Demystifying Kidney Disease for the Average Joe!

I set off to try and answer this question after one of my patients 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.

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 ...

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...

After I wrote my last post on the treatment options that patients with advanced kidney disease and kidney failure  have when it comes to managing their disease, I came across a really nice 10 minute long video on YouTube that pretty much summarizes everything that I wrote in that article. The video goes into options that patients with kidney disease will typically have- dialysis being the most common one, transplantation, and finally not doing anything aggressive and treating it conservatively (I have written on conservative management and what happens when patients refuse dialysis here ).  The video also covers questions like when to start dialysis, and the decision making that goes in to deciding who would make a good candidate for home dialysis. All in all, it is a great way in which kidney disease patients and their loved ones can educate themselves. The format is engaging and you won't have to read pages of text that many patients find boring!  The video...

We are years, if not decades away from creating an artificial kidney . Until then, in an ideal world, every patient with advanced stage-5 kidney disease who needs kidney replacement therapy would get a kidney transplant. Unfortunately, kidneys are a scarce and limited resource. The number of people with kidney failure who could use a transplant far outweighs the number of transplants that actually occur every year. As per the latest USRDS Annual Data Report (2013) , 17,671 kidney transplants were performed in the United States in 2011 (111 fewer than in 2010). Meanwhile, the waiting list had 90,474 patients in line, as of December 31st of the same year. As you can see, the active waiting list is more than three times larger than the actual supply of donor kidneys. In the light of this stark mismatch, desperate patients have to make a decision about the next best option, dialysis. And the question that any proactive patient will ask, and should ask, is what kind of dialysis is the ...