top of page
GlomCon Logo V7 - Black100-percent.png
Kidney Topics
Understanding Your Diagnosis

  • If you’ve recently been diagnosed with kidney disease, your doctor might have recommended a kidney biopsy to understand your disease better. Receiving the results of a biopsy can feel overwhelming, especially when faced with a new diagnosis which seems like medical jargon.

    • A kidney biopsy is a procedure in which a small piece of kidney tissue is removed and examined under a microscope. This helps doctors identify what is causing kidney problems, how much damage has occurred, and the best treatment options.

    • When you receive your biopsy results, you may see several sections. Each part offers important insights into your kidney health:

       

      1. Gross Description

      This section provides a basic description of the tissue sample, including its size and color. While it doesn’t contain diagnostic information, it ensures that the sample is large enough for proper evaluation.

       

      2. Light Microscopy (LM)

      Light microscopy involves examining the kidney tissue under a regular microscope. Here are the key parts of the kidney that are checked:

      • Glomeruli: These are tiny filtering units in your kidneys.

        • Normal: Healthy filtering structures.

        • Scarring or Sclerosis: Some of the glomeruli are damaged and have scar tissue, which can reduce kidney function and/or cause protein in urine.

        • Inflammation: If present, it could indicate an immune response causing damage.

      • Tubules: These structures transport filtered fluid through the kidney.

        • Atrophy: This means the tubules have shrunk or been damaged, often due to long-standing kidney disease.

      • Interstitium: This is the tissue surrounding the tubules.

        • Fibrosis: Fibrosis means scarring of the interstitial tissue, which can reduce how well your kidneys work.

      • Blood Vessels: The report may mention thickening or narrowing of the blood vessels, which can affect blood flow to your kidneys.

       

      3. Immunofluorescence (IF)

      This test looks for immune deposits in the kidney tissue. Immune deposits occur when your immune system mistakenly attacks your kidneys. These deposits can be made up of antibodies or proteins. Here are some common findings:

      • IgA, IgG, IgM: These are types of antibodies. For example, finding IgA deposits may indicate a condition called IgA nephropathy.

      • C3, C4: These are proteins involved in your immune system. Their presence might suggest an autoimmune disease.

      • Kappa and Lambda Light Chains: These proteins are part of normal antibodies but can be produced a lot in like multiple myeloma, a disease where abnormal proteins can damage the kidneys.

       

      4. Electron Microscopy (EM)

      Electron microscopy provides a highly detailed view with a magnification of 10,000X of your kidney tissue, showing tiny structures that regular microscopes can’t see. Here are a few things doctors look for:

      • Podocyte Effacement: Podocytes are special cells that help filter your blood. Effacement means they’re damaged, which is common in diseases like minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS).

      • Deposits: Electron-dense deposits can indicate the presence of immune complexes or abnormal proteins.

    • Here are some terms commonly found in biopsy reports and what they mean:

      • Global vs. Segmental:

        • Global: The entire glomerulus is affected.

        • Segmental: Only part of the glomerulus is affected.

      • Diffuse vs. Focal:

        • Diffuse: Most or all of the glomeruli are affected.

        • Focal: Only some glomeruli are affected.

      • Proliferative: This means there are more cells than normal, often due to inflammation.

      • Necrosis: Tissue death, indicating severe damage.

      • Crescent Formation: This is a sign of severe injury to the glomeruli and is often seen in rapidly progressing kidney diseases.

    • Your biopsy results help your doctor:

      • Identify the type of kidney disease you have (e.g., IgA nephropathy, lupus nephritis, or diabetic nephropathy).

      • Determine whether your disease is active (inflammation) or chronic (scarring).

      • Assess how much damage has already occurred.

      • Decide on the best treatment plan for you.

    • When discussing your biopsy results, consider asking these questions:

      1. What type of kidney disease do I have?

      2. Is my kidney disease active or chronic?

      3. How much permanent damage or scarring is present?

      4. What are my treatment options?

      5. How will this affect my kidney function in the long term?

    • Understanding your kidney biopsy report can help you feel more informed and empowered in managing your condition. While the medical terms may seem intimidating at first, your healthcare team is there to explain what they mean and guide you through your treatment options.

      ​

      If you have specific questions or concerns about your results, don’t hesitate to contact your nephrologist—they’re your best resource for understanding your kidney health.

  • Proteinuria, or the presence of excess protein in the urine, is a common sign of kidney disease. If you've been diagnosed with proteinuria, you might wonder what it means, why it is important and how to reduce it. This guide will help you understand proteinuria and provide actionable tips to lower it, helping protect your kidney health.

    • Proteinuria occurs when the tiny filtering units in the kidneys, called glomeruli, are damaged and leak protein into the urine instead of keeping it in the bloodstream.


      The most common protein found in urine is albumin. Very little protein passes into the urine normally, so when levels are high, it can be a sign of kidney damage or stress.

    • High levels of protein in the urine can worsen kidney function over time and lead to chronic kidney disease (CKD) progression. By lowering proteinuria, you can:

      ​

      • Slow down kidney damage.

      • Reduce the risk of kidney failure.

      • Improve overall kidney health 

    • 1. Control Blood Pressure

      High blood pressure is one of the leading causes of proteinuria and kidney damage. Keeping your blood pressure in a healthy range can significantly reduce protein leakage.

      • Target blood pressure: Aim for BP less than 130/80 mmHg (or as advised by your doctor).

      • Medications: ACE inhibitors (like lisinopril) and ARBs (like losartan) are commonly prescribed to lower blood pressure and reduce proteinuria. These medications help relax the blood vessels in the kidneys and reduce protein leakage.

       

      2. Manage Blood Sugar Levels

      If you have diabetes, high blood sugar can damage the kidneys over time. Keeping your blood sugar levels under control is essential for preventing and reducing proteinuria.

      • Target HbA1c: Aim for an HbA1c level below 7% (or as recommended by your doctor).

      • Diet and medication: Work with your healthcare team to create a plan that includes a balanced diet, regular exercise, and medications if needed.

       

      3. Adopt a Kidney-Friendly Diet

      What you eat plays a significant role in kidney health. A kidney-friendly diet can help reduce proteinuria by lowering kidney workload and improving blood pressure.

      • Reduce salt intake: High salt intake can increase blood pressure and worsen proteinuria. Aim for less than 2,300 mg of sodium per day.

      • Choose healthy protein sources: Too much dietary protein can stress the kidneys. Switch to plant-based protein sources (like beans, lentils, and tofu) or opt for lean proteins (like fish and chicken) in moderation.

      • Limit processed foods: Processed foods often contain high sodium levels and unhealthy fats.

      • Increase fruits and vegetables: These provide essential nutrients and help maintain a healthy blood pressure.

       

      4. Maintain a Healthy Weight

      Being overweight or obese can increase your risk of developing high blood pressure and diabetes, both of which can contribute to proteinuria. Losing even a small amount of weight can help reduce proteinuria.

      • Exercise regularly: Aim for at least 150 minutes of moderate-intensity weekly exercise.

      • Set realistic goals: Gradual, sustainable weight loss is more effective than quick fixes.

       

      5. Stay Hydrated

      Proper hydration helps your kidneys function better. However, if you have advanced kidney disease, you may need to limit your fluid intake. Talk to your doctor about how much water you should be drinking daily.

       

      6. Avoid NSAIDs and Other Harmful Medications

      Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can worsen kidney function and increase proteinuria. Avoid these medications unless specifically approved by your doctor.

       

      7. Monitor Proteinuria Regularly

      Regular doctor visits and urine tests can help track your protein levels. Early detection of worsening proteinuria allows for timely adjustments in your treatment plan.

      • Urine protein-to-creatinine ratio (UPCR): This test measures the amount of protein in urine compared to creatinine. It's commonly used to monitor proteinuria.

      • 24-hour urine test: Sometimes, your doctor may request a 24-hour urine collection to get a more accurate measure of protein loss.

       

      8. Manage Stress

      Chronic stress can contribute to high blood pressure and poor blood sugar control, worsening proteinuria. Finding ways to manage stress can positively impact your kidney health.

      • Relaxation techniques: Try mindfulness, meditation, or yoga.

      • Sleep well: Aim for 7-8 hours each night to allow your body to repair and recover.

    • Several medications can help reduce proteinuria and protect your kidneys:

      ​

      1. ACE Inhibitors: These lower blood pressure and reduce protein leakage by relaxing the blood vessels in your kidneys.

      2. ARBs (Angiotensin II Receptor Blockers): Like ACE inhibitors, ARBs help reduce proteinuria by protecting the kidney's blood vessels.

      3. SGLT2 Inhibitors: Originally developed for diabetes, these medications (like empagliflozin and dapagliflozin) have lowered proteinuria and slowed CKD progression.

      4. Aldosterone Antagonists: These may be added to treatment if proteinuria remains high despite other medications.

    • To better understand and manage proteinuria, you can ask your doctor the following questions:

      1. What is the cause of my proteinuria?

      2. How much protein is in my urine, and what is the target level?

      3. What medications should I take to lower proteinuria?

      4. Should I make any changes to my diet or lifestyle?

      5. How often should I monitor my protein levels?

    • Lowering proteinuria is a key step in protecting your kidneys and slowing down the progression of kidney disease. You can reduce protein leakage and improve your overall health by controlling blood pressure, managing blood sugar, adopting a healthy lifestyle, and taking prescribed medications.

       

      Remember, your healthcare team is there to support you, so don't hesitate to ask questions and seek guidance. Small changes in your daily routine can make a big difference in managing proteinuria and preserving kidney function.

  • eGFR stands for estimated Glomerular Filtration Rate. It’s a blood test to measure how well your kidneys filter waste and excess fluids from your blood. The eGFR is an essential indicator of kidney function and helps diagnose and monitor kidney disease.

    • eGFR is calculated using a formula that considers several factors, including:

      • Serum Creatinine: A waste product in your blood that comes from muscle metabolism. Higher levels indicate reduced kidney function.

      • Age: Kidney function naturally declines with age.

      • Sex: Men generally have more muscle mass than women, which can affect creatinine levels.

    • eGFR is reported in mL/min/1.73 m², representing the amount of blood filtered by the kidneys per minute per standardized body surface area. The results fall into different ranges, which correspond to the stages of chronic kidney disease (CKD):

      eGFR (mL/min/1.73 m²)
      Stage
      Meaning
      15-29
      Stage 4
      Severe loss of kidney function.
      Less than 15
      Stage 5
      Kidney failure (End-Stage Kidney Disease or ESRD).
      30-44
      Stage 3b
      Moderate to severe loss of kidney function.
      45-59
      Stage 3a
      Mild to moderate loss of kidney function.
      60-89
      Stage 2
      Mild loss of kidney function.
      90 or higher
      Stage 1
      Normal or high kidney function, but signs of kidney damage may be present.

      • Early Detection: A declining eGFR can indicate early kidney damage before you have noticeable symptoms.

      • Monitoring: If you have kidney disease, your eGFR helps track the progression of the disease.

      • Guiding Treatment: Your eGFR level helps your doctor decide on treatments, such as medications, dietary changes, or when dialysis may be needed.

    • eGFR is an estimate, so certain factors can influence the results:

      • Muscle mass: People with high or low muscle mass may have inaccurate eGFR readings.

      • Diet: High protein intake or recent vigorous exercise can temporarily raise creatinine levels, lowering eGFR.

      • Pregnancy: Kidney function changes during pregnancy, so special care is needed when interpreting eGFR.

      • Medications: Certain drugs can affect creatinine levels and, consequently, eGFR.

      • Supplements: Like creatine can increase serum creatinine levels

    • If your eGFR is lower than normal, your doctor may recommend:

      1. Further Testing: Urine tests to look for protein or blood in urine  and ultrasounds of kidneys  to assess the size and shape of kidneys.

      2. Lifestyle Changes:

        • Reducing salt intake.

        • Decreasing processed food intake

        • Staying hydrated.

        • Managing blood pressure and blood sugar levels.

      3. Medications: ACE inhibitors or ARBs may be prescribed to protect kidney function.

      4. Regular Monitoring: Routine eGFR tests to track kidney function over time.

    • eGFR is a simple but crucial test for understanding how well your kidneys are functioning and filtering toxins. If your eGFR is low, it doesn’t necessarily mean immediate kidney failure—it’s a sign to work with your doctor on a plan to manage and protect your kidney health.

  • If you have been diagnosed with kidney disease, your doctor will likely order various tests to monitor your kidney function and overall health. Understanding these tests can help you feel more in control of your care. Here's a breakdown of the key medical tests and what their results mean.

    • 1. Serum Creatinine

      • What it measures: The creatinine level, a waste product from muscle metabolism, in your blood.

      • Why it matters: High creatinine levels indicate that your kidneys aren't filtering waste effectively.

      • Normal range:

        • Men: 0.7 to 1.3 mg/dL

        • Women: 0.6 to 1.1 mg/dL

       

      2. eGFR (Estimated Glomerular Filtration Rate)

      • What it measures: How well your kidneys filter waste from your blood.

      • Why it matters: eGFR helps determine the stage of kidney disease.

      • Normal range: 90 mL/min/1.73 m² or higher. Lower values indicate reduced kidney function.

       

      3. Blood Urea Nitrogen (BUN)

      • What it measures: The amount of urea nitrogen, another waste product, in your blood.

      • Why it matters: High BUN levels may indicate reduced kidney function.

      • Normal range: 7 to 20 mg/dL.

       

      4. Electrolytes (Sodium, Potassium, Calcium, Phosphorus)

      • Why they matter: Electrolyte imbalances are common in kidney disease and can affect brain, heart and muscle function.

      • Key values to watch:

        • Sodium: 135-145 mmol/L

        • Potassium: 3.5-5.0 mmol/L (High potassium can harm the heart.)

        • Calcium: 8.5-10.5 mg/dL

        • Phosphorus: 2.5-4.5 mg/dL (High phosphorus can lead to bone problems.)

       

      5. Hemoglobin and Hematocrit

      • What they measure: The amount of hemoglobin (a protein in red blood cells) and the percentage of red blood cells in your blood.

      • Why it matters: Low levels may indicate anemia, a common complication of kidney disease.

      • Normal range:

        • Hemoglobin: 13.5-17.5 g/dL (men), 12.0-15.5 g/dL (women)

        • Hematocrit: 38.3-48.6% (men), 35.5-44.9% (women)

    • 1. Urine Protein/Creatinine Ratio (UPCR)

      • What it measures: The amount of protein in your urine relative to creatinine.

      • Why it matters: High protein levels in the urine (proteinuria) indicate kidney damage.

      • Normal range: Less than 150 mg of protein per day.

       

      2. Urinalysis

      • What it measures: The presence of protein, blood, and other substances in your urine.

      • Why it matters: It helps detect signs of kidney damage, infection, or other abnormalities.

       

      3. 24-Hour Urine Collection

      • What it measures: The total amount of urine produced in 24 hours and the amount of protein and waste products.

      • Why it matters: It provides a more accurate picture of kidney function and protein loss.

    • 1. Ultrasound

      • What it shows: Your kidneys' size, shape, and structure.

      • Why it matters: It can detect kidney stones, cysts, or structural abnormalities.

       

      2. CT Scan or MRI

      • What they show: Detailed images of your kidneys.

      • Why they matter: These tests can identify tumors, blockages, stones, cysts or other kidney function issues.

       

      3. Kidney Biopsy

      • What it involves: Removing a small sample of kidney tissue for examination under a microscope.

      • Why it matters: It helps diagnose specific types of kidney disease and guides treatment.

    • 1. Parathyroid Hormone (PTH)

      • What it measures: The level of PTH, a hormone that regulates calcium and phosphorus levels.

      • Why it matters: High PTH levels can occur in kidney disease and lead to bone problems.

       

      2. Vitamin D Levels

      • Why it matters: Kidney disease can lead to low active vitamin D levels, affecting bone health.

       

      3. Cystatin C

      • What it measures: A protein that may provide a more accurate estimate of kidney function than creatinine in some cases.

      1. Know Your Baseline: Everyone's normal values can vary slightly. To track changes, keep a record of your test results over time.

      2. Focus on Trends: A single abnormal result may not be significant, but consistent changes over time can indicate a problem.

      3. Ask Questions: Don't hesitate to ask your healthcare provider to explain your results and what they mean for your condition.

      4. Work with Your Healthcare Team: Your nephrologist, dietitian, and primary care physician can help you understand your results and make necessary lifestyle changes.

      • What do my current test results mean for my kidney function?

      • How often should I have these tests done?

      • Are there specific steps I can take to improve my test results?

      • What are the warning signs that I should watch for between tests?

    • Regular testing is essential for managing kidney disease. Understanding your lab results can help you actively participate in your care and work closely with your healthcare team to protect your kidney health. By knowing what each test measures and why it matters, you can better track your condition and make informed decisions about your treatment.

  • Genetic testing is a powerful tool that can provide essential insights into kidney disease. For patients with kidney disease, genetic testing can help identify hereditary conditions, guide treatment options, and provide valuable information for family members.

    • Genetic testing involves analyzing your DNA—the genetic material that carries instructions for how your body grows and functions. By looking at your DNA, genetic tests can identify changes (mutations) in your genes that may explain your kidney disease or increase your risk of developing certain kidney-related conditions.

    • For kidney disease patients, genetic testing can:

      1. Identify Hereditary Kidney Conditions: Some kidney diseases, such as polycystic kidney disease (PKD) or Alport syndrome, are caused by inherited genetic mutations. Knowing if your condition is hereditary can guide your treatment and inform family members about their risk.

      2. Help with Diagnosis: Genetic testing can help diagnose rare or complex kidney conditions when other tests are inconclusive.

      3. Guide Treatment Decisions: Certain genetic mutations can affect how you respond to specific medications. For example, genetic testing may help your doctor choose the most effective treatment and avoid medications that could worsen your condition.

      4. Provide Family Planning Information: Genetic testing can help assess the risk of passing it on to your children if you have a hereditary kidney condition.

      1. Diagnostic Testing

        • Purpose: To confirm or rule out a specific genetic cause of kidney disease.

        • When it’s used: If you have symptoms of a genetic kidney disorder but no clear diagnosis.

      2. Carrier Testing

        • Purpose: To determine if you carry a gene for a hereditary kidney condition that could be passed on to your children.

        • When it’s used: If you have a family history of kidney disease and are planning to have children.

      3. Predictive Testing

        • Purpose: To assess your risk of developing a genetic kidney condition before symptoms appear.

        • When it’s used: If a close family member has a hereditary kidney disease, such as PKD.

      4. Pharmacogenetic Testing

        • Purpose: To determine how your genes affect your response to certain medications.

        • When it’s used: To guide medication choices and dosages for better treatment outcomes.

      1. Polycystic Kidney Disease (PKD): A condition where fluid-filled cysts develop in the kidneys, often leading to kidney failure.

      2. Alport Syndrome: A genetic disorder affecting the kidneys, hearing, and eyes caused by mutations in genes responsible for collagen production.

      3. Focal Segmental Glomerulosclerosis (FSGS): A disease that causes kidney scarring. Some forms of FSGS are linked to genetic mutations.

      4. Cystinosis: A rare genetic disorder where cystine accumulates in the kidneys and other organs.

    • Genetic testing typically involves:

      1. Sample Collection: A sample of your blood, saliva, or a swab inside your cheek is collected.

      2. Laboratory Analysis: The sample is sent to a lab where technicians analyze your DNA for genetic changes.

      3. Results Interpretation: A genetic counselor or doctor will review the results with you and explain what they mean for your kidney health.

    • Genetic test results generally fall into three categories:

      1. Positive Result:

        • A positive result means a genetic change associated with a specific kidney condition was found. This can confirm a diagnosis or indicate an increased risk of developing a condition.

      2. Negative Result:

        • A negative result means no genetic change was found for the specific condition tested. However, this doesn’t completely rule out the possibility of a genetic cause.

      3. Variant of Uncertain Significance (VUS):

        • Sometimes, a genetic test identifies a change in your DNA, but it’s unclear whether it is harmful. Further research or testing may be needed.

      1. Emotional Impact: Learning about your genetic risks can be stressful. It’s important to be prepared for any result, positive or negative.

      2. Family Implications: Genetic information can affect you and your family members, as they may share similar genetic risks.

      3. Privacy and Discrimination: In many countries, laws like the Genetic Information Nondiscrimination Act (GINA) protect against discrimination based on genetic information in health insurance and employment.

      4. Cost: Genetic testing can be expensive, and not all tests are covered by insurance. Check with your provider to understand what costs may be involved.

      5. Genetic Counseling: Consider speaking with a genetic counselor before and after testing. They can help you understand the benefits, limitations, and potential outcomes of genetic testing.

      1. What specific genetic kidney condition are you testing for?

      2. How accurate is the test?

      3. What will the results tell me?

      4. How will the results affect my treatment or lifestyle?

      5. Should my family members also be tested?

      6. What support is available if I get a positive result?

    • Genetic testing can provide valuable information about kidney health and help guide important diagnosis, treatment, and family planning decisions. However, it’s not always straightforward, and the results can have significant implications for you and your family. Working with a genetic counselor or healthcare provider is key to understanding the process and making informed choices.

      ​

      If you’re considering genetic testing for kidney disease, don’t hesitate to ask questions and seek support. Knowledge is power—and understanding your genetic information can be an essential step toward taking control of your health.

Read More
1689680803-huge.jpg
GOT QUESTIONS?
Share your concerns confidentially and get expert insights from a nephrologist during our PACE meeting. 
bottom of page