Desert Nephrology

Your Kidneys

Your physician noticed an abnormal laboratory test and suggested you see a kidney specialist, known as a nephrologist. With blood and urine tests, and sometimes non-invasive studies such as an ultrasound, the cause of the problem may be determined. If this is not sufficient, a kidney biopsy may be suggested, but this is not performed very often.

The kidneys are a pair of bean-shaped organs located below the ribs near the middle of the back. They are protected by three layers of connective tissue: the renal fascia (fibrous membrane) surrounds the kidney and binds the organ to the abdominal wall; the adipose capsule (layer of fat) cushions the kidney; and the renal capsule (fibrous sac) surrounds the kidney and protects it from trauma and infection.

The kidneys regulate the volume and concentration of fluids in the body by producing urine. Urine is produced in a process called glomerular filtration, which is the removal of waste products, minerals, and water from the blood. The kidneys maintain the volume and concentration of urine by filtering waste products and reabsorbing useful substances and water from the blood. The kidneys also perform the following functions:

Diagnosis of Kidney Disease

If your doctor thinks that you may have CKD, he or she might do some or all of these tests to measure how well your kidneys work:

Some other tests that may be necessary:

Know Your Flow (GFR)

Your doctor will use your blood creatinine level along with your age, race, and gender to find your glomerular filtration rate (GFR); an estimated rate at which your kidneys are able to filter the wastes from your blood. A normal GFR is 125 mL/minute or higher. A lower GFR can mean a loss of kidney function. Your GFR also helps your doctor determine what stage of Chronic Kidney Disease you are in. Diagnosing your stage of CKD helps your doctor decide what treatment you need to keep you healthy.

The Importance of Early Diagnosis.

Kidney disease must be treated. Getting an early diagnosis and putting yourself under a doctor’s care is important, so you can make the best decisions about your healthcare. The quicker you are diagnosed and start treatment, the more likely you will be to feel better and able to slow down the disease progression. In the early stages of CKD, simple diet changes suggested by your doctor can help you feel better. Your doctor may also prescribe medications to help problems like high blood pressure and fluid retention.

Once kidney function is lost, it may not come back. Your symptoms are likely to get worse without medical treatment. Anything you can do, under your doctor’s care, to slow down this loss of kidney function is worth doing. Learn as much as you can and work closely with your healthcare team. Your medical team, including your primary care physician and nephrologist, will help guide you through the stages of kidney disease.

Prevention

Kidneys are so important to your body working correctly, you need to keep them as healthy as possible. If you have CKD, doing as much as you can to slow down the damage to your kidneys is very important as well.

Here is a checklist of things you can do to help slow the progression of CKD:

Causes & 5 Stages

The two main causes of CKD (Chronic Kidney Disease) are diabetes and high blood pressure. Other causes include inflammation of the nephrons (glomerulonephritis), diseases that are inherited like polycystic kidney disease and some birth defects, lupus; malformed kidneys, immune diseases, kidney stones, and repeated urinary tract infections.

All of these conditions damage the nephrons in your kidneys so they cannot do their job as filters. This leads to a buildup of wastes and extra fluid in your blood which makes you sick. The kidneys also lose the ability to produce hormones which assist in making red blood cells, controlling blood pressure, and maintaining healthy bones.

Risk factors for developing CKD:

The 5 Stages of Chronic Kidney Disease

There are five stages of CKD. Each stage is defined by changes in kidney function. A drop in GFR means that CKD is progressing or getting worse. As GFR gets lower, your CKD stage gets higher. Stage 5 CKD (also known as ESRD) means kidney failure and the need for dialysis or a transplant to live.

Described below are the stages and what steps you and your doctor can take to help you stay healthy. A diagnosis of CKD is serious, but if you educate yourself, take an active role in your care, get good treatment, and rely on the support of your family, friends, and healthcare team, you can live a full, active life.

Stage 1
90 mL/min or more. Kidney damage with normal or high GFR.

Stage 2
60-89 mL/min. Kidney damage with mild decrease in GFR.

Stage 3
30-59 mL/min. Kidney damage with moderate decrease in GFR.

Keep protecting your blood vessels.
Ask your healthcare team how to prevent other health problems that may result from CKD:

Anemia - happens when your red blood cell level drops and you can’t get enough oxygen in your body, which makes your heart work harder and you feel fatigued.
Malnutrition - is when your body is not getting enough or the right balance of the nutrients it needs to stay healthy.
Bone disease - your bones may start to break down, hurt, or become weaker.
Neuropathy - is a problem with your nerves that causes numbness, tingling or pain.

Reduced functioning and well-being - you may find that you can’t do as much as you used to and/or that you feel sick.

Stage 4
15-29 mL/min. Kidney damage with severe decrease in GFR.

Stage 5
Less than 15 mL/min. Kidney failure. In this stage, you need dialysis or a kidney transplant to replace your lost kidney function.

Kidney Failure

Unfortunately, signs and symptoms of kidney failure overlap with many diseases. The amount of urine one makes or doesn’t make is not a good sign of kidney disease. Even those who are on dialysis still make urine.

A person may be very tired, have no appetite, complain of itching, weight gain or loss, leg swelling or even shortness of breath. Laboratory studies may indicate an elevated potassium, low bicarbonate, high phosphorus and anemia. Renal replacement therapy is instituted when the function falls to 5 – 15%.

Electrolyte disturbances are quite common, and may need a nephrologist to assist in the management.

Your blood pressure may be difficult to control. Your doctor may have initiated more than three medications, and yet your blood pressure remains elevated. A nephrologist will help rule out certain disorders that could potentially be reversible and help fine tune your medications to get you to “goal” blood pressure of 120/70.

Not everyone with chronic kidney disease will require dialysis. If you are diagnoses with stage 3 kidney disease, only about 1 in 40 to 1 in 50 persons will make it to stage 5 and thus require kidney replacement therapy. Medications and lifestyle adjustments with dieting and exercise could prolong not only the life of the kidneys, but the life of the person.

Many persons are not fortunate to receive a kidney, and need to undergo kidney replacement therapy in the form of dialysis. Two current methods are available today. Home peritoneal dialysis (PD) takes advantage of the one cell thick covering of all your internal abdominal organs. A sugar solution of varying strength is placed into the abdominal cavity and allowed to sit for several hours at a time. The peritoneal membrane, via osmosis and diffusion, allows both fluids and toxins to pass. The fluid is changed several times per day or in multiple “cycles” overnight. Several advantage include: the comfort of being at home, ease of therapy, ability to work and travel, preservation of residual kidney function and possible avoidance of a “fistula” or “graft” that is needed for hemodialysis. This form of therapy is performed in center, three days per week. Advantages here include less time and less work by the patient.

Both modalities are sufficient medically and the patient, along with the physician, decide on the modality that best fits his or her lifestyle. Further information may be obtained from your nephrologist. Many websites today are available that further explain these therapies.

There are several modalities of kidney replacement therapy available today. The best option we suggest, is a kidney transplant. You may be considered for transplant should your function fall below 20%. Although you may yet need a new kidney, the evaluation and testing does take time. In addition, if a family member or friend is not capable of donating, you will need to be listed for a deceased donor kidney. This may not be available for several years. Many areas of the country have wait lists in excess of five years. The local transplant center average is much less. Of course, many factors may determine your place on the list.

About Dialysis

Dialysis is a treatment for kidney failure that helps filter waste products from the blood when the kidneys are not working properly. The two main types of dialysis are hemodialysis and peritoneal dialysis.

Patient Information
For your convenience, we offer guides providing extensive information on what to expect, how to prepare, how procedures are done, how the members of our team work together, and much more.

Hours of Operation
The Dialysis Centers operates Monday through Saturday, please contact the appropriate center for their hours of operation. Most outpatients dialyze three times a week. The centers make every effort to accommodate work or school schedules. For a dialysis-related problem during hours of operation, please call the appropriate dialysis center. After hours please call (760) 416-4819 and the answering service will contact the physician on call.

Meal Planning Tips

A.Meal Planning is Important! Eating well can help keep you healthy. Not eating well can cause you to become weak as you break down your muscles for protein and become malnourished. Malnutrition is linked to a higher risk for

infections, hospitalization and even death. If changes occur in your appetite talk with your dietitian to make changes in your meal plan. Your dietitian will be happy to work with you to provide a meal plan you can follow and enjoy.

B.Potassium – Potassium is a mineral needed for normal heart rhythm and muscle function. It is very important to have levels of potassium in your blood in a safe range. (Too high or too low potassium levels can stop your heart.)

PD allows you to have some dialysis most or all of the time, so excess potassium is being removed. Your potassium level will be checked during your monthly blood test. If it’s too low or high, your dietitian may suggest that you eat more or less of foods that are high in potassium. Some high-potassium foods include:

C.Controlling Phosphorus Intake Phosphorus and calcium work together to keep your bones and teeth strong. Healthy kidneys remove extra phosphorus, so if you have kidney failure - even with PD - your levels may be too high. Too

much phosphorus can cause itching, bone pain, brittle bones, muscle aches, and heart damage so it’s very important to make sure it doesn’t build up in your blood.

Most people on PD need to take a phosphate binder to help control the level of phosphorus in their blood. Phosphate binders "soak up" extra phosphorus from food before it reaches your bloodstream. It then passes from your body in your stool. You take phosphate binders along with meals and snacks. They may cause constipation, so you should ask your dietitian to suggest ways to increase fiber in your diet to help. It is very important that PD patients tell their care team if they become constipated.

Some people on PD will also need to limit the amount of phosphorus in their diet. If you need to do this your dietitian will work with you to limit the following high phosphorus foods:

Your care team will watch your phosphorus levels every month and help you make changes to your diet and medications if needed. If you have any questions about your phosphorus levels, ask your doctor or someone on your care team.

D.Controlling Sodium Intake Sodium (found in table salt) is an important mineral that helps to control your blood pressure and thirst. Your body only needs small amounts of it to be healthy. Most people get all the sodium they

need from their food, without adding extra salt. Eating too much salt can make you thirsty. If you drink too much fluid you may notice swelling, weight gain, or higher blood pressure. On PD, it’s important not to eat too much salt so your body doesn’t “hold onto” too much fluid. Read the list below for ideas to help you limit the salt in your diet. Avoid high sodium foods, like:

Talk to your care team to find out how much sodium you should eat each day. Your dietitian will help you stay within your limits.

E.Controlling Fluids - Often, people on PD can drink when they’re thirsty - up to 2 quarts of fluids a day. On PD, you’re getting dialysis most of the time so you may not have to limit the fluids you drink. If your PD treatments are not

removing enough fluid, you will see signs such as weight gain, higher blood pressure, or swelling and you will need to drink less.

Your doctor will tell you how much fluid you can drink every day and your care team will tell you what to look for and what you can do if you notice your PD is not getting rid of enough fluid.

It’s important to keep your fluid level under control. Too much fluid can end up in your lungs, making it hard to breathe. Over time, too much fluid can also hurt your heart and lead to heart failure. Below, you’ll find tips on how to limit fluids. You’ll also find ideas to help control your thirst.

What are Fluids?

Limiting Fluids

Controlling Thirst
Control your blood glucose (sugar) level if you have diabetes (high blood sugar can make you thirsty)

Try eating something like bread with margarine or jelly.

F.Important Vitamins and Minerals Most of the time, people get the vitamins and minerals they need to stay healthy by eating different foods from all the food groups. If your diet is limited because you’re on PD, you may not be getting all of the important vitamins and minerals you need from your food. You may also lose some vitamins from your body during your PD treatments.

To help you get the vitamins and minerals you need, it is important to work with your dietitian to try to eat as many different foods as you can - within your PD diet. Your doctor may also give you vitamin and mineral supplements to help. Take your supplements and vitamins as your doctor orders - not having enough vitamins can make it easier for you to get an infection. Only take the vitamins or minerals that your doctor prescribes - do not buy supplements from a store, off the shelf. They may have vitamins or minerals that are dangerous to you.

Your doctor may have you take the following supplements to keep you healthy:

Work with your care team to make sure you get all the vitamins and minerals you need by eating a varied diet and taking your supplements. If you have any questions, ask to your doctor or dietitian.

About Transplants

Options for Kidney Transplant
Patients awaiting kidney transplantation might receive a donor kidney from one of two sources, cadaver donors or living kidney donors.

Cadaver Donors Cadaver donors are individuals who have suffered brain death (the irreversible and total loss of brain function) who made a previous decision to donate their organs to patients in need. Cadaver kidneys that are damaged or have a high probability of not working well are not accepted for transplantation. Donors with communicable diseases are not accepted. Kidneys from cadaver donors represent approximately 75 percent of the kidneys used for transplantation in the United States.

Living Kidney Donors With living kidney donation, a kidney is donated by a healthy living donor. Benefits of living kidney donation include:

Living kidney donations can come from living related donors or emotionally related donors. Living related donors can be any healthy blood relative, ranked in the following order of preference:

Living emotionally related donors are not blood relatives and usually share no tissue similarities with the recipient. These donors may be spouses, in-laws or close friends of the patient. Any kidney donor, whether a blood relative or not, must be blood type compatible and immunologically compatible with the recipient, have normal kidney function and be in good health.

Kidney transplantation is an effective treatment option for patients with end stage renal disease. The procedure offers patients a normal lifestyle free from kidney dialysis, EPO injections and blood transfusions. Kidney transplant patients also have fewer dietary restrictions and enjoy an enhanced feeling of well-being.

How do I obtain more information?
For more information, please call: (760) 416-4819

Helpful Links

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