kidney disease 101: how do your kidneys function, what ...kdsap.org/kdsap-bkhs/2012-01 rhee-boston...
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Kidney Disease 101: How do your kidneys function, what causes kidney disease?
Connie Rhee, MD MSc
Boston Kidney Health Series 2012
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DISCLOSURES
• None to report
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OUTLINE
• Kidney disease as a public health burden
• Importance of kidney disease awareness
• Structure and function of kidneys
• Kidney disease recognition and diagnosis
• Kidney disease treatment and prevention
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Definitions
• Acute kidney injury (AKI)
– Sudden loss of kidney function
– May be reversible
• Chronic kidney disease (CKD)
– Gradual loss of kidney function
• End-stage renal disease (ESRD)
– Total and permanent kidney failure
– Dialysis or transplant needed for survival
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Chronic kidney disease is a major public health problem
• As of 2012, 14% of US population has CKD
• CKD accounts for $41 billion in Medicare costs
– 17% of Medicare expenditures
• End-stage renal disease accounts for 7.5% of Medicare costs
– 1.3% of Medicare patients have ESRD
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ESRD is increasing in the US
1 in 11,600 in 1980 -> 1 in 2900 as of 2010
USRDS 2012
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Why is this important?
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CKD is associated with heart disease and stroke
USRDS 2012
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CKD patients have higher hospitalization and death rates
USRDS 2012
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ESRD patients have higher death rates
USRDS 2012
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ESRD patients are surviving longer
USRDS 2012
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Many people with CKD are not aware of their disease
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Less than 1/3rd of CKD patients see a kidney doctor
USRDS 2012
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What are the kidneys’ structure and function?
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Kidney anatomy
• 2 bean-shaped organs in back of abdominal cavity
– 11-14cm long
– 6cm wide, 4cm thick
– 125-170g males
– 115-155g females
http://www.yalemedicalgroup.org
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Kidneys perform many functions
• Highly efficient “filtering machines”
– Process 180L of blood/day
• Removes wastes and extra water -> urine
• Retains important substances (proteins)
• Maintains acid-base and electrolyte balance in blood and urine
• Makes important hormones
– EPO -> makes RBC’s
– Renin -> regulates blood pressure
– Calcitriol -> maintains bone health
http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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What causes kidney damage?
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Normal loss of kidney function as we age
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Common causes of kidney damage • Diabetes
– ↑ blood sugar damages kidneys
– Prevalence ***
• High blood pressure (hypertension)
– ↑ blood pressure damages small blood vessels in kidneys
– “Silent” disease
– Prevalence *** http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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Other causes of kidney damage
• Toxins • NSAIDs
– AKI
– Minimal change, membranous, interstitial nephritis, papillary necrosis, etc
• Bowel preps
• Herbal medicines
– NOT regulated by the FDA
– Aristolochic acid
– Heavy metal contamination http://www.springerimages.com/Images/Chemistry/1-10.1007_s00216-007-1310-3-0 http://drpinna.com
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Other causes of kidney damage
• Obesity • Diabetes, hypertension, hyperfiltration, sleep
apnea
• Glomerulonephritis • Lupus, IgA
• Inherited • Polycystic kidney disease
• Urinary tract obstruction • Kidney stones, enlarged prostate
• Other factors still being studied
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How is kidney disease detected?
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Diagnostic methods
• Blood test – ↑ blood creatinine – ↓ estimated glomerular filtration rate
• “Filter Function”
• Urine test – Urine protein, albumin, creatinine levels
• NKF also recommends blood pressure measurement – Can cause or be a sign of kidney disease – Goal 130/80
• Additional tests may be needed
http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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Symptoms of CKD
• Oftentimes there are no signs, especially in early stages
• May have… – Back pain
– High blood pressure
– Swelling/edema
– Blood in urine “hematuria”
– Frothy urine from protein “proteinuria”
– Change in urinary frequency: ↑or ↓
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Symptoms of advanced CKD
• Fatigue
• Decreased appetite
• Nausea/vomiting
• Itchiness
• Problems concentration
• Darkening skin
• Muscle cramps
http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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Stages of kidney disease STAGE DESCRIPTION
1 Normal kidney function but abnormal urine or imaging tests
2 Mild ↓ function but abnormal urine or imaging tests
3 Moderate ↓ function with or without abnormal urine or imaging tests
4 Severe ↓ function with or without abnormal urine or imaging tests
5 Kidney failure
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Treatments if kidneys fail
http://trialx.com http://www.lincolndocs.com http://www.ninephrology.com/home_dialysis.htm http://blogs.itb.ac.id/pahlev/2012/03/29/peritoneal-dialysis/l
IN-CENTER HEMODIALYSIS
HOME HEMODIALYSIS
PERITONEAL DIALYSIS
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What can be done to treat and prevent kidney disease?
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Kidney disease treatment and prevention
#1 Important to see your physician regularly
#2 Blood pressure control
*Goal <130/80 for kidney disease
*Patients with protein in their urine will benefit from an ACE inhibitor or ARB
http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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Kidney disease treatment and prevention
#3 Blood sugar control
*Watch for both ↑ and ↓ blood glucose levels
#4 Dietary changes
*Low salt
*“Heart-healthy diet”
#5 Weight control
http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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Kidney disease treatment and prevention
#6 Smoking cessation
*Smoking can cause kidney disease and
increase rate of progression
#7 Appropriate use of medications
*Important to go over medications with physician
*Kidney involved in metabolism, excretion
of many meds -> may need dose adjustment
*Avoidance of kidney toxins
http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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Kidney disease treatment and prevention
#8 Kidney disease education and preparation
*“Kidney team:” Meeting with dieticians, social workers, kidney nurses in addition to physicians
*As kidney disease progresses, learn about
dialysis and transplant options
*Open communication between you and your kidney team
http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#kidneys
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QUESTIONS