The kidneys are vital organs that perform certain key functions without which it becomes practically impossible for the body to thrive. Some of the fundamental roles the kidneys play involve excretion of nitrogenous waste products and toxins from the body system; maintenance of fluid and electrolyte balance; synthesis of erythropoietin to drive red blood cell production and regulation of Blood Pressure. From the aforementioned, it is obvious that failure of both kidneys has grave implications for the affected individual. But do the kidneys have to fail before medical help and intervention is sought? The answer is NO. Discussed below are some of the warning or alarm signs that may point to failing kidneys, necessitating an urgent visit to your doctor for proper evaluation and management: 1. Change in urine volume If you have observed that you now pass large volumes of urine more often than usual (polyuria), especially if you need to urinate more than 2-3 times at night (nocturia), you may need to see the doctor for further evaluation of your kidneys. In the same vein, reduction in urine output (oliguria) may be a pointer to Acute Kidney Injury. In any case, if you have observed any persistent changes in your urine output, go and see the doctor. 2. Frothiness/Foaminess of the urine Did you notice that your urine foams excessively and over a prolonged period? It may be due to large quantities of protein leaking into your urine because of damaged kidneys. You will be doing yourself a lot of good to have your kidneys assessed properly. 3. Passage of bloody urine (Haematuria) This is a condition in which an individual passes blood - frank or altered in the urine. It's an alarm symptom that can be due to myriads of problems affecting the kidneys, ureters or the bladder. Some of the common causes are acute glomerulonephritis, sickle cell nephropathy, polycystic kidney disease, renal cancer, stones along the urinary tract, schistosomiasis and so on. Moreover, the bottom line is that the comprehensive evaluation of the kidneys to exclude a renal disease is crucial in this case. 4. Body swelling Early morning facial swelling or puffiness that regresses as the day goes by is especially suggestive of 'faulty' kidneys. Eventually, the swelling may progress to involve the entire body (anasarca). However, malnutrition, cardiac or liver diseases may also give a similar picture. If you have this symptom, it's necessary to present to the physician. 5. Persistent hiccups Inability of the failing kidneys to excrete urea (one of the waste products) ultimately leads to an accumulation of this toxic substance in the blood (uraemia) and this often irritates the diaphragm, leading to persistent hiccups. 6. Body itching/Pruritus This is another manifestation of accumulated toxic waste products in the bloodstream. Hence, if you experience persistent body itching, assessing your renal function may be of tremendous benefit. 7. Lethargy and Fatigue Patients with chronic renal disease often complain of easy fatiguability upon little or no exertion. This is understandable given the role of the kidneys in red blood cell production such that failure of both kidneys is likely to lead to low blood levels (Anaemia) and consequent inability to cope with the demands of body tissues. 8. Shortness of breath Based on the fact that the kidneys are responsible for maintaining body fluid balance, when the kidneys fail, accumulation of fluids in both lungs may result and this interferes with gaseous exchange in the lung alveoli thereby making breathing difficult if not impossible. 9. Nausea/Vomiting Some patients with kidney failure complain of persistent nausea and a tendency to throw up all the time. Again, this is likely due to waste products of metabolism, especially urea that has accumulated in the body due to renal disease. 10. Pain in the loins/flanks The kidneys are situated in the loins. Hence, the recurrent or persistent flank pain may be a pointer to kidney diseases due to stones (nephrolithiasis), infection (pyelonephritis) or cysts (polycystic kidney disease). Obviously, persistent loin pain warrants further evaluation in a hospital. In conclusion, it is pertinent to note that definite renal replacement therapy for End-Stage Kidney Disease is so capital-intensive that it's beyond the reach of the common man. Hence, early intervention to prevent or slow down the progression to End-Stage Kidney Disease may be life-saving. But this is only possible when patients recognize the early warning signs of kidney disease and make themselves available on time for proper evaluation.