The kidneys perform several essential functions that often go unnoticed. They filter waste products from the blood, regulate water and electrolyte balance, help control blood pressure and support red blood cell production.

When kidney function is affected, the changes may develop gradually. Some people notice unusual urine changes, swelling or persistent tiredness, while others feel completely normal even when kidney damage is present. Early chronic kidney disease frequently causes no obvious symptoms.

Understanding the signs your kidneys are not working properly can help you recognize when medical assessment may be necessary. However, symptoms alone cannot establish a diagnosis; blood and urine tests are often needed.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides evaluation and management for kidney-function abnormalities and kidney diseases.

1. Changes in Urine That May Signal a Kidney Problem

Urine can provide useful information about kidney and urinary tract health. Certain changes deserve attention, particularly when they persist or occur alongside other symptoms.

Foamy or Frothy Urine

Repeatedly foamy urine may indicate that protein is leaking into the urine. Persistent proteinuria can be a sign of damage to the kidney's filtering structures.

Occasional bubbles do not necessarily mean kidney disease, but ongoing foamy urine should be evaluated.

Blood in the Urine

Urine that appears pink, red, brown or tea-coloured may contain blood. Microscopic blood may only be detected through laboratory testing.

Possible causes include kidney disease, kidney stones, urinary infections and other urinary tract conditions. Visible blood should not be ignored.

Passing Urine More Frequently at Night

Waking up repeatedly at night to urinate may occur when kidney function is affected. However, diabetes, urinary infections, prostate problems, medications and other conditions can also cause this symptom.

Producing Less Urine Than Usual

A noticeable reduction in urine output can occur with dehydration, acute kidney injury, urinary obstruction or advanced kidney dysfunction.

A sudden, substantial reduction in urine output requires prompt medical assessment.

Changes in Urine Appearance

Cloudy urine, unusual colour or a strong smell may be associated with infection, blood, diet, medicines or other factors. These changes are not specific to kidney disease and need to be interpreted in context.

2. Persistent Tiredness That Does Not Improve With Rest

Feeling unusually exhausted can sometimes be associated with impaired kidney function.

Healthy kidneys produce erythropoietin, a hormone that helps the body make red blood cells. Chronic kidney disease can reduce this hormone's production and contribute to anaemia.

Anaemia may cause:

• Persistent fatigue

• Reduced stamina

• Weakness

• Difficulty concentrating

• Breathlessness during activity

Fatigue has many possible causes, including poor sleep, anaemia unrelated to kidney disease, thyroid problems and nutritional deficiencies. Blood tests can help determine what is responsible.

3. Swelling Around the Ankles, Feet or Eyes

When the kidneys cannot adequately remove excess sodium and water, fluid may accumulate in the tissues. Kidney conditions that cause substantial protein loss through urine can also lead to swelling.

You might notice:

• Shoes feeling tighter than usual

• Swelling around both ankles

• Puffy eyelids, particularly in the morning

• Rings becoming difficult to remove

• Unexplained weight gain associated with fluid retention

Swelling can also occur with heart disease, liver disease, venous circulation problems and certain medicines. It should not automatically be attributed to kidney disease.

4. High Blood Pressure or Difficulty Controlling It

The kidneys help regulate blood pressure by controlling fluid balance and participating in hormonal systems that influence blood vessel function.

Kidney disease can contribute to hypertension, and long-standing high blood pressure can damage the kidneys. This relationship can create a cycle in which each condition worsens the other.

Arrange medical assessment if your blood pressure remains above your prescribed target despite treatment. Your clinician may recommend kidney-function tests and urine albumin testing.

Very high blood pressure accompanied by chest pain, breathlessness, severe headache, confusion or vision changes requires emergency assessment.

5. Persistent Itching or Unusually Dry Skin

Dry, itchy skin may occur in advanced chronic kidney disease. Contributing factors can include skin dryness, altered mineral metabolism and changes in the body's inflammatory and nerve-signalling pathways.

However, itching is not a reliable way to determine whether someone has kidney disease or how advanced it is.

Eczema, allergies, medication reactions, liver disorders and other conditions can also cause persistent itching. If it continues without a clear explanation, a healthcare professional can help identify the cause.

6. Nausea, Reduced Appetite or an Unusual Taste in the Mouth

When kidney disease becomes advanced, waste products and fluid may accumulate in the body and contribute to digestive symptoms.

Possible changes include:

• Reduced appetite

• Nausea

• Vomiting

• Unintentional weight loss

• An unpleasant or metallic taste

• Feeling full or unwell after eating

These symptoms can also occur with digestive disorders, infections, medication side effects and other illnesses. Persistent vomiting or an inability to keep fluids down deserves prompt medical attention, particularly if kidney disease is already present.

7. Muscle Cramps, Weakness or Numbness

The kidneys help maintain the balance of electrolytes such as potassium, sodium, calcium and phosphorus. Kidney dysfunction can disturb this balance and contribute to muscle cramps, weakness or other symptoms.

However, cramps and weakness are not specific to kidney disease. Dehydration, medication effects, nerve problems and other medical conditions may produce similar symptoms.

A blood test can help identify electrolyte abnormalities. Do not start potassium, magnesium or other mineral supplements without medical advice, particularly if kidney function is reduced.

8. Breathlessness or Difficulty Sleeping Comfortably

Breathlessness can occur when advanced kidney disease causes significant fluid retention. In some cases, excess fluid can accumulate in or around the lungs.

Breathing difficulties may also arise from anaemia, heart disease, lung conditions or other serious problems.

New or severe breathlessness, especially when accompanied by chest pain, rapidly increasing swelling or markedly reduced urine output, requires urgent medical care.

Do not assume that breathing difficulty is simply a routine symptom of kidney disease.

9. Difficulty Concentrating or Unusual Sleepiness

Advanced kidney dysfunction can affect overall wellbeing and may be associated with poor sleep, difficulty concentrating or changes in alertness.

These symptoms are nonspecific and can also be caused by anaemia, sleep disorders, medication effects, infections and metabolic abnormalities.

New confusion, unusual drowsiness or difficulty staying awake warrants urgent medical assessment, particularly in someone with known kidney disease.

Can Your Kidneys Be Damaged Without Any Symptoms?

Yes. This is one of the most important facts about kidney disease.

Early chronic kidney disease often causes no noticeable symptoms. A person may feel healthy while blood or urine tests already show abnormalities.

Diabetes, high blood pressure, cardiovascular disease and a family history of kidney disease increase the importance of appropriate screening. Testing may identify problems before symptoms develop.

For this reason, waiting until pain, swelling or fatigue appears is not a reliable strategy for protecting kidney health.

What Are the Most Important Tests for Kidney Function?

If symptoms or risk factors suggest possible kidney disease, a doctor may recommend the following investigations.

Serum Creatinine and eGFR

Serum creatinine is a waste product measured in the blood. The estimated glomerular filtration rate, or eGFR, uses creatinine and other relevant information to estimate how well the kidneys filter blood.

A low eGFR may indicate reduced kidney function. Results must be interpreted alongside previous measurements, medical history and other findings.

Urine Albumin-to-Creatinine Ratio

The urine albumin-to-creatinine ratio (UACR) measures albumin, a protein that may leak into urine when the kidney's filtering barrier is damaged.

Persistent albuminuria can indicate kidney damage even when eGFR is relatively preserved.

Urinalysis

A urine test can detect blood, protein and other abnormalities that may help identify kidney or urinary tract problems.

Electrolyte and Blood Tests

Depending on the situation, doctors may assess potassium, sodium, bicarbonate, blood count, glucose and other markers.

Kidney Ultrasound or Other Imaging

Imaging may be recommended when a doctor suspects urinary obstruction, stones, structural abnormalities or another condition requiring visual assessment.

Blood testing for eGFR and urine testing for albumin are central to detecting and monitoring many forms of chronic kidney disease.

Who Should Get Their Kidneys Checked Even Without Symptoms?

Routine kidney assessment may be particularly important for people who have:

• Diabetes

• High blood pressure

• Heart disease or heart failure

• A family history of kidney failure or inherited kidney disease

• Previous acute kidney injury

• Recurrent kidney stones or urinary obstruction

• Previously abnormal creatinine, eGFR or urine albumin results

The appropriate screening schedule depends on individual risk factors and medical history.

What Should You Do If Your Kidney Function Is Abnormal?

An abnormal result does not automatically mean permanent kidney failure. Some changes may be related to acute illness, dehydration, medication effects or other potentially reversible conditions. Others may indicate chronic kidney disease.

A sensible next step is to:

1. Arrange a medical review of the abnormal result.

2. Compare it with previous creatinine and eGFR measurements.

3. Check urine for albumin, protein or blood when appropriate.

4. Review prescription medicines, over-the-counter products and supplements with your clinician.

5. Follow an individualized plan for blood pressure, diabetes, diet and monitoring.

Do not stop prescribed medicines or use unverified kidney-detox products in an attempt to improve kidney function.

How Can You Protect Your Kidneys?

Although not every kidney condition can be prevented, several measures can help reduce avoidable kidney damage.

Manage Diabetes and Blood Pressure

Follow the treatment plan recommended by your healthcare professional and attend scheduled monitoring appointments.

Use Medicines Carefully

Some painkillers, especially nonsteroidal anti-inflammatory drugs (NSAIDs), can harm kidney function in susceptible people. Ask a doctor or pharmacist about medication safety if you have kidney disease.

Follow an Appropriate Diet

Reduce excessive salt intake and follow dietary advice suited to your kidney function and other health conditions. Avoid extreme protein restriction or unnecessary supplement use.

Maintain Suitable Fluid Intake

Drink according to your needs and your clinician's advice. People with advanced kidney disease, heart failure or prescribed fluid restrictions should not automatically increase their water intake.

Keep Follow-Up Appointments

Regular monitoring helps clinicians identify changes in kidney function and adjust treatment when necessary.

When Should You Seek Urgent Medical Attention?

Do not wait for a routine appointment if you experience:

• Very little or no urine

• Severe breathlessness

• Chest pain

• New confusion or reduced alertness

• Rapidly worsening swelling with breathing difficulty

• Persistent vomiting with signs of dehydration

• Sudden deterioration in your general condition

These symptoms may indicate acute kidney injury or another serious medical problem and require prompt assessment.

Kidney Function Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation for patients with suspected or established kidney disease.

Depending on the patient's condition, assessment may include:

• Review of creatinine and eGFR results

• Urine protein and albumin evaluation

• Assessment of blood pressure and diabetes

• Investigation of electrolyte abnormalities

• Evaluation of acute or chronic kidney dysfunction

• Review of medicines and relevant medical history

• Monitoring of kidney disease progression

• Assessment and management planning for advanced kidney disease

The purpose of specialist assessment is to identify the underlying problem, understand its severity and establish an appropriate treatment and monitoring plan.

Frequently Asked Questions

What are the first signs that your kidneys are not working properly?

There may be no noticeable early symptoms. Persistent foamy urine, blood in urine, swelling, high blood pressure or abnormal kidney-function tests can indicate a problem and should be evaluated.

Can kidney problems occur without pain?

Yes. Many kidney conditions, particularly early chronic kidney disease, do not cause pain or obvious symptoms.

Does foamy urine mean kidney damage?

Not always. Occasional foam can have harmless causes, but persistent foamy urine may indicate protein in the urine. A urine test can help clarify the cause.

Does frequent urination mean the kidneys are failing?

No. Frequent urination can result from diabetes, urinary infections, prostate problems, medication effects and other causes. It requires assessment in context.

Which blood test shows whether kidneys are working properly?

Serum creatinine and eGFR are commonly used to assess kidney filtration. Urine albumin testing provides additional information about possible kidney damage.

Can kidney function improve after an abnormal test?

Sometimes. Kidney function may improve when a reversible cause of acute kidney injury is treated. Established chronic kidney damage may not be completely reversible, but appropriate management can help protect remaining function.

When should I consult a nephrologist?

A nephrologist may be appropriate if you have persistently abnormal creatinine, reduced eGFR, protein in urine, unexplained blood in urine, difficult-to-control blood pressure or progressive kidney-function decline.

Conclusion

Recognizing the signs your kidneys are not working properly means paying attention to persistent urine changes, swelling, unexplained fatigue, itching, blood-pressure problems and other changes in health. Yet the absence of symptoms does not guarantee that kidney function is normal.

Blood tests such as creatinine and eGFR, together with urine albumin testing and other investigations when indicated, provide a more reliable assessment than symptoms alone.

Early identification of kidney problems can help clinicians treat the underlying cause, manage risk factors and protect remaining kidney function. People with diabetes, hypertension, cardiovascular disease or a family history of kidney disease should discuss appropriate screening with their healthcare professional.

For personalized kidney evaluation and treatment planning, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. The signs discussed here can have many causes, and no symptom alone can confirm kidney disease or determine its severity. Kidney function should be assessed through appropriate medical evaluation and laboratory testing. Do not start, stop or change medicines, supplements, diet or fluid intake based solely on this article. Seek urgent medical attention for very little or no urine, severe breathlessness, chest pain, confusion, persistent vomiting or rapidly worsening symptoms. Consult Dr. Sandip Prabhakar Bhurke or another qualified healthcare professional for individualized advice.