Kidney Disease

What Are Kidneys?

Kidneys are vital organs, like the heart and the liver. You cannot live without them. Most people have two kidneys, one on each side. Some people only have one kidney because the missing kidney didn’t form in infancy, or was injured. Usually it makes little difference if you have one or two kidneys. The only real consideration is keeping the one kidney safe: no contact sports or high-risk activities like rock climbing or skydiving.  Kidneys sit behind your belly where your intestines and stomach are, but in front of the big muscles in your back that allow you to stand upright. Each kidney is about the size of your fist, but maybe a little taller and thinner. Like all organs, kidneys receive blood from the heart through arteries and return blood to the heart through veins. Urine drains from each kidney to your urinary bladder through thin muscular tubes called ureters. Ureters are thin muscular tubes resembling arteries or veins, but carry urine instead of blood.  Urine trickles into your bladder until the bladder is full enough that you have the urge to go to the bathroom.

What Do Kidneys Do?

The short answer is your kidneys do a lot.

  1. Your kidneys get rid of the wastes that are left over from the food that your body uses, especially the wastes from metabolizing proteins.
  2. Your kidneys also get rid of excess salt that you eat. Salt is necessary to live but uncommon in nature unless you are by the sea. As a result, you and many other animals crave salt when you can get it. In our modern world, salt is mined and abundantly available, so we tend to eat too much of it. Your kidneys dump what you do not need.
  3. There are other minerals your body needs besides regular table salt, sodium chloride. These include potassium (nerve conduction), calcium (bones), and magnesium (bones and teeth and many metabolic functions) and phosphorus (bones, teeth, metabolism, energy stores). Your kidneys closely regulate all of these to balance what you eat from day to day with what our body needs. It can be life-threatening if some of these minerals have concentrations in the blood that are too high or two low.
  4. All that water you drink has to go somewhere! You know from your own experience that the more you drink, the more you go. Your kidneys not only get rid of the extra water, but very precisely regulate the balance between salt and water.
  5. Baking soda? Vinegar? Your kidneys regulate the acidity of your blood and body. Most plants are slightly alkaline (more like baking soda) compared to you; most meat proteins are more acidic (like vinegar) than you are. Kidneys keep this balance even regardless of whether you devoured a steak or nibbled a salad.
  6. Blood pressure is a complicated thing. Your kidneys regulate blood pressure through controlling salt balance and by secreting hormones that affect your blood vessels.   This is one reason why most kidney doctors are also asked to treat blood pressure, just as heart doctors also treat blood pressure.
  7. Red blood. Your blood is red because the cells that carry oxygen around your body are bright red in color. These cells are produced in your bone marrow as are most cells in your blood circulation. Your kidneys secrete the hormone erythropoetin (“eh-rith-row-poe–it-in”) that stimulates the bone marrow to make more red cells.

With all this, is it any wonder that people with kidney failure feel crummy?

Who Gets Kidney Failure? Why Do People Get Kidney Failure?

Kidney diseases affect young and old, man and woman, and people of any family origin.

In the Western industrialized world, the two most common causes of kidney failure are diabetes and high blood pressure. It is not completely clear how these diseases cause kidney failure, but there are some clues. Diabetics tend to have problems with all their blood vessels: feet, eyes, heart, and kidneys too. The kidney is all about blood and blood vessels, so any disease that affects blood vessels will affect the kidney. High blood pressure is the same; it causes diseases in many blood vessels, including heart attacks and strokes, and kidneys are no different.

There are a large number of autoimmune diseases that cause kidney failure. Many have cumbersome names that represent how the kidney tissue visually appears to the pathologist when she or he examines kidney tissue. Names such as membranous glomerulopathy, minimal change disease, focal and segmental glomerulosclerosis, membranoproliferative glomerulonephritis, and other even rarer diseases may be discussed with your doctor. Lupus erythematosis and vasculitidies (inflammations of the blood vessels) are also relatively common causes of kidney disease. Cancers can also cause kidney failure.

Many people today routinely are treated with surgeries that were experimental even a few years ago, and survive infections and heart attacks that would have been fatal in their parents’ generation. Kidneys can become stunned or injured in these extreme, life-and-death situations, and many kidneys do not recover completely.

The kidneys are one of the ways your body eliminates drugs. Prescription and over-the-counter medicines can cause kidney failure.

There are genetic causes of kidney failure.  The most common are polycystic kidney disease and Alport’s Syndrome. In genetic diseases, the DNA code that tells your body how to assemble parts of the kidney has a mistake in it that leads to trouble. Its worthwhile noting that many patients with these diseases represent new mutations in the DNA. If you child has one of these diseases, and neither parent does, it doesn’t mean that one parent has been unfaithful.

Finally, blockages to the flow of urine can cause kidney disease. Men with enlarged prostates, men and woman with kidney stones, and patients who have received radiation treatments can have mechanical obstructions to the flow of urine, and the back pressure eventually causes damage to the cells of the kidney.

There are other causes

How Can I Tell If My Kidneys Are Healthy?

Unfortunately, kidney disease is a silent killer.  Healthy kidneys have about 10 times as much cleaning function as is absolutely needed to sustain life. People who donate a kidney are (obviously) missing half of their kidneys, yet they are healthy. A lot of damage can occur without anyone knowing it. Plus, who likes to talk about bathroom things?

There are a few red flags that should prompt you to visit your doctor, and sooner is nearly always better than later. Blood in the urine, pink urine, dark, tea-colored urine or very foamyurine are signs of trouble. Did you know eating red beets can cause pink urine?  Puffy eyes or ankles can also be a sign or trouble.  Any change, even gradual, in urinary habits, could signal kidney troubles.

The United States Preventive Services Task Force publishes guidelines for screening patients for different sorts of diseases. Screening means looking for a disease before it causes symptoms and is hopefully at an early enough stage that treatment can avoid trouble. The USPSTF says

No guidelines from primary care organizations recommend screening all adults for CKD. The National Kidney Foundation recommends assessing risk for CKD in all patients and doing the following for those at increased risk: measure blood pressure, test serum creatinine levels, test urine albumin levels, and examine urine for erythrocytes and leukocytes8. The American Diabetes Association recommends annual screening of all persons with diabetes using urine albumin and serum creatinine testing9. The National Institutes of Health’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that all persons diagnosed with hypertension should have urinalysis and serum creatinine testing; urine testing for albumin is optional10. (USPTF Website)

What does this mean? If you are healthy and don’t have any special reason to worry about kidney disease, going ahead and testing you for it is unlikely to uncover a hidden disease. If you have some reason to worry: you have high blood pressure or diabetes, or a family member with kidney trouble, it may be worthwhile considering some testing and you and your doctor should discuss what to do.

What Can I Do If My Kidneys Are In Trouble? What Should I Do?

First, take a deep breath and remember that most patients with kidney disease do not ever progress to having kidney failure. Your doctor will likely send you to see a kidney specialist. The kidney specialist  may order some blood and urine tests. Usually, some sort of imaging is ordered, such as an ultrasound, to show the size and shape of your kidneys. Your doctor might recommend that a kidney biopsy be performed to diagnose the cause of kidney disease.

Depending on the exact disease, your doctor may prescribe some medicines to treat the disease or slow its progression.

What Will Happen To Me If My Kidneys Do Fail?

There are many options available and many choices to be made. Most patients with kidney failure choose some form of dialysis to sustain their lives. Very briefly, dialysis uses a salt water solution to clean the blood of waste products. This can happen inside the body, using peritoneal dialysis, or outside the body, using hemodialysis. The National Kidney Foundation has terrific resources for patients and families, as does the American Association of Kidney Patients.

The best treatment for kidney failure is a new kidney. Kidney transplantation is the surgical removal of a kidney from one person and sewing it into another.   Despite its low cost and great results, transplant is limited by scarcity of donor organs. The United Network for Organ Sharing publishes information and statistics about organ transplant.

The goal of The Kidney Project is to overcome the scarcity problem in kidney failure by engineering a limitless supply of artificial kidneys.

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