A new case for young detectives

Someone you love lives with diabetes. Become their Kidney Detective.

Diabetes can quietly hurt the kidneys — the body's hard-working filters — along with the heart and blood vessels. The good news: kidney trouble can be found early with two simple tests, and families can help protect kidneys every day. Your mission starts here.

Learn the kidney clues Play the games

Yá'át'ééh! — that's "hello, it is good" in Diné Bizaad, the Navajo language. A special welcome to Navajo-speaking families: this site — and the Family Card below — were made with you in mind.

Illustration of a Native American family of five smiling together — a grandmother in the center, a mother and father beside her, and two children in front — wearing woven Southwest-patterned clothing and turquoise jewelry
Three generations, one team: a grandmother, two parents, and two kids looking out for each other. Every family is welcome here.
Start the case

Your kidneys: two small filters doing four big jobs

You have two kidneys, each about the size of your fist, tucked under your ribs in your back. Every day they filter all of your blood, over and over — about 50 gallons a day. Here is what they do while you are busy living your life.

1 · Clean the blood

Kidneys wash waste and extra stuff out of your blood. The waste leaves as urine — that's the kidneys taking out the trash, all day and all night.

2 · Balance the water

Drink a lot, and your kidneys let extra water go. Drink a little, and they hold on to it. They keep the amount of water in your body just right.

3 · Help control blood pressure

By balancing water and salt and sending chemical signals, the kidneys help set your blood pressure. Kidneys and blood pressure are a team.

4 · Build blood and bones

Kidneys send a signal that tells your body to make red blood cells, and they switch on vitamin D so your bones stay strong.

The tricky part: kidney trouble is quiet

Kidneys can lose a lot of their filtering power without hurting at all. Most people with early kidney damage feel completely fine. That's why detectives don't wait for clues you can feel — they use two tests that find kidney trouble early, while it can still be slowed down.

Test 1 · Urine test

The urine albumin test (ACR)

Healthy kidneys keep protein in the blood where it belongs. When the tiny filters are damaged, a protein called albumin leaks into the urine — one of the very first signs of kidney trouble.

How it works: a simple urine sample at the clinic. No needles. The lab compares albumin to creatinine — that's the ACR.

Test 2 · Blood test

The eGFR blood test

This blood test estimates how well the kidneys are filtering — the eGFR, or "filter score." Higher is better. It shows how much filtering power the kidneys have left.

How it works: one small blood draw. Doctors look at the eGFR together with the urine ACR to see the whole picture.

Know your kidney numbers — ask for both tests every year
Urine albumin (ACR) Under 30 mg/g No leak found — filters are holding. 30 or more A leak — early kidney damage. Time to act, not panic.
eGFR (filter score) 90 or above Usual healthy range. 60–89 Watch it · Under 60 for 3+ months means kidney disease range — make a plan with the doctor.

Everyone with diabetes should have the urine albumin test and the eGFR checked at least once a year — even when they feel perfectly fine. Feeling fine is exactly when these tests matter most.

The whole case

Four panels, one team: diabetes, blood pressure, heart, kidneys

Kidney patients usually don't have just one problem. Diabetes, high blood pressure, and heart disease travel together — and each one can hurt the kidneys. A good detective works all four panels of the case at once.

1

Diabetes — the sugar story

Diabetes is the #1 cause of kidney damage. Year after year of high blood sugar wears out the kidneys' tiny filters.

Think of blood sugar like sand in a stream. A little passes through fine, but too much, for too long, grinds down the filters. Keeping glucose near target is the single strongest way to protect the kidneys — and it protects the eyes, nerves, and heart at the same time.

Family jobs: help your loved one check glucose, cheer for walks after meals, and make water the easy drink at home. Every "on target" day is a day the filters are safe.

Detective targets (ACE / AACE)

  • Fasting glucose under 110 mg/dL
  • A1C at or below 6.5%
  • Urine albumin + eGFR checks every year
2

Blood pressure — the pressure story

High blood pressure is the #2 cause of kidney damage — and damaged kidneys push blood pressure even higher. It's a loop, and controlling pressure breaks it.

The kidney's filters are tiny, delicate blood vessels. Pressure that runs too high batters them like a garden hose turned up too strong. Bringing pressure down is proven to slow kidney damage — and it protects the heart and brain, too.

Family jobs: go easy on salt at the table, take pressure medicines every day (not just on "high" days), and check home readings if the doctor asks.

Detective targets (2025 AHA / ACC guideline)

  • Under 130/80 for everyone with hypertension
  • Systolic under 120 encouraged for higher-risk adults
  • These are personal targets — always check with your own doctor
3

Cholesterol & the heart — the partner story

Kidneys and heart fail together. Kidney disease raises heart risk, and a struggling heart starves the kidneys of blood flow. Protect one, and you protect the other.

After a heart attack or stroke, cholesterol control becomes urgent detective work. The European heart guidelines (ESC/EAS) set a clear goal: get LDL cholesterol under 55 mg/dL and at least 50% lower than where it started, with a statin taken every day.

Family jobs: the statin works only on the days it's taken — help make "every day" easy with a pill box and a routine tied to breakfast or bedtime.

Detective targets (ESC / EAS guidelines)

  • After a heart attack or stroke: LDL under 55 mg/dL
  • And at least 50% lower than the starting LDL
  • A statin every day — it only works when taken
Important for moms-to-be:

If you are pregnant, breastfeeding, planning a pregnancy, or could become pregnant while taking the pill — tell your doctor right away. Statins are usually paused during pregnancy, and the plan is revisited after the baby comes.

4

Kidney-protecting medicines — the shield story

Some medicines do double duty: they treat diabetes or blood pressure and shield the kidneys themselves. KDIGO — the global kidney guideline group — now recommends them.

SGLT2 inhibitors started out as diabetes medicines that lower glucose through the urine. Big studies then showed something bigger: they slow kidney damage and protect the heart, even helping people whose kidneys are already weakened. KDIGO now recommends them for people with type 2 diabetes and kidney disease.

ACE inhibitors and ARBs are blood-pressure medicines that also take pressure off the kidney filters and reduce protein leaking into the urine — a classic kidney shield when albumin is leaking.

These are prescription medicines a doctor chooses. This panel doesn't tell anyone to start a pill — it teaches families what the medicines are for, so they can ask smart questions at the next visit.

Ask the doctor

  • "Have my urine albumin and eGFR been checked this year?"
  • "Would an SGLT2 inhibitor help protect my kidneys?"
  • "If protein is leaking, should I be on an ACE inhibitor or ARB?"
  • "Are all my numbers — sugar, pressure, LDL — at target together?"
Important for moms-to-be:

If you are pregnant, breastfeeding, planning a pregnancy, or could become pregnant while taking the pill — tell your doctor right away. ACE inhibitors, ARBs, and statins are usually paused during pregnancy, and the plan is revisited after the baby comes.

Detective training

Kidney games

Train like a kidney detective. The clues from all four panels — sugar, pressure, cholesterol, and the kidney tests — are hidden inside the games.

Game 1 · Filter Frenzy

Kids game

You are the kidney filter! Move the filter basket with your mouse, finger, or arrow keys. Catch the good drops — water and healthy foods. Dodge the salt shakers and sugar cubes: catching one costs a heart. You have 45 seconds and 3 hearts.

Score: 0Hearts: 3Time: 45s

Game 2 · Memory Match — Kidney Clues

Kids game

Flip two cards at a time and find all six matching pairs of kidney clues.

Pairs found: 0 / 6Flips: 0

Game 3 · Word Search — Kidney Words

Kids game

Find the seven hidden words. Tap the first letter of a word, then tap its last letter — words run across, down, or diagonally.

    Game 4 · Myth or Fact?

    Teen game

    Kidney cases are full of rumors. Read each statement and call it: myth or fact?

    Case 1 / 6Score: 0

    Game 5 · Case Files — Kidney Quiz

    Teen game

    Six real cases from the four panels. Pick the right answer — a true detective checks every number.

    Case 1 / 6Score: 0
    Take it home

    The Kidney Family Card

    The card that goes on the fridge and into the pharmacy bag — the reason for taking every pill, every day, in the family's own words.

    Illustration of a Native American family of five — a grandmother, a mother and father, and two children — in woven Southwest-patterned clothing with turquoise jewelry

    I take my medicine for:

    Write the name of the person you're staying healthy for. Then remember: the medicine works on the days you take it — every day.

    Fasting glucose < 110 A1C ≤ 6.5% BP < 130/80 LDL < 55 after heart attack or stroke Urine albumin + eGFR every year

    Yá'át'ééh! — hello to our Navajo-speaking families. In Diné Bizaad, that means "it is good." This card is for you, too.

    For grown-ups

    The full case file

    Kidney disease in diabetes is common, silent, and slow-moving — which is precisely why it is worth catching. Two cheap tests (urine ACR and eGFR) find it years before symptoms. Once found, the four panels above are the plan: glucose at target, blood pressure controlled, LDL down after any heart attack or stroke, and kidney-protecting medicines — an SGLT2 inhibitor and, when albumin leaks, an ACE inhibitor or ARB — as KDIGO recommends.

    Questions that open the conversation

    • "When were my urine albumin (ACR) and eGFR last checked — and what were the numbers?"
    • "Are my sugar, blood pressure, and LDL all at target at the same time?"
    • "Would an SGLT2 inhibitor protect my kidneys? Is an ACE inhibitor or ARB right for me?"
    • "How often should we recheck my kidney numbers?"

    Everyday kidney protection

    • Take medicines every day — set a routine and a pill box.
    • Go easy on salt; most of it hides in processed and restaurant food.
    • Be careful with over-the-counter pain pills (NSAIDs like ibuprofen) — ask before using them regularly.
    • Don't smoke; keep moving; keep every yearly kidney check on the calendar.
    Important for moms-to-be:

    If you are pregnant, breastfeeding, planning a pregnancy, or could become pregnant while taking the pill — tell your doctor right away. Statins, ACE inhibitors, and ARBs are usually paused during pregnancy, and the plan is revisited after the baby comes.