Demystifying Kidney Disease for the Average Joe!

Sometime ago, I had posted a brief overview of treatment of chronic kidney disease . However, one factor that does determine the progression of chronic kidney disease that I did not touch upon was the amount of "acid" in your blood, and its consequent effect on the kidneys.

Sometime ago, I had written a post exploring the role of alternative herbal medications in the treatment of chronic kidney disease . That post had evoked strong reactions, both for and against, from the readers! Which set me thinking...is there a role of alternative therapies in the treatment of high blood pressure? If yes, is it based on hearsay, or solid medical evidence?  Luckily, to make my job easier, the American Heart Association came out with an official statement addressing this issue early this year. This was published in the journal Hypertension . I will try to summarize this statement's conclusion's addressing the efficacy of approaches like acupuncture, yoga, meditation, etc in treating high blood pressure. Please note that these conclusions apply only to treatment of high blood pressure, and not to other health/psychological benefits that may be derived from doing these activities .   

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.