Sakit buah pinggang usually refers to chronic kidney disease (CKD), a long-term condition where the kidneys do not work as well as they should. It is common in Malaysia: a national study found that about 1 in 6 adults (15.5%) had CKD in 2018, and high blood pressure and diabetes were the main risk factors. CKD usually causes no symptoms until it is advanced, so the only way to know is a blood test (eGFR) and a urine test. There is no cure, but controlling blood pressure and blood sugar, eating less salt, not smoking and avoiding regular use of NSAID painkillers can stop it getting worse. Most people with CKD never need dialysis.
What is sakit buah pinggang (chronic kidney disease)?
According to the NHS, chronic kidney disease (CKD) is a long-term condition where the kidneys do not work as well as they should. It is common, often linked to getting older, and more common in people of South Asian or Black origin.
CKD in Malaysia. A nationwide study using National Health and Morbidity Survey 2018 data found that 15.48% of Malaysian adults had CKD, up from 9.07% in 2011. Most were in the early stages: 3.85% at stage 1, 4.82% at stage 2, 6.48% at stage 3, and 0.33% at stages 4 to 5. High blood pressure, diabetes, higher body weight and older age were linked to a higher risk.
CKD can get worse over time, but this is not inevitable. According to the NHS, most people control it with medicine and check-ups, and it progresses to kidney failure in only around 2 in 100 people.
Tanda sakit buah pinggang: what are the symptoms?
Early stages usually have no symptoms. The body can cope with a large drop in kidney function, so CKD is often found only when a blood or urine test is done for another reason.
In later stages, according to the NHS, symptoms can include:
- tiredness;
- swollen ankles, feet or hands (fluid build-up, or oedema);
- shortness of breath;
- feeling sick, poor appetite and weight loss;
- blood in your pee;
- needing to pee more often, particularly at night;
- difficulty sleeping, headaches, muscle cramps;
- itchy skin; see our guide to gatal kulit.
These symptoms can also be caused by many less serious conditions, so get a proper diagnosis. Warna air kencing (urine colour) on its own cannot tell you whether your kidneys are healthy; blood in your pee should always be checked, and kidney function is measured with blood and urine tests.
What causes kidney disease?
According to the NHS, CKD is usually caused by other conditions that strain the kidneys, often a combination of them:
- high blood pressure, which strains the small blood vessels in the kidneys; see our guide to darah tinggi;
- diabetes, as too much glucose damages the tiny filters in the kidneys; see our guide to kencing manis;
- high cholesterol, which can build up in the blood vessels that supply the kidneys; see our guide to kolesterol tinggi;
- kidney infections, and kidney inflammation (glomerulonephritis);
- polycystic kidney disease, an inherited condition;
- blockages to the flow of urine, such as kidney stones that keep coming back or an enlarged prostate; see our guide to batu karang;
- long-term, regular use of some medicines, such as NSAID painkillers (for example ibuprofen) and lithium.
How is kidney disease tested?
CKD is diagnosed with blood and urine tests. According to the NHS, regular testing is recommended if you have high blood pressure, diabetes, heart or blood vessel disease, kidney stones, an enlarged prostate, lupus, a family history of kidney disease, or unexplained protein or blood in your urine, or if you take long-term medicines that can affect the kidneys.
- Blood test (eGFR). Measures a waste product called creatinine and estimates how many millilitres of blood your kidneys filter each minute. Healthy kidneys filter more than 90 ml/min.
- Urine test (ACR). The albumin:creatinine ratio checks whether protein is leaking into your urine. This is often what people mean by buah pinggang bocor (leaking kidneys).
- Sometimes a scan or a kidney biopsy is needed.
Tahap buah pinggang: what are the stages?
Your results are used to give a stage. According to the NHS, the eGFR stages are:
| Stage | eGFR (ml/min) | What it means |
|---|---|---|
| Stage 1 (G1) | Above 90 | Normal filtering, but other tests show signs of kidney damage |
| Stage 2 (G2) | 60 to 89 | Slightly reduced, with other signs of kidney damage |
| Stage 3a (G3a) | 45 to 59 | Kidney function reduced |
| Stage 3b (G3b) | 30 to 44 | Kidney function reduced further |
| Stage 4 (G4) | 15 to 29 | Kidney function greatly reduced |
| Stage 5 (G5) | Below 15 | Kidney failure: the kidneys have lost almost all their function |
The urine ACR is also staged: A1 is below 3 mg/mmol, A2 is 3 to 30 mg/mmol, and A3 is above 30 mg/mmol. For both, a higher stage means more severe kidney disease. Stage 1 often has no symptoms at all, which is why people at risk should be tested.
Is back pain a sign of kidney disease?
Many people say sakit buah pinggang when they have lower back pain, but chronic kidney disease rarely causes pain. Most lower back pain comes from the muscles or joints; see our guide to sakit pinggang. Pain in the side or back with a fever and pain when peeing may be a kidney infection (see our guide to UTI symptoms), and severe pain that comes in waves may be a kidney stone. These need a doctor's check, but they are different from CKD.
How is kidney disease treated?
There is no cure for CKD, but treatment can relieve symptoms and stop it getting worse. According to the NHS, treatment depends on the stage and may include:
- lifestyle changes (see below);
- blood pressure control, usually aiming for below 140/90 mmHg, or below 130/80 mmHg if you also have diabetes. ACE inhibitors such as ramipril or enalapril are often used;
- statins to lower the risk of heart attack and stroke, which is higher in people with CKD;
- SGLT2 inhibitors, such as dapagliflozin, which can help keep the kidneys working for longer in some people;
- treatment for complications such as anaemia, high potassium, fluid build-up or bone problems; see our guide to kurang darah;
- dialysis or a kidney transplant in advanced (stage 5) CKD.
Take your medicine even when you feel well. Check with a doctor or pharmacist before taking any over-the-counter painkillers or supplements, as some can affect your kidneys or interact with your medicines, and avoid potassium supplements.
Makanan pesakit buah pinggang: what should you eat?
Many people search for lists of "buah yang sesuai" or "pantang larang makanan" for kidney patients. According to the NHS, if you have CKD you may not need a special diet. A healthy, balanced diet helps:
- plenty of fruit and vegetables, aiming for at least 5 portions a day;
- starchy foods such as rice, wholegrain bread or potatoes;
- some dairy, and some beans, pulses, fish, eggs or meat for protein;
- low levels of saturated fat, sugar and salt (less than 6 g a day, about 1 teaspoon).
When diet needs to change. If blood tests show high levels of potassium or phosphate, which can happen when the kidneys cannot clear them, you may be referred to a dietitian. They will tell you how much potassium, phosphate and salt to include, which may mean limiting some foods high in potassium, or phosphate-rich foods such as red meat, dairy products, eggs and fish. If you have fluid build-up, you may also be asked to reduce fluids. Because these limits depend on your own blood results, do not cut out healthy foods based on general lists without advice.
How can you protect your kidneys?
According to the NHS, these steps help protect your kidneys and stop CKD getting worse:
- keep your blood pressure and blood sugar well controlled, and have regular check-ups;
- stop smoking, and keep alcohol within 14 units a week;
- eat a healthy, balanced diet with less salt;
- exercise regularly, aiming for at least 150 minutes a week;
- lose weight if you are overweight;
- avoid regular use of over-the-counter NSAID painkillers such as ibuprofen unless a doctor advises it;
- have the yearly flu vaccine and the pneumococcal vaccine, as CKD makes you more vulnerable to infections.
See a doctor if you have persistent or worrying symptoms that could be caused by kidney disease, and ask about regular kidney tests if you have high blood pressure or diabetes.
Frequently asked questions (FAQ)
What are the signs of kidney disease (tanda sakit buah pinggang)?
Chronic kidney disease usually has no symptoms in the early stages and is often found only through a blood or urine test. In later stages, symptoms can include tiredness, swollen ankles, feet or hands, shortness of breath, feeling sick, poor appetite and weight loss, blood in your pee, needing to pee more often at night, itchy skin and muscle cramps.
What are the stages of kidney disease (tahap buah pinggang)?
Kidney disease is staged from 1 to 5 using a blood test called eGFR. Stage 1 is a normal eGFR above 90 with other signs of kidney damage, stage 2 is 60 to 89, stage 3a is 45 to 59, stage 3b is 30 to 44, stage 4 is 15 to 29, and stage 5 is below 15, when the kidneys have lost almost all their function.
What causes kidney disease?
The most common causes are high blood pressure and diabetes, which damage the small blood vessels and filters in the kidneys. Other causes include high cholesterol, kidney infections, kidney inflammation (glomerulonephritis), inherited polycystic kidney disease, blockages such as repeated kidney stones or an enlarged prostate, and long-term use of some medicines such as NSAID painkillers.
Is lower back pain a sign of kidney disease?
Usually not. Chronic kidney disease rarely causes pain, and most lower back pain comes from the muscles or joints. Pain in the side or back with a fever and pain when peeing may be a kidney infection, and severe pain that comes in waves may be a kidney stone. The only way to check kidney function is a blood and urine test.
What is buah pinggang bocor?
Buah pinggang bocor (leaking kidneys) usually refers to protein leaking into the urine, which can be a sign of kidney damage. It is checked with a urine test called the albumin:creatinine ratio (ACR). A higher ACR stage means more protein is leaking and more severe kidney disease.
What fruits and foods can kidney patients eat (makanan pesakit buah pinggang)?
Many people with kidney disease do not need a special diet, just a healthy, balanced one with plenty of fruit and vegetables and less salt. If blood tests show high potassium or phosphate, a dietitian will advise which foods, including which fruits, to limit. Avoid potassium supplements and do not cut out foods based on online lists without advice.
Can kidney disease be cured?
There is no cure for chronic kidney disease, and damage that has already happened cannot be repaired, but treatment can relieve symptoms and stop it getting worse. Most people control it with medicine, lifestyle changes and regular check-ups, and only around 2 in 100 people with CKD progress to kidney failure needing dialysis or a transplant.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor, dietitian or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Chronic kidney disease — NHS
- Chronic kidney disease: symptoms — NHS
- Chronic kidney disease: diagnosis — NHS
- Chronic kidney disease: treatment — NHS
- Chronic kidney disease: living with — NHS
- Saminathan TA, Hooi LS, Mohd Yusoff MF, et al. Prevalence of chronic kidney disease and its associated factors in Malaysia; findings from a nationwide population-based cross-sectional study. BMC Nephrol. 2020;21(1):344.
