In America probably one of the biggest underlying problems is being overweight. That can lead to diabetes and higher blood pressure. However, plenty of people have diabetes and high BP, and are a good weight. They both can have genetic components. Either way, controlling those problems through diet, exercise, and/or dugs will help save your kidneys.
Staying well overall is a good idea, because a lot of medications tax the kidneys too. Avoiding the necessity for drugs has all sorts of benefits.
Statin meds for cholesterol can tax the kidneys, also heartburn drugs like Prilosec, chemo, NSAIDS, the list goes on. I’m not saying to be paranoid to use these drugs now and again, but long term use can be taxing on the kidneys. Some antibiotics are harder in the kidney than others. Statin drugs in particular can cause damage very fast in a small percentage of individuals. If you have bad muscle pain while taking statins tell your doctor immediately.