Dr. Lisette Casagrande says two-thirds of all kidney disease cases in the U.S. are related to diabetes or high blood pressure.

THE SPECIALIST: Dr. Lisette Casagrande

As medical director of the in-patient dialysis unit at Mount Sinai, Dr. Lisette Casagrande is a nephrologist who sees all types of patients with kidney disease. March is National Kidney Month.



Kidney disease may not be on the radar for many of us, but 1 in 3 Americans is currently at risk due to diabetes, high blood pressure or family history.

"We define chronic kidney disease as when both of your kidneys are not functioning to maximum capacity," says Casagrande. "In this country, two-thirds of all cases of kidney disease are the result of diabetes or high blood pressure — risk factors that can usually be kept under control with lifestyle modifications and medical intervention." About 26 million Americans are living with chronic kidney disease.

The kidneys are two fist-size organs that sit close to the back of the abdomen. "Their job is to filter your blood, fine-tune the electrolytes in it, and manage the volume of water in your body," says Casagrande. "The kidneys also have a number of hormonal jobs. They help make red blood cells, control blood pressure, and allow your body to use Vitamin D, which is essential for bone strength." At any given moment, 20% of the blood in your body is in the kidneys being cleaned.

While diabetes and high blood pressure are the most common culprits, kidney disease can also be caused by diseases intrinsic to the kidney like nephritis, as a side effect of some medications, or as secondary effect of other diseases like cancer and rheumatic diseases.

"Kidney disease affects both women and men, and the risk increases with age," says Casagrande. "With age, everyone loses some kidney function, which is why it's all the more important not to add unnecessary wear and tear by smoking or uncontrolled diabetes." Almost all ethnic minorities have an elevated risk of developing kidney disease.


Kidney disease is a stealthy illness that can go undiagnosed for years. "The problem with kidney disease is that you may have no signs until it is advanced," says Casagrande. "Later in the disease, patients experience swelling, fatigue, itchiness in the skin, a bitter or bad taste in the mouth, or a sleep reversal that leads them to sleep all day and be up all night."

In the early stages of kidney disease, there can be no sign at all. Most patients are diagnosed as the result of a blood or urine test, often done as part of a routine checkup. "We screen for blood or protein in the urine, or for the by-product creatinine in the blood," says Casagrande. "Screening for kidney disease is a simple and inexpensive process."

Once patients are diagnosed with kidney disease, the doctor will usually send for an ultrasound to determine how chronic the disease is and check the kidneys for any other abnormalities; a biopsy may also be in order to determine the root cause.


The good news about kidney disease is that it generally has a slow onset. "What this means is that awareness and early detection are the key, and we usually have time to take preventive steps or to control kidney disease so it doesn't advance to kidney failure," says Casagrande. "Not all diabetics will develop kidney disease, and many people who do develop kidney disease will never need dialysis."

All diabetics should, however, receive a urine test for kidney disease at least twice a year.

The treatment options for kidney disease depend on the underlying cause. "Controlling any diabetes or high blood pressure problems very, very well is the first thing for any patient," says Casagrande. "A huge part of that is making lifestyle modifications: tweaking your diet, getting exercise, probably losing some weight, and stopping smoking immediately."


Another essential step is avoiding medications that are toxic to patients with kidney disease, especially ibuprofen and the IV contrast dyes that are given before CT scans.

There are also drug therapies that can slow the progression of kidney disease. "For patients where the cause is nephritis from within the kidney, we can use ACE inhibitors, steroids or chemo to fight the inflammation," says Casagrande. "There are five stages of kidney disease, and we usually begin referring patients to prepare for kidney transplant or dialysis at stage 4."

Once the kidney fails entirely, the only options are kidney transplant or dialysis to filter the blood. "Kidney transplant is always the best option if you can get one — it can add years to your life," says Casagrande. "Even though patients can fear dialysis, it is effective. You have an organ that's failed and we have a machine that can keep you alive."

Patients can stay on dialysis for years and do well, though the goal is always to prevent chronic kidney disease from progressing to kidney failure.


Doctors have been laying the theoretical groundwork for treatment breakthroughs. "In the past several years, we've discovered several genes associated with heritable kidney diseases. For instance, in patients from Africa, there's a gene that makes you resistant to a parasitic infection but can give you kidney disease," says Casagrande. "Now that we've found these genes or proteins, the question becomes: How do we block their effect? We're hoping to develop a drug for each disease."


Two basic things for everyone to ask are "Is there any blood or protein in my urine?" and "What is my kidney function?" If you have risk factors like diabetes, high blood pressure or obesity, then ask, "Do I have any signs of kidney damage ?"

"So often, kidney disease is something we can prevent entirely or keep in check through lifestyle modifications," says Casagrande. "As the patient, there's a lot that you can do to cut your risk and improve your quality of life: simple things like walking, going to the gym, eating healthier and maintaining a healthy weight, and definitely not smoking."


Get informed. Start with the National Kidney Foundation (kidney.org) and Mount Sinai (mountsinai.org/patient-care/service-areas/kidney-diseases) for data you can trust.

Get moving. Of course exercise is crucial for your general health, but it also specifically helps keep blood pressure and diabetes under control.

Know your family history. If you have anyone in your family with kidney problems, you should have your kidney function tested.

Stay on top of blood pressure and diabetes. Casagrande recommends that patients with kidney disease or a risk of it take their blood pressure at home and carefully monitor and manage their diabetes.