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- What do the kidneys do?
The kidneys are bean-shaped organs about the size of your fist, located just below your rib cage in your back. They are responsible for filtering the blood to remove toxins and waste products, and remove excess fluid to keep the amount of fluid in your body balanced. The result is urine, which is stored in the bladder before it is eliminated. They are also responsible for producing hormones that prevent anemia, maintain healthy bones, and regulate blood pressure.
- How do we measure kidney function?
We perform blood and urine tests to determine someone's kidney function. The blood tests are called Blood Urea Nitrogen, or BUN, and the Creatinine level. These are both markers of the ability of the kidney to remove toxins. In general, the higher these numbers, the lower your kidney function. Your doctor will also likely ask you to do a 24 hour urine collection. By measuring substances in this collection, we can get a more accurate picture of the degree of your kidney function. The amount of urine you make is not a reflection of kidney function, because patients with very reduced kidney function can still make significant amounts of urine.
- What is protein in the urine?
Protein in the urine is not caused by your diet. There certain proteins that are present in your blood that are important for day-to-day functioning of your body. The filters of the kidney (the "glomerulus") are supposed to keep these proteins in the blood and remove only the toxins. If there is injury or damage to these filters (such as from diabetes) then proteins are able to spill into the urine. Protein in the urine, then, is a sign of kidney disease, and it is something we can measure with a 24 hour urine collection. It is felt that by reducing the amount of protein in the urine we can keep your kidneys healthier for a longer time.
- What is kidney failure?
Kidney failure occurs when your kidneys are not able to function properly. You can stay healthy with just one kidney functioning at about 15%, but most kidney diseases affect both kidneys. There are two types of kidney failure. Acute kidney failure ("Acute renal failure") happens quickly over days to weeks, and may occur after surgery, serious infections, and certain drugs. Depending on the type of injury, you may regain kidney function again. Chronic kidney failure ("Chronic Kidney Disease") happens slowly and progressively over years. Chronic kidney Disease is not reversible. People need replacement of kidney function (such as with dialysis or transplantation) when their total kidney function is below 10-15%; this is often referred to as End Stage Renal Disease (ESRD).
- What are the causes of chronic kidney disease?
The most common cause of chronic kidney disease is diabetes. High blood pressure can both cause reduced kidney function and be a result of kidney disease. Other common types of chronic kidney disease include Polycystic Kidney Disease (PKD), Glomerulonephritis (inflammation of the glomerulus, or filtering unit of the kidney), Renovascular disease (blockage of the arteries of the kidney with cholesterol/atherosclerosis), and Obstructive Uropathy (blockage of the flow of urine, for example by an enlarged prostate).
- Can't I just drink more water to keep my kidneys healthy?
One function of the kidneys is to remove excess fluid that you take in with your diet. With reduced kidney function, extra fluid may accumulate in your body and could be dangerous. While it's important to stay hydrated, you should talk to your doctor about how much fluid is appropriate for you.
- What are the complications of Chronic Kidney Disease?
There are a number of complications that may develop depending on the degree of your kidney disease. High blood pressure can be both a cause and a result of kidney disease. Anemia (low red blood cell counts) can develop if your kidneys don't make enough of a blood hormone called erythropoietin. Your bones can become weak because well functioning kidneys are required to keep calcium, phosphorus, and Vitamin D at the right levels. You may also require a special vitamin formulation. Depending on the type of kidney disease you have, you may also require medications to control excess fluid (diuretics) and to lower your cholesterol.
- Will I feel pain if my kidneys don't work?
The overwhelming majority of chronic kidney diseases don't cause pain. Often, you may not feel any different. Your doctor will try to help you monitor and treat the complications that may develop so that you will continue to feel healthy.
- How can I reduce the protein in my urine?
There are medications that your doctor may prescribe that can reduce the amount of protein in your urine. They fall into two classes: ACE inhibitors and ARBs (Angiotensin Receptor Blocker) are blood pressure meds that also decompress the microscopic pressures in the kidney and the newer SGLT2 (sodium-glucose co-transporter 2) inhibitors, diabetes medications that also decompress the kidney by dragging glucose out of the kidney while pulling water along with it. While these meds are well tolerated, certain side effects (such as changes in potassium levels, low blood pressure, urinary tract infections) may limit their use. They will probably not eliminate the protein from your urine entirely.
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