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July 19, 2011 > Protect Your Kidneys So They Can Protect You

Protect Your Kidneys So They Can Protect You

Chronic kidney disease (CKD) affects one of every nine American adults - approximately 26 million people - and up to 90 percent of them don't even know they have it. Another 20 million people are at risk of developing the disease, according to the National Kidney Foundation.

"Most people with chronic kidney disease don't know they have it because there usually are no symptoms until the disease is fairly advanced and the kidneys have suffered considerable damage," says Qi Che, M.D., PhD, a nephrologist (kidney specialist) on the medical staff at Washington Hospital. "Chronic kidney disease is divided into five stages of increasing severity. As the disease progresses, it can lead to kidney failure - called end-stage renal disease - in stage 5. Most people with stage 5 kidney disease need dialysis or a kidney transplant to stay alive."

Symptoms of advanced chronic kidney disease may include:
* Fatigue
* Trouble concentrating
* Loss of appetite
* Nausea
* Insomnia
* Easy bruising or bleeding
* Cramping
* Urinating more often, especially at night
* Dry, itchy skin
* Puffiness around the eyes, especially in the morning
* Shortness of breath
* Swollen feet and ankles
* Decreased interest in sex

"Having kidney disease also increases the risk of cardiovascular disease," Dr. Che adds. "The death rate from cardiovascular disease - including heart attacks, congestive heart failure and strokes - is eight times higher in patients who have chronic kidney disease. The increased risk of cardiovascular disease occurs whether or not the person develops end-stage renal disease."

The kidneys are bean-shaped organs about the size of a closed fist, located in the upper back where they are protected by the lower ribs. Each kidney is connected to tubes called "ureters," which carry urine to the bladder.

"The kidneys filter the body's blood supply, removing wastes, toxins and excess fluid from the body," Dr. Che explains. "The kidneys filter approximately 200 liters of blood each day, producing about two liters of urine. The kidneys also regulate various minerals in the body such as calcium, sodium, phosphorus and potassium. In addition, the kidneys release hormones into the blood that help your body regulate blood pressure, make red blood cells that carry oxygen throughout the body, and promote strong bones."

Dr. Che notes that with the loss of kidney function, the body accumulates excess water, wastes and toxic substances that are normally filtered out by the kidneys. Impaired kidney function also contributes to other health problems, including anemia (iron deficiency), high blood pressure, excess acid in body fluids and bone disease.

Know Your Risk Factors and Get Tested Regularly

"The two most common causes of chronic kidney disease are diabetes and high blood pressure," says Dr. Che. "Both these conditions damage the small blood vessels in the kidney that filter waste from the blood. Although you cannot reverse damage to the kidneys, numerous studies have shown that people with diabetes or high blood pressure can slow the progression of chronic kidney disease by controlling their diabetes and blood pressure."

Some other causes of chronic kidney disease include:
* Glomerulonephritis - an inflammation of the kidneys.
* Obstruction of urine flow caused by kidney stones, an enlarged prostate or cancer.
* Atherosclerosis - hardening of the arteries leading to the kidneys.
* Hereditary or genetic disorders such as polycystic kidney disease, wherein both kidneys have multiple cysts.
* Long-term, regular use of pain medications such as naproxen (Aleve) and ibuprofen (Motrin, Advil), which can damage the blood vessels in the kidneys.

"Just because some medications are available over-the-counter does not mean they are completely benign," Dr. Che cautions. "Many OTC drugs can damage the kidneys when used over long periods of time. You should consult your doctor about any medications you use on a regular basis and before taking herbal remedies or dietary supplements. In addition, you should consult your doctor about contrast dyes used in CT scans, since they can affect the kidneys. Smoking tobacco also slows the flow of blood through the kidneys and can contribute to chronic kidney disease and increase the risk of kidney cancer by about 50 percent."

Some risk factors for chronic kidney disease cannot be modified, including age and family history of kidney disease. People of African-American, Hispanic, Asian and Native American heritage also are more at risk.

"Early detection is key to effective treatment to slow the progression of chronic kidney disease," Dr. Che emphasizes. "Fortunately, chronic kidney disease can be diagnosed with three simple tests: measuring your blood pressure, a blood test to measure the level of the waste product creatinine in the blood, and a urine test for the level of protein in the urine. You should have these tests done by your primary care physician as part of your regular physical exam."

Follow the Golden Rules

Chronic kidney disease should be managed in close consultation with your physician, but Dr. Che offers seven "Golden Rules" that can help people slow the progression of chronic kidney disease and decrease the likelihood of complications:

1) Keep fit and active. Exercise 30 minutes per day, at least five days per week.
2) Maintain regular control of your blood sugar. In general, every percentage point drop in A1c blood test results can reduce the risk of complications from kidney disease by 40 percent.
3) Monitor your blood pressure and keep it under control.
4) Eat a healthy diet and keep your weight in check. Limit your intake of salt to around 1 tsp. per day if you are healthy; to 1/2 tsp. per day if you are over age 51, African-American, or suffering from high blood pressure, diabetes or chronic kidney disease.
5) Do not smoke.
6) Avoid taking over-the-counter pills - including ibuprofen and naproxen - on a regular basis. Tell your doctor about any OTC drugs, herbs or supplements you take, and ask about a drug's effects on the kidneys any time you take a new medication.
7) Get tested for your kidney function on a regular basis if you have one or more risk factors for chronic kidney disease.

"Our job is to help people slow down the progression of chronic kidney disease and prolong the lives of our patients," says Dr. Che. "The nephrologists who are affiliated with Washington Hospital, as well as the hospital dietitians, can offer guidance in how to manage chronic kidney disease before you get to the stage where dialysis or kidney transplant is required. But we can't help people unless they pay attention to their risk factors and get tested for chronic kidney disease."

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