Healthy kidneys also help control blood pressure, balance electrolytes (like sodium and potassium), and produce hormones important for bone health and red blood cell production. In CKD, these functions become impaired.

What are the causes of CKD?
The most common causes are:

• Diabetes (high blood sugar damages kidney filters)
• High blood pressure (hypertension) (puts strain on kidney blood vessels)
• Glomerulonephritis (inflammation of kidney filters)
• Polycystic kidney disease (genetic condition)
• Repeated kidney infections or obstruction (e.g., kidney stones, prostate problems)

Stages of CKD (based on eGFR – kidney function test)

Stage 1: Normal kidney function but with some kidney damage signs (eGFR ≥90)

Stage 2: Mild loss of function (eGFR 60–89)

Stage 3a: Mild-to-moderate loss (eGFR 45–59)

Stage 3b: Moderate-to-severe loss (eGFR 30–44)

Stage 4: Severe loss (eGFR 15–29)

Stage 5 (End-Stage Kidney Disease): Kidney failure, dialysis or transplant may be needed (eGFR <15)

What are the Symptoms?
CKD often has no symptoms in early stages. As it progresses, symptoms may include:

• Feel tired or weak
• Swelling in legs, ankles, or around eyes (fluid retention)
• Nausea, vomiting, loss of appetite
• Have itchy skin or muscle cramps
• Shortness of breath
• Changes in urination (frequency, color, frothy urine from protein leak)
• High blood pressure

Why CKD Matters?
CKD can increase your risk of:

• High blood pressure (and worsening of it)
• Anemia (low red blood cells)
• Bone disease (due to calcium/phosphate imbalance)
• Fluid overload (can cause heart failure)
• Increased risk of heart disease and stroke
• Kidney failure (when dialysis or transplant is needed)

What is the management for CKD?
While CKD usually cannot be cured, its progression can be slowed:

• Control underlying conditions: manage diabetes and blood pressure
• Medications: such as ACE inhibitors or ARBs to protect kidneys
• Diet changes: reduce salt, moderate protein, manage potassium and phosphate
• Lifestyle: stop smoking, maintain healthy weight, regular exercise
• Monitoring: regular blood/urine tests and blood pressure checks

In advanced CKD, treatment may include:

• Dialysis (hemodialysis or peritoneal dialysis)
• Kidney transplant

Recommendations:

• Regular check-ups are important to monitor your kidney health.
• Early detection helps prevent complications.

Vasculitis is inflammation of the blood vessels. When this involves the kidneys, it can cause glomerulonephritis. These conditions can be short-lived and treatable, or they may progress and lead to chronic kidney disease if not managed early.

Why does it happen?
Glomerulonephritis and vasculitis are usually caused by the body’s immune system becoming overactive or “misdirected.” Common causes include:

• Autoimmune conditions (e.g. ANCA-associated vasculitis, lupus nephritis, membranous nephropathy, minimal change disease)
• Infections triggering an immune reaction
• Certain medications
• Rarely, inherited or genetic conditions

Symptoms to look out for
Many patients do not feel unwell in the early stages. However, possible signs include:

• Blood in the urine (sometimes visible, sometimes only found on testing)
• Protein in the urine, which may cause foamy or frothy urine
• Swelling of the legs, feet, hands, or around the eyes
• High blood pressure
• Tiredness, reduced appetite, or unexplained weight changes
• In vasculitis, symptoms may also include joint pains, skin rashes, fevers, or sinus/respiratory issues

How we investigate it
Because there are many different types of GN and vasculitis, careful testing is essential to guide treatment. This may include:

• Blood tests – kidney function, markers of inflammation, immune system antibodies (e.g. ANCA, ANA, complement levels)
• Urine tests – looking for blood, protein, and markers of inflammation or infection
• Imaging – kidney ultrasound to assess size, structure, and rule out blockages
• Kidney biopsy – often the most important test, as it allows us to examine a small piece of kidney tissue under the microscope. This shows the exact pattern of inflammation and helps tailor treatment.

Treatment and management
The main goals are to:

• Control inflammation and prevent further kidney injury
• Manage symptoms such as swelling and high blood pressure
• Protect long-term kidney function

Treatment depends on the underlying type and severity:

• Immunosuppressive medications – corticosteroids and/or other agents (e.g. cyclophosphamide, rituximab, mycophenolate) to calm the immune system
• Blood pressure control – often with ACE inhibitors or ARBs, which also help reduce protein leakage
• Supportive measures – salt restriction, careful fluid management, and cholesterol control
• Dialysis – in severe cases where kidney function is severely reduced, dialysis may be required temporarily or long term
• Regular monitoring – blood and urine tests to track disease activity and treatment side effects

Our approach
At our clinic, we provide a comprehensive and personalised care plan:

• Clear explanations about your diagnosis and what it means
• A treatment pathway tailored to your condition, lifestyle, and health goals
• Close follow-up to monitor kidney function and adjust medications as needed
• Collaboration with other specialists (such as rheumatologists or immunologists) when appropriate

Our aim is to preserve kidney function for as long as possible, minimise complications, and support you throughout the journey with education and ongoing care.

The kidneys play a vital role in keeping the body’s internal environment stable. When they are not working properly, waste products can build up in the blood, fluid can accumulate in the body, and important salts (like potassium and sodium) may become dangerously unbalanced.

Common Causes of AKI
AKI is not a single disease but a complication that can arise from a number of underlying problems. These include:

• Reduced blood supply to the kidneys
  • Severe dehydration (from vomiting, diarrhoea, or blood loss)
  • Low blood pressure due to infection (sepsis), shock, or major surgery
  • Heart failure or liver disease reducing circulation to the kidneys
• Direct injury to the kidneys themselves
  • Certain medications (for example, non-steroidal anti-inflammatory drugs [NSAIDs], some antibiotics, or chemotherapy drugs)
  • Contrast dyes used in medical scans
  • Autoimmune diseases (such as vasculitis or lupus)
  • Severe infections affecting the kidneys
• Blockages to urine flow
  • Kidney stones
  • An enlarged prostate in men
  • Tumours or scarring in the urinary tract

Symptoms and Warning Signs
AKI can sometimes show no obvious symptoms, especially in the early stages. However, possible signs include:

• Passing less urine than usual, or sometimes not passing urine at all
• Swelling in the legs, ankles, or around the eyes
• Shortness of breath due to fluid build-up
• Nausea, vomiting, or loss of appetite
• Fatigue, confusion, or drowsiness
• Chest pain or irregular heartbeats (from electrolyte imbalance in severe cases)

Because these symptoms can also be seen in other illnesses, blood and urine tests are essential to confirm AKI.

How AKI is Diagnosed
Your doctor may arrange several investigations to determine the cause and severity of AKI:

• Blood tests – measuring creatinine, urea, and electrolytes to assess kidney function
• Urine tests – looking for blood, protein, or signs of infection
• Imaging (ultrasound or CT scans) – to check for blockages or changes in kidney size/structure
• Physical examination – to assess hydration, blood pressure, and swelling
• Medication review – to identify drugs that may be contributing to the problem

Treatment and Management
The key to treating AKI is identifying and addressing the underlying cause as early as possible. Treatment may involve:

• Fluids through a drip if dehydration or low blood pressure is the cause
• Stopping or adjusting medications that may be harmful to the kidneys
• Antibiotics if infection is present
• Relieving blockages with procedures such as inserting a urinary catheter or removing kidney stones
• Dialysis (kidney support machine) in severe cases, to filter the blood until the kidneys recover

During treatment, patients are often closely monitored in hospital. Blood tests may be repeated daily, and fluid balance is carefully tracked.

Recovery and Long-Term Outlook

• Many patients recover fully once the cause of AKI is treated, especially if recognised early.
• Some people may have a slower recovery, requiring ongoing monitoring and sometimes temporary dialysis.
• In those with existing chronic kidney disease, diabetes, or high blood pressure, AKI can increase the risk of developing long-term kidney problems.
• Regular follow-up blood tests and review with your doctor are important after an episode of AKI.

Protecting Your Kidneys
There are steps you can take to lower the risk of AKI, especially if you have other health conditions:

• Keep well hydrated, particularly in hot weather or during illness
• Avoid taking over-the-counter painkillers (such as NSAIDs) regularly without medical advice
• Inform your doctor about all medications you are taking
• Seek medical care early if you notice a sudden drop in urine output, swelling, or feel generally unwell

Key message: Acute Kidney Injury is often reversible if treated quickly. Early recognition and medical attention are essential to protect your kidneys and overall health.

This type of anaemia is called renal anaemia because it is directly related to kidney disease.

Why does it happen in kidney disease?
The kidneys normally play an important role in red blood cell production. In chronic kidney disease (CKD) or advanced kidney problems:

• The kidneys make less EPO.
• There may be a lack of iron, vitamin B12 or folate (all needed to build red blood cells).
• Toxins that build up in kidney disease can shorten the lifespan of red blood cells.
• Dialysis patients may also lose small amounts of blood during treatments.

What are the symptoms?
Renal anaemia often develops slowly, so the symptoms can be subtle at first. Common signs include:

• Feeling unusually tired or weak
• Shortness of breath, especially with activity
• Pale skin
• Dizziness or headaches
• Difficulty concentrating
• Cold hands and feet

Because these symptoms overlap with those of kidney disease itself, anaemia can sometimes be missed without blood tests.

How is renal anaemia diagnosed?
Your doctor will usually check for anaemia with:

• Full blood count (FBC): measures haemoglobin and red blood cells.
• Iron studies: check if iron levels are low.
• Other tests: vitamin B12, folate, markers of inflammation.

Why is treating renal anaemia important?
Untreated anaemia can make you feel constantly tired, reduce your ability to exercise, and affect your quality of life. It also puts extra strain on the heart, increasing the risk of heart disease and heart failure in people with kidney disease.

How is renal anaemia treated?
Treatment is personalised depending on the cause:

• Iron supplementation: either tablets or intravenous (IV) iron if levels are low.
• Erythropoiesis-stimulating agents (ESAs): injections of synthetic EPO to encourage the bone marrow to make red blood cells.
• Vitamin supplements: B12 or folate if deficient.
• Blood transfusions: sometimes needed if anaemia is severe and not responding to other treatments.

Your kidney doctor will carefully monitor your haemoglobin levels, iron stores, and symptoms to keep them in a safe range.

Living with renal anaemia
With the right treatment, most people feel more energetic and are able to enjoy a better quality of life. Regular check-ups are important to make sure anaemia is managed safely alongside your kidney condition.

RRT is not a cure for kidney disease, but it helps patients live longer and feel better by taking over some of the important work that the kidneys usually do.

Why is RRT needed?
Healthy kidneys:

• Remove waste products (like urea and creatinine) from the blood
• Balance fluids and electrolytes (e.g., potassium, sodium, calcium)
• Help control blood pressure
• Support bone health and red blood cell production

When kidneys lose most of their function, these processes are disrupted, leading to symptoms such as tiredness, nausea, fluid overload (swelling), shortness of breath, and dangerous electrolyte imbalances. RRT helps manage these problems.

Types of Renal Replacement Therapy
There are three main options for RRT. Each has its own benefits and challenges, and the right choice depends on medical factors and patient preferences.

1. Haemodialysis (HD)

• Blood is filtered through a machine called a dialyser, which removes waste and excess fluid before returning clean blood to the body.
• Usually done at a hospital or dialysis centre, but some patients can do it at home.
• Sessions typically last 4–5 hours, 3 times per week.
• Requires a special blood vessel access (fistula, graft, or catheter).

Pros: Effective cleaning of blood, regular medical supervision.
Cons: Time-consuming, dietary and fluid restrictions, travel to dialysis centre.

2. Peritoneal Dialysis (PD)

• Uses the lining of your abdomen (the peritoneum) as a natural filter.
• A special dialysis fluid is placed into the abdomen through a catheter, which absorbs waste and fluid, and is then drained out.
• Can be done manually several times a day (Continuous Ambulatory PD) or automatically overnight with a machine (Automated PD).

Pros: Can be done at home, offers more flexibility, gentler on the body.
Cons: Requires daily treatment, risk of infection (peritonitis), may not be suitable for everyone.

3. Kidney Transplant

• A healthy kidney from a donor is surgically placed into the patient’s body.
• The new kidney can do the work of the failed kidneys, freeing the patient from dialysis.
• Requires lifelong medications and regular blood tests to monitor and prevent rejection.

Pros: Offers the best quality of life and survival, no need for regular dialysis.
Cons: Surgery risks, long waiting times for a donor kidney, need for ongoing medication and monitoring.

Choosing the Right Therapy
The choice of RRT depends on:

• Age and general health
• Lifestyle and work commitments
• Support from family or carers
• Availability of treatment options locally
• Personal preference

Often, kidney specialists (nephrologists) and the healthcare team will guide patients through these options and help make the best choice.

Living with RRT
Starting RRT is a big life change, but with the right support, many patients continue to work, travel, and enjoy meaningful lives. It’s important to:

• Follow medical advice
• Take prescribed medications regularly
• Keep to diet and fluid recommendations
• Stay physically active as possible
• Seek emotional and psychological support when needed

Key message:
Renal Replacement Therapy is not a cure, but it is a life-sustaining treatment that allows people with advanced kidney disease to live longer and more active lives. With the right therapy and support, many patients adapt well and maintain a good quality of life.

Who May Need a Kidney Transplant?
A transplant may be considered for patients who have:

• Chronic Kidney Disease (CKD) stage 4–5, where kidney function is severely reduced
• End-Stage Kidney Disease (ESKD) requiring dialysis or anticipated dialysis in the near future
• Certain conditions affecting quality of life, such as poorly controlled hypertension or recurrent kidney infections

Our nephrologist (kidney specialist) will discuss whether transplantation is suitable for you, taking into account your overall health and medical history.

The Transplant Work-Up Process
The work-up is a thorough evaluation to ensure that you are a safe candidate for kidney transplantation. This process typically includes:

• Medical History and Physical Examination
  • Review of past illnesses, surgeries, and current medications
  • Assessment of overall health to ensure you can safely undergo surgery

• Blood Tests
  • Kidney and liver function, blood counts, and electrolyte levels
  • Screening for infections such as hepatitis and HIV
  • Blood type and tissue typing to help find compatible donors

• Heart and Lung Assessment
  • Electrocardiogram (ECG) and possibly an echocardiogram or stress test
  • Chest X-ray to assess lung health

• Imaging Studies
  • Ultrasound or CT scans of your kidneys and urinary tract
  • Sometimes additional scans to evaluate blood vessels

• Specialist Consultations
  • Cardiologist, endocrinologist, or other specialists as needed
  • Dental and eye evaluations to check for potential sources of infection

• Psychosocial Evaluation
  • Assessment by a social worker or psychologist
  • Evaluates mental health, social support, and understanding of transplant requirements

• Education and Counselling
  • Information about the transplant procedure, risks, benefits, and lifestyle changes
  • Guidance on immunosuppressive medications and infection prevention

Referral for Transplant
Once your work-up is complete, your nephrologist may refer you to a transplant centre. The referral process generally involves:

• Submission of your medical records and test results
• Placement on a waiting list if a living donor is not available
• Ongoing monitoring and care while waiting for a suitable kidney

Living vs. Deceased Donor Transplant

• Living Donor: A healthy individual (often a family member or friend) donates a kidney. This option usually allows for better outcomes and shorter waiting times.
• Deceased Donor: Kidney donation comes from a person who has recently passed away. Waiting times vary depending on compatibility and organ availability.

Preparing for the Transplant
While waiting for a transplant, patients are encouraged to:

• Maintain a healthy lifestyle, including balanced diet and exercise
• Keep vaccinations and routine health checks up-to-date
• Follow their nephrologist’s recommendations for dialysis or other treatments

After Referral
Being referred does not guarantee immediate transplantation. Transplant centres prioritize candidates based on medical urgency, compatibility, and overall health. Regular follow-up with your healthcare team ensures you remain ready for transplantation when a suitable kidney becomes available.

Key message:
The transplant work-up and referral process is comprehensive to maximize your safety and the success of the kidney transplant. Early referral and active engagement in your care can significantly improve outcomes.

Why is it Important to Recognize?
High blood pressure that is difficult to control can increase the risk of serious health problems, including:

• Heart attack
• Stroke
• Kidney damage
• Vision loss
• Heart failure

Early recognition and specialized care can reduce these risks and improve long-term health outcomes.

Causes of Resistant Hypertension
Resistant hypertension can result from a combination of factors, including:

• Lifestyle factors
  • Excess salt (sodium) intake
  • Obesity or being overweight
  • Physical inactivity
  • Excessive alcohol consumption
  • Smoking

• Medication-related factors
  • Not taking blood pressure medications as prescribed (non-adherence)
  • Interactions with other medications or supplements that raise blood pressure

• Secondary causes of hypertension
  These are medical conditions that can cause high blood pressure, such as:
  • Kidney disease
  • Hormonal disorders (e.g., hyperaldosteronism, thyroid problems)
  • Obstructive sleep apnoea

Symptoms
Most people with resistant hypertension do not have obvious symptoms. Some may experience headaches, dizziness, or nosebleeds, but high blood pressure is often called a “silent” condition. Regular monitoring is essential.

Diagnosis
If resistant hypertension is suspected, your healthcare provider may:

• Review your medical history and current medications
• Perform a physical examination
• Order blood tests to check kidney function and hormone levels
• Conduct imaging studies, such as ultrasound or CT scans of the kidneys
• Use ambulatory blood pressure monitoring to measure blood pressure over 24 hours

Management and Treatment
Management of resistant hypertension often requires a multi-faceted approach:

• Lifestyle changes
  • Reduce salt intake
  • Maintain a healthy weight
  • Exercise regularly
  • Limit alcohol and avoid smoking

• Medication adjustments
  • Your doctor may adjust doses, switch medications, or add additional medications to better control blood pressure.

• Treatment of underlying conditions
  • If a secondary cause is identified, treating it may improve blood pressure control.

• Specialist care
  • People with resistant hypertension are often referred to a hypertension specialist or a nephrologist (kidney specialist) for advanced evaluation and treatment.

Living with Resistant Hypertension
With careful management, many people with resistant hypertension can achieve better blood pressure control and reduce their risk of complications. Regular follow-up, adherence to medications, and lifestyle changes are key components of long-term success.