Kidney disease often progresses silently, with individuals feeling perfectly healthy even as their kidney function declines significantly. This is due to the kidneys' remarkable ability to adapt by having remaining nephrons compensate for damaged ones, a process that can continue for years without noticeable symptoms like swelling, nausea, or urinary issues.

Kidney disease often progresses silently, with individuals feeling perfectly healthy even as their kidney function declines significantly. This is due to the kidneys' remarkable ability to adapt by having remaining nephrons compensate for damaged ones, a process that can continue for years without noticeable symptoms like swelling, nausea, or urinary issues.

Kidney disease often progresses silently, with individuals feeling perfectly healthy even as their kidney function declines significantly. This is due to the kidneys' remarkable ability to adapt by having remaining nephrons compensate for damaged ones, a process that can continue for years without noticeable symptoms like swelling, nausea, or urinary issues.

A 52-year-old man once walked into my clinic for a routine health check-up. He was working full-time, eating normally and had no swelling, nausea or urinary complaints.

“I feel perfectly healthy, doctor,” he said. His blood pressure was slightly high, so I investigated further. His creatinine was elevated, and his urine showed significant protein leakage. By the time we completed his evaluation, his kidneys were functioning at only about 25 per cent of normal. He looked at me in disbelief.

“How can my kidneys be this bad when I feel absolutely fine?” It is a question nephrologists hear surprisingly often.

The kidneys suffer quietly

The kidneys are remarkably good at adapting. Each kidney contains hundreds of thousands of tiny filtering units called nephrons. When some are damaged, the remaining nephrons quietly take on more work. This compensation can continue for years without obvious symptoms.

That is why feeling well does not necessarily mean your kidneys are well. Passing urine normally is also not proof of healthy kidneys. Beyond producing urine, kidneys remove waste, regulate water, salt, potassium and acid balance, help control blood pressure, stimulate red blood cell production and activate vitamin D.

They are the body’s silent housekeeping department. When everything is running smoothly, nobody notices them.

Who should get their kidneys checked?

Anyone with diabetes, high blood pressure, obesity, cardiovascular disease, kidney stones, increasing age or a family history of kidney disease, dialysis or certain hereditary conditions should consider regular kidney screening.

Some risks are self-created. Frequent NSAID painkiller use, smoking and excessive salt can damage kidney health. Herbal remedies and supplements deserve caution too.

Patients often tell me, “But doctor, it is natural.” Unfortunately, the kidneys do not recognise the marketing department. Natural does not automatically mean kidney-safe.

The good news is that screening is simple. Start with blood pressure, serum creatinine with eGFR, and urine albumin-to-creatinine ratio (UACR). An ultrasound of the kidneys and urinary tract may be useful when clinically indicated. Importantly, urine protein can reveal kidney damage even when creatinine is still normal.

Finding kidney disease early changes the story

Modern kidney care is no longer about watching kidney function decline until dialysis becomes inevitable.

Depending on the cause, early treatment may include controlling blood pressure and diabetes, ACE inhibitors or ARBs, SGLT2 inhibitors, reducing protein leakage, weight and dietary management, and avoiding kidney-toxic medicines. In selected patients, a kidney biopsy can identify the precise disease and allow targeted treatment.

The principle is simple: protect the kidney function you still have rather than waiting to treat the kidney function you have lost. As kidney disease advances, we monitor for anaemia, high potassium, acidity, bone disease, fluid overload and cardiovascular complications. When eGFR falls below about 30, planning becomes important, but this does not mean dialysis must start immediately.

And if kidney failure eventually occurs, there are several options. Kidney transplantation is preferred for suitable patients. Today, deceased-donor transplantation, living-donor transplantation, swap transplantation and even ABO-incompatible transplantation can offer excellent outcomes. Haemodialysis, peritoneal dialysis and, for selected frail patients, conservative kidney care are equally important parts of individualised treatment.

Kidney disease may cause no pain, swelling or nausea. You may work normally, eat normally and pass urine normally while kidney function quietly declines. So don’t wait for your kidneys to complain. Protect your kidneys while they are still silent. Because feeling healthy is wonderful. Knowing your kidneys are healthy is even better.

(The author is a senior consultant nephrologist and renal transplant physician at Aster CMI Hospital)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.

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