Nottingham Renal Unit

The body has two kidneys and they are vital to maintain good health. They sit at the back of the abdominal cavity just below the ribs. They filter your blood and get rid of the body's waste in the urine. They also help to control the salt and water balance of the body.

If they kidneys don’t function properly the waste levels may rise in the blood. The kidney filter mechanism can also become ‘leaky’ and blood and protein may be detected in the urine.

Importantly many patients don't have any symptoms of kidney disease at all. The first time you may find out you have a problem is on a blood or urine test. In some patients fluid retention and high blood pressure can occur. In the later stages tiredness, poor appetite, nausea and itchy skin can develop.

Chronic Kidney Disease (CKD) means the kidneys are not working properly and the problem persists on repeated tests. In the population, about 1 in 10 people are affected. It is relatively uncommon in children and young adults but becomes more common as people age.

CKD is often caused by other common health problems such as high blood pressure or diabetes. Less often patients can be affected by inflammatory kidney diseases, whilst some have an inherited problem such as polycystic kidney disease.

Specific information and advice about your kidney condition will be discussed with you in the clinic.

Further information about some common conditions can be found here.

CKD STAGE	Description (eGFR ml/min/1.73m2)
Stage 1	Normal eGFR (>90) With other evidence of kidney damage *
Stage 2	eGFR 60-90 With other evidence of kidney damage *
Stage 3a Stage 3b	eGFR 45-59 eGFR 30-44
Stage 4	eGFR 15-29
Stage 5	eGFR < 15
* Evidence of chronic kidney damage includes: persistent albuminuria or proteinuria, haematuria, structural abnormalities, biopsy-proven glomerulonephritis.

 

eGFR - a blood test to estimate kidney function.

Creatinine – a waste product of the body. A raised level in the blood may be seen if the kidneys aren’t working correctly. This test is used to help calculate the eGFR.

Potassium – one of the main blood salts. This level may rise in kidney disease and if it’s especially high might need to be corrected to prevent complications. High levels can affect the heart rate and rhythm.

Full Blood Count - a blood test to look for anaemia. People with CKD can become anaemic.

Bone blood tests - calcium, phosphate and parathyroid hormone levels. This can be important to keep your bones healthy.

Bicarbonate test - a measure of the blood 'acidity'.

Immune blood tests - C-reactive protein, immunoglobulin levels, complement protein tests, anti-nuclear antibody test (ANA), anti-neutrophil cytoplasmic antigen (ANCA) antibody test, PLA2R anti-body test. These are associated with rare forms of inflammatory kidney disease.

Urine dipstick test – to check for blood or protein in the urine.

Urine albumin/creatinine or urine protein/creatinine ratio. This measures the protein level in the urine.

Kidney ultrasound scan – to look at the size and shape of the kidneys. It will also check that the kidneys are draining into the bladder correctly.

Kidney biopsy - this may be necessary to examine the microscopic structure of the kidney. This is only done if the other tests have not led to a diagnosis or we want to know how 'active' your kidney disease is.

Protein in the urine (Proteinuria)

Protein should not be detected in the urine. When it is found it's often the result of a kidney condition and you may need to see a kidney specialist.

If protein is detected in your urine then your doctor or nurse should arrange further tests. A urine sample should be sent away to accurately measure the amount of protein in the urine. Blood tests should also be taken to measure the kidney function and the blood protein level.

Common causes for protein in the urine include diabetic kidney disease and kidney disease caused by high blood pressure. Other causes are less common and are diagnosed with additional blood tests or by performing a kidney biopsy.

Your doctor should be able to advise you about whether you need to see a kidney specialist. This will depend on your medical history, the amount of protein in the urine and whether the other kidney tests are normal or not.

Blood in the urine (Haematuria)

If you see blood in the urine this is obviously alarming and shouldn’t be ignored. The blood can be caused by a urinary infection, kidney stones or sometimes kidney or bladder cancers. Some kidney diseases can also cause blood in the urine.

You should see you doctor as soon as possible. Most patients need to be referred to see a urology specialist.

Patients should receive a kidney scan. They may also need a camera test to examine the lining of the bladder. This is called a cystoscopy and is performed as a day case procedure by the urology specialist.

Blood in the urine but I can't see it ?

Small amounts of blood in the urine can sometimes be detected on a urine dip test but is not visible to the naked eye.  This still needs to be taken seriously. It can also be caused by the same set of disorders detailed above. The same tests are done – a kidney scan and a cystoscopy.

If no cause if found on the scan or the cystoscopy then this is hopefully reassuring. If however blood is found on more than one occasion then the blood may be leaking through the kidney’s filter. At this stage your GP or the urologist should consider referring you to see a kidney specialist (nephrologist).

You can now see your own blood and urine test results using the Patient view service.

You can access the Patient view service here.

You can get information about how to register and access this by asking at any of the renal out patient clinics. This helps you keep up to date and manage your own health.

We believe that managing your health is a partnership between you, your family or carers and our staff members. We want to tailor your care to suit you, your lifestyle and your circumstances. For us to be able to do this, it is important to us that you feel able to participate in your care, help make decisions about your treatments and give your opinion on the choices which are offered to you. There are a number of ways that you can do this.

Prepare for your clinic appointment by thinking about what you might want to discuss.

• What do you want to get out it?
• What are your own priorities when it comes to your health & lifestyle?
• Do you understand your condition?
• Do you feel confident about how you can help manage your condition or symptoms?
• Have you got questions about your health or treatments?
• Have any new treatments been working in the way you expected?
• Have you got any new health concerns?

It may be helpful to write down your questions before you come to clinic.

Bring someone with you to your clinic appointment if you think that would help. Sometimes it can be difficult to remember everything which is said at a clinic appointment, and the other person may remember things that you did not. They may also have a different understanding of what was said. It can be helpful to discuss any issues with this person after the clinic appointment has finished so that you can make a considered choice about any treatments or check your own understanding of what was said.

Ask questions if you don’t understand something which is said to you. We are always happy to explain something to you as many times as you need so that you leave the department feeling confident that you understand what we have said. Please encourage anyone who comes with you to ask any questions that they may have too. Particular questions could include: What are my options at this stage? What are the pros & cons of each option? How do I get the support to help me make that decision? What happens if I do nothing?

Be ready to give your opinion about choices which are offered to you. It is your health and whilst we can advise you, the final decision is yours.

Don’t feel rushed into making a decision. If you need more time to discuss something with family or carers, then please say so. Some decisions do have to be made quickly, but we try as far as possible to give you time to consider your choices and to make a decision which is right for you.

We hope that by following these simple suggestions, you are more able to take part in discussions about your health when you come to the Renal Department and as a result, your care will be more suitable to you. Our staff members are experts in renal problems and their treatments, but you are the expert in how you feel and how you want to live your life. We need to work together to make sure that the care we offer to you keeps you as well as possible for as long as possible in order for you to live well.

We very much value the perspective of patients and carers and therefore, we have an active and very friendly Patient and Public Involvement Group within the Renal Department. This group meets once every 2 months taking part in a range of activities. Speakers from the hospital and elsewhere relevant to renal services come to talk to the group about their work. Researchers may present their research ideas or staff from the Renal Department may come to the group to ask for feedback on proposals to change or improve services.

A range of patients, carers and members of the public attend these very informal meetings. It’s not necessary to come to every meeting and many members choose whether to attend dependant on the topic for discussion at a particular meeting. There is also a social element to these meetings as patients and carers can discuss their experiences and support each other on their healthcare journey. This is of course helped along by plenty of tea, coffee and chocolate biscuits!

The group is coordinated by Sarah Brand, our Senior Research Nurse. Sarah can provide travel assistance if that is required for you to attend. If you think you would like to know more about the group and what it does, please contact Sarah directly. You would be most welcome!

Tel: 0115 840 5859

Kidney research

Nottingham Renal and Transplant Unit is a very research active department. We feel that taking part in research is the best way to ensure that our patients are offered the best and most up to date treatments. We believe that research is crucial to improving the outcomes for our patients both now and in the future.

The department takes part in research studies in the areas of renal medicine, transplant and dialysis. These may be interventional – testing new treatments – or observational – not changing treatments, but recording what treatments patients are having and what their outcomes are over time. Many of our patients are, or have been, participants in a range of research studies.

With the support of our medical staff, we have a team of dedicated and experienced research nurses and practitioners who carry out the research studies we are participating in. They ensure that the participants are monitored carefully and that the research studies are carried out properly. Patient safety is always our first priority. You may be approached by a member of this team about relevant research studies when you are visiting the department as we want to give as many patients as possible the opportunity to take part in research and receive new treatments. Of course, you do not have to take part in any research if you do not want to, and your medical care will not be affected by any decision you make about a research study.

If you would like to know more about the research going on in the department, see our Research noticeboard in Renal Outpatients, ask a member of medical staff or contact our research team directly.

Tel: 0115 840 5859