Kidney Health: The Complete Guide

How your kidneys work, why kidney disease so often goes unnoticed, and what you can do to protect them, from understanding your eGFR and urine tests to stones, infections, medicines and treatment options. Written for anyone who wants to look after their kidneys, and especially for people with diabetes, high blood pressure or a family history of kidney disease.

Key numbers at a glance

What your kidneys do

You have two kidneys, each roughly the size of a fist, tucked against the back muscles just below your rib cage. Every day they filter about 120 to 150 quarts of blood and turn the waste and spare water they remove into about 1 to 2 quarts of urine. Each kidney contains around a million tiny filtering units called nephrons. In each nephron, a cluster of small blood vessels called a glomerulus acts as a sieve, and a long tubule then reclaims the water, salts and nutrients your body still needs.

Filtering waste is only part of the job. Your kidneys keep the levels of sodium, potassium, calcium, phosphorus and acid in your blood within a narrow range, which your heart, nerves and muscles depend on. They help set your blood pressure by controlling how much salt and water you keep. They make a hormone called erythropoietin that tells your bone marrow to produce red blood cells, and they convert vitamin D into its active form so you can absorb calcium and keep your bones strong.

This is why kidney disease affects so much more than urine. When kidney function falls, people can develop high blood pressure, anemia, weak bones, swelling, and dangerous shifts in potassium. Understanding these jobs also explains why the advice in this guide reaches beyond the kidneys themselves: protecting your kidneys and protecting your heart and blood vessels are, to a large extent, the same project.

Why kidney disease is so easy to miss

Chronic kidney disease (CKD) means a long-term reduction in kidney function or evidence of kidney damage, such as protein leaking into the urine, lasting at least 3 months. The CDC estimates that more than 1 in 7 US adults have CKD, and that as many as 9 in 10 of them do not know it. The reason is simple: healthy kidneys have a great deal of reserve, so you can lose a large share of function before you feel anything at all.

Symptoms such as tiredness, swelling of the ankles, itching, poor appetite, nausea or needing to pass urine at night usually appear only when the disease is advanced. By then, options to slow it are fewer. The only reliable way to find CKD early is to test for it, and that means a blood test and a urine test, not waiting for symptoms.

It also helps to know what CKD usually leads to. Most people with early CKD never reach kidney failure. Their main risk is cardiovascular: heart attack, stroke and heart failure are far more likely than dialysis. That is good news in one sense, because the same treatments that protect the heart, such as controlling blood pressure, blood glucose and cholesterol and not smoking, also slow kidney damage.

Who is at higher risk

Diabetes and high blood pressure are the two leading causes of kidney failure in the US, and together they account for most cases. High blood glucose damages the small blood vessels in the glomeruli over years, and high blood pressure strains and scars them. Each makes the other worse: damaged kidneys raise blood pressure, and raised blood pressure damages the kidneys further. Heart disease and obesity add to the risk, partly through the same routes.

Family history matters. If a parent, brother or sister has kidney failure, your own risk is higher, partly because of inherited conditions such as polycystic kidney disease and partly because families share risk factors. Black, Hispanic and American Indian or Alaska Native adults are more likely to develop kidney failure than white adults, largely because of higher rates of diabetes and high blood pressure, differences in access to care, and, for some Black Americans, inherited gene variants that raise risk.

• Diabetes, type 1 or type 2
• High blood pressure
• Heart disease or heart failure
• A family history of kidney failure
• Being age 60 or older
• Obesity
• Long-term regular use of NSAIDs such as ibuprofen or naproxen
• A past episode of acute kidney injury
• Repeated kidney stones or kidney infections

How kidney health is checked

Two simple tests tell you most of what you need to know. The first is a blood test for creatinine, a waste product from muscle, which the lab uses to calculate your estimated glomerular filtration rate (eGFR). The second is a urine test for the albumin-to-creatinine ratio (UACR), which measures how much albumin, a protein, is leaking through the filters. Asking for both, and asking for the actual numbers rather than "your kidney function is fine," puts you in a much better position.

Doctors combine the two results to grade CKD. The eGFR places you in a stage from G1 to G5, and the UACR places you in a category from A1 to A3. A person with an eGFR of 70 and no albumin in the urine has a very different outlook from a person with the same eGFR and a high UACR. Albumin in the urine is one of the strongest signals that kidney damage is active and that heart and kidney risk is raised, which is why a normal eGFR alone does not give the all-clear.

If you have diabetes, the American Diabetes Association recommends checking both UACR and eGFR at least once a year, starting at diagnosis for type 2 diabetes and 5 years after diagnosis for type 1. If you have high blood pressure, heart disease or a family history of kidney failure, ask your doctor how often you should be tested. Routine testing of healthy people with no risk factors is not generally recommended.

Understanding eGFR

An eGFR of 90 or above is generally normal. CKD is diagnosed when eGFR stays below 60 for at least 3 months, or when there is other evidence of kidney damage such as albumin in the urine at a higher eGFR. An eGFR below 15 means kidney failure. The figure is an estimate calculated from creatinine, age and sex; since 2021, US laboratories have moved to an equation that no longer uses race.

Because creatinine comes from muscle, eGFR can read low in people who are very muscular, dehydrated, or who ate a large meat meal shortly before the test, and some medicines nudge creatinine up without harming the kidneys. A single low result often turns out to be nothing, which is why it should be repeated before anyone diagnoses CKD. What matters most is the trend over months and years, not one number.

Understanding UACR

A UACR below 30 mg/g is normal (category A1). From 30 to 300 mg/g is moderately increased (A2), and above 300 mg/g is severely increased (A3). Vigorous exercise, fever, a urinary infection or very high blood glucose can raise the result temporarily, so an abnormal result is usually confirmed with repeat samples over a few months. A first-morning sample gives the most reliable reading.

What helps protect your kidneys

Blood pressure control is the single most powerful thing you can do. Your doctor will set a target based on your overall health; for many people with diabetes or CKD, that is below 130/80 mm Hg. Checking your blood pressure at home with a validated upper-arm cuff, and bringing the readings to appointments, gives a truer picture than one reading in the clinic. If you have diabetes, keeping your A1C near the target you and your doctor agree on slows the damage high glucose does to the glomeruli.

Food and activity support both. Keeping sodium under 2,300 mg a day helps lower blood pressure, reduces the fluid your body holds onto, and makes some blood pressure medicines work better. Most sodium comes from packaged, restaurant and processed foods rather than the salt shaker, so reading labels makes a real difference. Aim for at least 150 minutes of moderate activity a week, plus muscle-strengthening activity on 2 days, which helps blood pressure, blood glucose and weight together.

Not smoking protects the blood vessels in your kidneys just as it protects those in your heart, and smoking speeds the progression of kidney disease. If you drink alcohol, the Dietary Guidelines for Americans 2020–2025 advise no more than 2 drinks a day for men and 1 for women. A healthy weight lowers the workload on your kidneys and improves blood pressure and blood glucose.

Be careful with medicines and supplements. Regular use of NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) reduces blood flow to the kidneys and can damage them, especially when you are dehydrated or already have kidney disease. For occasional pain, ask your doctor or pharmacist whether acetaminophen (Tylenol) is a better choice for you, keeping within the label limit. Several herbal products and high-dose supplements can harm the kidneys, and the FDA does not review dietary supplements for safety before they are sold.

If you are diagnosed with chronic kidney disease

A CKD diagnosis is a reason to act, not a reason to panic. The goals are to slow the decline in kidney function, lower your heart and blood vessel risk, and catch complications early. Your doctor will usually review your eGFR, UACR, blood pressure, potassium and other blood tests regularly, more often as the stage advances. Many people manage early CKD entirely with their primary care provider; at more advanced stages, or if function is falling quickly, you will usually be referred to a nephrologist, a doctor who specializes in kidney disease.

Medicines now play a bigger protective role than they did a decade ago. ACE inhibitors and ARBs lower blood pressure and reduce the amount of albumin leaking into the urine. SGLT2 inhibitors, first developed for diabetes, can slow the progression of CKD in many people, with or without diabetes. Statins are often recommended to lower cardiovascular risk. Ask your doctor which of these are right for you and why; they protect you quietly, so stopping them because you feel well removes the benefit.

As CKD advances, other problems may need attention: anemia, high potassium, high phosphorus, bone changes, acid buildup and fluid retention. Each has a treatment, and your care team will look for them with regular blood tests. Keep every prescriber and pharmacist informed of your kidney function, because many medicines need lower doses or should be avoided when the kidneys clear them more slowly.

Eating well with kidney disease

In early CKD, the advice is usually standard healthy eating with less sodium. In advanced CKD, things can change sharply: you may need to limit potassium, found in foods such as bananas, potatoes, tomatoes, dried fruit and nuts, and phosphorus, which is added to many processed foods and colas as phosphate additives. That is why general "eat more fruit and vegetables" advice can be wrong for some people with advanced disease.

Do not cut protein, potassium or fluids on your own. Ask for a referral to a registered dietitian who specializes in kidney disease, and check any salt substitute before using it, because many replace sodium with potassium, which can build up to dangerous levels when the kidneys cannot remove it. Medicare Part B covers medical nutrition therapy with a registered dietitian for people with CKD who meet its criteria.

Acute kidney injury and sick-day rules

Acute kidney injury (AKI) is a sudden fall in kidney function over hours or days. It is common in hospitals, but many cases start at home, when a dehydrating illness such as vomiting, diarrhea or a high fever combines with ordinary medicines. NSAIDs, ACE inhibitors, ARBs and diuretics each reduce the kidneys' ability to cope with low fluid levels, and the combination of all three is particularly risky. Metformin and SGLT2 inhibitors are not kidney-damaging in themselves but can cause problems if continued while you are dehydrated and your kidneys are struggling.

If you take any of these medicines, ask your doctor for a written sick-day plan before you need it. It should say which medicines to pause during a dehydrating illness, when to restart them, and when to call. Follow that plan rather than general advice, keep sipping fluids if you can, and avoid NSAIDs while you are unwell. AKI is often reversible if it is recognized and treated early, but each episode raises the risk of later CKD, so it is worth preventing.

Warning signs include passing much less urine than usual, new swelling of the legs or face, nausea, breathlessness, and confusion or drowsiness. Older adults may become confused without other obvious signs. Any of these during an illness needs same-day medical help. Once you have recovered, ask whether your kidney blood tests should be repeated, and do not restart paused medicines until your doctor or your written plan says it is safe to do so.

Stones, infections and other warning signs

Not every kidney problem is chronic. Stones and infections come on suddenly, cause obvious symptoms and are among the most common reasons people see a doctor about their kidneys. Other signs, listed below, are quieter but just as worth reporting. None of them proves kidney disease on its own, and most turn out to have a simple explanation, but each is a reason to ask for a urine test and a blood test rather than to wait and see.

• Foamy or bubbly urine that persists, which can mean protein leakage
• New swelling around the ankles, feet or eyes
• Passing much more or much less urine than usual
• Persistent itching, poor appetite or nausea without another cause
• A rise in blood pressure that is hard to control

Kidney stones

Kidney stones are hard deposits that form when substances in urine, most often calcium and oxalate, become concentrated enough to crystallize. Many small stones pass without trouble, but a stone moving down the ureter can cause some of the most severe pain people experience: waves of cramping pain from the side or back toward the groin, often with nausea and sometimes blood in the urine. Without prevention, stones commonly come back.

Fluid is the most effective protection. Guidance for people who have had stones is to drink enough to pass about 2.5 liters (85 fl oz) of urine a day; your doctor can turn that into a daily drinking target for you, which will be higher in hot weather or with heavy sweating. Pale, straw-colored urine is a useful daily check. Keeping sodium under 2,300 mg a day helps, because salt raises the amount of calcium in urine.

Surprisingly, you should not cut back on calcium from food. Dietary calcium binds oxalate in the gut so less reaches the kidneys, and low calcium intake can actually raise stone risk. If you pass a stone, try to catch it so it can be analyzed, because the type of stone guides what prevention works best. People with repeated stones may be offered urine collections and tailored medicines.

Kidney infections and blood in the urine

Most urinary tract infections stay in the bladder, causing burning, urgency and frequent urination. A kidney infection, or pyelonephritis, is more serious: the infection travels up to the kidney and causes fever, chills, back or flank pain and a sense of being properly unwell. It needs same-day assessment and antibiotics, sometimes intravenously, and it can lead to sepsis. In older adults, new confusion may be the main sign. Finish any antibiotic course exactly as prescribed.

Blood in the urine, called hematuria, always needs explaining. It has many harmless causes, including infection, stones, vigorous exercise and menstruation, but painless visible blood is also one of the clearest warning signs of bladder and kidney cancer, particularly if you smoke or used to. See your doctor even if it happened only once and then stopped. Evaluation often includes urine tests, imaging and a look inside the bladder with a thin camera, called cystoscopy.

Kidney failure, dialysis and transplant

When eGFR falls below 15, or symptoms become hard to manage, the kidneys can no longer keep the body in balance on their own. This is kidney failure, also called end-stage kidney disease. The options are dialysis, a kidney transplant, or conservative care that focuses on symptoms and quality of life without dialysis. Each is a real choice, and the best time to learn about them is well before you need one, usually when eGFR is in the 20s, so you can plan rather than start treatment in an emergency.

Hemodialysis filters your blood through a machine. In a dialysis center it is usually done 3 times a week for several hours at a time, and it can also be done at home with training. It needs a vascular access, ideally a fistula made by joining an artery and a vein in the arm, which takes months to mature, another reason to plan early. Peritoneal dialysis uses the lining of your abdomen as a filter and is done at home every day, often overnight with a machine.

A kidney transplant, from a deceased or a living donor, usually offers the longest life and the most freedom for people who are well enough for surgery. Transplant recipients take anti-rejection medicines for life. You can be evaluated and placed on the waiting list before you start dialysis, and a living donor transplant can sometimes avoid dialysis altogether, so ask your nephrologist about a referral early.

Conservative kidney management is a recognized option, particularly for older adults with other serious illnesses, for whom dialysis may add treatment burden without adding much time. It still involves active care: medicines, diet, symptom control and support for you and your family. Whatever you choose, you can revisit the decision as your health and priorities change, and palliative care teams can help with symptoms at any stage, not only at the end of life.

Costs, coverage and getting care in the US

The basic kidney tests, a blood test for eGFR and a urine test for UACR, are inexpensive and commonly covered by insurance when ordered for diabetes, high blood pressure or other risk factors. If you have Medicare, the Annual Wellness Visit is a good moment to ask whether you need them, and a yearly checkup serves the same purpose for people with private insurance or Medicaid.

Kidney failure has unusual coverage rules. People of any age with permanent kidney failure who need regular dialysis or a transplant can usually qualify for Medicare, provided they or a spouse or parent have enough work history, or they already receive certain benefits. Medicare also covers kidney disease education sessions for people with stage 4 CKD, which help you weigh dialysis, transplant and conservative care. Ask your care team for a social worker, who can help you navigate insurance, transport to dialysis and costs of medicines.

Pregnancy, children and older adults

Kidney health looks different at different stages of life. The basics in this guide apply to everyone, but pregnancy, childhood and older age each bring particular risks and some changes to how results are read and which treatments are safe. If you fall into one of these groups, or care for someone who does, the notes below explain what is different and what to ask about.

Pregnancy

Pregnancy changes the urinary tract and makes kidney infections more likely, so urinary symptoms in pregnancy always need prompt assessment, and the US Preventive Services Task Force recommends that pregnant people be screened for bacteria in the urine even without symptoms. If you have CKD, talk with your kidney and obstetric teams before trying to conceive. Some blood pressure medicines, including ACE inhibitors and ARBs, are not safe in pregnancy and usually need changing beforehand. High blood pressure in pregnancy, including preeclampsia, also affects the kidneys and needs close monitoring.

Children and teens

Kidney disease in children is less common and more often due to conditions present from birth, such as structural problems of the urinary tract. A fever with no obvious source in a baby or young child can be a urinary infection and needs medical assessment. Rising rates of obesity and type 2 diabetes in teens mean that kidney checks are becoming part of their care too; your child's doctor will advise when testing is needed.

Older adults

Kidney function tends to decline gradually with age, so a modest fall in eGFR in your 70s or 80s, with no albumin in the urine, may simply reflect aging rather than disease. Older adults are, however, more vulnerable to AKI and to the side effects of medicines cleared by the kidneys. Thirst also becomes a less reliable guide, so drinking regularly during hot weather and illness matters more. A yearly medicine review with your doctor or pharmacist is worthwhile.

Myths and facts

Kidney health attracts more than its share of products and slogans. The common thread in the facts below is that the kidneys are protected mainly by controlling blood pressure and blood glucose, avoiding harm from medicines, and testing rather than guessing. When a product or claim promises to cleanse, flush or restore your kidneys, it is worth asking what evidence supports it and checking with your doctor or pharmacist before you try it.

• Myth: You would feel it if your kidneys were failing. Fact: CKD usually causes no symptoms until it is advanced; testing is the only way to find it early.
• Myth: Drinking huge amounts of water flushes and protects the kidneys. Fact: Enough fluid helps prevent stones and infections, but forcing very large volumes does not improve kidney function, and some people with advanced CKD or heart failure need to limit fluids.
• Myth: If you have kidney stones, cut out dairy. Fact: Normal dietary calcium helps prevent the most common type of stone.
• Myth: Over-the-counter painkillers are always harmless. Fact: Regular NSAID use can damage the kidneys, especially in people with CKD, heart failure or dehydration.
• Myth: Kidney cleanses and detox products support kidney health. Fact: There is no good evidence they help, and some herbal ingredients can harm the kidneys.
• Myth: A low eGFR always means kidney disease. Fact: One low result needs repeating; dehydration, muscle mass and recent meals can all affect it.

Talking to your doctor and a practical plan

You get the most from appointments by asking specific questions. Bring a list of every medicine and supplement you take, your home blood pressure readings, and your questions written down. Ask to see your results over time so you can follow the trend yourself; many patient portals show them as a graph. If a result worries you, ask what it means for you specifically and what would change the plan.

Kidney care is a long game. Small, steady habits, kept up over years, protect the kidneys far more than any short burst of effort, so treat the plan below as a routine to come back to rather than a one-off project. The first part of the list gives questions to take to your next appointment; the second gives a four-week start and a yearly habit.

• What are my eGFR and UACR numbers, and how have they changed over time?
• What stage of CKD, if any, do these results mean, and how often should they be checked?
• What blood pressure and A1C targets should I aim for?
• Would an ACE inhibitor, ARB or SGLT2 inhibitor help protect my kidneys?
• Which of my medicines should I pause if I become dehydrated, and can I have that in writing?
• Are any of my medicines or supplements a problem for my kidneys?
• Should I see a nephrologist or a registered dietitian?
• Week 1: Book a checkup and ask for eGFR and UACR if you have diabetes, high blood pressure, heart disease or a family history of kidney failure.
• Week 2: Start home blood pressure checks and read sodium on food labels, aiming for under 2,300 mg a day.
• Week 3: Review every medicine and supplement with your pharmacist, and get a written sick-day plan if you need one.
• Week 4: Build toward 150 minutes of activity a week, and if you smoke, ask your doctor about support to quit or call 1-800-QUIT-NOW.
• Every year: Repeat the tests your doctor recommends and compare them with last year's.

Every guide in this topic

• The Evidence on Chronic Kidney Disease, Without the Hype
• What the Guidance Really Says About Kidney Stones
• Kidney Infection: Sorting the Evidence From the Noise
• Medicines and the Kidneys: Sorting the Evidence From the Noise
• The Evidence on Blood in Urine, Without the Hype
• Fluid and Kidney Health: What Published Guidance Supports
• What the Guidance Really Says About Diabetes and the Kidneys
• What the Guidance Really Says About Understanding eGFR
• The Evidence on Diet and Kidney Disease, Without the Hype
• Acute Kidney Injury: What the Evidence Actually Says

Frequently asked questions

What is a normal eGFR?

An eGFR of 90 or above is generally normal. Between 60 and 89 can be normal, especially in older adults, unless there is albumin in the urine or other evidence of damage. CKD is diagnosed when eGFR stays below 60 for at least 3 months, or when kidney damage is present at a higher eGFR. A single low result should always be repeated before any diagnosis is made.

Can kidney disease be reversed?

Acute kidney injury is often reversible if it is caught and treated early. Chronic kidney disease usually is not, but its progression can often be slowed or halted by controlling blood pressure and blood glucose, taking protective medicines such as ACE inhibitors, ARBs or SGLT2 inhibitors where appropriate, avoiding NSAIDs, and not smoking. Most people with early CKD never reach kidney failure.

How much water should I drink for healthy kidneys?

There is no single target for everyone, because needs vary with heat, activity, size and health. Pale, straw-colored urine is a practical guide. If you have had kidney stones, the aim is enough fluid to pass about 2.5 liters (85 fl oz) of urine a day. If you have advanced CKD or heart failure, follow the fluid advice your care team gives you instead.

Is ibuprofen bad for my kidneys?

Occasional short-term use is usually fine for people with healthy kidneys. Regular use of NSAIDs such as ibuprofen or naproxen can reduce kidney blood flow and damage the kidneys, especially if you have CKD, heart failure, are dehydrated, or take an ACE inhibitor, ARB or diuretic. Ask your doctor or pharmacist whether acetaminophen (Tylenol) is a safer choice for you.

What does foamy urine mean?

Occasional foam can simply come from a strong stream or concentrated urine. Foam that persists day after day can be a sign of protein leaking into the urine, which is an early marker of kidney damage. A simple urine test, the albumin-to-creatinine ratio, can check for this, so mention persistent foamy urine to your doctor.

Should I cut out dairy if I get kidney stones?

No. For the most common type of stone, calcium oxalate, normal amounts of calcium from food actually help, because calcium binds oxalate in the gut so less reaches the kidneys. Restricting calcium can raise stone risk. Drinking more fluid and reducing sodium are more effective steps. Ask for your stone to be analyzed so your prevention plan fits its type.

Who should be tested for kidney disease?

People with diabetes should have both a urine albumin test and an eGFR blood test at least once a year. Testing is also sensible if you have high blood pressure, heart disease, a family history of kidney failure, or are over 60 with other risk factors. Ask your doctor how often you should be tested.

Are salt substitutes safe with kidney disease?

Many salt substitutes replace sodium with potassium. When the kidneys cannot remove potassium well, it can build up to dangerous levels that affect the heart rhythm. If you have CKD, or take medicines that raise potassium such as ACE inhibitors, ARBs or some diuretics, do not use them unless your doctor approves. Herbs, spices, lemon and vinegar are safer ways to add flavor.

Does Medicare cover dialysis for people under 65?

Usually, yes. People of any age with permanent kidney failure who need regular dialysis or a kidney transplant can generally qualify for Medicare if they, a spouse or a parent has enough work history, or if they already receive certain benefits. Ask the social worker at your kidney care center to help you apply and to explain how Medicare works with other coverage.

Can I exercise if I have kidney disease?

For most people with CKD, yes, and it helps. Regular activity lowers blood pressure, improves blood glucose and supports heart health, which is the biggest risk in CKD. Aim to build toward the general target of 150 minutes of moderate activity a week, adapted to your fitness. If you are on dialysis or have heart disease, ask your care team what is safe for you.

When to speak to a doctor

See your doctor for persistent foamy urine, new swelling of the ankles or face, any visible blood in the urine (even once), or symptoms of a urinary infection that are not settling. Seek same-day medical help for urinary symptoms with fever, chills or flank pain; for passing much less urine than usual; for confusion or drowsiness during an illness; or for urinary symptoms in pregnancy. Go to the emergency room for severe flank or groin pain with fever or vomiting. Call 911 for severe breathlessness, chest pain, collapse, signs of sepsis such as confusion, rapid breathing and clammy or mottled skin, or muscle weakness with palpitations, which can indicate dangerously high potassium.

Where this comes from

• National Institute of Diabetes and Digestive and Kidney Diseases — Your Kidneys & How They Work
• National Institute of Diabetes and Digestive and Kidney Diseases — Chronic Kidney Disease (CKD)
• CDC — Chronic Kidney Disease in the United States, 2023
• National Kidney Foundation — Estimated Glomerular Filtration Rate (eGFR)
• American Diabetes Association — Standards of Care in Diabetes
• National Institute of Diabetes and Digestive and Kidney Diseases — Kidney Stones
• National Kidney Foundation — Pain Medicines (Analgesics)
• National Institute of Diabetes and Digestive and Kidney Diseases — Eating Right for Chronic Kidney Disease
• Medicare.gov — Medicare Coverage of Kidney Dialysis & Kidney Transplant Services
• US Preventive Services Task Force — Asymptomatic Bacteriuria in Adults: Screening

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.