How do physicians check your kidneys' function?

Most people know that getting a stress test is a way to test your heart's function. But how do you test your kidney function? You might have heard doctors mention words like "creatinine", or "GFR" when checking how good or bad your kidneys are doing. Although there are a lot of methods by which the kidneys' performance can be measured, I will explain the ones that are used most often in clinical setting

How does contrast/dye given during a CT scan harm your kidneys? What can you do to prevent and minimize the damage?

Certain types of CT scans will often require that the patient get intravenous (iv) "dye" or contrast to make the organs stand out and delineate them better. This usually would lead to better images with greater sensitivity that help the radiologist in picking up features that would otherwise get missed. The downside however is that this very contrast could sometimes cause damage to the kidneys. The medical term for this is "contrast induced nephropathy" (CIN). What do you then do in a situation where iv contrast is necessarily required? Lets try and understand a few nuances about contrast-mediated kidney damage, and what you can do about it?

I do not want dialysis: how long can I expect to live, and how would I feel?

I often see patients in my office who refuse dialysis (should it become necessary) for their advancing kidney disease. I divide these patients in to two categories. The more common category is patients who refuse it because of the "fear of dialysis". They could have trouble understanding dialysis and what potential benefits they could derive from it. They would often make good dialysis candidates who have more to lose than gain by refusing dialysis therapies.

The other category is the patient who rightfully refuses dialysis because she or he would not make a good candidate for such treatment. There could be multiple reasons for that. It could be advanced age and frailty, presence of other severe disease conditions like heart failure or metastatic cancer, etc. In such cases, it is hard to always predict if dialysis would add anything to the quality/quantity of life. And often, patients are simply looking at the "big picture". So the questions that come up in this s…

What are "kidney cysts"? Should I be worried? How do you treat them?

Cysts, or abnormal pockets of fluid filled sacs, are a common finding on imaging studies like ultrasounds that are done on the kidney. I often see concerned patients in consultation about this finding. The question in that situation is...should you be worried if you discovered that you have cyst/s in your kidney?

Cysts in the kidney are a pretty common occurrence. They tend to get more prevalent in the older age groups. For instance, 11.5% of individuals aged 50-70, and 22.1% of all individuals aged over 70 yrs will have at least one cyst in the kidney. However, the challenge is to identify whether it is a benign age related finding or something as serious as cancer (which can present as cysts). Cysts often will have no symptoms, and will usually be discovered incidentally as part of imaging of the kidneys for unrelated reasons.

When do you really need to start seeing a nephrologist (a kidney doctor)?

I often call kidney disease the "Rodney Dangerfield of Medicine". It gets no respect! Well, outside of the medical community, the same could be said for nephrologists (to a certain extent)! No one is quite sure what they do, or why does anybody need to see one anyway.  For some, we are just another version of urologists. Nephrologists, as the readers of this blog know are physicians who specialize in the diagnosis and treatment of kidney disease, electrolytes, high blood pressure, dialysis, kidney stones, etc.

What is "Chronic Kidney Disease", or CKD?

In my previous post, I had talked about how physicians check your kidney function, as well as the concept of glomerular filtration rate (a measure of your kidneys' function, or more accurately, its filtration capacity), or GFR. I want to talk today about an entity that you might have heard before: chronic kidney disease, or CKD. 
CKD is a generic, umbrella term. Nephrologists define it as "kidney damage or reduction in kidney function that persists for 3 or more months". The definition does not include the cause of kidney disease. In other words, whether you have reduction in kidney function from diabetes, or high blood pressure, or a genetic cause, you could still carry a common diagnosis of CKD. This diagnosis is then further subdivided in to stages 1 thru 5, depending on the disease severity. This is where the concept of GFR that I talked about before becomes useful. 

Take a look at the above picture (courtesy of The National Kidney Disease Education Program). Now th…

Can certain herbal medications treat chronic kidney disease (CKD)? Is alternative medicine the cure for CKD?

I set off to try and answer this question after one of my patients whom I saw at my Bradenton clinic brought along an article that claimed that "nettle leaf lowers creatinine level in the blood". This by extension would mean that it could perhaps cure CKD? I was quick to admit that not once during my typical "western medicine" training had I heard of that claim. To me, CKD had always been this inexorable malady that can be, at best, controlled or slowed down from progressing further. "Cure" is not a word that gets thrown around a lot when you talk about CKD. As I had discussed earlier, once kidney function declines chronically, it can typically not be regained.   
But I do try to have an open mind, the good old scientific temper and all that. So rather than dousing disdain over my patient's excitement, I tried to look for evidence to see if the article's claim was indeed true.