Chronic Kidney Disease

Your kidneys do quiet but essential work, filtering waste from your blood, balancing fluid levels, controlling blood pressure, and producing hormones that keep your bones strong. Chronic kidney disease means these filters have been damaged over time and are no longer working as well as they should. It develops slowly, often over months or years, and in the early stages, most people feel completely fine. That is part of what makes it so dangerous.

High blood pressure, diabetes, repeated kidney infections, certain herbal remedies, and long-term use of anti-inflammatory painkillers may cause chronic kidney disease. If you or someone in your family has any of these risk factors, it is worth taking kidney health seriously, even before symptoms appear.

Kidney damage can result from several conditions, many of which are common in our communities. The most common causes include:

• Diabetes (diabetic nephropathy)
  High blood sugar over time damages the small blood vessels in the kidneys.
• High blood pressure (hypertensive nephropathy)
  Persistently elevated blood pressure puts strain on the kidney’s filtering units, gradually scarring them over the years.
• Chronic glomerulonephritis
  Inflammation of the kidney’s filtering units, often immune-related.
• Repeated kidney infections (chronic pyelonephritis)
  Frequent urinary tract infections that ascend to the kidneys can leave permanent scarring.
• Kidney stones and urinary obstruction
  Blockages that prevent urine from draining properly can cause back-pressure damage to the kidneys over time.
• Polycystic kidney disease
  An inherited condition in which fluid-filled cysts grow within the kidneys, gradually reducing function.
• Herbal and traditional remedies
  Some herbal and traditional remedies may contain substances that can damage the kidneys, especially when used frequently or without medical supervision.
• Long-term use of NSAIDs (non-steroidal anti-inflammatory drugs)
  Excessive use of painkillers can impair kidney function.

In some patients, more than one cause is present. Identifying all contributing factors is an important part of the assessment we carry out at the first consultation.

CKD is classified into five stages based on how well the kidneys filter the blood. This is measured using a calculation called the estimated Glomerular Filtration Rate (eGFR), which is derived from a simple blood test. Staging helps us understand how advanced the disease is, guide treatment decisions, and plan appropriately.

• Stage 1 — eGFR 90 or above (Kidney damage with normal or high function)
  At this stage, the kidneys are filtering normally or even slightly above normal, but there are signs of damage, such as protein in the urine or abnormalities on ultrasound. Most patients have no symptoms.
• Stage 2 — eGFR 60–89 (Mildly reduced function)
  Kidney function is mildly reduced. Symptoms are still unlikely. Blood pressure control and management of diabetes or other underlying conditions become priorities. Regular monitoring is recommended.
• Stage 3a and 3b — eGFR 30–59 (Moderately reduced function)
  This is the stage at which most patients first notice something is wrong, though many remain asymptomatic. Fatigue and mild swelling may begin. Referral to a nephrologist is strongly recommended at this stage, if not sooner.
• Stage 4 — eGFR 15–29 (Severely reduced function)
  Kidney function is significantly impaired, and symptoms are more apparent - fatigue, reduced appetite, swelling, and difficulty concentrating. At this stage, planning for kidney replacement therapy (dialysis or transplantation) begins, even if it is not yet needed.
• Stage 5 — eGFR below 15 (Kidney failure / End-stage kidney disease)
  The kidneys can no longer maintain the body’s needs without support. Haemodialysis, peritoneal dialysis, or kidney transplantation is required to sustain life. Symptoms at this stage are significant and may include severe fatigue, breathlessness, confusion, and markedly reduced urine output in some patients.

It is worth noting that CKD does not always progress through every stage. With the right chronic kidney disease treatment in Kampala at UMC Victoria Hospital, you can preserve your kidney health.

• Persistent swelling in the legs, ankles, or face — particularly noticeable in the morning
• Unexplained fatigue that does not improve with rest
• Changes in urination - going more or less frequently than usual
• Foamy or dark urine - often an early sign that the kidneys are leaking protein
• A dull ache in the lower back - though this is not always present
• Poor appetite, difficulty concentrating, or breathlessness — these tend to appear as the condition progresses

These symptoms overlap with many other conditions, which is why testing is so important. Do not wait for things to become severe. Because early CKD often causes no symptoms, routine screening is important for people with diabetes, hypertension, obesity, or a family history of kidney disease

Seek urgent medical attention if you develop severe shortness of breath, chest pain, confusion, or a sudden inability to pass urine

Apart from having kidney disease symptoms, if you have diabetes or high blood pressure and your GP has noticed abnormal kidney function tests - even mildly elevated creatinine or protein in the urine, you must see a nephrologist in Uganda. The same applies if you have a family history of kidney disease or have experienced repeated urinary tract infections over the years.

Diagnosis begins with simple blood and urine tests. A serum creatinine and estimated GFR (eGFR) tell us how well the kidneys are filtering. A urine dipstick and urine protein-to-creatinine ratio reveal whether the kidneys are leaking protein - an early and important sign of damage. We also check electrolytes, full blood count, and blood pressure at rest. Where indicated, a kidney ultrasound helps us assess the size and structure of the kidneys and identify cysts, obstruction, or scarring. In selected cases, a kidney biopsy may be needed to determine the exact cause of damage, particularly for inflammatory or immune-mediated conditions.

Treatment depends on the stage of disease and its underlying cause, but the goals are consistent: slow progression, manage symptoms, and protect your overall health. For most patients, this begins with getting blood pressure under tight control - typically around or below 130/80 mmHg, depending on individual circumstances. If diabetes is the cause, good blood sugar control is equally critical.

Dietary adjustments also matter. Reducing salt, managing protein intake, and, in later stages, limiting potassium and phosphorus in the diet can reduce the burden on damaged kidneys. Our dietitian team provides practical guidance tailored to locally available foods.

For patients who progress to end-stage kidney disease, haemodialysis is available at our hospital. We understand that dialysis is a significant commitment - financially, logistically, and emotionally - and we involve patients and their families fully in planning that transition. Kidney transplantation can be discussed for appropriate candidates, and we support referrals where needed.

UMC Victoria Hospital provides comprehensive and advanced kidney treatment in Uganda, from early diagnosis and disease monitoring to dialysis support and long-term management of chronic kidney disease.. Patients with CKD, including those secondary to conditions such as diabetes and hypertension, can access a multidisciplinary team of nephrologists, endocrinologists, cardiologists, and dietitians—all under one roof with coordinated care and shared medical records. We focus on practical, patient-centered management, not just treatment. If you have been informed that your kidney function is reduced, or if you have concerns based on symptoms or risk factors, we encourage you to reach out. Early consultation and timely intervention can significantly improve long-term outcomes.