Nephrology Questions

Nephrology is the medical subspecialty that deals with the kidneys, especially their functions and diseases. The term “nephrology” is derived from the Greek word for kidney, “nephros” and the suffix -logy, meaning “the study of”.

Healthy people have two kidneys. A normal kidney can fit in the palm of your hand. Fortunately, if one organ stops working, or if both are partially damaged, the remaining kidney is usually able to perform adequately on its own. Unfortunately, many people suffer from loss of function of both kidneys resulting in total kidney failure.

Your kidneys serve several vital functions, including:

• Remove waste from the body in the form of urine
• Filter toxins from the blood
• Help to regulate blood pressure and the balance of certain important nutrients, including potassium and calcium.

Because the kidneys perform several essential functions, treatment of kidney failure is complex and should be performed by a qualified nephrology specialist.

Kidneys are essentially blood-cleansing organs. An artery from the heart brings blood into the kidneys to be cleaned by a network of millions of tiny units called nephrons. The nephrons filter out toxins, excess nutrients and body fluid and excrete them in the form of urine into the bladder. The remaining cleaned and filtered blood then passes through veins back into circulation.

As the population ages and as other at-risk populations increase, End-Stage Renal Disease (ESRD) incidence is sharply on the rise. In fact, the U.S. incidence rate is the highest in the world — 210 per million. While dialysis and improved treatments keep most ESRD patients alive far longer than we were able to just two decades ago, these developments also mean that more people are living with this debilitating and costly disease.

The best hope for ESRD patients, and those who care about them, is research. Through research in basic science and genetics, nephrologists today are beginning to unlock the root causes of many kidney diseases. The National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) provides funding for most of the kidney disease research in the United States. Other organizations, including the American Society of Nephrology, also fund grants for kidney research. A commitment to research is our best hope to reduce the enormous costs and human suffering imposed by ESRD.

You can do a lot to help fight this life-threatening condition. To maintain kidney health, you should:

• Drink plenty of fluids
• Exercise regularly
• Don’t smoke
• Maintain your proper weight
• Get checked regularly for diabetes and high blood pressure

You can also help by becoming an organ donor. Becoming a donor is as easy as taking the time to speak with your family and let them know of your wishes.

Hypertension or high blood pressure, is the force of blood against your artery walls as it circulates through your body. Blood pressure normally rises and falls throughout the day, but it can cause health problems if it stays high for a long time.

There are two types of hypertension.

Primary (essential) hypertension

In 9 out of 10 people with high blood pressure, there is no identifiable cause. This is called “primary hypertension” or “essential hypertension.” Most people with primary hypertension don’t even realize that they have it; the majority of people with hypertension feel no different from those who have normal blood pressure. That’s why hypertension is often referred to as “the silent killer.” Some facts about Primary hypertension:

• Has no identifiable cause
• Most common type of hypertension
• Tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors
• Essential hypertension increases with age

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

• Kidney problems
• Adrenal gland tumors
• Certain defects in blood vessels you’re born with (congenital)
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

Hypertension is most common among people who have specific risk factors such as:

• Age
• Race
• Family History
• Overweight and Obesity
• Tobacco use
• Salt and Potassium in your diet
• Stress

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.

You can prevent high blood pressure by:

• Maintaining a healthy weight
• Exercising regularly
• Reducing salt intake
• Drinking alcohol in moderation, if at all
• Reduce Stress

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

Diabetes and high blood pressure are the two leading causes of ESRD, accounting for more than 60 percent of new cases. Kidney disease can also develop from infection, inflammation of blood vessels in the kidneys, kidney stones and cysts. Other possible causes include prolonged use of pain relievers and use of alcohol or other drugs (including prescription medications).

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

The warning signs of kidney disease include:

• High blood pressure
• Swelling of the face and ankles
• Puffiness around the eyes
• Rusty or brown colored urine

If any of these symptoms develop, see a physician right away.

If you experience any of these warning signs, you should see your healthcare provider right away.  Your primary care physician will determine if your kidney function is abnormal and if a kidney specialist is needed. Treatment of ESRD and kidney diseases are complex, so if you or someone close to you has kidney disease, be sure to consult a qualified nephrologist. Studies show that your chances of surviving kidney failure are best if you are under the care of a nephrology specialist.

ERSD stands for End Stage Renal Disease. Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

Chronic kidney disease (CKD) is when there is permanent damage to your kidneys. Your kidneys may still work well enough for you to live, even if they have some damage.

If your kidneys keep getting worse, CKD can lead to kidney failure (ESRD). This is when the kidneys do not work well enough for you to live. If this happens, you will need dialysis or a kidney transplant to live.

If both kidneys stop functioning due to disease, patients experience end-stage renal disease (ESRD), or total kidney failure. Because the kidneys perform so many critical functions, people whose kidneys fail face an immediate life-threatening condition. Kidney failure means that the body can no longer rid itself of certain toxins and cannot properly regulate blood pressure and critical nutrients. Unless those experiencing kidney failure are treated, they can die within days due to the build-up of toxins and fluid in their blood. More than 300,000 Americans today have ESRD and are dependent on artificial dialysis to stay alive.

If your kidneys keep getting worse, CKD can lead to kidney failure (ESRD). This is when the kidneys do not work well enough for you to live. If this happens, you will need dialysis or a kidney transplant to live.

Anyone can have ESRD. Some people are more likely to have ESRD than others. You are more at risk for ESRD if you have:

• Chronic kidney disease (CKD)
• Diabetes
• Hypertension
• Major blood loss.
• Serious medical problems
• Injury or trauma to the kidneys

The best way to prevent ESRD is to prevent CKD. Diabetes and high blood pressure are the two leading causes of CKD. You can help to protect your kidneys by keeping these in control. Get your blood sugar and blood pressure checked often.

You an also help protect your kidneys with other healthy habits. You should:

• Have regular check-ups with your doctor
• Eat a low-fat, low-salt diet
• Exercise most days of the week
• Avoid tobacco
• Drink alcohol only in moderation, if at all

Also, take medicines the way your doctor tells you. Talk to your doctor before you start any new medicine or supplement.

You may not know that you have a kidney problem until it is very far along. The only way to know how your kidneys are working is to have some simple medical tests.

Ask your doctor about these tests:

• Blood pressure check
• Urine test
• Blood test for eGFR (Estimated Glomerular Filtration Rate)

The main job of the kidneys is to clean wastes and extra fluid from your blood. If your kidneys fail, you will need dialysis or a kidney transplant to live. These are treatments to help replace the job of the kidneys.

Dialysis is a life-saving process that artificially replaces the functions of the kidney. There are two types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis involves removing blood from the body and filtering it in a machine. The patient is connected by a tube to the dialysis machine, which continuously draws blood out, cleanses it and removes excess fluid and then returns the blood back to the patient. Hemodialysis must be performed for 3 to 4 hours at least three times a week. It is usually performed at a dialysis center, though home dialysis is also possible. Peritoneal Dialysis is internal or in-body dialysis.

Peritoneal dialysis entails use of a blood-cleansing solution called “dialysate” that is injected into the peritoneal cavity, the region of the abdomen that is lined by the peritoneum. While in the peritoneal cavity, the dialysate works to extract toxins and excess fluid from the blood. After a period of time, the solution is then drained from the body cavity. Peritoneal dialysis may be done during the day or at night. Continuous ambulatory peritoneal dialysis (CAPD) is the name given to this procedure when it is performed at five-hour intervals four times a day during waking hours.

No. While dialysis is life sustaining and allows patients to work and perform many normal activities, dependence on dialysis is strenuous, costly and is accompanied by severe dietary and lifestyle restrictions. Improvements in kidney function may occur but dialysis is considered a life sustaining treatment not a cure.

If both kidneys stop functioning due to disease, patients experience end-stage renal disease (ESRD), or total kidney failure. Because the kidneys perform so many critical functions, people whose kidneys fail face an immediate life-threatening condition. Kidney failure means that the body can no longer rid itself of certain toxins and cannot properly regulate blood pressure and critical nutrients. Unless those experiencing kidney failure are treated, they can die within days due to the build-up of toxins and fluid in their blood. More than 300,000 Americans today have ESRD and are dependent on artificial dialysis to stay alive.

If your kidneys keep getting worse, CKD can lead to kidney failure (ESRD). This is when the kidneys do not work well enough for you to live. If this happens, you will need dialysis or a kidney transplant to live.

Many ESRD patients benefit greatly from a kidney transplant. After successful transplantation, patients no longer require dialysis. Today there are tens of thousands of Americans on waiting lists to receive a kidney transplant. The development of effective anti-rejection drugs means that the prognosis for five-year survival for most of these patients is high. To avoid rejection, the best possible source of kidney donation is a close relative whose blood and tissue type match the patient’s. Donated organs from cadavers also have high success rates. A growing source of kidneys for transplantation comes from living donors who are not blood relatives, but with whom the patient has an emotional tie, such as a spouse, friend or co-worker. Due to improved anti-rejection drugs, this promising type of donation has demonstrated success rates close to that of blood relative donation.