Our two kidneys are fist-sized and bean-shaped and are an important part of our urinary tract. These remarkable organs filter blood and remove waste and excess fluids from our bodies. Each contains about a million microscopic units called nephrons, and small amounts of blood filter through each nephron.
With this filtering, kidneys can maintain the tricky balance of sodium, potassium and phosphorous in the body that keeps the body working at its best. They also produce some of the body’s hormones, which perform important functions like blood pressure regulation and anemia prevention.
It’s easy to take our kidneys’ amazing work for granted — especially because when these organs aren’t healthy, most people won’t notice any symptoms or signs until they have advanced kidney disease.
That’s why I think everyone should learn more about their kidneys, find out the risk factors for kidney disease, and get tested by a doctor if they have any of those risk factors. What is Chronic Kidney Disease?
The definition of chronic kidney disease (CKD) is having a kidney abnormality, also called a “marker,” for three months or longer. Markers include protein in the urine and decreased kidney function, both of which are discovered through testing. If you have been diagnosed with kidney disease, your kidneys are damaged and aren’t functioning as they should be.
it’s important to know that chronic kidney disease (CKD) is often very treatable in the early stages and that many people will go on to live regular, healthy lives with treatment. Risk factors for CKD
Having type 1 or type 2 diabetes (problems with blood sugar)
Having high blood pressure
Having heart disease
Having a mother, father, sister, or brother with kidney disease—it that runs in families
Anyone with any of these factors should get tested for kidney disease. Being obese and/or smoking also increase risk of CKD. African-Americans, Hispanics, Pacific Islanders, American Indians and the elderly are at increased risk for CKD. Screening for CKD in the general population without risk factor is not recommended.
Causes of kidney disease include congenital abnormalities in the kidneys (like polycystic kidney disease); prolonged obstruction of the urinary tract from conditions such as enlarged prostate, autoimmune disorders, kidney stones and some cancers; and recurrent kidney infections. Ingesting large amounts of over-the-counter pain relievers, or consuming toxic substances or “street” drugs, such as heroin, can cause kidney damage. Treatment of kidney disease
There are several tests doctors use to check for and track kidney disease.
Creatinine blood test: Creatinine is a waste product that kidneys normally remove from the blood. When kidney function decreases, the creatinine level rises. You want to avoid having this number trend higher. The results of this test will be used to calculate your GFR.
GFR (glomerular filtration rate) blood test: This measures the amount of blood kidneys filter each minute. It’s a bit counterintuitive, but when reading GFR numbers, you want to avoid having the number trend lower. A GFR of 60 or higher is normal. A GFR below 60 indicates possible kidney disease.
Urine protein test: Sometimes called a urine albumin-to-creatinine ratio. This measures the level of protein in urine. If it is elevated, that indicates that protein is leaking into the urine, which can happen when the kidneys are damaged. This elevated condition can be a sign of kidney disease. Worsening proteinuria is a sign of progression of CKD and needs to be monitored closely.
There is no way to reverse kidney damage, but there are ways to prevent further damage to the kidneys, particularly for a disease that is caught in the early stages. Damage happens over years, so it is important to protect the kidneys. For people with diabetes, it starts with closely monitoring blood glucose levels. To protect kidneys it is also important to control blood pressure. If you have chronic kidney disease and chronic high blood pressure, your health care provider will likely prescribe one of two kinds of blood pressure medicines for you—an ACE inhibitors or an ARBs. These medications slow the progression of CKD, decrease proteinuria and delay onset of renal failure even in people without hypertension.
NSAIDs, such as aspirin, ibuprofen and naproxen, have been associated with acute kidney injury in the general population and progression of CKD and should be avoided.
Because damage occurs over years, I also want to emphasize that for some elderly people, being diagnosed with moderate or stage 3 kidney disease may not warrant major concern about losing kidney function altogether. Kidney function does decline with age. But the diagnosis is important to make sure those individuals avoid medications that can harm kidneys, and as an extra reminder to stay vigilant about controlling blood pressure, diabetes, weight gain, and any other issue that can impact kidney health. Medical providers also take into account kidney function when dosing other medications that are excreted by the kidneys.
Individuals with CKD should be careful with their diet, to avoid eating foods with too much salt and sodium, and to choose protein amounts and sources more carefully. The body produces waste when using protein, and since kidneys remove this waste, eating excess protein will make those organs work harder. If you have been diagnosed with kidney disease, make sure your health care provider gives you information about which foods you should eat and which you should avoid. Dehydration also stresses kidneys, so drinking plenty of water is also important in caring for kidneys. Since the sensation of thirst declines with age, older people will likely need to remind themselves to drink enough water.
My Dad has had hypertension most of this adult life and now has chronic kidney disease as well. He has taken the advice from his nephrologist (kidney doctor) and has lost weight and limited protein and salt in his diet. He has learned first-hand the importance of avoiding dehydration that can lead to acute renal failure and further damage to renal function. He regularly monitors his lab results and questions his medical providers if there is a change. I think understanding the basics of any chronic disease, you have and how it is monitored by health professionals leads to co-management and better medical outcomes.
Ginny Sugimoto, MD, is a board-certified family practice doctor at Kaiser Permanente Port Orchard Medical Center. Her philosophy of care includes emphasizing a preventive lifestyle and shared decision-making in partnership with her patients. Ginny Sugimoto, MD (Photo: Kitsap Sun)
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