Patient guide

First of all

To understand how your kidneys are doing, a kidney specialist (nephrologist) looks mostly at your numbers and your medicines. The more complete they are, the sooner the first visit reaches a useful answer. If you do not have something, do not worry and come anyway. Just bring what you have.

What to bring

1. A list of all medicines, supplements and herbs

NIDDK recommends keeping an up-to-date list of everything you take and bringing the bottles and boxes to the visit. This includes:

• Prescription medicines, including those for blood pressure and diabetes.
• Painkillers and over-the-counter medicines, such as ibuprofen, naproxen and combined cold tablets.
• Vitamins, supplements, herbal teas and herbal remedies. NKF says to bring the label or a photo of the packaging so the ingredients can be checked.
• Any medicine you stopped some time ago, or tend to forget.

With the list or the bottles, it becomes clear whether your medicines and supplements suit your kidneys. Do not stop any medicine for the visit. Just bring it.

2. Earlier test results

NKF notes that the trend of your numbers over time is usually more useful than a single number. If you have them, bring:

• Creatinine and eGFR from several earlier tests, even from years ago.
• Urine tests, especially protein or albumin and the albumin-to-creatinine ratio (ACR).
• Blood sugar and A1C if you have diabetes.
• An ultrasound or CT of the kidneys and urinary tract.

If you have no tests yet, the doctor will say which are needed. Creatinine is not an absolute number: food, muscle mass and medicines change it. NKF says you may sometimes be asked not to eat cooked meat the night before a test. If you take creatine supplements, tell the doctor.

3. Your blood pressure record

If you measure your blood pressure at home, bring the sheet of readings (see the guide “Blood pressure at home”). If you do not have one, start today.

4. Medical and family history

• Known conditions: diabetes, high blood pressure, heart, liver, gout, kidney stones, repeated urinary infections.
• Kidney disease, dialysis or transplant in the family.
• Earlier operations, hospital stays, and every time a doctor said your kidneys were “weak”.
• Drug allergies and any reaction to contrast dye.

5. Your symptoms and questions

Write down your symptoms with when they started: swelling, foamy urine, a change in urine colour or amount, tiredness, itching, nausea. NIDDK says you can ask at every visit how your eGFR and urine albumin compare with before, and whether the disease is getting worse.

What you might ask

NKF and NIDDK suggest questions like these:

• What does my number mean, and which stage am I in?
• What is causing the drop in function or the protein in my urine? Should another condition be checked?
• Could dehydration, illness or an infection have changed the number for a while?
• Are my medicines safe for my kidneys? Should anything be changed on your advice?
• Which tests do I need, and how often?
• What should my diet be like? Do I need a dietitian?
• What should I do before a scan that uses contrast dye?
• When should I get in touch urgently?

What to expect from the first visit

You do not have to get a final answer to every question at the first visit. NKF says that diagnosing chronic kidney disease needs test results that stay the same for three months or more, so tests may be repeated. Ask this of the first visit: know which tests are needed, when to come back and which symptoms to take seriously.

A note for a companion

If you booked for an elderly parent, gather the medicine list and test results yourself and go with them to the visit. A patient may not remember the names of their medicines, and this list prevents mistakes.

Before the visit arrives

• Passing very little urine or none, short of breath, sudden swelling or severe vomiting? Do not wait for your appointment. See the guide “When to get urgent help” and call 115, Iran’s emergency number.
• Planning a CT scan with contrast dye? Tell the imaging centre you have a kidney problem (see the guide “Medicines, painkillers and contrast dye”).

Why test?

MedlinePlus says blood and urine tests are the only way to know about kidney disease. NIDDK adds that the early stages usually have no symptoms. So numbers have to take the place of symptoms.

1. Blood creatinine

Creatinine is a waste product from the normal breakdown of muscle, and the kidneys remove it from the blood (NKF). If the kidneys work less well, creatinine rises.

But creatinine alone does not diagnose kidney disease. NKF says:

• The “normal” limit varies with age, sex and body size. Look at the reference range on your own lab sheet.
• A lot of cooked meat, creatine supplements, hard exercise and large muscle mass raise it. Some medicines do too.
• A plant-based diet, low muscle mass, pregnancy and severe liver disease lower it.
• Creatinine can be “normal” and kidney disease can still be present, and the reverse.

See the article “Does high creatinine mean kidney failure?” for more.

2. eGFR

eGFR is an estimate of how much blood the kidneys filter each minute. NKF writes that it is calculated from creatinine, age and sex, and sometimes from cystatin C, another test, which is more accurate when both are used together.

NKF lists the stages like this (in mL/min/1.73m²):

Stage	eGFR	Description
G1	90 or more	Good function (with a sign of damage such as protein in the urine)
G2	60 to 89	Mildly reduced (with a sign of damage)
G3a	45 to 59	Mildly to moderately reduced
G3b	30 to 44	Moderately to severely reduced
G4	15 to 29	Severely reduced
G5	Less than 15	Kidney failure

A few points (NKF):

• In the NKF table, stages 1 and 2 count only when a sign of damage, such as protein in the urine, is also present.
• On average, eGFR falls as age goes up.
• It is less accurate in the early stages, and pregnancy, age over 70, unusual muscle mass, cirrhosis, nephrotic syndrome and some medicines affect it.
• NKF suggests repeating a low number after about three months and says “looking at the trend over time is usually more useful than a single number”. This interval is for confirming a chronic condition, not for a number that has suddenly got worse.
• If you are a patient, ask whether dehydration, illness or an infection could have changed the number for a while.

3. Urine albumin-to-creatinine ratio (ACR)

Albumin is a protein that healthy kidneys keep in the blood. ACR shows how much of it passes into the urine. NKF gives the categories like this (mg/g):

ACR	Meaning
Less than 30	Normal
30 to 299	Moderately increased
300 or more	Severely increased

NKF says urine albumin can be a sign of damage even when eGFR is above 60. A high ACR usually needs to be repeated to see whether it stays high, because dehydration, hard exercise, fever and infection can raise it for a while. NIDDK also says that if albumin is found, the test is done one or two more times.

NIDDK describes follow-up this way: treatment is working when eGFR stays steady and urine albumin stays steady or falls.

4. The routine urine test

A urine dipstick, a strip treated with chemicals, shows protein. A positive result is usually confirmed with the more precise ACR test. NIDDK says that when checking for disease of the kidney’s filters, a urine test shows extra protein and red blood cells. Give the urine sample as the lab tells you.

Why test more than once?

By NKF’s definition, chronic kidney disease is damage or reduced function that lasts three months or more. Repeated tests tell the doctor whether the situation is stable or temporary. If you see one bad number, do not diagnose yourself, and show it to your doctor soon. Your doctor decides when to repeat the test. If the number is suddenly much worse than your last result, or you feel unwell, do not wait for months: contact a doctor the same day, because it may be sudden kidney injury.

For your next test

• Keep earlier results in one folder and take them to the visit.
• Ask the doctor how often each test is needed. The intervals differ from patient to patient.
• If you have diabetes or high blood pressure, NIDDK says your risk of kidney disease is higher and regular testing is needed.
• Do not stop any medicine on your own because of a test result.
• If the lab gave special instructions, such as no cooked meat the night before, follow them.

The main message

• Before you take any new painkiller, medicine, supplement or herb, ask your doctor or pharmacist, and say that you have a kidney problem.
• Before any scan that uses contrast dye, tell the imaging centre that you have kidney disease.
• Do not stop or change any prescribed medicine on your own, especially blood pressure medicine. If a medicine worries you, contact your doctor before doing anything.

Why medicines and kidneys are linked

NKF says some medicines damage the kidneys, and the kidneys remove many others from the body. When kidney function falls, some of these build up, so their dose or timing may need to change. Your doctor makes this decision based on your eGFR, and eGFR needs to be checked regularly.

Painkillers

Non-steroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen, naproxen, diclofenac in any form taken into the body (tablet, capsule, suppository or injection), celecoxib, meloxicam and ketorolac. NKF says these medicines reduce blood flow to the kidneys and can make chronic disease worse or cause sudden kidney injury, especially with long or heavy use. NKF writes that people with chronic kidney disease should avoid NSAIDs, especially with an eGFR below 60. NIDDK also considers ibuprofen and naproxen harmful for people with kidney disease, diabetes or high blood pressure. NHS says kidney disease may make ibuprofen unsuitable, and that signs of a kidney problem can include shortness of breath, blood in the urine or swelling.

The risk is higher in these groups (NKF): chronic kidney disease, liver or heart disease, high blood pressure, and people taking blood pressure medicines of the “-pril” or “-sartan” groups or water tablets (diuretics). Also look for the word NSAID on the labels of cold remedies.

Paracetamol (acetaminophen). NKF generally considers it safe for the kidneys at a suitable dose, but recommends asking your doctor before using it and being careful with combination products that may add up to more than you intend. Liver disease can also rule it out.

Topical gels and ointments. NKF treats diclofenac gel as a lower-risk exception, because little of it reaches the blood. Capsaicin, menthol and lidocaine ointments are not a kidney problem, but heavy use raises the blood level of the drug.

Aspirin. NKF writes that low-dose aspirin may be recommended for heart disease, but high-dose aspirin acts like an NSAID. The decision for each kind rests with your doctor.

Cortisone-type medicines and opioids. Cortisone may hold on to water and raise blood pressure and blood sugar. Some opioids, such as tramadol or codeine, have breakdown products that are cleared by the kidneys, and their dose has to suit the eGFR (NKF). Use these only on a doctor’s prescription and under their supervision.

Before using any painkiller (NKF): talk with your care team; tell them your eGFR, your liver and heart condition and your medicine list; use the smallest effective amount for the shortest time; avoid alcohol; and ask about non-drug options such as physiotherapy, stretching and gentle exercise.

Over-the-counter medicines, antacids and supplements

NKF says antacids usually contain calcium, magnesium, bismuth or aluminium, and these can build up in the body in chronic kidney disease. Check antacids and stomach medicines with your doctor before use, and do not take products containing aluminium without their advice. If your doctor has prescribed one of these, do not stop it yourself; ask. NIDDK says to use one pharmacy, keep an up-to-date list and take the bottles to your visit.

Herbs and supplements

NKF says herbal remedies may worsen kidney disease, interact with medicines, be contaminated (for example with heavy metals or toxic compounds), and vary in strength from one brand to another. NKF gives a long list of high-risk herbs (such as liquorice root, nettle, horsetail and creatine supplements) and says the list is not complete. Some products contain a lot of potassium or phosphorus, which matters more for people on dialysis.

About “kidney cleanses”: NKF writes that teas and supplements that claim to cleanse the kidneys of toxins have limited evidence, and some of their ingredients damage the kidneys or interact with medicines. A healthy diet, regular activity and not smoking do more for the kidneys.

If you take a supplement or herbal tea, bring the bottle or a photo of the label to your visit and ask whether it is suitable for your stage of disease. NKF says not to use mixed products with unclear ingredients.

Contrast dye

Contrast dye is an injected medicine that makes the picture clearer in some CT and MRI scans.

Iodine contrast (CT). NKF says it may cause sudden kidney injury. For most people the risk is low, but it rises with advanced chronic kidney disease, diabetes, dehydration or severe illness. NHS also lists contrast dye among the causes of sudden kidney injury.

Gadolinium (MRI). NKF says that with newer agents the kidney risk is very low, and the imaging team chooses the option according to your eGFR.

Barium (for the digestive tract) and ultrasound contrast are unlikely to affect the kidneys, according to NKF.

Before a CT or MRI (NKF)

• Say if you have kidney disease, dialysis or a transplant, and tell them all your medicines, vitamins and supplements.
• Say if you have reacted to contrast dye before, have asthma or have a severe allergy.
• Ask whether the information can be obtained without contrast dye. NKF says not every imaging test needs contrast, and an ultrasound may be enough. Sometimes contrast avoids repeat tests, so weighing this up is a decision with your doctor. In an emergency the care team decides, and worry about contrast should not delay urgent tests. Just tell them about your kidney disease.
• Enough water before and after the test helps, unless your doctor has told you to limit fluids, as in heart failure. You may also be given a drip before the test.
• Some medicines, including metformin, anti-inflammatory drugs, water tablets and some antibiotics, may be paused for a while. NKF says to get written instructions on when to stop and restart. Do this only on your doctor’s instruction.
• If you are on dialysis, arrange the timing of the injection with your kidney team and the imaging team.

Summary

• Discuss every medicine and supplement with your care team before taking it.
• Do not take an anti-inflammatory painkiller without asking.
• Tell the imaging centre about your kidney disease before a scan.
• Do not stop or change any prescribed medicine on your own.
• If after a medicine or a scan you pass very little urine, or get swelling or shortness of breath, see the guide “When to get urgent help”.

Why there is no general diet plan

NIDDK writes that there is no single eating plan for chronic kidney disease. In the early stages you may have few limits, and they change as the disease advances. The size of each limit is set by your doctor or dietitian from your blood tests and your situation.

For this reason we do not give amounts in this guide. Whatever you have heard online or from friends about “how much protein” or “how much water” may be wrong for your kidneys. More important still: the advice for one condition is sometimes the opposite of the advice for another. For example, kidney stones usually call for more fluids, while in advanced kidney failure fluids may be limited.

Salt

Salt (sodium) raises blood pressure and makes the body hold on to water. NIDDK says cutting down on salt helps control blood pressure. NIDDK and NKF recommend:

• Eat fewer packaged, ready-made and fast foods.
• Use spices and fresh herbs instead of salt.
• Read food labels. NIDDK says 20% of the daily value or more is high in sodium and 5% or less is low.

NIDDK points out that many kidney patients need to limit salt even more than the general advice, and your doctor will tell you how much.

Protein

NIDDK gives no fixed figure for protein. Some kidney patients need a moderate amount, and eating very little may lead to malnutrition. NIDDK suggests limiting protein from meat and dairy, using more plant sources and choosing lean meat. People on dialysis may need more protein.

In nephrotic syndrome, NKF says a high-protein diet does not help and may make things worse.

Do not cut protein sharply or raise it sharply without the advice of a doctor or dietitian.

Potassium

Healthy kidneys remove potassium. NKF says that as kidney function falls, potassium may build up in the blood, and a sudden or severe rise is dangerous. Some medicines, salt substitutes that contain potassium chloride, and large amounts of high-potassium foods can raise it.

NIDDK says the allowed amount is decided by the blood potassium test. If potassium is high, portions of some foods may be reduced and methods such as leaching or boiling vegetables may be used. Do not cut out fruit and vegetables on your own without a potassium test. Do not use a salt substitute without asking.

Phosphorus

NIDDK says phosphorus in the blood is measured by a test. Reduce phosphorus additives in processed foods and read the label. Animal phosphorus is absorbed more than plant phosphorus. As the disease advances, a phosphate-binding tablet taken with meals may be needed, and prescribing it is up to the doctor.

Fluids

A damaged kidney may not remove extra water, so some patients need to limit fluids (NIDDK). But there is no fixed amount for everyone, and some patients, such as those with kidney stones, need to drink more instead. To help prevent sudden kidney injury, NHS says to drink enough that your urine is pale and regular, especially in hot weather or with vomiting and diarrhoea, unless your doctor has limited your fluids.

Ask your doctor: “What amount is right in my situation?” If you get swelling of the face, hands, feet or abdomen, tell your doctor (NIDDK).

Diabetes, blood pressure and weight

NIDDK says to write a meal plan with a dietitian that suits both diabetes and blood pressure and that you enjoy. NIDDK says excess weight makes the kidneys work harder, and regular activity and a suitable weight help. On a kidney stone plan, NIDDK says advice depends on the type of stone.

Supplements and “cleansing diets”

NKF warns that some herbs and supplements contain a lot of potassium or phosphorus or are harmful to the kidneys, and that “kidney cleanses” lack enough evidence. Ask before taking any supplement.

A dietitian

NIDDK recommends working with a dietitian, ideally one who knows kidney disease. In the patient support section of this site, “special diets suited to the patient’s clinical condition” is named among the support services. If you need this service, bring your test results with you.

For your next visit

• Write down what you eat and drink for a week.
• Bring your latest potassium, phosphorus and albumin results.
• Ask: which limit do I need, and which not?
• Do not remove foods on your own, and do not start a supplement.

Why at home?

NIDDK says lowering blood pressure is the main way to slow or prevent kidney damage and one of the most important steps in treating kidney disease. NHS writes that if the clinic reading is high, the doctor may ask for several days of home measurements. A home record gives your doctor a picture of your blood pressure on different days.

Do not use the numbers to make decisions about medicine. Your blood pressure target is set by your doctor and may differ for a kidney patient, a person with diabetes or an older person. Different sources give different targets, so do not take a number you heard online as your yardstick.

The device

CDC says your care team can show you how to use a home device correctly and how often to measure. Ask your doctor or pharmacist before you buy or start.

Steps for measuring (CDC)

Before you start

• Empty your bladder.
• Do not eat or drink for thirty minutes before measuring. Smoking, alcohol, caffeine and exercise in that time raise blood pressure.

Sitting

• Sit in a chair with a back and stay calm for at least five minutes.
• Put both feet on the floor and do not cross your legs.
• Rest your forearm on a table so the cuff is level with your chest.
• Do not talk during the reading.

The cuff

• Put the cuff on your bare upper arm, not over clothing, and make sure it fits.
• If you have a dialysis fistula or graft, do not measure on that arm.

Repeating

• Take at least two readings, one to two minutes apart.
• Measure at the same time each day.
• If the numbers are high, your doctor may ask you to measure more often.

Recording

Write each reading in a notebook or on a printed sheet (CDC): the date, the time, the top and bottom numbers, and the pulse if the device shows it. Add when you took your medicines and whether you felt unusual. For diagnosis, NHS sometimes asks for several days of readings or a 24-hour monitor.

Take the notebook, your medicine list and your questions to the visit. CDC suggests a list of questions about managing blood pressure.

What do the numbers mean?

NHS names two numbers: the top number should always be larger than the bottom one, and it counts blood pressure as high at 140/90 or more in the clinic and 135/85 or more at home. Sources use different cut-offs for diagnosis (NIDDK names 130/80 in the clinic), and your target is a separate matter. For this reason we cannot give you a single target number. Your doctor tells you your target.

Very high blood pressure

NHLBI says a reading above 180/120 should be taken seriously:

• No symptoms: wait five minutes and measure again. If it is still high, tell your doctor.
• With symptoms: if you have a sudden severe headache, difficulty breathing, sudden pain in the abdomen, chest or back, numbness or weakness, a sudden change in vision or trouble speaking, do not stop to measure again. Call emergency services now (115 in Iran, Iran’s emergency number). These signs are urgent at any reading.

NHS also says high blood pressure usually has no symptoms. Frequent headaches and blurred vision are reasons to see a doctor, and sudden severe chest pain is an emergency.

What not to do

• Do not stop, reduce or increase a blood pressure medicine on your own because of one high or low reading. A lower reading may simply be the result of the medicine. If a low reading comes with dizziness, weakness or fainting, contact a doctor the same day.
• If the home reading differs from the clinic reading, show both to your doctor.
• Ask your doctor how often to measure and keep to that plan.

Going further

For controlling blood pressure NIDDK considers these helpful: a low-salt diet, stopping smoking, regular physical activity, enough sleep and taking medicines as prescribed. See the guide “Food and fluids” for diet details.

If you are not sure

Most kidney problems can be followed up at a routine appointment. But a few situations should not wait. This list does not cover everything. If you are worried or unsure, call your doctor, and if you cannot reach them, call 115 or go to the emergency department. The support number on this site is for appointments and coordination and does not replace emergency care. In Iran the emergency number is 115. It works only while you are in Iran; from abroad, use your local emergency number. If you are very unwell, do not drive yourself, and take your medicines and your medicine list with you. NHS gives the same advice.

This list does not replace a doctor’s diagnosis. If you have kidney disease, any new or sudden symptom is reason enough to call.

1. Call 115 now or go to the emergency department

Very little urine, or none

NHS says a sharp fall in urine is a sign of sudden kidney injury, along with great thirst, nausea, swollen legs, tiredness and drowsiness or confusion, and that urgent medical help is needed. On its kidney infection page, NHS also counts “not passing urine all day” as an urgent sign. If you have kidney disease and are passing almost no urine, do not wait.

Sudden shortness of breath or swelling

NHS says to call immediately if breathing has become very hard, you cannot finish a sentence, your chest feels heavy, your lips or skin look blue, grey or very pale, or you have suddenly become confused. In kidney injury, shortness of breath (especially when lying down) and swollen legs or hands are warning signs (NHS). Treat sudden swelling together with difficulty breathing as an emergency.

Chest pain

NHS says chest pain that does not go away, especially if it spreads to the arm, neck, jaw, abdomen or back, or comes with sweating, nausea, dizziness or shortness of breath, may be a heart attack. Kidney disease raises the risk of heart disease, so this matters more.

Flank pain with fever and chills

For kidney infection, NHS writes that pain in the side or back with a high temperature, chills or feeling cold and shivery, nausea and vomiting, or dark or cloudy urine may be a kidney infection. If you are confused, drowsy or have trouble speaking, go to the emergency department or call 115 right away. On its kidney stones page, NHS also says a stone with severe pain, or a high temperature or chills, needs urgent help. This is more serious in someone who has had kidney problems or stones before. In kidney infection NHS also advises against taking ibuprofen without a doctor’s advice.

Severe vomiting or diarrhoea and dehydration

In a kidney patient, dehydration can suddenly make the kidneys worse. NHS lists dehydration, vomiting and diarrhoea among the causes of sudden kidney injury. On its dehydration page, NHS says that if dehydration comes with cold, pale or blotchy skin, fast shallow breathing, confusion or unusual drowsiness, these are signs of shock and you need emergency care. If you cannot keep down fluids or your medicines, or your urine has become scant and dark, contact a doctor the same day, and if you cannot reach one, go to the emergency department. Ask your doctor in advance what to do with your medicines on sick days. Do not stop blood pressure medicine or water tablets on your own.

Severe weakness or a sudden racing heart

NKF says blood potassium may rise in kidney disease. Muscle weakness, numbness, tingling or nausea are vague signs of it. A sudden or severe rise in potassium is dangerous, and a racing or pounding heart, especially with difficulty breathing, chest discomfort or vomiting, is an emergency. If you have severe weakness or a sudden racing heart, go to the emergency department. NHS also considers palpitations a reason to contact health services urgently.

Severe headache or blurred vision with very high blood pressure

NHLBI says a reading above 180/120 needs medical attention, especially with symptoms. With a sudden severe headache, difficulty breathing, sudden pain in the abdomen, chest or back, numbness or weakness, a sudden change in vision or trouble speaking, do not stop to measure again: call emergency services. MedlinePlus calls very high blood pressure with blurred vision, confusion, chest pain, headache, numbness and reduced urine a “medical emergency” that can permanently damage the kidneys.

Signs of a stroke

NHS says if one side of the face has drooped or smiling is hard, you cannot hold both arms up, or your speech is suddenly slurred, call immediately. High blood pressure is a risk factor for stroke.

A lot of blood or clots in the urine, or being unable to pass urine

NHS says any blood in the urine, even a little, needs an urgent doctor’s appointment. If there is a lot of blood, clots, severe pain, you cannot pass urine, or fever and chills come with it, go to the emergency department. NIDDK lists blood in the urine, difficulty passing urine and severe flank pain among the signs of a stone that need urgent help.

Dialysis or transplant patients

• Transplanted kidney. NIDDK says to tell the transplant centre right away about fever, discharge or pain at the surgical site, burning when passing urine, or a cold with a stubborn cough, because anti-rejection medicines may hide the signs of infection. Swelling and high blood pressure may also be signs of rejection. Report pain or tenderness over the transplanted kidney, and reduced urine, the same day too.
• Dialysis access (fistula, graft or catheter). NIDDK says to check the site for signs of infection. Tell the dialysis centre the same day about warmth or redness, or if you can no longer feel the normal buzz of a fistula. Fever and chills with a dialysis access are urgent. If bleeding from the access does not stop with firm pressure, keep pressing and call 115.
• Peritoneal dialysis. NIDDK says to get care right away for abdominal pain, fever, nausea or vomiting, redness or pain around the catheter, cloudy drained fluid, or pus or swelling at the catheter exit site.

2. Contact a doctor or the emergency department the same day

If you cannot reach a doctor the same day, go to the emergency department.

• Any blood in the urine, even a little. NHS says to contact a doctor for an urgent appointment.
• Less urine than usual or darker urine, dizziness on standing that does not go away, or unusual tiredness on sick days (NHS on dehydration).
• New swelling of the legs or around the eyes, sudden weight gain, or new foamy urine in a patient who has protein in the urine.
• Fever with burning or frequent urination, without flank pain.
• Sudden severe flank pain that comes and goes, especially with nausea (NHS on stones).
• Frequent headaches or occasional blurred vision that you think come from blood pressure (NHS: contact a doctor).
• After taking an anti-inflammatory painkiller or having contrast dye, reduced urine or swelling.
• A test result with creatinine suddenly much higher, or eGFR much lower, than before.

3. See a doctor as soon as you can (not urgent)

• A new test result that is slightly worse than before.
• Persistent foamy urine or mild, long-standing leg swelling without the signs above.
• Home blood pressure that stays above your usual for several days in a row.
• Any question about medicines, supplements or imaging.

If you are not sure

Call your doctor or 115. “It may not matter, but I’m worried” is reason enough. When you call, have ready: the names of your medicines, your latest creatinine or eGFR if you know it, your symptoms and when they began, and whether you have a fever. At the emergency department, be sure to say that you have kidney disease, which medicines you take, and whether you are on dialysis or have a transplant.