Questions to Ask Kidney Doctor
Questions for a nephrology appointment, covering test results and staging, blood pressure and medication decisions, monitoring, and planning ahead for dialysis or transplant.
The questions
Open any question for the note
What are my eGFR and urine albumin results, and what stage do they put me at?
Why ask it
Kidney disease is staged using both filtration rate and the amount of albumin in the urine, so one number alone is incomplete. Ask for the figures themselves rather than a general reassurance, and write them down so you can compare at the next visit.
What is causing the damage to my kidneys?
Why ask it
Diabetes and high blood pressure account for most cases, but the cause may be a specific disease, a medication, an obstruction, or something inherited. The answer determines what treatment is possible, and if it is genetic it may matter to your relatives.
Is my kidney function stable, or how quickly has it been changing?
Why ask it
A single result says less than the trend across several years. Ask to see the previous values plotted or listed, because a slow decline and a rapid one call for different levels of urgency and planning.
What is my blood pressure target, and what is the plan for reaching it?
Why ask it
Blood pressure control does more than anything else to slow decline, and targets for kidney patients are often lower than general ones. Ask whether they want readings taken at home, and how they want them recorded.
Which of my current medicines protect my kidneys, and which need watching?
Why ask it
Some drugs slow kidney disease while causing an expected small drop in filtration when started, which is not a reason to stop them. Others simply need dose adjustment as function falls. Knowing which is which prevents you from stopping the wrong one.
Are there over-the-counter medicines or supplements I should stop?
Why ask it
Anti-inflammatory painkillers, certain heartburn drugs, and some herbal and bodybuilding supplements are common contributors to further damage. Bring the actual bottles, since patients often do not think of these as medication worth mentioning.
Do I need to change what I eat, and can you refer me to a renal dietitian?
Why ask it
General kidney diet advice from the internet is often wrong for the individual, since restrictions on potassium, phosphate, protein, and salt depend on your stage and your blood results. A dietitian referral is usually available and underused.
What should I do about my medicines if I get sick with vomiting or diarrhoea?
Why ask it
Dehydration combined with certain blood pressure and diabetes medicines can cause a sharp, sometimes lasting drop in kidney function. Ask for written instructions about which tablets to pause during an illness and when to resume them.
What precautions do I need before a scan with contrast dye or any surgery?
Why ask it
Imaging departments and surgical teams need to know your kidney function, and some preparations, dyes, and bowel cleansing agents require adjustment or avoidance. It is easier to raise this now than in a pre-operative rush.
How often will you check my blood and urine, and how will I get the results?
Why ask it
Establishes both the schedule and the route: portal, letter, or phone call. Ask specifically what happens if a result is abnormal and whether silence means the result was normal or simply that nobody has looked.
Which symptoms mean I should call you rather than wait for the next appointment?
Why ask it
Useful because early kidney disease causes few symptoms, so the list is usually specific: much less urine, swelling that is new or worsening, breathlessness lying flat, confusion, or persistent nausea. Ask for the phone number to use out of hours.
Are my haemoglobin, calcium, phosphate, and parathyroid levels a concern?
Why ask it
Anaemia and bone and mineral problems develop alongside kidney disease and are treated separately from the kidney disease itself. These are often managed quietly in the background, and patients are frequently unaware they are being monitored at all.
Which vaccinations should I have, given my kidney condition?
Why ask it
Hepatitis B, pneumococcal, and seasonal vaccinations are commonly recommended for people with reduced kidney function, and hepatitis B protection matters particularly if dialysis may lie ahead. Responses can be weaker, so timing and boosters are worth asking about.
Based on how my function is changing, when would we need to prepare for dialysis or a transplant?
Why ask it
Preparation takes months rather than weeks, and starting the conversation early is not the same as starting treatment early. Ask what level of function would trigger a referral, so the timing is not a surprise.
If I needed dialysis, what forms are available and which would fit my life?
Why ask it
In-centre haemodialysis, home haemodialysis, and peritoneal dialysis differ enormously in schedule, travel, and who does the work. Ask which are offered locally, since availability rather than preference often decides it.
Am I a candidate for a transplant, and what does being assessed involve?
Why ask it
Referral criteria and waiting times vary, and assessment includes heart, cancer screening, and dental checks that take time to complete. Ask whether a living donor is a possibility for you and how someone would begin to be tested.
Is choosing not to have dialysis a reasonable option for someone in my situation, and what would that involve?
Why ask it
Managing kidney failure without dialysis, focusing on symptoms and quality of life, is a recognised choice, particularly for older patients with other serious illness. Doctors do not always raise it, and it is a fair question to put directly.
What should I expect to be able to keep doing: work, travel, exercise?
Why ask it
Most people continue working and travelling with kidney disease and with dialysis, though it takes arrangement. Ask about practical matters such as arranging dialysis away from home, since the answer is usually more permissive than people assume.
What will this cost me, and who here helps with the paperwork?
Why ask it
Coverage for medication, dialysis, and transplant follows complicated rules, and many kidney units have a social worker or financial counsellor whose job includes this. Ask who that person is by name.
Who is coordinating my care between you, my regular doctor, and any other specialists?
Why ask it
Kidney patients typically see several clinicians who each adjust medications. Ask who holds the full list, who to contact with a question, and how changes made in one clinic reach the others.
Preparing for a Nephrology Appointment
Practical guidance for the conversation itself
Before the appointment
- Bring every medicine, including inhalers, eye drops, painkillers, and supplements, in a bag or as photographs of the labels. Lists written from memory routinely miss the ones that matter.
- Bring your home blood pressure readings if you take them, with dates. A record over weeks is more useful than the single reading taken in the clinic.
- Write down your three most important questions and ask them first. Appointments are short and the last item on a long list often goes unasked.
- Ask a family member or friend to come and take notes, particularly if results or a change of plan are expected.
Understanding your own results
Two numbers define the stage
Filtration rate, reported as eGFR, and the amount of albumin leaking into the urine are used together. Someone with a moderate eGFR and no albumin is in a different position from someone with the same eGFR and heavy albumin loss.
Creatinine moves for ordinary reasons
Dehydration, a heavy protein meal, intense exercise, and muscle mass all shift the result. One worse reading is not necessarily a decline, which is why the trend across several tests is what matters.
Keep your own record
A single page with dates, eGFR, albumin, potassium, haemoglobin, and blood pressure lets you and any new doctor see the direction of travel immediately. Clinic systems do not always follow you between hospitals.
Planning ahead without alarm
- Preparation for dialysis, including creating and allowing time for access to mature, is measured in months. Discussing it early is what keeps the options open rather than forced.
- Transplant assessment involves several other specialties and can take a long time to complete, so ask about referral before it becomes urgent.
- Ask what your unit's education sessions cover and whether a partner or family member can attend. Decisions about dialysis at home affect the household.
- If your condition is advanced, it is reasonable to talk about what you would and would not want, and to record it. This is a routine conversation in kidney care, not a sign of giving up.
Common pitfalls
Stopping medication because you feel well
Kidney disease is largely symptomless until it is advanced, so feeling fine is not evidence that treatment is unnecessary. If a medicine is causing problems, raise it rather than quietly stopping.
Assuming supplements are harmless
Products sold for energy, joints, or muscle can contain substantial potassium, phosphate, or unlisted ingredients. Ask before starting anything, including things recommended by people who mean well.
Leaving without understanding the plan
If you cannot repeat back your stage, your blood pressure target, and when you are next being tested, the appointment is unfinished. Ask for it in writing before you leave.
Reading general advice as if it applied to you
Dietary restrictions in particular differ by stage and by blood results. Advice aimed at someone on dialysis can be wrong, sometimes harmfully so, for someone in early disease.