Maintaining a Positive Balance on Kidney Disease

Most people understand the danger of high blood pressure and diabetes. But according to experts at the Froedtert & the Medical College of Wisconsin health network, many people are not aware these diseases raise the risk of another serious health problem — kidney disease.

“Diabetes and hypertension are the most common causes of kidney disease in the U.S.,” said Anna Gaddy, MD, nephrologist and MCW faculty member. “Since these conditions are widespread, many people are at risk for kidney problems.”

Thee challenge is finding these patients early.

“Kidney disease is tough because people can go a long time without knowing they have it,” Dr. Gaddy said. “When it is very advanced, you may have problems such as nausea, fatigue, confusion and swelling throughout the body, but in most stages of kidney disease, there are no symptoms at all.”

Function of the Kidneys

What role do the kidneys play in overall health? Their main job, according to Dr. Gaddy, is to maintain the body in a state of balance.

“The kidneys perform this ‘balancing act’ in several different domains,” she said. “One is fluid volume. Kidneys keep you from getting dehydrated but also from getting overloaded with water. Another domain is electrolyte content. Here, the kidneys keep things like salt and potassium in a state of balance. The kidneys also clean toxins out of your blood.”

Problems develop when conditions like high blood pressure create an environment that is harmful to the kidneys.

“Over time, this leads to an irreversible decrease in kidney function,” Dr. Gaddy said. “We call this chronic kidney disease. Essentially, the kidneys can no longer do their job efficiently or effectively.”

There are several kinds of kidney disease. One common problem is kidney stone disease, which occurs when chemicals such as calcium or uric acid become concentrated inside the kidney and crystallize. Another is polycystic kidney disease, an inherited condition that affects about 1 in 1,000 Americans and causes fluid-filled cysts to form inside the organs.

Kidney Disease Treatment Options

“Kidney disease is typically detected with a basic blood test,” said Abhilash Koratala, MD, nephrologist and MCW faculty member. “We use a routine chemistry called ‘serum creatinine’ that indicates how well the kidneys are filtering.” A separate test looks for blood or protein in the urine, which are early signs of chronic kidney disease.

According to Dr. Koratala, most minor kidney diseases can be managed by a primary care provider. If any signs of rapidly declining kidney function or other warning signs are detected, patients are usually referred to a nephrologist. Nephrologists work with patients to control any underlying hypertension or diabetes. In addition, they are often able to prescribe medications to hold kidney disease in check.

“Recent data shows that a new class of medications called SGLT2 inhibitors can help slow the progression of kidney disease,” Dr. Koratala said. “They also lower the risk of kidney failure in people with diabetes.”

For patients who experience a severe decrease in kidney function, dialysis is essential. The Froedtert & MCW health network provides a full range of dialysis services, including home dialysis and nocturnal dialysis.

“Nocturnal dialysis is a less explored option that can benefit many patients,” said Rima Patel, DO, nephrologist, medical director of the Kidney Transplant Program and MCW faculty member. “Patients can come in to our dialysis unit at night so they can work during the day.”

For patients with severe kidney disease, transplant is an important option. Froedtert Hospital is one of only three kidney transplant centers in Wisconsin.

“We have a lot of options for patients considering a transplant,” she said. “We offer a living donor program, participate in paired kidney exchange programs, and can also do what are known as ‘ABO-incompatible’ transplants, meaning we can perform transplants between people who are not in the same blood group.”

“Transplant gives people with end-stage kidney disease a chance to come off dialysis, feel good and have a better quality of life,” Dr. Patel said.

Ways to Prevent Kidney Conditions

Patients can help prevent kidney disease and keep existing problems at bay by eating a balanced diet and avoiding high-salt and high-sugar foods. Regular exercise is also beneficial.

Should you drink a lot of water? According to Dr. Gaddy, that is a common myth.

“Drinking water to satisfy thirst is beneficial in preventing kidney stones,” she said, “But drinking excess water will not prevent kidney disease.”

The most important takeaway is awareness. Dr. Gaddy encourages patients to understand their risk of kidney disease and get screened.

“Unless you are screened for kidney disease, in most cases you will not know whether or not you have it,” she said.

The Froedtert & MCW health network offers comprehensive and expert care for kidney disease. Visit froedtert.com/kidney-disease for more information.