Demystifying Kidney Disease for the Average Joe!

BACKGROUND It is estimated that more than 20 million Americans may have chronic kidney disease (CKD). That means roughly 1 in 15 Americans. Subjectively speaking, and for some reason, the rate seems to be even higher where I practice (Bradenton / Sarasota, Florida), but that could be related to the older aged population here. Whether you could "cure" CKD would depend on the cause of kidney disease . Quite often, the cause happens to be a chronic disease that can only be "controlled" (like diabetes or hypertension), but not technically cured. And so is the case with CKD. That is, you can usually not cure and get rid of CKD, but you should be able to control the worsening of your CKD and prevent the fall in your GFR.  I have discussed in my previous posts about how physicians measure your kidneys' function and the concept of GFR. You may want to take a look at the picture of the " GFR meter " again wherein I had mentioned that the needl...

I had covered why excess protein in the urine needs to be treated in my earlier post.  Lets talk briefly about how we go about achieving that.

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. 

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 Kidne...

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? HOW COMMON ARE KIDNEY CYSTS? 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.

Protein in the urine is medically referred to as "proteinuria". As we had discussed earlier, abnormally high amount of protein in the urine is one of the hallmarks of Chronic Kidney Disease (CKD). We also talked about the role of moderate protein diet in preventing CKD progression . But if protein in the urine is just another downstream effect of kidney disease, then why do we nephrologists make so much fuss about treating it?

Earlier, I had talked about the recommended dietary guidelines for patients who have kidney disease . I want to tackle the issue of protein intake in patients with chronic kidney disease (CKD) in a little more detail today because this is an issue that patients seem to be the most confused about. The question is not just limited to how much protein you need to eat to for your kidneys' health and your overall health. What also needs to be realized is that not all sources of protein are created equal, even if they have the same amount of protein. Quality hence matters as much as quantity.