Demystifying Kidney Disease for the Average Joe!

Uric acid is a substance found in the blood. It gets there when "purines" which are one of the building blocks of your DNA, are broken down. This is normal cell metabolism, and hence it is ok to see some amount of uric acid in the blood. However certain disease conditions, foods, and medications can also raise blood uric acid levels to abnormal levels. High uric acid levels, or "hyperuricemia", may lead to "gout/gouty arthritis", but these terms are not interchangeable. 

It is a fact we are all too well aware of. The world, as we know it, continues to grow fat. The popular press has done an excellent job of educating the lay person about the link between obesity and heart disease, high blood pressure, diabetes, etc. However, despite scientific evidence to the contrary, the effect of obesity on the kidneys’ function is less widely known. 

For many of my patients, it is hard to see the connection between chronic kidney disease (CKD) and low red blood count, or anemia. The two entities just seem so disconnected that one wonders, what would one have to do with the other? The key to appreciating this link is recognizing two fundamental principles; one, that the function of the kidneys extends to beyond just "making urine", and two, kidney disease has numerous repercussions that affect multiple organ systems. Well, one of these organ systems happens to be your body's machinery that makes red blood cells, known as the hematopoietic system. And the reason this machinery gets affected in kidney disease is because of the kidneys' function in producing a hormone called, erythropoietin.

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