Demystifying Kidney Disease for the Average Joe!

This is one the commonest questions that I get as a nephrologist. The typical situation is a patient with advanced kidney disease that I see in the office. The patient is accompanied by a family member who is eager to donate their kidney to the patient, but is concerned about any potential health pitfalls.  Assuming you have a donor who is willing to donate you their kidney and is fit to do so (I covered the steps involved in kidney transplantation and the prerequisites for a potential donor here ), the donor as well as you would need to be aware of what donation entails, and what, if any, future health consequences can they expect. So assuming the potential donor has no major contraindications to kidney donation (these will include impaired kidney function, active infections, cancers, chronic lung/heart/liver/autoimmune disease, substance abuse, pregnancy, etc.), this is what they could expect:

When patients develop advanced kidney disease, medically called stage 5 CKD , they could begin to develop symptoms or signs of kidney failure, called uremia. Up to a certain point, your nephrologist will try and treat these complications medically as much as possible. However, as kidney disease progresses, the symptoms may no longer be amenable to medical treatment. At this point, you will need either dialysis or a kidney transplant. Image courtesy NIDDK

Pregnancy is a physiologic stressor on a woman's body. The cardiac output has to increase to keep up with the increased metabolic demands of the woman and the developing fetus. The blood flow to the kidneys increases. Changes in blood electrolyte and acid levels occur. These changes, among others, have implications for both the kidney's function, as well the state of the pregnancy. Hence, nephrologists typically try to answer two questions when assessing these issues: 1) How does kidney disease affect the chances of getting pregnant, and kidney disease's effect on pregnancy? 2) What effects does pregnancy have on the status of your underlying kidney disease?  Continuing on my last discussion about sexual and reproductive issues in people with kidney disease, lets carry this forward.

The damaging  effects of smoking on lung and cardiovascular function are well known. Does smoking have similar effects on the kidney function as well? If yes, what is the evidence to support that conclusion? Most recently, this question was addressed by two different studies, both of which were published in the Journal of the American Society of Nephrology. The first study I want to discuss came out from the Johns Hopkins University School of Medicine. Unlike a lot of its predecessor studies, this study was a prospective study (rather than a retrospective analysis of patients' charts), following about 23,000 patients over a span of 20 years. The results of this study clearly established that current cigarette smoking was a significant risk factor for development of chronic kidney disease (CKD). However, what was even more profound was that the attributable risk (difference in CKD rates between people who smoke and those who don't)  of CKD for smokers was 31%, which was...

I often get the question, "hey doc, do I need to be tested for kidney disease"? The answer would depend on whether you have the risk factors to develop serious kidney disease. Kidney disease is often called a "silent killer", because all too often, patients do not have any symptoms, period. A common misconception is that if you "make urine", your kidneys are healthy. This is not true. As you might have noticed in my previous post , the amount of urine you make is not necessarily considered a valid test of your kidneys' function. In fact, I personally have a lot of patients who are on dialysis due to kidney failure; yet they continue to pee out a liter of urine daily! I will talk about the symptoms of kidney disease later, but for now let's focus on who needs testing; knowing that you may or may not have the relevant symptoms.

Nephrologists typically would question you about your alcohol intake as part of a routine office visit.  Let's see why is that so? Humanity's association with alcohol dates back to antiquity, as evidenced by the now-famous discovery of the Stone Age Beer Jugs ! So for millenia, we have been using alcohol variously as a medication, an antidote, a source of inspiration for treatment of writer's block, a medium to make friends and political connections, etc. "I have taken more out of alcohol than alcohol has taken out of me", claimed Winston Churchill. I am not sure if that included kidney disease or not, but I do intend to explore that question today.  Does alcohol cause kidney disease? Image courtesy of arztsamui/FreeDigitalPhotos.net You would think that 9000 years of binge drinking would lead to some solid evidence about the association between alcohol use and kidney disease. Surprisingly, there are not a lot many good studies out there that have addre...

The short answer is, "probably not". So is this another one of those medical myths, then? I had a patient's relative ask me this question recently. They had driven up from Sarasota to see me for some other nephrological issue, when we got talking about the role of recurrent kidney infections in causing chronic kidney disease (CKD). Recurrent kidney infections (called pyelonephritis, which is a type of a UTI) are known to cause renal scarring. They might also be associated with genetic or developmental abnormalities that could be lead to CKD.  That is a separate discussion in itself, but for the time being, I wanted to delve a little bit in to whether cranberry juice is worth your money. This is another one of those "top ten" questions that nephrologists get all the time! Do cranberries prevent UTIs? Image courtesy of James Barker/FreeDigitalPhotos.net Jokes about cranberry juice aside, there do seem to be plausible biological mechanisms to suggest t...