The kidneys perform several essential functions. They filter waste and excess water from the blood, help maintain electrolyte and acid-base balance, regulate fluid levels and contribute to blood-pressure control and red blood cell production.

When kidney function decreases, waste and fluid can accumulate and other body processes may be affected.

One important point is that kidney disease may not cause noticeable symptoms in its early stages. Many people discover reduced kidney function only after blood or urine testing. As kidney disease becomes more advanced, symptoms may become easier to recognize.

Therefore, knowing the signs of kidneys not working properly is useful, but symptoms alone cannot determine how well the kidneys are functioning.

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

1. Changes in Urination

Changes in urination can sometimes occur when kidney function is affected.

You may notice:

• Urinating more or less often than usual

• Passing urine more frequently at night

• A noticeable reduction in urine volume

• Very little or no urine in severe kidney dysfunction

• Changes in urine appearance

However, changes in urination are not specific to kidney disease. Urinary infections, prostate problems, medicines, diabetes and other conditions can also alter urine patterns.

A sudden major reduction in urine output requires prompt medical assessment.

2. Swelling Around the Feet, Ankles or Legs

One of the visible signs of impaired kidney function can be edema, or swelling.

When the kidneys cannot adequately remove excess sodium and water, fluid may accumulate in tissues.

Swelling can occur around:

• Feet

• Ankles

• Lower legs

• Hands

• Face

It may become more noticeable as kidney disease becomes advanced. Significant protein loss through urine can also contribute to edema.

Persistent unexplained swelling should be evaluated rather than automatically attributed to kidney disease because heart, liver, venous and medication-related conditions can also cause edema.

3. Foamy or Frothy Urine

Persistent foamy urine may occur when there is excess protein in the urine.

Protein leakage can result from damage to the kidney's filtering structures and may occur in conditions such as diabetic kidney disease and glomerular diseases.

Foamy urine does not always mean kidney disease. The appearance can vary with urine concentration and other factors.

If persistent, urine testing—particularly an urine albumin-to-creatinine ratio (UACR) or another appropriate protein measurement—can help determine whether significant protein leakage is present.

4. Blood in the Urine

Blood in the urine, known as hematuria, can be another indication that the urinary system needs evaluation.

Possible causes include:

• Kidney stones

• Urinary infections

• Glomerular kidney disease

• Kidney or urinary tract abnormalities

• Other urinary conditions

Visible blood in urine should not automatically be assumed to be a kidney problem, but it should not be ignored.

A doctor may recommend urine testing and additional investigations depending on the patient's age, symptoms and medical history.

5. Persistent Tiredness and Low Energy

Fatigue can occur with advanced kidney disease.

Reduced kidney function may contribute to anemia and other metabolic problems, while the accumulation of waste products can affect how a person feels.

However, tiredness is extremely common and can result from:

• Poor sleep

• Anemia from other causes

• Thyroid disorders

• Nutritional deficiencies

• Infections

• Stress

• Other chronic illnesses

Fatigue by itself does not establish a kidney diagnosis.

6. Itchy or Dry Skin

Persistent itching or unusually dry skin can occur as kidney disease advances.

CKD-associated itching may occur without a primary skin rash, although repeated scratching can subsequently cause skin marks or irritation.

Mineral and metabolic abnormalities, dry skin, inflammation and altered nerve signaling may all contribute to itching in advanced kidney disease.

If itching is persistent, both kidney-related and dermatological causes should be considered.

7. Muscle Cramps, Weakness or Numbness

Changes in electrolyte and mineral balance can occur when kidney function is significantly impaired.

Some people with advanced kidney disease may experience:

• Muscle cramps

• Weakness

• Numbness

• Restless or uncomfortable legs

These symptoms can also result from dehydration, medicines, electrolyte disorders unrelated to kidney disease, nerve problems or other conditions.

Blood tests can help identify whether an electrolyte or metabolic abnormality is contributing.

8. Nausea, Vomiting or Loss of Appetite

As kidney function becomes severely reduced, waste products can accumulate in the bloodstream.

Possible symptoms include:

• Nausea

• Vomiting

• Reduced appetite

• Altered taste

• Unintentional weight loss

These symptoms are more concerning when they occur together with known kidney disease or other abnormalities.

Persistent vomiting can also cause dehydration and potentially worsen kidney function, so medical assessment may be important.

9. Difficulty Concentrating or Feeling Confused

Advanced kidney dysfunction can affect mental clarity.

A person may notice:

• Difficulty concentrating

• Sleep-related changes

• Reduced alertness

• Memory difficulties

• Confusion in severe cases

These symptoms require medical evaluation because neurological changes can have many causes.

Sudden confusion should be treated as an urgent medical problem rather than assuming that it is caused by kidney disease.

10. Shortness of Breath

Breathlessness can occur in people with advanced kidney disease, particularly when excess fluid accumulates.

Kidney dysfunction can contribute to fluid overload, and severe fluid accumulation may affect the lungs. Kidney disease can also be associated with anemia, which may contribute to fatigue and breathlessness.

New or severe breathlessness requires prompt medical evaluation because heart and lung conditions can cause the same symptom.

11. Sleep Problems

Changes in sleep can occur with advanced kidney disease.

Some people may experience:

• Difficulty falling asleep

• Poor-quality sleep

• Daytime tiredness

• Restlessness

• Itching that becomes worse at night

Sleep problems are not specific to kidney disease, but they may become more troublesome when several CKD-related symptoms occur together.

12. High Blood Pressure

Kidneys and blood pressure are closely connected.

Kidney disease can contribute to high blood pressure, while long-standing hypertension can also damage the kidneys.

Importantly, early kidney disease often causes no obvious symptoms, so a person can have kidney damage even when they feel completely well.

Regular blood-pressure checks are therefore useful, particularly for people with diabetes, hypertension or other kidney-disease risk factors.

Which Signs Suggest Advanced Kidney Dysfunction?

Several symptoms occurring together may indicate more significant kidney impairment.

These can include:

• Increasing swelling

• Markedly reduced urine output

• Persistent nausea or vomiting

• Loss of appetite

• Significant fatigue

• Persistent itching

• Muscle cramps or weakness

• Difficulty concentrating

• Breathlessness

• Unintentional weight loss

However, symptoms cannot determine the severity of kidney disease on their own. Kidney function needs to be assessed through appropriate laboratory testing.

Can Kidneys Stop Working Without Symptoms?

Yes.

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

Early CKD can be silent. A person may feel healthy even while kidney damage is developing.

This is why testing is especially important for people at increased risk, including those with:

• Diabetes

• High blood pressure

• Heart disease

• A family history of kidney failure

• Previous kidney disease

• Certain recurrent urinary or kidney problems

NIDDK recommends kidney evaluation using blood and urine tests for people with important risk factors.

Which Tests Show Whether the Kidneys Are Working Properly?

Symptoms can raise suspicion, but laboratory testing provides a more reliable assessment.

Serum Creatinine

Creatinine is a waste product filtered by the kidneys. It is used as part of kidney-function assessment.

An elevated creatinine level can occur when kidney filtration decreases, but creatinine is influenced by factors such as muscle mass, diet, hydration and certain medicines.

eGFR

The estimated glomerular filtration rate (eGFR) provides an estimate of how effectively the kidneys filter blood.

A persistently reduced eGFR can indicate chronic kidney disease. The result needs to be interpreted in context and over time.

Urine Albumin Test

A urine albumin test can identify leakage of albumin through damaged kidney filters.

The UACR is commonly used to quantify albumin loss in urine.

Urinalysis

A urine examination may detect:

• Blood

• Protein

• Infection

• Other abnormalities

Additional Blood Tests

Depending on the clinical situation, a doctor may evaluate:

• Potassium

• Sodium

• Bicarbonate

• Hemoglobin

• Calcium

• Phosphorus

• Blood glucose

The exact tests depend on the suspected kidney condition.

What Does an eGFR Below 15 Mean?

An eGFR below 15 mL/min/1.73 m² is generally within the kidney failure range.

At this level, symptoms and complications may occur because the kidneys are unable to perform enough of their normal functions. Kidney replacement options may need to be discussed depending on the patient's clinical condition.

Importantly, dialysis is not started solely because of one eGFR or creatinine value. Symptoms, complications, fluid status, electrolyte abnormalities and the overall clinical situation are considered.

What Causes Kidneys to Stop Working Properly?

Kidney dysfunction can develop for many reasons.

Common causes include:

Diabetes

Diabetes can damage the kidney's filtering structures over time and is a major cause of CKD.

High Blood Pressure

Long-standing hypertension can injure the kidneys and accelerate existing kidney disease.

Kidney Inflammation

Glomerular and autoimmune diseases can damage the kidney's filtering units.

Kidney Stones and Obstruction

Persistent obstruction can interfere with urine drainage and impair kidney function.

Recurrent Kidney Infections

Repeated or severe kidney infections may damage the kidneys in certain circumstances.

Medicines and Toxins

Some medicines or toxic exposures can cause acute or chronic kidney injury in susceptible individuals.

Inherited Kidney Diseases

Conditions such as polycystic kidney disease can gradually affect kidney structure and function.

Identifying the underlying cause is essential because treatment differs substantially between conditions.

Can Kidney Function Improve?

Sometimes.

Kidney dysfunction caused by an acute and reversible problem may improve after the underlying cause is treated.

Examples can include:

• Severe dehydration

• Certain medication-related injuries

• Urinary obstruction

• Some infections

• Certain acute kidney injuries

Established chronic kidney damage is often not completely reversible, but appropriate treatment may slow further deterioration and protect remaining kidney function.

What Should You Do If You Notice These Signs?

Do not wait for severe symptoms before checking kidney health.

If you notice persistent swelling, changes in urine, unexplained fatigue, foamy urine, recurrent blood in urine or other concerning symptoms, speak with a healthcare professional.

People with diabetes or hypertension should be particularly attentive because early kidney disease may not cause symptoms.

Avoid attempting to “clean” or “detox” the kidneys with unproven herbal products, supplements or excessive water intake.

When Is a Kidney Problem an Emergency?

Seek urgent medical attention if kidney-related symptoms occur with:

• Very little or no urine

• Severe breathlessness

• Chest pain

• Severe or rapidly increasing swelling

• Confusion or altered consciousness

• Persistent vomiting with dehydration

• Sudden severe weakness

• Rapid deterioration in health

These symptoms may indicate serious kidney dysfunction or another medical emergency.

Kidney Function Evaluation at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and management for patients with abnormal kidney-function tests and suspected kidney disease.

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

• Review of kidney-related symptoms

• Creatinine and eGFR assessment

• Urinalysis

• Urine albumin or protein testing

• Blood-pressure evaluation

• Electrolyte assessment

• Diabetes-related kidney evaluation

• Assessment of kidney stones or urinary obstruction

• Evaluation of acute kidney injury

• Chronic kidney disease monitoring

• Dialysis-related assessment when indicated

• Kidney transplant-related evaluation when appropriate

The aim is to identify the cause of kidney dysfunction and develop a treatment plan suited to the individual's kidney function and overall health.

Frequently Asked Questions

What are the first signs of kidneys not working properly?

There may be no noticeable symptoms in the early stages. When kidney disease becomes more advanced, swelling, urine changes, fatigue, itching, muscle cramps, nausea and changes in concentration may occur.

How do I know if my kidneys are failing?

Symptoms such as reduced urine output, swelling, nausea, itching, weakness, breathlessness or confusion can occur in advanced kidney failure, but symptoms alone cannot confirm kidney failure. Blood and urine tests are needed.

Can kidney problems occur without pain?

Yes. Many kidney diseases, including CKD, may cause no pain or obvious symptoms in the early stages.

Is foamy urine a sign of kidney disease?

Persistent foamy urine can be associated with protein in the urine. A urine test is needed to determine whether significant protein or albumin is present.

Does swelling mean the kidneys are failing?

Not necessarily. Swelling can result from kidney disease but also from heart disease, liver disease, venous problems, medicines and other conditions.

What blood test checks kidney function?

Serum creatinine is commonly used to estimate kidney filtration through the eGFR. Urine testing, particularly UACR, provides additional information about kidney damage.

Can kidney function return to normal?

Some acute kidney injuries are reversible or partially reversible. Established chronic kidney damage may not return to normal, but appropriate treatment can sometimes slow progression and preserve remaining function.

When should I see a nephrologist?

A nephrologist may be appropriate if you have persistently abnormal creatinine or eGFR, significant protein or albumin in urine, unexplained blood in urine, difficult-to-control blood pressure, recurrent kidney problems or progressive loss of kidney function.

Conclusion

The signs of kidneys not working properly can range from subtle changes in urination to swelling, foamy urine, fatigue, itching, muscle cramps, nausea and breathlessness. However, many people with early kidney disease have no symptoms at all.

For this reason, symptoms should be considered warning clues rather than a substitute for kidney-function testing.

Creatinine, eGFR, urine albumin and urinalysis can help determine whether the kidneys are functioning normally and whether kidney damage is present. Finding kidney disease early can provide an opportunity to identify its cause, treat modifiable risks and protect remaining kidney function.

If you have symptoms or risk factors for kidney disease, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic for individualized nephrology evaluation.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered a substitute for medical diagnosis, treatment or individualized medical advice. Kidney disease can develop without noticeable symptoms, and the symptoms described in this article can also occur with many other medical conditions. Do not diagnose kidney failure based on symptoms alone or start, stop or change medicines, supplements or fluid intake without professional guidance. Seek urgent medical attention for very little or no urine, severe breathlessness, chest pain, confusion, severe swelling, persistent vomiting or rapidly worsening symptoms. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for appropriate kidney-function testing and personalized treatment.