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Did you know that more than 30 million American adults are living with kidney disease but don’t know it? There are many signs and symptoms that go along with kidney disease, but they are often attributed to other conditions. For many people, it’s not until they are in the very late stages of the disease that they begin to feel symptoms. By identifying the disease early on, people can take the appropriate steps to treat their symptoms.

Below we share 10 potential signs of kidney disease. If you are concerned about yourself or a loved one, schedule an appointment with your doctor.

1. Decrease in energy. When the kidneys stop working properly, toxins can build up in the body and lead to impurities in the blood. This can make you feel tired, weak and unmotivated. It’s not uncommon for people with kidney disease to have anemia as well, which can also create fatigue and weakness.

2. Trouble sleeping. A lot of older adults have difficulty sleeping, but there could be a medical reason why. When the kidneys don’t work, toxins stay in the body and can affect your ability to fall asleep and stay asleep. Sleep apnea is also more common in people with kidney disease.

3. Feeling cold. Are you always cold when everyone else is warm? Anemia can make you feel cold, even if you are in a warm room or warm clothes. Anemia is more common in adults with kidney problems.

4. Dry, itchy skin. The kidneys help make red blood cells, keep the bones strong, manage the right amount of minerals in the body and move fluids out of the body. Without the proper balance of minerals, dry, itchy skin can occur.

5. Having to pee more often. There could be other reasons for needing to use the bathroom more, including regular aging, but it’s also possible that the kidneys are to blame. Rule out a bladder infection first, but do pay attention to the need to urinate, especially at night.

6. Blood in the urine. When the kidneys’ filters become damaged, blood cells can leak into the urine. If you do see blood in the toilet, talk to your doctor to rule out kidney stones, infection or a tumor.

7. Shortness of breath. If extra fluid builds up in the lungs, it can cause you to be short of breath. Anemia may also be to blame, as your body doesn’t have as much oxygen running through it.

8. Foamy urine. Another thing to look for when using the bathroom is the texture of your urine. If it’s foamy, let your doctor know. Bubbles in the urine indicate that protein is present, which is a sign that things aren’t working right.

9. Swollen ankles and feet. Kidney disease affects the kidneys’ ability to push out water, allowing water to build up. Swelling in the ankles and feet can be a sign of kidney failure, though it may also indicate heart problems or liver disease.

10. Muscle cramps. People with kidney problems often experience muscle cramps because their body has an imbalance of electrolytes. The two elements that are believed to cause muscle tightening are low calcium levels and uncontrolled phosphorus levels.

Kidney disease can be diagnosed through lab tests and imaging. If you are concerned that you or a loved one may have kidney failure, contact your doctor and ask for the appropriate tests.