Most patients leave a kidney appointment with at least some questions unanswered — not because their doctor withheld information, but because they did not know what to ask. Kidney disease management involves numbers that many patients have never encountered before: eGFR, ACR, creatinine trends, phosphate levels, SGLT2 inhibitors. Without a framework for what these numbers mean and what questions they generate, it is easy to nod through an appointment and walk out without a clear picture of what is happening.
This guide organizes the most important questions you can bring to a kidney checkup into seven categories: test results, cause, treatment, diet and lifestyle, medications to avoid, monitoring, and future planning. You do not need to ask every question at every visit — but knowing these questions exist means you can choose the ones most relevant to where you are right now.
Questions About Your Test Results
The kidney checkup always includes a review of laboratory values. These questions help you understand what the numbers mean and whether your kidneys are stable, improving, or declining.
- What is my eGFR today, and how does it compare to my last visit? The eGFR (estimated glomerular filtration rate) is the primary measure of kidney function. A single value is less meaningful than the trend. Ask your doctor to tell you whether your eGFR has been stable, declining slowly, or declining rapidly over the past year.
- What is my urine albumin level (ACR), and what does it mean? The albumin-to-creatinine ratio (ACR) in your urine measures how much protein the kidneys are leaking. An ACR below 30 mg/g is normal. Between 30 and 300 indicates early damage that needs to be monitored and treated. Above 300 indicates established kidney damage. The ACR is one of the most important independent predictors of whether kidney disease will progress. More on what ACR means is in our guide to protein in urine.
- What CKD stage am I in, and what does that mean practically? CKD is staged from G1 (eGFR above 90) to G5 (eGFR below 15), and also from A1 (normal ACR) to A3 (high ACR). The combined staging system tells you and your doctor how closely to monitor, which treatments to start, and when to plan for kidney replacement therapy.
- Are my electrolytes in a safe range? As CKD progresses, the kidneys lose the ability to excrete potassium, acid (bicarbonate falls), and phosphate normally. Ask whether your potassium, bicarbonate, and phosphate levels are in the target ranges and whether you need supplements or dietary changes to correct them.
- Do I have anemia from kidney disease, and does it need to be treated? Damaged kidneys produce less erythropoietin, leading to anemia. Ask what your hemoglobin level is, whether your iron stores are adequate (ferritin and transferrin saturation), and whether you need erythropoiesis-stimulating agents (ESAs) such as darbepoetin.
Questions About What Is Causing Your Kidney Disease
- Do we know what caused my kidney disease? In many patients with CKD, the cause is clear — diabetes, hypertension, or polycystic kidney disease. In others, the cause may be uncertain. If the cause is unknown and CKD is progressive, a kidney biopsy may be needed to identify a potentially treatable condition. More on when biopsies are needed is in our article on kidney biopsy.
- Is any medication I am taking damaging my kidneys? NSAIDs (ibuprofen, naproxen), lithium, calcineurin inhibitors (tacrolimus, cyclosporine), and certain chemotherapy agents cause kidney damage. Your doctor should review your full medication list — including over-the-counter drugs — at every kidney visit.
- Am I at risk of kidney failure, and over what timeframe? Ask your doctor to explain the trajectory they see based on your eGFR slope. If your eGFR has been declining at 3 to 5 ml/min per year, you and your doctor can calculate roughly when you might reach an eGFR of 15 — the threshold at which kidney replacement planning needs to actively begin. A concrete timeline helps you make informed decisions about work, family, and financial planning.
Questions About Medications and Treatment
- What blood pressure target should I have? For patients with CKD and proteinuria (ACR above 300 mg/g), the target is below 130/80 mmHg per KDIGO 2021 guidelines. Tight blood pressure control is one of the most effective interventions to slow CKD progression.
- Should I be on an ACE inhibitor or ARB for kidney protection? ACE inhibitors (lisinopril, ramipril) and ARBs (losartan, valsartan) reduce glomerular pressure and protein leakage independent of their blood pressure effect. They are the cornerstone of treatment for proteinuric CKD. Ask whether you are on one and whether the dose is optimized.
- Should I be on an SGLT2 inhibitor? SGLT2 inhibitors — dapagliflozin (Farxiga), empagliflozin (Jardiance), canagliflozin (Invokana) — have been proven in the CREDENCE, DAPA-CKD, and EMPA-KIDNEY trials to reduce the risk of eGFR halving, kidney failure, and cardiovascular death in patients with CKD and proteinuria, regardless of whether they have diabetes. Ask your doctor whether you qualify.
- Should I be on a GLP-1 receptor agonist? The FLOW trial (2024) demonstrated that semaglutide reduced major kidney events and cardiovascular death in patients with type 2 diabetes and CKD. If you have both conditions, ask whether a GLP-1 agent is appropriate alongside your kidney-protective regimen.
- Do any of my current medications need dose adjustment for my eGFR? Many medications — including metformin, antibiotics, pain medications, and heart medications — are cleared by the kidneys and require dose reduction as eGFR declines. Ask your doctor to review your doses with your current eGFR in mind.
Questions About Diet and Lifestyle
- How much protein should I eat? In CKD Stages 3 to 5, a protein intake of 0.6 to 0.8 grams per kilogram of body weight per day is recommended to slow progression. Ask your doctor or dietitian for the specific target appropriate to your eGFR and nutritional status.
- How much potassium and phosphate should I limit? Potassium restriction becomes important when eGFR falls below 30 to 45 ml/min or when serum potassium is already elevated. Phosphate restriction similarly becomes necessary as eGFR declines, driving secondary hyperparathyroidism and bone weakening. Your physician or dietitian can provide a specific dietary plan based on your current blood levels.
- Should I see a kidney dietitian? Kidney (renal) dietitians specialize in the complex dietary balancing act required in CKD — adjusting protein, potassium, phosphate, and sodium simultaneously while preventing malnutrition. Most patients with CKD Stage 3b or higher benefit from a renal dietitian referral.
Medications and Substances to Avoid — What to Ask
- Is it safe to take ibuprofen or naproxen for pain? NSAIDs reduce blood flow to the kidneys by blocking prostaglandin-mediated renal vasodilation. In CKD, even short-term NSAID use can cause acute-on-chronic kidney injury. Acetaminophen (not exceeding 2 grams per day in CKD), topical diclofenac, or nerve-modulating agents are generally safer alternatives.
- Which herbal or over-the-counter supplements are safe? Several herbal products are directly nephrotoxic. Aristolochic acid (found in certain Chinese and Ayurvedic herbal preparations) causes progressive interstitial nephritis and urothelial cancer. Ask your doctor or pharmacist before starting any supplement, and disclose all supplements at every appointment.
- Do I need special preparation for a CT scan with contrast dye? Iodinated contrast poses highest AKI risk when eGFR is below 30. Ask whether contrast CT is necessary (versus ultrasound or MRI), whether metformin should be held for 48 hours post-contrast (standard for eGFR below 60), and whether IV hydration is needed around the procedure.
Questions About Monitoring and Follow-Up
- How often should I have blood and urine tests? Patients with low-risk CKD (eGFR above 60, ACR below 30) need testing once a year. Moderate-risk: twice a year. High-risk (eGFR 15 to 29): three to four times per year. Very high-risk: every 1 to 3 months.
- What symptoms should prompt me to contact you before the next scheduled visit? Ask your doctor for a specific list: rapid leg or face swelling, very low urine output, gross blood in the urine, potassium above a certain threshold, new confusion or extreme fatigue, or blood pressure readings above a certain value despite medications.
- Do I need to see a nephrologist, or can my primary care doctor manage this? Referral to a nephrologist is indicated when the cause of CKD is unclear, when CKD is progressing despite treatment, when eGFR falls below 45, or when complications such as severe anemia, hyperparathyroidism, or metabolic acidosis require specialist management.
Questions About Future Planning — Advanced CKD
If your eGFR is below 20 to 30 ml/min, future planning conversations should begin well before dialysis is actually needed.
- What kidney replacement options are right for me? The three options are in-center hemodialysis (3 sessions per week, each 3 to 4 hours), peritoneal dialysis (daily, done at home), and kidney transplant (from a deceased or living donor — the best long-term option for those who qualify).
- When should I have an AV fistula created? An arteriovenous (AV) fistula requires 6 to 12 weeks of maturation before it can be used for hemodialysis. It should be created at least 6 months before anticipated dialysis start. Ask whether you should be referred to vascular surgery now.
- Am I a candidate for a kidney transplant? Ask your nephrologist for an honest assessment of transplant candidacy. Many patients who ask are candidates — but they never ask, so they are never referred. If you qualify, early registration on the deceased-donor waitlist maximizes time accrued toward a transplant.
Frequently Asked Questions
What numbers should I track between kidney checkups? The most important numbers to track at home are blood pressure (check daily or weekly and keep a log to bring to appointments) and, if advised by your doctor, blood glucose (for diabetics). Keep a log of your most recent eGFR and ACR values so you can track the trend yourself. Sudden changes — blood pressure much higher than usual, very swollen ankles, decreased urine output — should prompt an early call to your doctor rather than waiting for the next scheduled visit.
Can I take ibuprofen or other pain relievers with kidney disease? NSAIDs (ibuprofen, naproxen, aspirin in anti-inflammatory doses) should be avoided in CKD because they reduce blood flow to the kidneys and can cause acute kidney injury even with short-term use. Acetaminophen (Tylenol) is a safer alternative for mild to moderate pain, at doses not exceeding 2 grams per day. Topical pain relief (diclofenac gel) has much lower systemic absorption and is generally considered safer. For severe or chronic pain, discuss nerve-modulating options with your doctor.
How do I know if I need to see a nephrologist? You should see a nephrologist if your eGFR is below 45 and declining, if the cause of your kidney disease is uncertain, if your blood pressure or electrolytes are difficult to control, if you develop significant proteinuria (ACR above 300 mg/g), or if your eGFR falls below 30 and kidney replacement therapy planning needs to begin. If your primary care physician has not yet referred you and any of these conditions apply, ask directly for a referral. More on what kidney testing shows is in our guides to kidney function tests and how doctors diagnose kidney disease.
How to Prepare Before Your Kidney Appointment
The value of a kidney checkup increases significantly when you arrive prepared. Physicians typically have 15 to 30 minutes per appointment, and that time is more useful when it is spent reviewing results, adjusting treatment, and answering your questions — not reconstructing which medications you take or which lab was drawn when. These preparation steps make every minute count.
Bring a current medication list. Include the name, dose, and frequency of every medication — prescription, over-the-counter, vitamins, and herbal supplements. Many patients take supplements that are nephrotoxic (aristolochic acid, chromium, high-dose vitamin C) without realizing it, and others take NSAIDs or pain pills intermittently without tracking them. Your physician cannot advise you on drug interactions or dose adjustments without knowing your full list.
Bring your most recent lab results. If you had blood and urine tests done at a different laboratory or by a different physician, bring the paper results or ask for them to be faxed before your appointment. CKD staging and progression assessment require trend data — a single creatinine value from today is far less informative than that same value compared to values from 6, 12, and 24 months ago.
Bring a blood pressure log. Home blood pressure readings provide far more information than a single office measurement. If you have a home blood pressure cuff, record your readings for at least 2 weeks before the appointment — ideally twice daily in the morning and evening, in the same arm, in a seated position after 5 minutes of rest. This log helps your doctor distinguish white-coat hypertension (elevated only in the office) from true uncontrolled hypertension requiring medication adjustment.
Write your questions down and prioritize them. At the start of the appointment, tell your doctor: “I have three questions I want to make sure we get to today.” Stating the number upfront helps the physician allocate time. If you have more questions than time allows, the less time-sensitive ones can be handled through a patient portal message or at the next visit — but the most important ones should be asked first.
Bring a companion if possible. A second person in the appointment listens with fresh ears, may notice something you missed, and can help you remember what was said afterward. Medical conversations are information-dense; studies consistently show that patients recall only a fraction of what is discussed in a single appointment. Your companion can also help advocate for clear answers when medical jargon becomes too technical.
Keep a symptom diary for the two weeks before your appointment. Note any new or changing symptoms: swelling in the ankles or feet (worse in the evening?), foamy urine, changes in urine color, how often you are waking up at night to urinate, any episodes of unusual fatigue, itching, metallic taste, nausea, or muscle cramps. These details help your doctor assess whether CKD complications are emerging or worsening.
Questions for Specific Kidney Diagnoses
Depending on the specific cause of your kidney disease, there are additional targeted questions worth raising at your checkup.
If you have diabetic nephropathy: Ask how tightly your blood glucose should be controlled to protect your kidneys (A1c target is typically 7.0 to 7.5% — stricter control in older adults with advanced CKD may increase hypoglycemia risk without kidney benefit). Ask whether your diabetes medication doses need adjustment for your eGFR — metformin should be dose-reduced at eGFR below 45 and stopped at eGFR below 30. Ask whether you are on both an ACE inhibitor or ARB (for proteinuria) and an SGLT2 inhibitor (for combined cardiorenal protection). Ask whether your eye doctor has found diabetic retinopathy, because its presence or absence provides useful information about how long your kidney disease has been developing.
If you have lupus nephritis: Ask what class of lupus nephritis your biopsy showed (Class III or IV means you have proliferative disease requiring aggressive immunosuppression; Class V means membranous lupus, treated differently). Ask what your anti-dsDNA antibody titers and complement C3/C4 levels are — these serological markers trend with disease activity. Ask whether your current immunosuppressive regimen (typically mycophenolate mofetil or tacrolimus for maintenance) needs dose adjustment. Ask when your next kidney biopsy might be needed to assess whether the nephritis has responded to treatment or whether fibrosis has developed. Ask about contraception, because cyclophosphamide (used in some induction regimens) is teratogenic and affects fertility, and pregnancy planning in lupus nephritis requires careful coordination with both rheumatology and nephrology.
If you have IgA nephropathy: Ask what your current Oxford-MEST-C score was on biopsy (the mesangial, endocapillary, segmental sclerosis, tubular atrophy, and crescent components predict which patients progress rapidly). Ask whether you are a candidate for sparsentan (Filspari) — a dual endothelin/angiotensin receptor antagonist approved in 2023 specifically for IgA nephropathy with proteinuria — or for iptacopan (Fabhalta), a complement factor B inhibitor approved in 2024 for IgA nephropathy. Ask about the role of fish oil (omega-3 fatty acids), which has been used in IgA nephropathy for decades with mixed evidence; newer trials are ongoing. Ask whether tonsillectomy is recommended — in patients with clear tonsillar infection triggering gross hematuria episodes of IgA nephropathy (synpharyngitic hematuria), tonsillectomy may reduce disease activity, particularly in Asian populations where this pattern is more common.
Questions About Lifestyle Interventions Beyond Diet
Diet is not the only lifestyle factor that matters in CKD. Several other modifiable behaviors have been shown to affect kidney disease progression and overall health, and they are worth asking about explicitly.
Is exercise beneficial for my kidneys? Yes — regular aerobic exercise improves cardiovascular fitness, reduces blood pressure, helps with weight management, and is associated with slower CKD progression in observational studies. Ask your doctor what intensity is safe given your current eGFR and cardiovascular status. Most patients with CKD Stages 1 through 4 can safely walk briskly for 30 minutes five days per week. High-intensity strength training is generally safe in earlier CKD but should be discussed if you have advanced disease, dialysis access (AV fistula), or recent cardiovascular events.
Does weight loss help my kidneys? Obesity is an independent risk factor for both CKD development and progression. Weight loss — even modest reductions of 5 to 10% of body weight — can reduce glomerular hyperfiltration (a stress pattern the kidneys adopt in obesity), decrease albuminuria, and improve blood pressure control. Ask whether a structured weight management program or bariatric surgery consultation is appropriate, particularly if your BMI is above 35. SGLT2 inhibitors and GLP-1 receptor agonists also contribute modest weight loss as a secondary benefit.
Should I quit smoking? Smoking is an independent risk factor for CKD progression — nicotine causes renal vasoconstriction and accelerates proteinuria. It also dramatically increases cardiovascular disease risk, which is already elevated in CKD. Ask your doctor about cessation support: nicotine replacement therapy, varenicline (Champix/Chantix), or bupropion — all of which are safe in CKD with appropriate dose adjustment.
Can I drink alcohol with kidney disease? Moderate alcohol intake (up to 1 drink per day for women, up to 2 for men) is not directly nephrotoxic and is generally considered acceptable in CKD. However, alcohol raises blood pressure, interacts with many medications, and adds empty calories that compete with a nutritionally optimized CKD diet. Ask your physician for guidance specific to your medication regimen and blood pressure control status.
Sources: NIDDK — Kidney Disease | National Kidney Foundation | KDIGO CKD Guidelines | American Association of Kidney Patients | Related: Kidney Function Tests | How Doctors Diagnose Kidney Disease | Protein in Urine | Kidney Biopsy
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