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The Kidneys

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Are you one of the 20 million adults in this country who has kidney disease? Have you been able to pinpoint what caused it? Is treatment working?

Unless we are diagnosed with kidney problems, most of us likely don’t pay much attention to the bean-shaped pair of organs sitting just beneath our ribcage. We may not know that our kidneys filter between 480 and 600 cups of blood EVERY DAY. Yes, 600 cups, or 150 quarts, every day. The end result of all this filtering is the production of about 1-2 quarts of urine for removal from the body.

“Kidneys filter blood to get rid of poisons and chemicals,” says Brad Yuan, M.D., a nephrologist—or kidney specialist—with Pikes Peak Nephrology Associates. “They also eliminate excess fluid and regulate electrolytes such as sodium, potassium and calcium within a narrow range in order for a body to function. Adequate kidney function is essential to life.”

The kidneys also generate chemicals to regulate blood pressure, explains Dr. Yuan, and they produce erythropoietin, a hormone that signals bone marrow to make red blood cells. 

“More than one million microscopic filters, or nephrons, inside the kidneys remove waste,” says Melinda Hockensmith, M.D, also a nephrologist with Pikes Peak Nephrology Associates. “The waste that is collected combines with water, which is also filtered out of the kidneys, to make urine. In basic terms, nutrients enter the blood; the blood travels to the kidneys and then the kidneys filter out what your body needs and what it doesn’t.”

Unhealthy kidneys, explains Hockensmith, can lead to high blood pressure, heart disease, anemia, weak bones, nerve damage, malnutrition, stroke and even death. “Between 8 and 10% of the adult U.S. population has some form of kidney disease. The main risk factors are a personal or family history of diabetes and high blood pressure, the two leading causes of kidney failure. However, there are other less common factors that may also play a role in the development of kidney disease. These include inflammation (glomerulonephritis), infections, longstanding blockage to the urine system from kidney stones or an enlarged prostate, for example, inherited diseases, pain medication or analgesics, autoimmune diseases such as lupus, vascular disease, which may develop from high cholesterol levels or smoking and low birth weight.”

Kidney disease can happen at any age, says Dr. Hockensmith, “but becomes more common with increasing age. After the age of 40, kidney filtration begins to fall by approximately 1% per year. Of course, in addition to the natural aging of the kidneys, conditions that damage the kidneys are more common in older people, including diabetes, high blood pressure and heart disease.”

Dr. Yuan says kidney failure due to diabetes accounts for a whopping 40% of the dialysis population. “In diabetes, it is very important to keep blood sugar under control. Your doctor can monitor early diabetic kidney disease with simple urine and blood tests. Early discovery of kidney involvement from diabetes can be treated and sometimes reversed.”

So let’s say we’re in good health and as far as we know, our kidneys are functioning properly. What can we do to keep it that way? “For a healthy person,” explains Yuan, “make sure your blood pressure is normal. Adequate fluid intake of more than 1.5 quarts [6 cups] of liquid a day is helpful. Beware of over-the-counter medicine such as NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve), which can cause kidney damage if used excessively. Prevent and treat urinary tract infections.”

Maintaining a healthy body weight, not smoking and exercise all help minimize risk factors for kidney disease.

If, on the other hand, our kidneys are not able to function properly, we may be headed toward kidney failure. “When kidney function falls below a certain point,” says Dr. Hockensmith, “it’s called kidney failure or end stage renal disease. Untreated kidney failure can be life threatening. Treatment options include dialysis and transplantation. Transplantation is considered the best treatment because quality of life and survival are often better when compared to dialysis.”

We only need one kidney to live a normal life, says Dr. Hockensmith. “When one kidney is donated, the other compensates for the loss. Kidney donation does not change our life expectancy or increase our risk of kidney failure.”

Dr. Yuan says it is ideal to receive a kidney from living donors, such as relatives, friends, or even strangers. “If a good tissue match is not available,” he explains, “there are paired or pooled donor programs, where a patient can receive a kidney from another patient’s donor with a better tissue match, and vice versa. A deceased donor can provide two kidneys, heart, lungs, liver, cornea and other organs. It would make a tremendous improvement in a patient’s life. It’s as simple as putting a checkmark on the driver’s license and informing your family.”