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:
- Detoxify harmful substances (e.g., free radicals, drugs)
- Increase the absorption of calcium by producing calcitriol (form of vitamin D)
- Produce erythropoietin (hormone that stimulates red blood cell production in the bone marrow)
- Secrete renin (hormone that regulates blood pressure and electrolyte balance)
Diagnosis of Kidney DiseaseIf 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:
- Test for protein in your urine.
- Blood pressure, to see if it’s high.
- Blood test to measure your creatinine.
- 24-hour urine test.
- Ultrasound or CAT scan, to look at your kidneys.
- Kidney biopsy, to find the cause of your kidney disease and/or look at the damage to your kidney(s).
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.
PreventionKidneys 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:
- See your doctor regularly, especially if you have diabetes or high blood pressure.
- Keeping your diabetes and blood pressure under control may help to prevent CKD or slow it down.
- If you smoke, quit. Smoking makes kidney disease get worse faster.
- Work with your doctor and healthcare team. Tell them about any changes in your health.
- Follow all medication and diet changes prescribed by your doctor.
- Take an active role in your healthcare. Educate yourself about kidney disease and its treatments.
Causes & 5 Stages
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:
- A family history of Chronic Kidney Disease
- Being older.
- Being born prematurely.
- Being African American, Hispanic, Asian, or American Indian.
- Uncontrolled high blood pressure or diabetes - tight control can reduce your risk of CKD.
- Blockages in your kidneys or ureters - these can be treated by your doctor.
- Overuse of over-the-counter pain pills with ibuprofen, naproxen, or acetaminophen (NSAIDs) - talk to your doctor if you need pain pills each day, or even a few times each week.
- Taking street drugs - get help if you need it to stop taking street drugs that could damage your kidneys.
- Taking prescription drugs that you are allergic to - know your drug allergies and promptly tell your doctor about any symptoms you have after you start a new drug.
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.
90 mL/min or more. Kidney damage with normal or high GFR.
- Find out your GFR and check it regularly.
- Control your blood pressure.
- Control your blood sugar if you have diabetes.
- Ask your doctor what you can do to keep your kidney disease from advancing.
- Keep your heart as healthy as possible. Lose weight if your doctor advises you to. Eat healthy meals. Exercise regularly. Quit smoking. Limit alcohol use. Reduce stress. Get enough sleep.
60-89 mL/min. Kidney damage with mild decrease in GFR.
- Talk with your doctor about your blood tests and be sure to ask about any changes. Ask for a copy to keep for your records.
- 'Know Your Flow’ (GFR). Ask your doctor to explain any change in your GFR and what you can do to slow CKD down.
- Control blood pressure, blood sugar, and cholesterol.
- Lose weight if advise by your doctor. Eat healthy meals. Exercise regularly. Quit smoking. Limit alcohol use. Reduce stress. Get enough sleep.
- Take medications exactly as your doctor prescribes them.
- Protect your blood vessels - you may need them for future dialysis access. Don’t let anyone draw blood or put an intravenous line in your arms - use your hands instead. Ask your doctor to write you a letter you can show to healthcare staff in case they don’t understand.
- Follow up with your doctor.
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.
15-29 mL/min. Kidney damage with severe decrease in GFR.
- See your doctors more often in Stage 4 and follow the advice of your CKD team for your diet, medications, and lifestyle changes. You are at high risk for complications related to CKD and other health problems.
- Start getting ready for kidney replacement therapy. Learn about your options - this site can help you.
- Get a dialysis access created by a surgeon. Having an access made now will give it time to heal so you stay healthier.
Less than 15 mL/min. Kidney failure. In this stage, you need dialysis or a kidney transplant to replace your lost kidney function.
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 DialysisDialysis 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.
- Hemodialysis uses a man-made membrane (dialyzer) to filter wastes and remove extra fluid from the blood. It is usually done in a hospital or outpatient dialysis center 3 times per week.
- Peritoneal dialysis uses the lining of the abdomen (peritoneal membrane) and a salt solution (dialysate) to remove wastes and extra fluid from the body. Treatment can be done at home over several sessions each day or for several hours at night.
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
- Do not add salt to the foods you cook or eat
- Processed meats (hot dogs, bologna, corned beef, ham, etc.)
- Canned soups and dried soup mixes
- Packaged “Helper” foods
- Fast foods & Snack foods (pretzels, popcorn, chips)
- Bottled seasonings and sauces
- Frozen foods & Canned foods
- Pickles, pickle juice, olives, and other pickled foods
- Cook with herbs and spices instead of salt
- Choose fresh foods when you can
- When eating out, ask for your food to be made without salt and ask for sauces and gravies on the side so you can eat less of them and have less salt in your meal.
- Read food labels
- Do not buy food with more than 300mg of sodium
- Do not buy or eat foods if salt is one of the first five ingredients
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?
- Alcohol (drink only with your doctor’s permission)
- Coffee and Tea and other hot beverages
- Gelatin (Jell-O) (1/2 Cup = 1/2 Cup fluid = 4 ounces)
- Ice cream, sherbet, sorbet (1/2 Cup = 1/2 Cup fluid = 4 ounces)
- Ice cubes, ice chips (1 Cup = 1/2 Cup fluid = 4 ounces)
- Milk, liquid creamer
- Nutritional supplements
- Popsicles (1 twin stick = 1/4 Cup fluid = 2 ounces)
- Vegetable and fruit juices
- Soft drinks, lemonade, limeade
- Water for drinking and taking medicine
- Drink only when you’re thirsty
- Don’t drink to be social or out of habit
- Drink from a small glass or cup
- Drain canned fruits and vegetables
- Stay active so you don’t think about drinking
- Put drinks in the refrigerator to be chilled instead of adding ice
- Take your medicine with mealtime liquids, or even applesauce or other soft foods
- Don’t drink from a fountain where you can’t measure what you’re drinking
Control your blood glucose (sugar) level if you have diabetes (high blood sugar can make you thirsty)
- Limit sweets
- Brush your teeth more often to feel refreshed
- Stay out of the sun if it makes you more thirsty
- Suck on a lemon wedge. You can freeze it first if you like.
- Eat less sodium (salt)
- Rinse your mouth with water or mouthwash but don’t swallow it
- Suck on a few ice chips. Ice stays in your mouth longer than water.
- Eat sugar-free sour candy or chew gum to wet your mouth.
- Eat frozen fruit like grapes, peaches, or pineapple chunks (make sure to count these as part of your fruit allowance)
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:
- Vitamin C - keeps many body tissues healthy, helps cuts and bruises heal faster, and can help prevent infection
- Iron - to treat or help prevent anemia
- Vitamin B Complex - a grouping of different B vitamins. Some work with EPO and Iron to help prevent anemia. Others help change the food you eat into energy that your body can use.
- Calcium - to bind phosphorus and help keep your bones healthy
- Vitamin D - to keep your bones 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.
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.
- The procedure eliminates the need to wait for a compatible cadaver donor.
- The transplant surgery is entirely elective and can be performed when the recipient is in optimal medical condition.
- Graft survival rates are significantly increased.
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:
- An identical twin.
- A sibling, parent, or child over 18 years of age.
- Another blood relative (half-sibling, niece, nephew, etc.)
For more information, please call: (760) 416-4819
Helpful LinksHelpful Nephrology Related Web Resources
*These links will open in a new window.
- National Kidney Disease Education Program
- National Kidney Foundation
- ASN - American Society of Nephrology
- PKD Foundation
- AAKP - American Association of Kidney Patients
- National Institute of Diabetes & Digestive & Kidney Diseases
- US News Top Doctors-Bryan Stone
- Palm Springs Life-Bryan Stone
- American Health Journal-Bryan Stone