Renal health: how to spot trouble and protect your kidneys

Kidneys do a lot: filter waste, balance fluids and salts, and help control blood pressure. You rarely notice them until something goes wrong. Want to keep them working well? Small habits and smart medication choices make a big difference.

Signs, tests, and what they mean

Watch for swelling in the ankles, feeling tired, less urine or darker urine, and unexplained nausea. Those aren't proof of kidney disease, but they’re signals you should check. Two simple lab tests tell most of the story: serum creatinine (used to calculate eGFR) and urine albumin-to-creatinine ratio (ACR). eGFR shows filtering ability; values under 60 for three months suggest chronic kidney disease (CKD). Urine ACR detects protein leaking into urine — an early sign of damage.

Doctors may order a kidney ultrasound or other imaging if labs look off. Acute kidney injury (AKI) shows up suddenly — after dehydration, an infection, or a new medication — and needs prompt care. CKD is gradual and often linked to high blood pressure or diabetes.

Medications and supplements: what to watch for

Some drugs can hurt kidneys or need dose changes when kidney function drops. Common offenders: NSAIDs (ibuprofen, naproxen) can reduce blood flow to kidneys. Certain antibiotics (like aminoglycosides) and some contrast dyes used for scans can cause harm. Diabetes drugs and blood pressure meds may need dose changes too. For example, metformin is used more cautiously at lower eGFR, and many providers stop it if eGFR falls below a threshold. ACE inhibitors and ARBs help protect kidneys when there’s protein in the urine, but they need monitoring because they can raise creatinine or potassium right after starting.

Herbal supplements aren’t always safe. Some herbal weight-loss remedies and high-dose vitamin mixes have been linked to kidney injury. Tell your clinician about every pill or supplement you take.

So what should you do today? Get a baseline: ask for a creatinine/eGFR and a urine ACR if you have diabetes, high blood pressure, or a family history of kidney disease. If you take regular painkillers, ask about safer options. Keep blood pressure and blood sugar in target ranges — those two things slow kidney decline more than almost anything else. Stay hydrated, but don’t overdo fluids if you’re on dialysis or your doctor gave limits.

If tests show decreased kidney function, your provider may refer you to a nephrologist. That’s useful early — they can help adjust medicines, suggest treatments like SGLT2 inhibitors (which lower kidney decline in many patients), and plan next steps. Quick action matters: catching problems early keeps more kidney function intact.

Have questions about a medicine or test result? Bring the bottle or lab printout to your appointment. Clear info and simple steps go a long way in keeping your kidneys healthy.