Kidney disease a sneaky conditionDate: 1/15/2015 Our kidneys may be small – each about the size of a fist – but these vital organs perform critical functions in the human body. They clean our blood, remove waste, and control blood pressure. Yet chronic kidney disease is one of the most widespread illnesses in the U.S. today, affecting more than 20 million American adults and raising the risks of heart attack, stroke, and end-stage kidney disease.
A major characteristic of chronic kidney disease is its insidious nature: a patient will often not know that kidney damage has occurred, as symptoms are unlikely to appear in the early stages of the disease. The incidence of the disease, which can progress over time, also rises with age: the chances of having kidney disease increase after 50, and it’s most common in adults over 70.
It’s important to check regularly for kidney damage. It can be and should be done as part of a normal physical exam, and it’s not complicated to do. It requires analysis of blood and urine samples, usually taken as routine parts of a medical checkup.
The blood is checked for a substance called creatinine, a waste product resulting from muscle breakdown that the kidneys are supposed to remove from the body. Kidney function declines with higher levels of creatinine in the body, so an increase in creatinine can indicate kidney damage. Urine samples are checked for the presence of a protein called albumin. Too much albumin in the urine is also an indication of kidney damage. Both creatinine and albumin represent two important markers of early kidney disease.
Kidney disease is rated in five stages, one through five, according to its level of severity, with stage five being the most serious and requiring dialysis. Nearly one and a half million people in the U.S. are currently in the higher stages of four and five, with approximately 500,000 on dialysis.
The two most common causes of chronic kidney disease – diabetes and high blood pressure – are themselves widespread chronic conditions. According to the U.S. Centers for Disease Control, diabetes has been diagnosed in nearly 21 million people and high blood pressure in 67 million adults. Millions more have pre-diabetes and prehypertension – conditions that warrant close follow-up.
Diabetes causes kidney disease by damaging the blood vessels (vascular damage) at the same time that it affects blood sugar. Similarly, high blood pressure can also result in vascular damage. And even when a patient’s control of diabetes is good, and even when blood pressure returns to normal, vascular damage can continue.
The impact of diabetes and high blood pressure on chronic kidney disease is vast: of the population in the late stages of the disease, 50 percent have diabetes and 25 percent have high blood pressure. Diabetes and high blood pressure have become the leading causes of stage five kidney disease, or end-stage renal disease, requiring dialysis or a transplant.
Kidney disease can also create additional, serious health problems. As an example, patients in stages four or five of chronic kidney disease have an astonishing 340 percent greater risk of cardiovascular disease. Those patients need the combined attention of a cardiologist and other specialists, along with the nephrologist, to manage heart problems effectively along with the kidney disease.
Once diagnosed, chronic kidney disease can be treated with medicines and lifestyle changes. Such treatments can slow the progression of the disease and prevent other health problems. The important messages, however, are prevention and early detection. Patients should establish lifestyle habits that will avoid diabetes and control blood pressure and be sure to get tested regularly for the disease. For more information on chronic kidney disease, visit the National Kidney Foundation at www.kidney.org.
Martin Gelman, M.D. is a board-certified internist with a subspecialty in nephrology who practices at Milford Regional Medical Center and St. Elizabeth’s Medical Center in Boston and is an assistant professor at the Tufts University School of Medicine. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org
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