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Am I at Risk For Kidney Disease

 

Chronic kidney disease is a growing world wide health problem. Despite advances in medicine and better understanding of physiology, progression and complications of CKD (chronic kidney disease), the population of ESRD (end stage renal disease) patients continues to increase. They experience significant mortality and morbidity, and often require significant changes in lifestyle that affects not only the patient, but the whole family. Once damage occurs, very often it cannot be reversed. It is essential to prevent kidney disease from occurring, or if present, treat at early stages to stop or slow down the progression to ESRD.

 

As kidney function decreases, at the early stages, the patient has no symptoms. Symptoms occur as kidney disease advances.  They are very nonspecific and are shared with many other medical problems (increased fatigue, decreased appetite, nausea, weight loss or gain, sleepiness, leg swelling).  Often, the patient has other medical problems. Many of the aforementioned signs may be attributed to the advancing of other medical problems, age or medications.  Unfortunately, at that time the patient is close to requiring kidney intervention which may be in the form of dialysis support or transplant.

 

Hopefully, by answering a few questions, we can help in a better understanding and early recognition of some signs and possible risks that may lead to chronic kidney disease.


What may be some first signs of kidney disease?

Increased creatinine /or decreased GFR.A normal creatinine is about, 1 mg/dL (often less than one for females, closely corresponding to muscle mass). This blood test is a part of routine evaluation.

 

Abnormal urine analysis.This may include the presence of albumin or protein in the urine, blood in the urine (often not seen by the naked eye) or presence of cells in the urine (white blood cells, red blood cells, casts).

 

Anemia otherwise unexplained. Especially in elderly patients, although the creatinine may appear to be very close to normal, it can already suggest the presence of CKD (e.g., a 75  year old person with a creatinine of 1.2 mg/dL has GFR close to 50 cc/min.)  Judging only by creatinine, sometimes the presence of CKD is underestimated. The presence of anemia may be one of first signs in recognizing decreased kidney  function.
           
Low albumin. Low albumin will show in routine blood work, especially if associated with edema (lower leg swelling), and absence of liver disease.  This may suggest loss of protein in the urine. Depending on the amount of urinary protein loss, further evaluation, prognosis, and treatment may vary. If the patient is “nephrotic” (urinary protein loss in excess of 3 -3.5 gm/24 hours), this may directly cause kidney damage.
       
Abnormal electrolytes. Elevated potassium or phosphorus, low calcium or bicarbonate are a few examples. 

 

What are some chronic diseases that contribute to an increased risk of CKD?

Diabetes Mellitus This is the leading cause of ESRD in the United States and makes dialysis support across the world necessary.  For a long time there are no symptoms. One of the first signs of kidney involvement may be presence of microalbumin in the urine. ( 30-300 mg).

                        Uncontrolled Hypertension Often patients consider blood pressure of systolic 140 mmHg as good. Optimal blood pressure is 120/70 mm Hg.


Presence of vascular disease.  Peripheral vascular disease, and heart disease, especially if  associated with a “weak” heart (cardiomyopathy) may suggest disturbances in blood flow through the kidneys.


Autoimmune disease. SLE, Wegener's granulomatosis, Rheumatoid arthritis, etc. or their treatment.


Malignant Disease.  Multiple myeloma, lymphoma, or solid tumors that may lead to nephrotic syndrome or their treatment.

                        Infectious Disease such as Hepatitis, HIV

 

Pre-eclampsia/ Eclampsia In pregnancy may be one of the first signs to suggest an underlying kidney disease.


Could  medication cause kidney damage? Many medications may affect kidney function.  NSAID's (nonsteroidal anti-inflammatory drugs) such as advil, motrin, ibuprofen, mobic, celebrex and naproxen, where some are readily available in all supermarkets, and are often  considered as “not drugs” may worsen the disease.  If taken chronically or in excess they may cause direct kidney damage.


Is family history important?
Some diseases run in families and if present, the patient should be evaluated by a nephrologist early on (Polycistic kidney disease, Fabry’s disease and Alports syndrome, for example)

 

If you are told you have a kidney disease, many of your routine medications may need to be changed or your dose adjusted (some include metformin, osteoporosis therapy and antibiotics).

 

Only early recognition of risk factors and early diagnosis of kidney disease can help to slow down progression of CKD.  The goal is to avert or prolong the need for dialysis or transplant.  If you are one of the unfortunate, knowledge of your overall function is key to your maintaining a healthy lifestyle.  Should your GFR fall below 20cc/min, you can be evaluated for transplant BEFORE your kidneys fail.  Dialysis or transplant is usually suggested once the GFR falls below 10 to 15 cc/min.  This number may differ, depending upon your co-existing medical conditions.


Vera M. Stricevic, MD and Mark S. Russo, MD, PhD are at Naples Nephrology, PA.  They have privileges at all four hospitals in Collier County as well as all dialysis centers, including North Naples Dialysis located near North Collier Hospital across Immokalee Road.  In addition, they see patients at the only free standing Peritoneal Dialysis Center in Southwest Florida, Kidney Institute of Naples, located at 878 109th Avenue North in Naples Park.  Both are accepting new patients.