In this blog article, Dr Fiona Wu, Aare Urocare’s Medical Director and Senior Consultant Urologist, an expert in kidney diseases and other urological conditions, sheds light on silent kidney problems.
Understanding Silent Kidney Disease
Did you know that feeling perfectly well does not necessarily mean your kidneys are healthy? Kidney diseases, particularly Chronic Kidney Disease (CKD), are often “silent” in nature, especially in the early stages. This is because the kidneys can compensate for damage and continue to function adequately despite losing a significant portion of their filtering capacity. Symptoms often don’t appear until the disease has progressed significantly, making early detection challenging without specific testing.
Chronic Kidney Disease in Singapore
CKD refers to abnormalities of kidney function or structure lasting for three months onwards, with implications for health.
The National Population Health Survey 2022 reported that 14% of Singaporeans are suffering from CKD—an increase from 9% two years prior. If the current rising trend continues unabated, there is likely to be a kidney disease crisis in Singapore.
The increasing prevalence of CKD cases is linked to several risk factors, which include an ageing population, sedentary lifestyles, and rising rates of diabetes and hypertension.
Causes and Risk Factors of Chronic Kidney Disease
Several factors contribute to the development of CKD. Common causes include long-term conditions such as diabetes and hypertension, which place excessive strain on the kidneys. Diabetes can particularly damage the delicate blood vessels located within the kidneys, thus weakening their functions. Meanwhile, hypertension exerts higher pressure on these vessels and can further accelerate kidney damage.
Other contributing factors include a family history of kidney disease, recurrent urinary tract infections, and exposure to nephrotoxic medications or substances. Lifestyle risk factors also add to the severity of kidney disease, such as obesity, smoking, and excessive salt intake. Older adults and elders are more prone to the natural decline in kidney function with age. Recognising these causes and risk factors is critical to taking preventive measures and seeking timely medical attention.
Common Symptoms of Chronic Kidney Disease
The presence and severity of symptoms depend on the stage of CKD.
Early-Stage Chronic Kidney Disease
In the early stages, CKD is usually asymptomatic. Thus, most individuals within the early stage of CKD feel normal, as their kidneys can still compensate for minor functional loss. Hence, data from the National Kidney Foundation reports that more than 300,000 individuals have chronic kidney disease, but there could be another 200,000 undiagnosed cases in Singapore.
The lack of noticeable CKD symptoms underscores the necessity of regular kidney check-ups for populations at risk.
Late-Stage Chronic Kidney Disease
Individuals may start to have symptoms as CKD progresses. Symptoms that may show in this stage include:
- Swelling in the legs, feet, or hands is mainly caused by fluid retention, a key indicator of declining kidney function.
- Fatigue and weakness become more prominent as waste products start to accumulate in the blood, decreasing overall energy levels.
- Difficulty concentrating may also arise as toxins affect brain function.
- Changes in urination are another significant indicator. These may manifest as an increased or decreased frequency, foamy urine due to protein leakage, or blood in the urine.
- High blood pressure that resists standard treatment can also signal advanced kidney disease.
Don’t ignore the warning signs of kidney disease. If you are suffering from any of the symptoms above, it is advisable for you to seek medical attention promptly.
Complications of Undiagnosed Chronic Kidney Disease
Progression to End-Stage Kidney Disease (ESKD)
When CKD goes undiagnosed and untreated, it can progress to end-stage kidney disease (ESKD). The kidneys lose almost all their functional capacity at this stage, accumulating waste and toxins. Individuals with ESKD require either dialysis or a kidney transplant to survive, as the kidneys can no longer support life on their own.
Impact on Other Organs
The effects of undiagnosed kidney disease extend beyond the kidneys. Cardiovascular complications like heart attacks and strokes are common due to the increased strain on the heart. Bone disorders may arise from the impaired regulation of calcium and phosphorus, weakening bones and increasing fracture risk. Additionally, CKD can lead to anaemia as the kidneys produce less erythropoietin, a hormone essential for red blood cell production.
Tests for Detecting Chronic Kidney Disease
At Aare Urocare, a urology specialist clinic in Singapore, we provide a wide range of kidney screening tests for individuals without symptoms and diagnostic tests for patients with symptoms of kidney conditions.
Screening Tests (Used for Early Detection)
These are non-invasive tests that help identify potential kidney issues before symptoms appear:
- Blood tests (serum creatinine & eGFR) – Used to detect early kidney dysfunction.
- Urine tests (albuminuria or haematuria detection) – Helps identify early kidney damage.
Diagnostic Tests (Used to Confirm or Investigate a Condition)
These are usually performed when kidney disease is suspected or detected through screening:
- Imaging studies (ultrasound, CT scans) – Used to identify structural abnormalities or blockages.
Kidney Screening and Preventive Guidance in Singapore
We recommend our patients to be proactive about their kidney health by gaining a better understanding of how their kidneys are doing. Patients with higher risk but do not have CKD should still be followed up regularly. Although all patients at increased risk of CKD should be followed up at least yearly, closer monitoring may be recommended in some cases, for instance, when risk factors are poorly controlled.
This is because detecting and treating CKD early slows disease progression as well as improves quality of life and long-term outcomes. Poor kidney function can typically be reversible if urological causes are found and resolved quickly. Urological conditions can significantly impair kidney function, but timely intervention can often restore renal health. It is crucial for patients to understand that early detection and treatment of urological issues can prevent permanent kidney damage and potentially reverse declining kidney function, highlighting the need for comprehensive urological evaluations in cases of unexplained renal impairment.
Don’t wait until symptoms appear; take charge of your kidney health today, especially for high-risk individuals with diabetes, hypertension, or a family history of kidney disease.
Treatment Options for Chronic Kidney Disease
At Aare Urocare, Dr Fiona Wu, our Senior Consultant Urologist, will recommend a tailored treatment plan based on your individual condition.
Slowing Progression in Early Stages
In the early stages of CKD, treatment focuses on slowing disease progression through changing lifestyle choices and medical management. Recommended lifestyle adjustments include maintaining a balanced diet, engaging in regular physical activity, and smoking cessation. Medical management also involves controlling underlying conditions like diabetes and hypertension, often with the help of medication that protects kidney function.
Management in Advanced Stages
Urologists focus on treating reversible conditions of renal failure, such as kidney stones, retention of urine and prostate conditions causing acute renal failure. In severe cases of CKD in its late stages, a kidney transplant may be warranted to improve survival.
Preventing Chronic Kidney Disease
Lifestyle Modifications
Adopting a healthy lifestyle is important for preventing CKD:
- Consume an adequate amount of fruit, vegetables, grains and lean meat.
- Limit your intake of salt and fat.
- Drink plenty of water, and drink less soft and alcoholic drinks.
- Exercise at least five times weekly, and do not smoke.
- Attend regular health check-ups.
Monitoring and Managing Risk Factors
The key to reducing CKD risk is monitoring and managing underlying conditions. Individuals with diabetic conditions should control blood sugar levels, while those with hypertension need to keep their blood pressure within a healthy range.
Schedule an Appointment with an Experienced Urologist in Singapore
If you or a loved one is concerned about kidney disease, schedule an appointment with Dr Fiona Wu, an experienced Senior Consultant Urologist and Medical Director at Aare Urocare. Dr Wu will help you conduct a thorough assessment and take charge of your kidney wellbeing. Aare Urocare is a urology specialist clinic conveniently located in Singapore’s Gleneagles Hospital and Mt Elizabeth Hospital.
References
- Yip C, Chew E. “We’re at the brink”: Kidney disease crisis looms in Singapore as some doctors urge more action. CNA. Published July 22, 2023. https://www.channelnewsasia.com/singapore/chronic-kidney-disease-failure-singapore-early-screening-nkf-dialysis-3620561
- Mayo Clinic. End-stage Renal Disease – Symptoms and Causes. Mayo Clinic. Published October 10, 2023. https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/symptoms-causes/syc-20354532
