Chronic Kidney Disease Education

 

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Did you know?

  • There are 26 million Americans who have chronic kidney disease and many more are at risk.
  • Seeing your kidney doctor regularly can help slow down the progression of kidney disease.
  • Having persistent protein in your urine is one of the early signs of kidney disease
  • So what have your kidneys done for you today?
  • Your kidneys filter about 200 quarts of blood a day.
  • Your kidneys regulate the electrolytes in your body such as sodium, potassium, calcium and phosphorous.
  • Your kidneys also help regulate the water in your body.
  • Your kidneys play an important role in excreting the drugs and toxins in your body.
  • Did you know that kidneys also release hormones that help make red blood cells?
  • Did you know that your kidneys also play an important role in maintaining healthy bones?
  • Your kidneys produce an active form of Vitamin D that promotes strong healthy bones.
  • Your kidney also releases hormones that affect blood pressure.
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So what do you mean by "I have chronic kidney disease"?

  • Chronic Kidney Disease (CKD) includes diseases and conditions that damage your kidneys and decrease the ability of your kidneys to perform its usual functions. 
  • Chronic Kidney Disease may result in conditions such as high blood pressure, anemia, weak bones, and decreased nutritional state.  You may not feel these conditions initially as they often happen over a long period of time.
  • If Chronic Kidney Disease progresses to the point of kidney failure, then one may require dialysis or a kidney transplant.
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How does my doctor know I have kidney disease?

  • Your doctor can detect kidney disease through measurement of urine and blood.  
  • Spilling protein into the urine is often an early sign of kidney disease.  Normal kidneys reabsorb filtered protein. However, if you have persistent protein leakage into urine above normal amounts, that means the kidneys are damaged.  
  • Your doctor will also measure your level of creatinine which is a byproduct of muscle activity. 
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What does Creatinine have to do with my kidneys?

  • Creatinine is a breakdown product from muscles and filtered by the kidneys.
  • Creatinine in normal kidneys is cleared into the urine.  People with kidney disease can build high levels of creatinine in the blood. The elevated Creatinine is an indirect measure of your kidney function.
  • The Creatinine can be used to estimate your kidney function, measured as glomerular filtration rate (GFR).
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What causes kidney disease?

  • There are many causes for kidney disease.
  • Hypertension and diabetes are two of the most common reasons for kidney disease, responsible for up to 2/3 of all kidney disease.
  • In the United States, diabetes is the largest leading cause for kidney failure, accounting for 45% of people who start treatment for kidney failure.
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Why do hypertension and diabetes cause kidney disease?

  • Uncontrolled high blood pressure increases the pressure against the walls of the blood vessels.  This can cause heart attacks and strokes, and in a similar fashion can also cause damage to your kidneys.
  • Uncontrolled diabetes can also cause damage to your kidneys, as it causes damage to blood vessels of many organs such as eyes, heart, and nerves.  It is important to work closely with your doctor managing your diabetes to get your blood sugars under control.
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There are many other causes of kidney disease:>

  • Disease that cause inflammation of the filtering units to your kidneys (glomerulonephritis).
  • Inherited diseases such as polycystic kidney disease
  • Congenital malformations.
  • Certain medications such as NSAIDs that may be toxic or may cause inflammation in your kidneys.
  • Conditions that obstruct the urinary flow from your kidneys such as kidney stones, enlarged prostates and tumors.
  • Recurrent urinary infections during childhood or sometimes as an adult.
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So how come I don’t feel like I have kidney disease?

  • Most people do not feel any symptoms until they have very advanced kidney disease.
  • I have Chronic Kidney Disease, does that mean I’ll need dialysis?
  • Chronic kidney disease does not mean dialysis!  
  • It is important to determine what stage of kidney disease you are at, the type of kidney disease, and the damage that has been done.  
  • Most people will not need dialysis if their kidney disease is not advanced and their underlying health problems are well controlled.
  • I have been told that my chronic kidney disease is stable, so why do I still need to see a kidney doctor?
  • It is important to detect any progression of kidney disease early on as appropriate intervention of any reversible causes can often prevent it from getting worse.  Your kidney function from blood and urine should be checked regularly to determine the status of your kidney disease. 
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The 5 Stages of kidney disease

  • Stage 1:  GFR >90 (normal kidney function but with some evidence of damage)
  • Stage 2:  GFR 60-89 (mild)
  • Stage 3:  GFR 30-59 (moderate)
  • Stage 4:  GFR 15-29 (severe)
  • Stage 5:  GFR <15 (kidney failure/End Stage Renal Disease)
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Symptoms of Stage 5 kidney disease

  • Nausea, vomiting
  • Poor appetite
  • Metallic tastes in your mouth
  • Worsened swelling
  • Blood pressure difficult to control
  • Potassium and other electrolytes become difficult to control
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My blood pressure and blood sugars are well controlled.  What else can I do to help?

  • It is important to cut down on salt in your diet.  
  • It is also important to have healthy cholesterol levels
  • Smoke is associated with faster decline in kidney function, so don’t do it!
  • If your kidney doctor determines you have anemia requiring hormone shots, be sure to take them.
  • Follow any dietary restrictions that your kidney doctor recommends.
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Why am I anemic (low blood count)?

  • There are many reasons for anemia.  Having chronic kidney disease can be one of them.  
  • Your kidney doctor may check iron and other vitamins in your blood to determine if other factors are contributing to your anemia.
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Why should I be treated for the anemia?

  • Your red blood cells carry oxygen that is vital to your organs.  Having too low a blood count can also lead to heart damage and weakness/fatigue.  Your kidney doctor will determine what the appropriate level of blood count is for you.  
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What can be done about my anemia?

  • If you have Anemia that is caused by chronic kidney disease, it may be controlled by taking a hormone called EPO (erythropoietin) and iron supplements.
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Why does my kidney doctor care about my bones?

  • Your kidney plays an integral role in regulating your bones.
  • Kidney disease stage 3 and beyond is associated with diminished bone strength.
  • Your kidney doctor may check your parathyroid hormone to assess your risk for bone disease.
  • Your kidney doctor may also prescribe Vitamin D to help reduce risk for bone disease.
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My kidney doctor has also asked me to watch out for high phosphorous foods.  Why is my phosphorous high?

  • Your kidneys are the main means of excreting phosphorous that you take in from your diet. 
  • At certain stages of chronic kidney disease, the kidney has difficulty getting rid of the phosphorous.
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I don't feel any different with a high phosphorous, so why is it bad?

  • Prolonged high phosphorous can cause bone and heart problems.  Phosphorous can cause calcified deposits in the heart, arteries, joints, and skin that can pose serious health problems.
  • It can cause a elevation of your parathyroid hormone which can weaken your bones.
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Does having a high phosphorous mean I should cut out protein from my diet?

  • Chronic kidney disease can often cause malnutrition.
  • Maintaining good nutrition also plays as important a role as making sure your phosphorous is controlled.  
  • There are certain foods with a lot of phosphorous but without a lot of nutritional value such as dark sodas and chocolate cookies which should be avoided, but cutting out protein completely from your diet is not recommended.  
  • Your kidney doctor may prescribe a medication to help you control your phosphorous while achieving enough protein nutrition.  Your kidney doctor may also refer you to a nutritionist to help plan your diet.
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My kidney doctor has also told me to follow a low potassium diet.  Why is it not good to have a high potassium?

  • Not all people with kidney disease will have difficulty with high potassium.  But if you do, it is a good idea to watch the amount of potassium you have in your diet.
  • High potassium may cause heart rhythm problems.  
  • Some examples of foods that are rich in potassium include potatoes, oranges, bananas, tomatoes, diary products.  
  • Your doctor may give you a list of high potassium foods to follow.
  • He may also refer you to a dietician if your potassium is still difficult to control despite a low potassium diet.
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Besides taking my medications on time, what can I do about my blood pressure?

  • A low salt diet is very important in helping lower your blood pressure
  • I don’t add salt, shouldn’t that be enough?…likely not!
  • Most processed foods already have a lot of salt.
  • A low salt diet should be less than 2 grams of salt a day.  The average American consumes 5 grams a day!
  • Weight loss if there is obesity.
  • Limiting alcohol to fewer than 2 drinks a day.
  • Stopping smoking.
  • Reducing stressors in life.
  • What are NSAIDs.
  • NSAIDs stand for Nonsteroidal anti-inflammatory drugs.
  • They are a class of pain medications that include Motrin (ibuprofen), Aleve, Advil, naproxyn…and many more!
  • Why Does My Kidney Doctor Want me to Avoid NSAIDs.
  • Use of NSAIDs can worsen you kidney function.
  • They can also contribute to hypertension.
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Got Stones?

  • Stones beget stones.  Odds are that there is another kidney stone developing in your kidneys if you’ve had one.
  • It is thought that one in ten people will have a kidney stone at some time in their lives.
  • More than half a million people go to emergency rooms for kidney stone problems.
  • Stone formation can be prevented!
  • Did you know a high salt diet contributes to formation of kidney stones?
  • All we have to do is get rid of the calcium right…?  Not so simple!
  • Actually,  there are many different types of stones including: calcium, oxalate, urate, cystine, xanthine, and phosphate.
  • Treatment depends on the type of stone you have.
  • Your kidney doctor can you determine your risk factors for kidney stones.
  • You may be asked to collect a 24 hour urine.
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True of False? Kidney Quiz

Your kidneys play an important role in maintaining healthy bones
  • True...... Your kidney is integral in regulating your calcium, phosphorous, vitamin D and parathyroid hormone, all important factors in maintaining healthy bones.

Your kidneys secrete a hormone that builds red blood cells.
  • True...... The hormone is known as erythropoietin and stimulates the production of red blood cells.

Early detection of kidney disease and regularly following up with your kidney doctor can help slow down progression of kidney disease.
  • True...... Patients who have kidney disease and follow-up with a kidney doctor tend to do better in slowing down the progression of their kidney disease.

Having persistent protein is an early sign of kidney disease.
  • True...... Increased protein excretion is a sensitive marker for kidney disease, particularly those diseases that affect the filtering units.

Heart disease is a major cause of death in people with kidney disease.
  • True...... Kidney disease increases your risk of having heart and blood vessel disease.  Heart disease is a major cause of death in people with chronic kidney disease.

Smoking is associated with faster kidney function decline
  • True...... Smoking is a risk factor in progression of chronic kidney disease.

A low salt diet is one where I don’t add salt to food
  • False...... A successful low salt diet consists of now adding salt to your foods and also watching the amount of salt that is already in your food.  One should aim for 2 grams or less per day.

Making lots of urine means that my kidneys must be fine
  • False!...... People with kidney disease can still make a lot of urine, but may not be getting rid of the toxins in the body.

Drinking milk or eating dairy products high in calcium will predispose me to kidney stones
  • False...... Dietary modifications should depend on the type of stone.  Some stones are made of calcium, but restricting calcium can often make things worse.  Based on your 24 hour urine collection, your kidney doctor can determine whether restricting calcium is a good idea.