“But I pee just fine…….” CKD and the silent road to renal failure

Christopher BrownBlog Series Vol. 1, Dr. Christopher Brown

“But I pee just fine…….”

CKD and the silent road to renal failure

There is a disease that is not talked about much but affects over 26 million Americans.  This disease is one of the “silent killers” in healthcare that doesn’t cause a lot of symptoms until it is at an advanced state.  It can’t be cured, but it can be controlled if it is found early.    The disease is Chronic Kidney Disease.  Chronic Kidney Disease usually called “CKD” or “kidney disease” is an injury to the kidney that results in loss of kidney function that lasts for over 3 months. It is usually progressive and while it can’t be cured it can be controlled in most people.

The kidneys are small organs that are located just below your ribcage where the ribs connect to the spine.  They are not often talked about, but serve multiple vital roles in the body.   They are important in controlling the amount of water in your body.   They control the amount of several electrolytes such as sodium and potassium in your blood stream. They help the body make vitamin D which is a hormone with many major functions.  They also get rid of waste products produced by the body by making urine (commonly called “pee”).

Fortunately the kidneys are pretty tough.  They can be damaged significantly and you can’t really tell from symptoms you can feel or see.    They also can heal themselves from certain types of injury.    Unfortunately the same way a tough person doesn’t show signs of fatigue or damage until it’s too late it can be the same way with the kidneys.  It is not uncommon for someone to have worsening kidney function for years without symptoms and when they show up to the doctor’s office with symptoms they have advanced kidney disease and have to start dialysis.

Those people who develop symptoms will notice signs and symptoms such as:

  • Swelling of the legs
  • Blood pressure problems
  • Fatigue
  • A change in the way certain foods taste (advanced kidney damage)

The way to tell if the kidneys have been damaged is by blood work, testing the urine and looking at the urine with a microscope (urinalysis).

In the blood we can measure a substance called creatinine.  Creatinine is a waste product that comes from muscles.    The amount of creatinine in the blood is a measure of how well the kidneys are functioning. As the amount of creatinine in the body rises this is a sign that the kidneys are not able to get it out of your body meaning that they have been damaged.    The creatinine level is used to calculate a number called glomerular filtration rate or GFR.    GFR can be considered your “kidney number” which gives a rough estimate of what percentage of your kidney function is left.   A kidney number of 60 means that the kidney is performing at 60%.  A kidney number higher than 60% and you really don’t notice any signs or symptoms, but below 60% then there can be changes in your bloodwork that result from the kidney damage or a person can develop symptoms.

Although the kidneys are tough, they can be damaged from a number of different things.   Some of the things that damage the kidney can’t be avoided such as the genes that a person is born with.   Other things that damage the kidney can be avoided or controlled such as high blood pressure or diabetes.  Below are a few of the categories of problems that can result in damage to the kidneys:

  • Genetics – some people just have genes that makes them susceptible to certain diseases.    One of the genetic diseases is polycystic kidney disease which causes cysts to occur in the kidney and over time can affect the function of the kidneys.
  • Medications/drugs – Certain drugs can cause kidney damage.   Some medications may be prescribed for certain medical conditions and kidney damage is  a side effect that has to be monitored. Other medications can be obtained over the counter.   NSAIDS, which are medications commonly used for pain such as ibuprofen, can be a cause of kidney damage when taken at high dosage and/or for a long time.   While usually the damage caused by NSAIDs is temporary, occasionally it can cause damage that can’t be reversed.  There have been cases of kidney damage being caused by herbal medications as well.   Aristolochic acid is an ingredient found in a Chinese herb called Aristolochia fangchi and has been linked to permanent kidney damage.  
  • Medical conditions – these are the most common cause of damage to the kidney.   People with certain medical conditions such as hypertension or diabetes should be routinely screened to evaluate for kidney disease.

The majority of cases of CKD are from longstanding injury to the kidney and can’t be reversed.    However you can work with your doctor to slow down how fast the kidney fails.  A few of the ways to slow down kidney failure are as follows:

  • Control your blood pressure
  • Control your diabetes
  • Avoid medications/drugs that harm the kidney
  • Avoid dehydration
  • Moderate your salt intake

CKD can be a silent road to kidney failure, but there are things you can do to find out if you are on that road by talking to your primary doctor, nurse practitioner or physician assistant to see if you need to be screened for the disease.     If you find out that do have CKD remember  that not everyone will develop kidney failure and for those that are destined to develop kidney failure there is a fast lane and a slow lane to kidney failure and you can switch to the slow lane by keeping your appointment with your doctor, getting referred to see a kidney specialist and being active in learning about the disease so you can take steps to slow down the disease process.

 

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To learn more about Dr. Christopher Brown, check out his bio.

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