By: Dr. Chima Oleru
Board Certified Nephrologist
Kidney disease is a silent disease in its initial stages because millions of people who have lost more than half of their kidney function are not even aware of it. Even though it is a silent disease in its early stages, untreated patients ultimately develop malnutrition, bone disease, heart failure and end stage renal disease ( i.e. need for dialysis or kidney transplant). Fortunately, medications known as ACE inhibitors or ARB blockers, if started early, may delay development of heart failure or end stage renal disease and need for dialysis. Also strict control of blood pressure to below 130/80 may slow down progression of kidney disease.
End stage renal disease (need for dialysis or kidney transplant) currently affects close to 400,000 people in the US and it is estimated that in the year 2010 this number will be more than 650,000 people. Approximately 20% of people with end stage renal disease and on dialysis die each year mainly due to heart diseases.
African Americans account for more than 30% of patients with end stage renal disease and on dialysis in the US even though African Americans were only 12.9% of the US population in 2000. In the state of Tennessee, the situation is even worse for the African Americans where they accounted for 51.6% of the 6,244 people who had end stage renal disease (in 2004) and were on dialysis. (Note that African Americans were only 16% of the population in Tennessee in the 2000 census). The reasons behind the disparity in the risk of development of kidney failure in African Americans when compared to other races are not entirely clear.
Causes of Kidney Failure
Diabetes (problem with how the body handles sugar) remains to be the number one cause of kidney failure and it accounts for approximately 40% of the people with end stage renal disease (ESRD) requiring dialysis. Other common causes of kidney disease include high blood pressure (hypertension), glomerulonephritis (inflammation of a part of the kidney) and polycystic kidney disease (where the kidney converts to numerous sacs). Other less common causes include kidney stones, enlarged prostate, some pain medications, etc.
Signs and Symptoms of Kidney Disease
Most people do not know that they have kidney disease until it is advanced. Possible signs and symptoms include:
- Protein in the urine -- this can be detected by a simple urine test in the doctor's office.
- Blood in the urine -- the patient may report seeing blood in the urine or this might only be detected by microscopic examination of the urine.
- Anemia or low blood count
- Loss of appetite
- Nausea and vomiting
- Swelling of the body
- Heart failure
- Worsening hypertension
- Bone disease leading to easy fractures
Treatment of Kidney Disease and Prevention of Kidney Disease Progression
In the early stages of kidney disease, there are special medications known as ACE inhibitors or ARB blockers which have been shown to slow progression of kidney disease by decreasing the amount of protein in urine and also by controlling blood pressure. However, these group of medications may not be for every patient, so all patients with kidney disease should discuss with a kidney doctor (Nephrologist) to find out if they need to be on those medications. Also it has been shown that very good control of blood sugar (for patients with diabetes) and control of blood pressure to below 130/80 slow down progression of kidney disease.
There are treatments for the different complications of kidney disease. For example, the body swelling is usually treated with different type of water pills (known as diuretics); the bone disease is treated with Vitamin D replacements and other medications, while the anemia is treated with injections of a substance known as Erythropoetin. For the details of these treatments, the patient should speak to a kidney doctor (Nephrologist).
For the patients with end stage renal disease (fully advanced renal failure), they are treated with dialysis or kidney transplantation. There are two types of dialysis namely hemodialysis and peritoneal dialysis. In hemodialysis, the patient usually goes to a dialysis center three times a week. Each dialysis section usually lasts about three to four hours. During each hemodialysis section, blood from the patient is run through a machine and an artificial kidney which removes toxic substances (that accumulate in kidney failure) and then the blood is returned to the patient.For the patients who do not want to go to a dialysis center three times a week, peritoneal dialysis might be an option. In peritoneal dialysis, the patient instills dialysis fluid through a tube into their abdomen, the fluid is removed after several hours and the process is repeated 4-6 times in a day. These exchanges of fluid in the abdomen help to clean toxic substances that build up in kidney failure.
Kidney transplantation remains the best option for people with established advanced kidney failure (end stage renal disease). In fact it is best to receive a kidney transplant even before starting on dialysis when less than 20% of kidney function remains. Kidney transplant can be from a living donor (family member, relatives, friends) or a cadaver donor (a donor who is brain dead). Transplantation with living donors is better than with cadaver donor. Besides, there is a very long waiting list for cadaver donors. Healthy family members and friends of people with end stage renal disease (advanced kidney failure) are encouraged to consider kidney donation since one can remain healthy even with only one kidney.
Diagnosis of Kidney Disease
Kidney disease can be diagnosed by simple blood tests and urine tests. The blood tests check the level of blood urea and creatinine. Also the level of the blood creatinine helps the doctor determine what stages of kidney disease the patient might have (there are six stages, with stage one being the least severe and stage six the most severe requiring dialysis). Urine test can be used to determine the presence or absence of protein and/or blood in the urine. Also evaluation of a 24-hour urine specimen can be used to determine the level of kidney function. If there are abnormalities in the above tests, most doctors usually refer the patient to a Nephrologist (kidney doctor).
Kidney disease is a progressive disease especially if it is left untreated. Most patients die from the complications especially those due to heart disease. African American race, diabetes and high blood pressure (Hypertension) are risk factors. People in the high risk groups and others identified by their primary care providers should seek the advice of a Nephrologist (kidney doctor).