Last reviewed by Dr. Leena Joshi, MD, August 2026
Dr. Leena Joshi, MD is a board-certified nephrologist who treats chronic kidney disease (CKD) in Burlingame, Daly City, and San Mateo County. CKD means the kidneys have lost some filtering ability for three months or longer. Dr. Joshi’s goal is to find the cause, slow the decline, and keep you off dialysis for as long as possible. New patient appointments are typically available within days at both offices. Call (650) 355-5551.
What is chronic kidney disease?
CKD is gradual, lasting damage to the kidneys. It is defined by an eGFR (estimated glomerular filtration rate) below 60 for three months or longer, or by kidney damage such as protein in the urine, even when the eGFR is normal. CKD has five stages. Stage 1 is mild damage with normal filtering; stage 5 is kidney failure. The most common causes are diabetes and high blood pressure. Others include polycystic kidney disease, glomerular diseases such as lupus nephritis, and repeated kidney stones or infections.
What are the symptoms of chronic kidney disease?
Early CKD usually has no symptoms, which is why blood and urine tests matter. As it advances, patients may notice:
- Swelling in the ankles, feet, or hands
- Changes in urination, including foamy urine (a sign of protein loss)
- Fatigue, trouble concentrating, or shortness of breath
- Poor appetite, nausea, or a metallic taste
- Muscle cramps, restless legs, or persistent itching
- Blood pressure that stays high despite medication
How does Dr. Joshi manage chronic kidney disease?
The first visit sets the baseline: history, exam, kidney function labs, and urine testing to measure albumin. Dr. Joshi then names your stage and the likely cause. Treatment focuses on what slows CKD: blood pressure control with kidney-protective medicines, blood sugar control for diabetic patients, medications such as SGLT2 inhibitors where they fit, and a diet plan matched to your labs. She reviews every medication you take for kidney safety and treats complications such as anemia and bone disease early. Labs are repeated on a schedule so changes are caught before they become problems. If CKD advances, she starts the conversation about dialysis or transplant well ahead, so decisions are made calmly with time to plan.
When should you see a nephrologist for CKD?
- Your eGFR is below 60 on more than one test
- You have protein or albumin in your urine
- Your kidney function is falling faster than expected
- You have diabetes or high blood pressure with signs of kidney involvement
- Your blood pressure stays high despite two or more medications
Related reading: kidney lab results explained, diabetic kidney disease, high blood pressure and the kidneys, and dialysis options.
Frequently asked questions
Can chronic kidney disease be reversed?
Most CKD cannot be reversed, but its progression can often be slowed or stopped. Dr. Joshi focuses on the causes that can be controlled: blood pressure, blood sugar, protein in the urine, and medications that stress the kidneys.
What do the CKD stages mean?
Stages run from 1 (mild damage, normal filtering) to 5 (kidney failure). Your stage is set by your eGFR and how much albumin is in your urine. Dr. Joshi explains your stage and what it means for treatment at your first visit.
What diet changes help with chronic kidney disease?
Usually less sodium, and depending on your stage, limits on potassium, phosphorus, and protein. Dr. Joshi bases advice on your labs and may refer you to a renal dietitian.
What medications treat chronic kidney disease?
Blood pressure medicines that also protect the kidneys (ACE inhibitors or ARBs), SGLT2 inhibitors for many patients, and treatment for anemia, bone health, and acid balance when needed. Dr. Joshi tailors this to your labs.
How often will I need appointments for CKD?
Early stages are often seen every 6 to 12 months; later stages every 3 months or more. Dr. Joshi sets the schedule by your stage and how fast your numbers are changing.
Will I need dialysis with chronic kidney disease?
Most people with CKD never need dialysis. Dr. Joshi discusses dialysis and transplant options only if kidney function falls to a level where they become necessary, and plans well ahead so nothing is rushed.
Does insurance cover CKD treatment?
Most major insurances, including Medicare and Medi-Cal, cover nephrology care. A referral is always required. Call (650) 355-5551 to confirm your plan.
Schedule an appointment
Dr. Leena Joshi, MD is a board-certified nephrologist with offices at 1750 El Camino Real, Suite 301, Burlingame and 1800 Sullivan Ave, Suite 507, Daly City. New patient appointments are typically available within days. A referral from your doctor is required; visits are by appointment only. Call (650) 355-5551.
This page is for general education and is not a substitute for medical advice. Always consult your physician about your specific situation.
Medically reviewed by Leena Joshi, MD.