The Organs You Never Think About — Until They Start Failing
India has the fastest-growing rate of chronic kidney disease in the world. An estimated 17% of Indians have some degree of kidney dysfunction — most without knowing it.
You could lose 75% of your kidney function silently, without a single symptom. You'd feel completely fine. That's the problem with kidney disease: by the time symptoms appear, it's often past the point of reversal.
Years of poorly controlled diabetes or ignored high blood pressure can quietly destroy your kidneys while you "feel fine." This is why understanding creatinine, eGFR, and other kidney markers is critical — they reveal damage long before symptoms appear.
What Your Kidneys Actually Do
Your kidneys aren't just filters. They're sophisticated chemical processing plants that:
- Filter blood: 150 liters per day, producing about 1.5 liters of urine
- Remove waste: Creatinine, urea, toxins, drug metabolites
- Balance electrolytes: Sodium, potassium, calcium, phosphorus
- Regulate blood pressure: Through the renin-angiotensin system
- Produce hormones: Erythropoietin (for red blood cells), active vitamin D
- Maintain acid-base balance: Preventing metabolic acidosis
When kidneys fail, all of these functions are compromised. Toxins accumulate. Blood pressure rises. Anemia develops. Bones weaken. Electrolytes become dangerous.
India's Silent Kidney Crisis
The statistics are sobering:
- 17% of Indians have some form of chronic kidney disease (CKD)
- Over 200,000 Indians progress to end-stage kidney disease each year
- Only 10% of those who need dialysis actually receive it (cost and access barriers)
- Diabetes and hypertension cause 60-70% of kidney failure cases
- Average age of kidney failure in India: 10 years younger than in Western countries
India faces a kidney disease epidemic driven by the diabetes and hypertension epidemics.
Understanding Creatinine: The Number Everyone Watches
Creatinine is a waste product from muscle metabolism. Your kidneys filter it out. When kidney function declines, creatinine rises.
| Creatinine Level | What It Generally Means | Important Context |
|---|---|---|
| 0.6 - 1.2 mg/dL (men) 0.5 - 1.1 mg/dL (women) | Normal range | But "normal" creatinine can hide significant kidney damage |
| 1.3 - 1.9 mg/dL | Mildly elevated | Could indicate 30-50% kidney function loss |
| 2.0 - 4.0 mg/dL | Moderately elevated | Significant kidney impairment |
| Above 4.0 mg/dL | Severely elevated | Advanced kidney disease, approaching dialysis |
Why Creatinine Alone Is Misleading:
A muscular 30-year-old man and a frail 80-year-old woman can have the same creatinine level despite vastly different kidney function. Creatinine depends on muscle mass, diet, and other factors.
This is why eGFR is needed — an estimate that accounts for age, sex, and sometimes race.
eGFR: The Number That Actually Matters
eGFR (estimated Glomerular Filtration Rate) tells you how many milliliters of blood your kidneys can filter per minute. It's calculated from creatinine, age, and sex.
| eGFR (ml/min/1.73m²) | CKD Stage | Interpretation |
|---|---|---|
| Above 90 | Stage 1 (if other signs of kidney damage) | Normal or high function |
| 60 - 89 | Stage 2 (if other signs) | Mildly decreased, usually no symptoms |
| 45 - 59 | Stage 3a | Mild-moderate decrease, may be reversible |
| 30 - 44 | Stage 3b | Moderate-severe decrease, complications possible |
| 15 - 29 | Stage 4 | Severe decrease, prepare for dialysis/transplant |
| Below 15 | Stage 5 | Kidney failure, dialysis or transplant needed |
Notice something important: you can lose 40% of kidney function (eGFR dropping from 100 to 60) while still being in "normal" creatinine range. This is why eGFR catches problems earlier.
The Warning Sign Most People Miss: Urine
Your urine tells a story. Here's what to watch for:
Protein in Urine (Albuminuria)
Healthy kidneys don't leak protein. When they're damaged, protein (especially albumin) spills into urine.
| Urine Albumin-to-Creatinine Ratio (UACR) | Category | Significance |
|---|---|---|
| Below 30 mg/g | Normal | No significant protein leak |
| 30 - 300 mg/g | Moderately Increased (microalbuminuria) | Early kidney damage — treatable and often reversible |
| Above 300 mg/g | Severely Increased (macroalbuminuria) | Significant damage — aggressive treatment needed |
Microalbuminuria is a critical early warning. It appears years before creatinine rises. In diabetics and hypertensives, it's the canary in the coal mine.
Other Urine Changes to Notice
- Foamy urine: Suggests protein (like egg whites in a pan)
- Blood in urine: Could indicate kidney disease, stones, infection, or cancer
- Decreased output: Less than usual despite normal intake
- Getting up at night to urinate: Can indicate kidneys losing concentrating ability
The Causes: Why Kidneys Fail
The Big Two
Diabetes: The leading cause of kidney failure in India (and globally). High blood sugar damages the tiny blood vessels in kidney filtering units. Over 10-20 years, this leads to progressive loss.
Hypertension: The second leading cause. High pressure damages blood vessels throughout the kidneys. Uncontrolled BP + uncontrolled diabetes = accelerated kidney decline.
Other Important Causes
- Chronic glomerulonephritis: Inflammation of kidney filtering units
- Polycystic kidney disease: Genetic — kidneys develop multiple cysts
- Obstructive uropathy: Blocked urine flow (stones, enlarged prostate)
- Drug-induced: NSAIDs (painkillers), certain antibiotics, chemotherapy
- Recurrent kidney infections
- Unknown (idiopathic): ~10-15% of cases
The NSAID Danger:
Over-the-counter painkillers like ibuprofen (Brufen, Advil), diclofenac (Voveran), and naproxen are kidney-toxic when used regularly. Many Indians pop these pills frequently for headaches, joint pain, or menstrual cramps. Long-term use can cause irreversible kidney damage.
If you need regular pain medication, use paracetamol (acetaminophen) instead — it's kidney-safe.
Symptoms: The Late Arrivals
The tragedy of kidney disease is that symptoms appear only in advanced stages. Kidneys have so much reserve capacity that they compensate until 70-80% function is lost.
Early Stages (Often Nothing)
- No symptoms at all
- Maybe some fatigue (attributed to stress)
- Slightly elevated blood pressure
Moderate Stages
- Fatigue, weakness
- Swelling in feet and ankles (edema)
- Puffiness around eyes (especially morning)
- More frequent urination, especially at night
- Foamy urine
- Poor appetite, nausea
- Difficulty concentrating
Advanced Stages
- Severe fatigue, weakness
- Significant swelling
- Breathlessness (fluid accumulation)
- Persistent nausea, vomiting
- Muscle cramps
- Itching (uremic toxins)
- Sleep problems
- Mental confusion
The Tests Every Indian Should Know
Basic Kidney Panel
- Serum Creatinine + eGFR: The foundation
- Blood Urea/BUN: Another waste product, rises with kidney impairment
- Urine Albumin: Catches early damage
- Urine Routine: Checks for blood, protein, infection
Additional Tests When Abnormal
- Electrolytes: Sodium, potassium, calcium, phosphorus
- Hemoglobin: Anemia common in CKD (kidneys produce erythropoietin)
- Vitamin D: Often low (kidneys activate vitamin D)
- PTH (Parathyroid Hormone): Rises in CKD, affects bones
- Ultrasound: Checks kidney size, structure, obstruction
Who Should Be Screened
Annual Kidney Screening If:
- You have diabetes (any type)
- You have hypertension
- You have heart disease
- You have a family history of kidney disease
- You're over 60 years old
- You use NSAIDs regularly
- You have recurrent kidney stones or UTIs
Screening = creatinine, eGFR, and urine albumin. Simple blood and urine tests.
Protection: How to Save Your Kidneys
Control Diabetes Tightly
Keep HbA1c below 7%. Every point of HbA1c above target accelerates kidney damage. This is the single most important intervention for diabetic kidney protection.
Control Blood Pressure
Target below 130/80 if you have diabetes or kidney disease. ACE inhibitors or ARBs are preferred — they protect kidneys beyond just lowering BP.
Avoid Nephrotoxic Drugs
- Limit NSAIDs (ibuprofen, diclofenac, naproxen)
- Be cautious with certain antibiotics (aminoglycosides)
- Avoid herbal supplements with unknown ingredients
- Tell every doctor about your kidney status before they prescribe anything
Stay Hydrated (But Don't Overdo It)
Drink enough water to keep urine pale yellow. Dehydration stresses kidneys. But there's no need to force 8 glasses if you're not thirsty — overhydration isn't protective either.
Limit Protein (In Advanced CKD)
If eGFR is below 30, excessive protein can accelerate decline. Consult a renal dietitian.
Quit Smoking
Smoking directly damages kidney blood vessels and accelerates CKD progression.
When Kidneys Fail: The Options
If kidneys fail completely (Stage 5, eGFR below 15), there are three options:
1. Hemodialysis
Blood is filtered through a machine 3 times per week, 4 hours per session. Effective but demanding. Requires access creation (fistula or catheter). Most common option in India.
2. Peritoneal Dialysis
Done at home. Uses the abdominal lining as a filter. More freedom but requires training and discipline. Underutilized in India.
3. Kidney Transplant
The best option for suitable candidates. A living donor kidney lasts 15-20 years on average; a deceased donor kidney 10-15 years. Requires lifelong immunosuppression but offers the best quality of life.
The Transplant Reality in India:
There are over 200,000 patients waiting for kidneys but only about 8,000 transplants happen annually. The gap is due to donor shortage, cost, and access barriers. Living donor transplants (usually from relatives) are more common than deceased donor transplants.
The Drug That's Changing Everything: SGLT2 Inhibitors
A class of diabetes drugs — empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana) — has been shown to dramatically slow kidney disease progression.
Originally developed for diabetes, these drugs protect kidneys even in non-diabetics with CKD. They've reduced progression to kidney failure by 30-40% in trials.
If you have diabetes and kidney disease, ask your doctor about these medications. They're game-changers.
Common Questions About Kidney Health
"Can kidney damage be reversed?"
In early stages (Stage 1-2), yes — especially if the cause is addressed (e.g., controlling diabetes and BP). In later stages, the goal is slowing progression, not reversal. But every bit of preserved function matters.
"My creatinine is normal but eGFR is 58. Should I worry?"
Mild reduction (60-89) may be normal in older adults or reflect a stable condition. But with diabetes, hypertension, or protein in urine, even an eGFR of 58 warrants close monitoring and protection strategies.
"How much water should I drink?"
Enough to produce pale yellow urine. For most people, 1.5-2 liters daily. Don't force excessive amounts — there's no evidence that extra water protects kidneys.
"Should I avoid protein?"
In early CKD, moderate protein is fine. In advanced CKD (Stage 4-5), protein restriction may help slow progression and reduce symptoms. Consult a kidney specialist.
"Can I take creatine supplements?"
Creatine can raise creatinine levels slightly (it's metabolized to creatinine), potentially confusing kidney function assessment. Avoid if you have CKD or if you're being monitored for kidney health.
The Importance of Early Detection
Mr. Sharma's story doesn't have a happy ending — not yet. His kidneys had been damaged too much by years of neglected diabetes and hypertension. He's now on dialysis, three times a week, hoping for a transplant.
But his son, who accompanied him that first day, got himself tested. At 32, with borderline diabetes and slightly elevated BP, his eGFR was normal. He was caught early. He's now on medication, lifestyle changes, and close monitoring.
He won't repeat his father's journey. That's the power of awareness and early action.
Your Kidney Action Plan:
- Know your numbers: Creatinine, eGFR, urine albumin
- Control the big two: Diabetes and blood pressure
- Get screened annually if you have risk factors
- Avoid NSAIDs: Use paracetamol for pain instead
- Act on early warnings: Microalbuminuria is reversible — don't ignore it
- Don't wait for symptoms: By then, it's often too late
Track your kidney function over time with ExaHealth. Upload your lab reports and see your eGFR trends — because catching decline early can save your kidneys.
