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The kidneys are complex organs, functioning together as traffic cop, filtration plant, and biochemical factory. They keep us healthy by removing waste produced by cells. They also clear the body of medications, balance fluid levels and blood pressure, orchestrate red blood cell production, and even produce the active form of vitamin D for strong bones.
The entire body depends on the kidneys to get through the day.
Our two kidneys, each about the size of a fist, are situated in the lower back, at either side of the spine. Together, they’re a powerful metabolic engine, filtering blood via millions of microscopic blood vessels, at the rate of a gallon-and-a-half per hour. These tiny filters process blood plasma at the molecular level, extracting waste that then exits the body as urine.
Because this essential work stream depends entirely on blood flow, any disease that affects the blood vessels will also affect the kidneys—making high blood pressure a major cause of kidney damage. Kidneys can also be damaged by diabetes, injury, or infection. And some people are born with urinary system malformations that may affect their kidney function.
Kidney disease affects at least 37 million Americans. Men are at higher risk than women, and African Americans and Latinos have a higher risk than whites. We’re also learning more about the role that family history may play.
When Damage Occurs
The kidneys are so dependable that they continue to work even after disease sets in.
When a filter within a kidney becomes damaged, other filters must work harder to compensate, and as these filters become more stressed, a chain reaction of damage can begin. But because each kidney has millions of such filters, it may take a long time for enough filters to become damaged and for symptoms to finally become apparent.
So early-stage kidney disease is often without symptoms—as many as 90 percent of patients with the disease are not aware they have it. This is why we depend on laboratory blood and urine testing to monitor kidney function, particularly in early stages of the disease.
When kidney function drops below 15 percent, a patient may experience chronic kidney disease symptoms such as loss of appetite, nausea, restless legs, daytime drowsiness, and anemia, even though their volume of urine output may be surprisingly close to normal. Fluid buildup can also occur within the body, causing shortness of breath and swollen ankles. At this stage, the patient’s condition is considered a medical emergency.
Living with Kidney Disease
When kidney disease has been diagnosed, proper medication and diet can help slow its progress. In treatment and management of chronic kidney disease, we focus on managing blood pressure and diabetes, to protect the blood vessels and prevent additional damage to the kidneys.
We can prescribe a number of effective medications to help control both conditions. Some newer agents have secondary benefits that can protect the kidney as well. With successful maintenance, we may even see limited recovery of scarred kidney tissue, depending on severity.
We also restrict certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (Motrin®, Advil®). We may also restrict certain proton pump inhibitors for gastrointestinal disease, like omeprazole (Prilosec OTC®) and lansoprazole (Prevacid®) if alternatives are available. Acetaminophen (Tylenol®) is recommended to treat pain or fever. Check with your doctor before taking other over-the-counter drugs or herbal supplements.
Nutritional management of chronic kidney disease includes the critical step of reducing sodium. And for diabetics, regulating carbohydrate consumption helps keep blood sugar even, preventing the dangerous highs and lows that can spur blood vessel damage.
I recommend the Mediterranean diet or the DASH (Dietary Approaches to Stop Hypertension) diet. Both include lots of fruits, vegetables, whole grains, fiber, and other healthy foods, and exclude overly salty or processed foods. I follow these dietary approaches myself and can confirm that, when you give yourself time to adjust to it, food tastes fine with less salt. Choose high-quality, flavorful foods to satisfy your taste buds.
We find that kidney disease patients who have the greatest success at managing their diet have the support of their family members. If the patient craves pizza, Chinese food, or another high-salt meal, it can be easier to resist if the family helps steer them to healthier options.
Managing blood pressure and diabetes protects blood vessels, which in turn protects the kidneys. Learn more about living with kidney disease from Dr. Judith Veis. https://bit.ly/308KlUz via @MedStarWHC.
Help from Dialysis
When kidney function dips to 10 percent or lower, we turn to dialysis for help. Although most kidney patients will not need it, a small percentage will.
The patient’s healthcare provider recommends a type of dialysis based on the patient’s physical condition, access to transportation, and home environment. There are two types of dialysis:
• With hemodialysis, the blood is circulated through an artificial kidney that removes waste products. Before the process begins, the surgeon performs a minor procedure on the patient’s arm or leg to allow access to the bloodstream. Hemodialysis is done at an outpatient dialysis center and generally requires three sessions per week, about four hours a session. Patients can also have training to do hemodialysis at home.
• Peritoneal dialysis is performed within the abdominal cavity. Before the procedure, the cavity is slowly filled with a special fluid that draws waste from the blood directly through the network of blood vessels that line the abdomen. Both fluid and waste products can then be removed.
Peritoneal dialysis can be performed by the patient at home. It can even be done overnight so it doesn’t affect the patient’s normal daytime routine. Patients are required to visit their specialist about twice a month to check lab results and review their treatment.
Of course, with kidney disease, a patient may experience occasional days of not feeling well, especially if anemia—lack of iron in the blood—creates fatigue. Dialysis and medication for the anemia help us stay ahead of the anemia and make our patients feel more like themselves.
Dialysis represents a big life change. But, although it can cause some temporary minor discomfort, most patients do very well with it. I have seen patients who resisted it at first, then helped those around them adjust to kidney failure when they realized how many opportunities dialysis gave them to enjoy everyday life again.
In the rare event that kidneys shut down completely, transplantation is the remaining option.
As a national leader in transplant surgery, MedStar Health has a large, highly skilled surgical and nephrology team to support transplantation, with the full assistance of dozens of specialists and other experts in both clinical and support roles.
We take a very holistic, teamwork approach and have treated many kidney patients, so we are capable of managing even the most difficult cases.
COVID-19 and Kidney Disease
Kidney disease is not thought to increase the risk of contracting COVID-19, but having kidney disease as a preexisting condition can definitely make the virus worse.
And the virus itself can stress your kidney function, particularly for patients on a ventilator. The coronavirus can also infect the kidney directly.
During the pandemic, it’s critical that kidney disease patients stay in touch with their specialist and take all advised precautions to prevent infection. Don’t delay scheduled lab work for your kidneys—that information is critical to your health, and having blood drawn is very safe with all the COVID-19 protocols we have in place. Our robust telehealth system is another great way to stay in touch with your doctor as needed, in between on-site visits.
If you have kidney disease, it doesn’t have to interfere with living your life. With the right care and vigilance, patients with kidney disease can most certainly live their best lives and enjoy family, work, and play almost as well as those without kidney issues.
We encourage you to do your part: eat healthy, exercise, and stay connected with your doctor to keep blood pressure and blood sugar under control.
Your kidneys will thank you.