Kidney disease – catching it long before dialysis
Kidneys can lose most of their function without a single symptom. Who should be tested, what the numbers mean, and what protects what is left.
Silent until very late
Kidneys can lose a large share of their function before causing any symptom at all. By the time someone feels tired, itchy, swollen or nauseated, the disease is usually advanced. That is the entire reason for testing people who feel well.
In South Africa the leading causes are high blood pressure and diabetes, followed by HIV-related kidney disease and glomerular disease. Access to dialysis in the public sector is limited, which makes prevention and early detection matter more here than in countries where late-stage treatment is readily available.
Who should be tested, and with what
- Anyone with high blood pressure or diabetes, at least yearly.
- Anyone living with HIV.
- Anyone with a family history of kidney disease.
- Anyone who has taken anti-inflammatory painkillers regularly for a long time.
- Anyone with heart disease, or who is significantly overweight.
Two simple tests do most of the work: a blood test for creatinine, from which an estimated filtration rate is calculated, and a urine test for protein. Protein in the urine is often the earliest sign and is frequently the more important of the two.
Protecting what is left
- Control blood pressure. This is the single most effective thing, and certain classes of blood pressure medicine protect kidneys beyond their effect on the reading — which is why the specific medicine matters here.
- Control blood sugar if you have diabetes.
- Stop anti-inflammatory painkillers unless a clinician has agreed you can use them. Long-term regular use is a genuinely common cause of avoidable damage.
- Reduce salt, which helps blood pressure and protein loss.
- Stop smoking.
- Stay hydrated, and be careful in hot weather and during illness with vomiting or diarrhoea — dehydration injures already-vulnerable kidneys.
- Have any herbal or traditional remedy checked. Several are directly toxic to kidneys, and this is a recognised cause of acute kidney injury in South Africa.
Commonly used where kidney protection is the goal:
Enalapril — Pharmapress, Enap, Adco-Enalapril, Renitec
Hypertension; heart failure; diabetic nephropathy
Lisinopril — Zestril, Adco-Zetomax, Lizro, Prinivil
Hypertension; heart failure; post-myocardial infarction
Losartan — Zartan, Cozaar, Adco-Losartan, Pharmapress Losartan
Hypertension; diabetic nephropathy; heart failure; alternative when ACE inhibitor causes cough
Dapagliflozin — Forxiga
Type 2 diabetes; heart failure (with or without diabetes); chronic kidney disease
Empagliflozin — Jardiance, Synjardy (with metformin)
Type 2 diabetes; heart failure with reduced ejection fraction; chronic kidney disease
Warning signs and sick-day rules
If you have kidney disease and become ill with vomiting, diarrhoea or a fever, ask your clinic which of your medicines should be paused during that illness. Several are safe day to day and harmful when you are dehydrated, and knowing which ones in advance prevents a hospital admission.
Common questions
- Does kidney disease always lead to dialysis?
- No. Most people with chronic kidney disease never need dialysis, particularly when it is found early and blood pressure and diabetes are controlled. Progression can be slowed substantially.
- Are anti-inflammatory painkillers really that bad for kidneys?
- Occasional use in a healthy person is generally fine. Regular long-term use, use in someone already at risk, or use while dehydrated is a well-recognised cause of kidney damage — and these are among the most-used medicines in the country.
- Should I drink extra water to flush my kidneys?
- Normal hydration is good; deliberately drinking large volumes does not clean the kidneys and can be harmful in advanced kidney disease or heart failure. Follow your clinician's advice rather than a general rule.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Adult Primary Care guideNational Department of Health, South Africa
Last reviewed 4 August 2026.