Protect Your Kidneys: How Blood and Urine Tests Reveal Early Kidney Disease

According to recent statistics, the number of dialysis patients in Taiwan has exceeded 92,000, and 46% of newly diagnosed dialysis patients are caused by diabetes. Our hospital is a health promotion institution for diabetes and kidney disease. Early awareness, early diagnosis, and early treatment of kidney disease are the key ways to stay away from uremia.

As mentioned previously by Dr. Huang Cheng-Pin
(“Your First Experience at the Nephrology Clinic—What You Need to Know!!!”), kidney function can be assessed through blood tests (creatinine) and urine tests (urine protein).

From the blood creatinine level, another value will also be shown in the report, which is the glomerular filtration rate (GFR). Creatinine and GFR are inversely related:

• High creatinine → low GFR

• Low creatinine → high GFR

We usually refer to the GFR as a “kidney score.”

• 60 or above = passing

• Below 60 = failing

When blood test results show a failing GFR, it indicates that kidney function may have acute or chronic damage.

A passing kidney score is generally considered normal. However, even if the kidney score is normal, the presence of proteinuria indicates an early sign of serious kidney disease.
If the kidney score is failing or proteinuria persists for more than three months, it is defined as chronic kidney disease (CKD). Based on the GFR and whether proteinuria is present, kidney disease is classified into five stages.
The image shows the five stages of chronic kidney disease.

In the clinic, I am often asked:

“Doctor, my test report shows urine protein with one plus (+) or two pluses (2+ or ++). Does that mean there's a kidney problem? Is it serious?”

or

“Doctor, my urine looks foamy. Does that mean I have proteinuria?”

In fact, foamy urine does not necessarily mean proteinuria, nor does it always indicate a kidney problem. However, if kidney function is already impaired and obvious foamy urine appears, this is a serious concern, and prompt medical evaluation and treatment are necessary.

Therefore, we remind everyone not to ignore foamy urine. If foamy urine occurs or proteinuria is detected in test results, you should seek medical attention early for further evaluation and examination.

Chronic Kidney Disease (CKD) Case Manager Specialty:

Prevention and Management of CKD-Related Complications

Diabetes

-Prevention of Diabetic Nephropathy

1. Diabetes is one of the most common causes of end-stage renal disease.

2. Early intervention can significantly reduce the incidence and progression of diabetic kidney disease.

3. Maintaining glycated hemoglobin (HbA1c) at around 7% can lower the risk of developing diabetic nephropathy.

Hypertension

-Blood Pressure Management in Chronic Kidney Disease

1. The goal of antihypertensive treatment—regardless of whether hypertension is present—is to control blood pressure in order to slow the progression of kidney disease and reduce the risk of cardiovascular events.

2. The recommended blood pressure target is below 130/80 mmHg, which helps slow kidney disease progression and reduce cardiovascular risk.

3. Regular blood pressure monitoring is an essential and effective strategy for patients with CKD and hypertension.

Cardiovascular Disease

-Prevention of Cardiovascular Disease

1. Patients with chronic kidney disease have an increased risk of cardiovascular disease.

2. Risk factors associated with CKD play an important role in the development of cardiovascular disease.

3. Cardiovascular disease is one of the leading causes of death in patients with CKD.

4. Early intervention in CKD and control of risk factors can help achieve better outcomes.

-Gout

1. Many patients with chronic kidney disease develop gout due to impaired uric acid excretion.

2. Elevated blood uric acid levels can lead to gout attacks.

3. Studies show that hyperuricemia may increase the risk of hypertension, cardiovascular disease, and progression of kidney disease.

4. Treatment includes both medication therapy and non-pharmacological management.

Directions for Blood Glucose Control

Source: American Diabetes Association Guidelines, 2017

Benefits of Blood Glucose Control:
Proper blood glucose control can reduce the risk of cardiovascular disease, kidney disease, retinopathy, and neuropathy associated with diabetes.

Control Targets

Item	Target
HbA1c	< 7%
Fasting Blood Glucose	80–130 mg/dL
Postprandial Blood Glucose (2 hours)	< 180 mg/dL
Blood Pressure	Systolic ≤ 140 mmHg / Diastolic ≤ 90 mmHg