electrolyte levels (for example, your potassium level)
Urine tests
Ultrasound of your kidney
Biopsy of your kidney (a procedure in which a small tissue sample is taken of your kidney and examined under a microscope)
CT scan of your kidneys
Your doctor will also want to determine your glomerular filtration rate (GFR). This number allows your doctor to best understand your kidney function and determine the stage of your disease. The GFR is easily calculated using your blood creatinine level, age, gender, and race.
While some of these tests are initially ordered by an internist or family medicine doctor, a person with chronic kidney disease is eventually referred to a kidney specialist called a nephrologist, especially as he progresses to later stages.
In fact, studies have found that those who are referred to a nephrologist often live longer than those who do not see a specialist.
A nephrologist can follow your kidney function carefully and discuss a treatment plan with you if your kidneys fail. She can also monitor any complications that arise as a result of your kidney disease, such as anaemia or bone disease.
Symptoms
Just as the progression of chronic kidney disease is variable, so are the associated symptoms. In addition, the timing at which a person begins to experience symptoms of his or her kidney disease is not cut and dry. In fact, many people feel relatively OK until their disease is advanced. This is one reason to see your doctor regularly for blood tests.
Some of the symptoms a person may experience in chronic kidney disease, especially as it advances towards the final stage, include:
Loss of Energy
The first thing you might notice is feeling more sleepy or tired than usual. Your sleeping patterns might change. You might sleep more during the day or have difficulty sleeping at night. The fatigue associated with kidney failure is different than ordinary tiredness. You may feel tired despite a good night of sleep or a cup of coffee.
Mental Changes
You might notice mild confusion or problems concentrating early on that might progress to disorientation, anxiety, irritability, or even delirium. When a person develops severe waste buildup from kidney failure, seizures and coma may occur.
Abnormal Sensations
Restless legs, burning feet, or other sensory problems may develop as a result of a significant waste buildup in the body. In fact, when this happens, it can be a sign that dialysis is urgently needed.
Muscle Changes
As minerals build up in the blood, you might notice muscle twitching or cramps, especially at night.
Skin Changes
The build-up of a chemical called urea in the blood may cause your skin to itch, and you might even develop a fine white powder on your skin. Itching can usually be controlled with topical creams or antihistamines, such as Benadryl (diphenhydramine).
Appetite and Weight Changes
Your appetite will decrease, and you might lose weight. Alternatively, you might gain weight as your body retains extra fluid.
If you are not producing much urine but still drinking fluids, you might notice that your feet, legs, and ankles swell, which is called edema.
Malnutrition in chronic kidney disease is a major problem, which is why people will often follow a special diet to optimize their nutritional status.
Changes in Urination
You might pass little or no urine at all. If this is the case for you, limiting the amount of fluid you drink might improve your comfort level by decreasing the amount of excess fluid in your body.
Others may experience changes in their pattern of urination like urinating more, losing control of their urine (called incontinence), or developing more urinary tract infections.
Sexual Dysfunction
Women often develop menstrual and fertility problems in chronic kidney disease whereas men develop erectile dysfunction. In addition, most women who reach end-stage kidney disease stop having periods.
Breathing Changes
The build-up of acids in the blood might cause changes in breathing, such as breathing faster and more shallow, but these changes are generally not uncomfortable. However, fluid can build up in the lungs and chest wall causing shortness of breath and chest pain.
Other Changes
There are other health issues associated with chronic kidney diseases such as a low blood count, low platelets (which help clot your blood and can lead to easy bruising), bone problems, malnutrition, fluid shifts, and electrolyte abnormalities. Breath odor, vomiting, and challenging hiccups may also occur.
Treatment
Treatment of your chronic kidney disease depends on the functioning of your individual kidneys. For instance, a person in a lower stage of chronic kidney disease may be able to take a diuretic to urinate out excess fluid. On the other hand, a person with end-stage kidney disease who makes no urine needs dialysis to remove excess fluid from the body.
Your doctor will also treat any complications related to your kidney disease. For example, you may need medication for anaemia or a drug to prevent bone loss.
Final Stages of Kidney Disease for Loved Ones
People can sometimes live many years with the help of dialysis. Yet, without dialysis, or if a person chooses to forego dialysis, death often occurs within a few weeks. As toxins build up in the blood (which is called uraemia), a person will begin to sleep most of the day. She may see things that aren’t there, or talk about speaking with people who have died in the past. Her skin may become mottled, and she will lose all sense of hunger. The sense of thirst may also disappear, although kidney failure can often cause excessive thirst. As she gets closer to death, she may become very congested and develop irregular breathing (Cheyne-Stokes respiration). These symptoms may be very uncomfortable for loved ones, but do not appear to be uncomfortable for the person who is dying. As she nears death, she will probably slip into a coma. At this time, simply spending time with her is important. We’ve learned that the sense of hearing is the last sense to leave, so talking to her may be a great comfort.
When compared to people dying from cancer, those dying from end-stage kidney disease were found to have higher rates of hospitalization and fewer end of life instructions. It’s thought that people with stage 5 kidney disease could benefit from better palliative care and planning at the end of life. If your loved one is facing these last stages, talk to her doctor about palliative care and options such as hospice care.
A Word From Verywell
If you have chronic kidney disease, you may experience anxiety thinking about the future. Remain resilient and continue to work closely with your doctor. Careful monitoring and early detection of kidney disease are paramount in protecting your kidneys.
If you have end-stage kidney disease and are on dialysis or very close to starting dialysis, please be sure to discuss all your questions, worries, expectations, and goals of care with your doctor.
Whether you choose to have dialysis, or if not, talk to your doctor about palliative care. For people with cancer, this is often built into clinic visits, and a careful plan is made. With kidney failure, you may need to initiate this discussion to receive the best treatment and have the best quality of life with however much time you have left.
A common misconception that people often have is equating urine output to kidney function. Hence, the assumption is that if you are “making urine,” your kidneys are working just fine. However, nothing is further from the truth, and assessing the function of your kidneys requires lab testing and sometimes radiological imaging.
Most people know that getting a stress test is a way to test your heart’s function.
But how do you test your kidney function? You might have heard doctors mention words like “creatinine” or “GFR” when checking how good or bad your kidneys are doing. Although there are a lot of methods by which the kidneys’ performance can be measured, I will explain the ones that are used most often in a clinical setting.
Broadly speaking, you could check kidney function through either:
This is the most common and usually the most reliable method. Doctors will often order tests that could be variously worded like “basic metabolic panel (BMP),” “chem 7,” “renal function panel,” “GFR,” etc. Essentially, what they are measuring is the levels of electrolytes and two other chemicals called blood urea nitrogen (BUN) and creatinine.
BUN measures the amount of nitrogen present in your blood in the form of urea, hence the name BUN! In other words, what we are measuring is the urea level in the blood.
Urea, as you might know, is a nitrogen-containing compound present in the urine of mammals and often used as a fertilizer. Before you conclude that there is fertilizer flowing in your blood, let me make emphasize that industrial grade urea that is used in fertilizers is manufactured artificially. In fact, urea was the first “organic“ (that is, found in nature in living organisms) compound that was artificially synthesized in a laboratory when German scientist Friedrich Wohler synthesized ammonium cyanate in 1828.
BUN: An Imperfect Test
So why do we measure the urea level in the blood? That is because the blood urea level, (or BUN!) depends on the balance between processes that increase its blood level vs. the processes that decrease its blood level. Factors that increase the level of urea in the blood include dietary protein intake, the ability of your liver to synthesize urea, and the rate of normal cell breakdown (medically referred to as “catabolism”) that also leads to urea production. Finally, the process that decreases the urea level in the blood is your kidney’s ability to excrete urea in the urine.
Assuming that the factors that increase urea level stay constant on a day to day basis, you could argue that the urea level in the blood would be most dependent on your kidneys’ functioning. Hence, kidney disease could be detected by an increase in the blood level of urea, or BUN. However, please bear in mind that this is a simplistic explanation, and the BUN levels, as you might have guessed, could be influenced by diet, catabolism, and the liver function.
Creatinine Is a Better Alternative
You thus don’t need to be a medical professional to realize that BUN is but an utterly imperfect test of kidneys’ function, subject to the vagaries of a multitude of other non-renal factors.
So let’s talk about the other chemical I mentioned above: creatinine.
The word “creatinine” comes from the Greek word for flesh, and it is a product of muscle breakdown. Since your muscle mass does not change on a daily basis, the rate of creatinine production is also fairly constant. As creatinine level in the blood builds up (from muscle breakdown), the kidneys do a great job of filtering it out of your system. (A very small, and usually insignificant (unlike urea!) amount of creatinine is reabsorbed by the kidneys, which could technically influence its blood level, but for simplicity, let’s disregard that for now).
Hence, assuming a steady muscle mass, the level of creatinine in the blood should only be influenced by the kidney’s ability to filter it out. Therefore, increase in blood level of creatinine usually implies worse kidney function.
The blood’s creatinine level is hence a useful piece of data that can help physicians estimate the rate at which kidneys filter blood using validated formulas and equations (that we obviously don’t need to worry about here). That rate is referred to as Glomerular Filtration Rate or GFR; a term you might hear physicians throw around a lot when talking about your kidney function. For most average sized people, a normal GFR would lie between 60 to 120 ml/min.
Normal Is Normal for Normal People!
GFR estimation is based on a formula that was designed for average sized normal people. Since the calculation depends on the blood creatinine level, which in turn depends on the muscle mass, it may not be applicable in people in extremes of age (kids, people over 70 yrs.), or muscle mass (people with muscle wasting, liver failure, etc). In other words, a creatinine level of 1.2 (considered “normal” as per most lab ranges) might be ok for a muscular person like Arnold Schwarzenegger but could reflect significant kidney disease in a 90-year-old woman. Just like the BUN level, a medical professional should be able to tell when to consider creatinine and GFR levels really abnormal.
Urine Tests
Testing the urine to look for protein or blood, and its chemical composition may help in indicating the presence of kidney disease. Protein or blood should usually not be detectable in urine and are non-specific markers of kidney disease. A physician should determine whether further specific workup and/or a referral to a nephrologist is warranted.
Radiological Imaging
These techniques entail taking pictures of the kidneys using different methods like ultrasound, CT scan, or MRI. This can help in determining the shape and size of the kidneys. The kidneys are smooth bean-shaped organs approximately 8-14 cm (3-5.5 inches) in size (depending on the person’s size). Most chronic kidney diseases, with some exceptions, tend to distort the kidneys’ architecture and this can be picked up easily on imaging. One might also be able to pick specific causes of kidney disease/dysfunction like stones, obstructions, hydronephrosis, polycystic kidney disease, etc.
Source:
Hall JE, Guyton AC. (2011). Guyton and Hall textbook of medical physiology. Philadelphia, PA: Saunders Elsevier.
