Did You Know?

Protein In The Urine Is One Of The Signs Of Kidney Disease

Nephrology is a sub-specialty of internal medicine concerned with the diagnoses, treatment and management of kidney functions and renal (kidney) replacement therapy such as dialysis and kidney transplantation. Nephrologists treat systemic conditions affecting kidneys such as diabetes and autoimmune disease, as well as hypertension (high blood pressure) and electrolyte disturbances.Nephrologists are experts in kidney care. Their training includes completion of medical school followed by a residency in internal medicine and additional specialty training in nephrology.

Their critical functions are to cleanse blood, to maintain a stable balance of salt and minerals, and to help regulate blood pressure. This is done through the filtering and removal of waste products and excess fluid through the urine.
Kidneys do the following:

Regulate the body’s salt, potassium and acid content
Release hormones that regulate blood pressure
Produce an active form of Vitamin D that promotes strong, healthy bones
Control the production of red blood cells

There are two kidneys, each about the size of a fist. They are located just below the waist in the middle of your back, on either side of the spine.

Patients are referred for many reasons:

Protein or blood in the urine
Severe high blood pressure
Kidney stones
Renal (kidney) insufficiency
Acute Kidney failure
Chronic Kidney Disease

What Causes CKD?

The two most leading common causes are :

Diabetes (Types 1 & 2)

Waste products produced in the blood are filtered out through the kidneys, leaving the body as urine. Useful substances such as proteins and red blood cells stay in the body, as they are too large to pass through the millions of tiny capillaries in the kidney’s filtering system. With high levels of blood sugar, as in diabetes, the small blood vessels in the kidneys become damaged and can no longer clean the blood properly. Over a period of time:

The kidneys start to leak and useful proteins are emptied in the urine.
The body retains more water and salt than it should resulting in weight gain and ankle swelling.
Nerve damage can cause difficulty emptying the bladder developing bacteria in the urine.

Keeping tight control of your blood glucose and blood pressure are critical. Follow your provider’s recommendations on medications and diet. Have regular checkups to monitor your diabetes. Kidney disease cannot be reversed, but it can be controlled.

Hypertension (High Blood Pressure)

Other Causes Include:

Glomerulonephritis – inflammation of the kidney’s filtering units called glomeruli
Proteinuria- Protein in the urine
Polycystic kidney disease and other inherited kidney diseases
Systemic lupus erythematosus
Chronic kidney infections
Kidney stones

When abnormal kidney function persists for three months or longer, chronic kidney disease occurs. This affects your kidneys ability to keep you healthy.

What are the Symptoms of CKD?

Increased frequency in urination
Loss of appetite
Muscle cramping at night
Difficulty sleeping
Mental changes such as inability to concentrate
Swelling of the face, feet, ankles (edema)
Puffiness around the eyes, especially in the morning
Dry, itchy skin

Who is most at risk?

African Americans
Pacific Islanders
American Indians

3 Simple Tests can detect CKD

A yearly checkup with your primary care physician is the most effective way to monitor your risk.
Early detection and treatment can prevent or slow the progression of kidney disease.

3 tests to detect kidney problems are:

Blood test to measure your creatinine level. A high level of creatinine may indicate the kidneys are not functioning well. This test result is often reported as a calculated Glomerular Filtration Rate (GFR).
Blood Pressure measurement
Urinalysis to evaluate abnormal protein or cells in your urine.

Stages Of CKD

Stages 3 – 5 are treated by a nephrologist, a specialist in kidney disease.
To identify the extent of kidney damage, CKD is classified into 5 stages. These stages are measured by a patient’s GFR (Glomerular Filtration Rate).
GFR is a blood test to measure the amount of creatinine in the blood. Creatinine is a normal waste product from the muscles that is filtered out through the kidneys. The lower the GFR, the less creatinine is filtered out. This means the kidneys are not functioning well enough to extract the creatinine.
Stages 1 and 2 are treated by your primary care provider. While you can’t reverse damage, in these stages it is possible to prevent further damage and maintain kidney function. Changes in lifestyle and diet along with regular checkups can help keep the kidneys from further deterioration.

Stages OF CKD

Stage 1

Onset CKD : GFR: 90+

Description : Normal kidney function, but tests show early signs of kidney damage. Usually no symptoms of kidney damage.

Stage 2

Mild CKD : GFR: 60-89

Description: Mildly reduced kidney function. Some signs of kidney damage.

Stage 3

Moderate CKD : GFR: 30-59

Description : Moderately reduced kidney function. Beginning of moderate physical changes. Get evaluated by a nephrologist.

Stage 4

Advanced CKD : GFR: 15-29

Description : Severely reduced kidney function.

Stage 5

End Stage CKD GFR: Less than 15

Description : Need dialysis or kidney transplant