Your Kidneys Called… They Have Questions

The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

What are patients really asking when they’re told they have chronic kidney disease? 

In this insightful and open episode, Sister Joana Teles steps out from behind the scenes to bring frontline wisdom from the “Know Your Kidneys” education programme. From the deceptively simple (“Is protein in my urine serious?”) to the quietly worrying (“Can my kidneys improve?”), Joana unpacks the real concerns patients carry and challenges clinicians to rethink how we communicate CKD with clarity, confidence, and compassion.

Prof Jeremy Levy and Dr Andrew Frankel join the conversation to tackle myths, refine messaging, and emphasise the power of early intervention. Along the way, they cover everything from medication fears and heredity to diet, exercise, and when (not) to refer. 

The result? A practical, witty, and highly usable guide for primary care clinicians navigating early CKD conversations.

Top 5 Takeaways

1. Protein in urine = CKD (even with normal GFR) > Patients often hear “your kidneys are fine,” but proteinuria alone signals kidney damage and should be labelled and acted on.

2. CKD can “improve” > While eGFR rarely rises, reducing albuminuria meaningfully lowers risks of kidney failure and cardiovascular disease. That’s a win worth explaining.

3. Language matters > Avoiding the term “chronic kidney disease” can create confusion. Clear, honest terminology (with reassurance) empowers patients.

4. Most CKD isn’t hereditary > Aside from conditions like polycystic kidney disease, CKD is usually linked to diabetes, hypertension, and cardiovascular risk.

5. Primary care leads early CKD > Most patients don’t need a nephrologist. With the right tools, knowledge, and confidence, primary care teams are the experts.

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

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Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub 

Transcript

Joana Teles 

For Kidney's Sake makes kidney disease management easy. For Kidneys Sake is for primary care clinicians. For Kidney's Sake is nice, consistent, short and sweet. Welcome to For Kidneys Sake brought to you by Northwest London NHS Kidney Care Team.

Jeremy 
So hello, I'm Jeremy Levy, consultant nephrologist at Imperial Healthcare NHS Trust, and this is another episode of For Kidneys Sake.

Andrew Frankel 
Hello there, and I'm Andrew Frankel, a kidney doctor working at Imperial College. And today we have Sister Joana Teles back, although she will tell you during the course of this podcast that she's actually always around when we're doing this, keeping check on both Jeremy and myself. Yeah, needs a bit more discipline. Joana is a kidney nurse specialist at Imperial.

Jeremy 
Very badly though.

Andrew Frankel 
And the key reason we wanted to invite you back is first of all to congratulate you on being nominated as the best renal nurse in the UK 2026. And we're waiting to see the outcome of that. ⁓ But also because you have been delivering Know Your Kidneys, a fantastic education program for people with early CKD. And because of its interactive nature,

Jeremy 
Woo!

Andrew Frankel 
You have been and indeed are in a privileged position to share with us what are the common questions patients with early CKD who are generally sitting in primary care ask you.

Joana  Teles 
Hi, hello again. I'm delighted to be here again. As you said, I'm always here in the backstage, but it's nice to have a mic again and join you both. Thanks for the congratulations. I'm over the moon. So let's make a start. And today you will notice that some of the questions that people ask us can be quite obvious to clinicians, but may cause a lot of confusion.

to individuals who live the condition because they don't have the knowledge or the experience. And I guess the challenge of today's episode is to clarify what patients are often thinking and learning how to adjust our communication to them, not making inaccurate assumptions. So let's make a start with a very common question I'm asked. I've been told that my kidneys are good, but just leaking protein. Is this chronic kidney disease?

Jeremy 
⁓ Yeah, I get asked that as well, Joana. So I think it's a very important question. So and we're delighted that primary care GPs, practice nurses, pharmacists are sending urine for ACR testing. That's clearly always good news. So ⁓ what do I tell patients? Well, we can first tell the patient that it's really, really good and really important that their urine has been sent by their practice to test for protein. And then it's all about the language, isn't it?

⁓ And the clinician, whether it's a GP or a primary care nurse, nephrologist or even pharmacist, needs to explain that we actually can measure sort of kidney behaviour, kidney function in two different ways. Are the kidneys cleaning the blood well? And that's the GFR number. And then completely separately, are they keeping all the protein in your body and not leaking out? That's normal.

Proteins should be in your body and not being peed in urine. And those are really rather separate things and either can go wrong. But damage to either of those two functions can lead to what we call chronic kidney disease, assuming we know it's been there for some time. So you can have either a lower GFR or kidneys leaking protein. And both of those indicate chronic kidney damage.

and which should be coded by the GP so that we know that there is some damage there. So these are two separate things and it's really important that it's recognised because it allows us to intervene.

Andrew Frankel 
Yes, Jeremy, I just want to reinforce some of that. first of all, absolutely delighted that patients are having urine sent for protein. And indeed, our clinicians in Northwest London are doing much, much better at this, but we still need to do even better. And it's a situation that many patients find themselves in, particularly where they have diabetes, where they're being monitored regularly on an annual basis.

The other point to make is that patients may start with that protein leak, but that often highlights that they are likely to then suffer a drop in their GFR or the ability for their kidney to clean the blood, the kidney number, the GFR in the future. And that's one of the reasons why we discuss this with primary care clinicians and to encourage them

to label people with proteinuria, even with preserved GFR as chronic kidney disease, because that spurs everyone on to intervening in order to preserve kidney function.

Joana  Teles 
Absolutely, so we just need to be bit more factual and not shy away from naming the problem without taboo with the reassurance that actually chronic does not mean severe and most importantly now we have treatments that improve and reduce the risk of other problems such as kidney failure down the line. Let's move on to another question. Can my kidneys improve? I guess we already touched a little bit on this but don't we just need to be a bit more confident to reassure the patients that the kidneys can improve?

Andrew Frankel 
So Joanne, this is such a common question that I'm asked even in secondary care. And we do tend to focus on GFR. And generally, once you've got chronic kidney disease, GFR often doesn't improve, well, very rarely improves. But the situation is that what we're trying to do is to stop it deteriorating. And this is the important bit. In regard to protein leak,

with the treatments we currently have, this can definitely improve. And if it does improve with the treatments we've got, the RAS inhibitors, the SGLT2 inhibitors, Phenolone and GLP1 receptor agonists, then what happens is the patient stabilises and can stabilise for prolonged periods. So yes, they are improving if we can control the albuminuria.

Jeremy 
Yeah, I Yeah, no, no, and I completely agree. And I think I've changed my language a bit as well. And as you just say, we now know that if if the protein area, the ACR improves, reduces, actually all the risks that we're worried about get better. Your risk of kidney failure improves your risk of cardiovascular disease, heart attack, strokes, all of those decrease. And that's clear from multiple trials. So so I agree. And I think we need to be more confident. And I think I've been also full side generally say to patients or have done, I'm about to change that, that no, the GFR won't get better. So that's a rather negative statement. But yes, with these treatments, the proteinuria should and will and likely will get better. And that's really, really useful, even if the GFR number doesn't change.

Joana  Teles 
Absolutely. And one thing that I use and I think can be very useful for primary care staff as well is the CKD heat map. It shows clearly that when the ACR improves, patients move from a red zone to an orange or even a green zone. So it can be very useful for individuals who may not completely understand the significance of the numbers to understand the disease response to treatments, and it can be used as well with cardiorenal metabolic issues, not just CKD, and everyone pretty much understands a simple traffic light explanation, and green always means better than red.

Jeremy 
I like that journal and I've not used that before but actually you're right going from red to orange or even green is very reassuring so that's a tip I'm gonna remember.

Joana  Teles 
I'm pleased it's the right moment that I'm teaching you something. And another one.

Jeremy 
You teach me loads, Joana, loads.

Joana  Teles 
Is CKD hereditary can I pass it on to my children?

Andrew Frankel 
So Joana, yes it can be, but not usually. The commonest cause of CKD that runs in family is adult polycystic kidney disease. However, most forms of CKD do not. Most CKD in primary care is caused by cardiovascular disease, diabetes and hypertension. And that is typically not hereditary. However, the diabetes...does run in families because of genetic predisposition and the poor diets and obesity. It's still important to ask patients if there are cases of family members who have reached kidney failure, dialysis or transplant, because that might point to other rarer causes of CKD, which will be important for families. And it does raise a red flag when you are looking at kidney health.

Jeremy 
And I'm just going to pop in the button there because I think also you use that phrase red flag. think anybody who's got a family history of end stage renal failure, but they might not have other criteria to refer from primary to secondary care should be referred. Because if you're young, 30 years old and you had a parent or an aunt or an uncle who ended up on dialysis, unless it's age 90, that's worrying when you're young. So it's a really important question, even if it's even though the answer might be rarely. Yes.

Joana  Teles 
Thanks, Jeremy. Another question. Do I need to see a kidney doctor now that I have this thing called CKD or chronic kidney disease? And usually we reassure the people that early CKD, stages one to three, can and should be managed by the primary care clinicians. GPs and their teams and pharmacists are very good at managing early CKD. Treatments are available and can be started in primary care. But we tend to also inform people what is the recommendation for referral and when would they need to see a nephrologist. And this will be if there is a suspicion of an autoimmune or genetic conditions, rapid declining of kidney function, very heavy proteinuria or CKD with a kidney function or EGFR less than 30 or in young people who may need clarification of diagnosis and understanding of the underlying cause.

Jeremy 
That's right Joana, the challenge here is for primary care to identify who to refer and to be able to talk to patients confidently about that. And we would very much hope that primary care should be expert at these sorts of early chronic diseases. They've been managing hypertension for years and other cardiovascular diseases and we can reinforce that with patients as well. But I'm going to repeat, there's never harm in repeating, who do we want to see? And we really want to see people with significant albuminuria, so ACRs of more than 70 in the absence of diabetes. If they've got diabetes, it can be a bit higher. Rapid loss of eGFR without really defining rapid, but it's going down quite fast. And the combination of hematuria and proteinuria, so blood and protein on a urine dipstick. And of course, if the GFR is dropping really very low in anybody of any age, so progressive stage four chronic kidney disease, because even if dialysis or transplantation may not be appropriate. It's important to think about planning for what happens as the kidneys get worse. So that a lot of people we definitely do want to see. But we don't we want to reinforce to patients that GPs and primary care is experts at managing early chronic kidney disease.

Andrew Frankel 
Yes, you're right, primary care should definitely not be frightened to say they are expert at managing early CKD. And not being bad enough to see a kidney doctor is a good thing, if the treatments are being started in primary care. But it's also important to understand that the hospital doctors and primary care doctors work together these days is changing. And quite often, Your GP may be managing you, but may be seeking advice from us or may refer you to us and we will actually give the advice without the need for us to see you and the GP can then go on and introduce the changes that we recommend. So the way we're managing things is changing and you may not need to see kidney doctor in hospital but your primary care doctor may still be ⁓ seeking advice from them or as I've said, managing it themselves because it's straightforward early CKD.

Joana  Teles 
I'm going to slightly move the subject now. During our education, we often talk about medication and seek their guidance. And people often ask us, how do they know that their medication is safe and not harming the kidneys? And one of the topics that always comes up is metformin. People keep asking me, has the metformin been the cause of their CKD?

Straight away I give them lots of reassurance that that is not metformin, is a very good drug, not nephrotoxic. Andrew, I know diabetes is very close to your heart, do you want to comment on this?

Andrew Frankel 
Yeah, absolutely, because it's again a common issue. And there's three elements here. Firstly, you are right. We must not tell people their metformin is nephrotoxic or kidney damaging. But secondly, we do need to stop it if the GFR is low, less than 30, you'll recall. But this is not because it's harmful to the kidneys.

But because when the GFR is low, levels of metformin can build up and that can cause serious complications of which the most important is lactic acidosis. And thirdly, it is important to highlight it is the diabetes that's causing the CKD and not the treatment.

Joana  Teles 
Now, still in the topic of medication and moving away of metformin, people often ask us as well, how do they know that all their medication are safe and not harming the kidneys? Because often people are polymedicated. And this is very important we are in an era where we have lots of protective medicines. So I tend to give patients the tip of asking two questions during consultations. Which ones are my kidney treatments when they attend their GP or pharmacy review, and are my medications safe for my kidneys? And I also tend to give them another tip that if they for any reason see another doctor who prescribes them a new medication, always ask them, is that safe for my kidneys? I mean, it is a safety check that also prompts clinicians to check. Do you agree with this approach? Do you mind when people challenge you during consultations?

Jeremy 
I think that's great advice, John. Two very straightforward questions and they're brilliant. Of course, I don't mind. think as always, we need to make sure things are done properly and safely, the right things are prescribed, patients can be confident and our primary care colleagues. So I think that was a brilliant two questions to tell patients to ask. And especially because if people do read the leaflets for their medicines because these are written so cautiously, they very often say, be careful or cautious with kidney disease. The Aids and ARB are good examples. The leaflets for all these medicines say, should be used with caution in people with kidney disease, but we really want them to be used in people because they're going to be kidney protective. So it's not surprising patients can be confused. So that's really, really good advice. And then we do also want to give people that sick day advice or guidance or rules. Just to say well if you get acutely unwell you might need to stop them temporarily. It's not because they're damaging your drugs but we just this combination being sick with the medicines isn't so good and the one medicine you didn't mention we should always remind them not to use regular non-steroidal anti-inflammatories if they've got some kidney damage because these can be damaging again in the setting often of acute illness. So I thought that was that's great tips Joana thanks.

Andrew Frankel 
It's also important to remember people are often reticent about taking medications and if you've got diabetes, cardiac disease and kidney disease you're often on a lot of medications. It's really important to get across to the patient that these medications will save them from harm in the future and that they should see them as their friends. rather than something they're trying to avoid or come off of.

Joana  Teles 
Thank you. Now, still in the topic of medication, we go into what's been flooding the news, the weight loss traps. People are obsessed with it and people want to know if they can take it and if it's safe for the kidneys. I know we recorded an episode on this, but Andrew, do you want to briefly comment?

Andrew Frankel 
Yeah, just to clarify, we're talking about the GLP-1 agonists, aren't we? And the simple answer is yes, they're safe in CKD and there's growing evidence they are good for kidneys. The main challenge remains access to these drugs and currently primary care is facing significant restrictions, but patients quite rightly are asking for these medications.

Joana Teles 
Thank you. We're getting short of time so I'm going to be very brief but Jeremy this one I'll ask you to comment Supplements and vitamins. Can I take supplements and will they help my kidneys?

Jeremy 
So again, yeah, really common question. So no, no, no, no, no, they won't help your kidneys or rather there's no evidence that they will. And in fact, most evidence suggests that things like herbal remedies might in fact be rather damaging. And we did a whole episode on this, which everybody can go and listen to. But simple Marcy vitamins are perfectly safe. They may not help, but they're going to be perfectly safe in CKD. But not mega dose these sort of big dissolvable vitamin C. Vitamin D is often prescribed and can be completely safe in CKD if the blood levels of things like calcium are completely normal. So in CKD should really only be used sort of with sort of medical advice, but all other supplements are very unlikely to help and may be a concern. So people should be really cautious.

Joana  Teles 
And finally, you are, you are considering this is a topic you're so passionate about. Final question. What can I eat to improve my kidneys and which exercise is best? People get very obsessed with a kidney diet and people often are overwhelmed and start googling a kidney diet. And I usually reassure them that in early CKD, people do not need to have restricted specific

Jeremy 
And look, I was brief, I was short, I was quick.

Joana  Teles 
kidney diets apart from the healthy advice of low salt, low sugar, avoiding ultra processed foods, which is the same recommendation for the general population anyway. Regarding exercise, I tend to say do what you like and build it up. Andrew do you agree?

Andrew Frankel 
Joanne, I completely agree with you, but can I remind listeners that we have a full episode with a fantastic dietician on dietary advice that's on the For Kidney Sake site and has just been released prior to this one.

Joana  Teles 
Thank you. Jeremy, as our exercise enthusiast, do you want to comment on exercise very briefly?

Jeremy 
Yeah, of course I do, John. Of course I do. I bag on about this to absolutely everybody. And what you said was basically right. But I really reinforce it. Exercise is fabulous medicine overall. It's great for kidneys and for people with CKD. I tell people that any exercise is better than none. Even if you can only do 10 minutes. But the more is better. Whatever you're doing, try and do a bit more. There is not any one particular exercise that's recommended or that should be avoided.

and a good mixture of cardio and weight based exercise is in general preferred so mixing exercises and then do as much as you can as much as you can fit around your life but as exact as you said importantly just get moving do something and people don't need to go and buy kit and coaches and kit but just anything is better the one minor caveat will be very heavy weight work if you've got hypertension might be a minor concern but there's very few people doing that with CKD so yeah just get moving

Joana  Teles 
Thank you. I said this was the last question, but I forgot an important one, which is asked a lot. How do people know they are OK between appointments? It is important to realise that for the majority of people in primary care, the appointment gap may be anything between 6 to 12 months. So how do they know they are OK between appointments?

Andrew Frankel 
So generally CKD progresses very slowly. So six to 12 monthly reviews is perfectly acceptable for people with CKD. However, should they become unwell between appointments, their GP may need to review kidney function and undertake some blood tests. Between routine appointments,

People with CKD can also, of course, check their blood pressure to ensure that it is well controlled, since this is really important, not just for kidney health, but for cardio health as well, and indeed long-term health. And they should be weighing themselves and making sure they're not gaining weight or losing it a significant And if there are any significant changes, they should bring that to the attention of their GP.

Jeremy 
I agree completely and actually getting people to measure their blood pressure is really important not every day but to keep it under control to make sure it really is controlled because we know that is really important for CKD and I encourage everybody to go and spend 30 or 40 pounds dollars euros to buy a machine and measure their blood pressure regularly and write the numbers down that they can share with their teams.

Joana  Teles 
and today is going to be my job to share the takeaway messages. So message number one, please explain CKD using the words chronic kidney disease. Don't shy away from the name and chronic does not mean severe, it means for a long time. Takeaway message two, CKD can improve whilst EGFR doesn't tend to significantly improve.

Urine ACR improves and sometimes corrects completely with treatment, which is good for the kidneys but also for the heart. And finally, blood pressure, blood pressure, blood pressure. Thank you so much.

Jeremy 
Joana, it's been great having you. Those were a really good set of questions that you brought to our attention from patients. And I think this is the last of our current series. If you haven't listened to all the earlier ones, go back and listen now. They're brilliant. And hopefully we'll have another year of podcasts coming soon.

Andrew Frankel 
Thank you very much and goodbye to you all.