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Kidney Disease Is on the Rise

 

What do you know about kidney disease? Would you know if you had it? Chronic kidney disease (CKD) kills more Americans each year than breast and prostate cancer combined. Yet most persons with the disease do not know they have it and have very little knowledge about the disorder.

Kidney disease now affects about 13 percent of the U.S. population, according to federal health data, up from 10 percent only a decade ago. This trend upward is expected to continue for several reasons.

• An increasing number of Americans, including children and adolescents, are overweight or obese. And obesity has been linked to an increased risk of kidney disease.

• Diabetes, another risk factor for kidney disease, is also increasing.

• Finally, the serious effects of kidney disease are more likely to occur with advancing age. And the percentage of older Americans in the population is increasing.

Chronic kidney disease (CKD) usually develops gradually over a number of years, and the symptoms may go unnoticed until the final stages. But when kidney failure (also known as end-stage renal disease) strikes, there is no going back. Without dialysis or a kidney transplant, the patient will likely die.

Unless you’ve already donated one, you have two kidneys, located on each side of your spine right near your mid-section. These important organs are charged with removing waste and excess fluids from the blood; maintaining a proper balance of salt, potassium and other minerals; and regulating blood pressure. They produce erythropoietin, which stimulates the production of red blood cells. And they produce an active form of vitamin D that is necessary for healthy bones.

Causes of Kidney Disease

Acute or sudden damage to the kidneys can occur because of a traumatic injury, a severe infection, damage from certain drugs or toxins, complications of pregnancy or severe dehydration such as that sometimes suffered by marathon runners. Although they are usually serious, these short-term problems are usually detected early enough for successful treatment.

Chronic kidney disease, by definition, lasts longer than three months and can be more dangerous because symptoms may not occur or be noticed until irreparable damage has occurred.

More than 60 percent of CKD cases are caused by diabetes (both types 1 and 2) and/or high blood pressure. The tiny blood vessels in the kidneys become damaged by excess blood sugar or by the extra pressure of poorly controlled blood pressure.

Glomerulonephritis is an inflammation of the filtering units of the kidney; interstitial nephritis, an inflammation of the tubules and their surrounding structures inside the kidney. Other causes of CKD include urinary tract infections; obstruction caused by kidney stones or an enlarged prostate gland, congenital defects, polycystic kidney disease and disorders such as lupus that affect the immune system. Over-the-counter NSAIDs such as ibuprofen or naproxen are cleared through the kidneys; overuse of misuse of these drugs can lead to chronic kidney disease.

African Americans, Hispanics, Native Americans and Asian Americans all have a high risk of kidney disease compared to Caucasian Americans.

Symptoms of kidney disease include:

• swollen feet or ankles caused by excess fluid;

• puffiness around the eyes;

• dry, itchy skin and

• a need to urinate more frequently, particularly at night.

A person with CKD may also feel tired, have trouble concentrating and suffer from muscle cramps at night.

One way to know about the health of your kidneys is to keep an eye on your blood pressure. The two tend to go together.

Not only is hypertension a major cause of kidney disease, it is also an effect. When the kidneys are not filtering properly, blood doesn’t flow freely through the tiny blood vessels, and the result is elevated blood pressure.

Doctors check for kidney disease by measuring your glomerular filtration rate. This is the rate at which wastes, toxins and excess fluids are removed from the blood, and it is the best test of kidney function.

Checking glomerular filtration rate does not require an invasive nor high tech procedure but merely a blood test that reveals creatinine levels in the blood. The doctor uses a mathematical formula comparing your size, age, gender and race to your serum creatinine.

If you’re having regular blood tests for another reason, it’s easy for your doctor to spot abnormalities in glomerular filtration rate and start treatments that are likely to head off serious problems.

One sign of chronic kidney disease, usually in the later stages, is abnormally high levels of protein in the urine, known as proteinuria. When the glomeruli or filters of the kidney are damaged, protein from the blood leaks through into the urine. This may cause the urine to look foamy in the toilet, but the best way to find out for sure is through a urinalysis.

Whether it’s a cause or an effect of kidney problems, high blood pressure should be brought under control. Two common blood pressure medications–ACE inhibitors and ARBs–have a positive effect on kidney disease as well as blood pressure.

If swelling in the ankles and feet has occurred, diuretics may be prescribed to help with both the swelling and the hypertension.

CKD patients often have high levels of cholesterol, which can be controlled, with statin medications. If anemia is present, supplements of iron or erythropoietin may be prescribed.

If you have kidney disease or a high risk of kidney disease, you should probably avoid low carbohydrate, high protein diets since protein increases the amount of work the kidneys must do to process wastes. You should also cut back on sodium.

In the later stages, kidney disease begins to cause noticeable symptoms as waste is not being properly processed. Fatigue, poor concentration, nausea, vomiting, poor sleep, constant swelling of the feet and ankles are some of the signs that kidney failure is imminent.

You don’t want to let that happen. With careful control of your blood pressure and blood sugar, a healthy diet and lifestyle and routine tests of your blood and urine, the worst consequences of kidney disease can nearly always be avoided.

REFERENCES:

“About chronic kidney disease,” National Kidney Foundation, 2013.

Jane E. Brody, “Kidney disease, an underestimated killer,” New York Times, July 15, 2013.

“The global issue of kidney disease,” The Lancet, July 13, 2013.

“High blood pressure and kidney disease,” National Kidney and Urological Diseases Information Clearing House (NKUDIC), NIH Publication No. 14-4572, February, 2014.

“High protein diets may increase risk of kidney disease,” Medical News Today, January 26, 2014.

“Kidney diseases,” MedlinePlus, last updated April 28, 2014.

Mayo Clinic Staff, “Chronic kidney diseases,” MayoClinic.com, January 2, 2014.

Bridget Novak, “‘Healthy people 2020' kidneydisease numbers worry researchers,” Reuters Health, May 3, 2014.

“Proteinuria,” National Kidney and Urological Diseases Information Clearing House (NKUDIC), NIH Publication No. 14-4732, February, 2014.

MarcelloTonelli and Miguel Riella, “Chronic kidney disease and the aging population,” Nephrology, Dialysis andTransplantation, 2014;29(2):221-224.

David Tuller, “Kidney disease takes a growing toll,” New York Times, November 18, 2008.

“Understanding kidneydisease–the basics,” WebMD, reviewed by Melinda Ratini, D.O., M.S., March 22, 2014.

07/21/2014

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