Approximately 30 million Americans have kidney disease, with many not even knowing this vital organ is compromised, according to the National Kidney Foundation (NKF). March 14 is recognized as World Kidney Day, while United States focuses on the integral organ all month long. Organizations such as NKF host workshops, Q&As and even offer free screenings throughout March for those at risk of kidney disease.
“The kidneys do the background work. They’re kind of like the guys who take the trash away every week,” Dr. Gia Tran, a nephrologist at Dignity Health – St. Mary Medical Center, said. “If you don’t have a trash man who comes in and cleans you out, toxins build up. That is the function of the kidneys. They filter 150 to 200 liters of blood per day, actively and continuously, doing the work for you.”
Dr. Sapna Patel, director of Adult Inpatient Dialysis and section chair for the Department of Nephrology at MemorialCare Long Beach Medical Center, left, and clinical coordinator Linda Sheppard are pictured with a dialysis machine, which is used to treat patients with kidney disease. Kidney disease is the ninth leading cause of death in the United States, ahead of breast and prostate cancer. (Photograph by the Business Journal’s Pat Flynn)
The kidneys’ importance to bodily function cannot be understated. The fist-sized organs regulate the body’s salt, potassium and acid content, remove drugs from the body, balance the body’s fluids, release hormones to regulate blood pressure, produce an active form of Vitamin D that promotes healthy bones, and control the production of red blood cells. When these functions are interrupted by blockages or organ failure, the results are deadly if left untreated.
Dr. Sapna Patel, director of Adult Inpatient Dialysis and section chair for the Department of Nephrology at MemorialCare Long Beach Medical Center (LBMC), explained that the body can last only months without a properly functioning kidney or some form of treatment, such as dialysis. According to LBMC, more than 661,000 Americans currently have kidney failure, which kills more people than breast or prostate cancer, making it the ninth leading cause of death in the country.
“By far, the most common causes of kidney disease are diabetes and hypertension, which account for [almost 75%] of the cases of chronic kidney disease in the U.S.,” Patel said. “The biggest thing for people to be aware of is the importance of preventative care before it starts. Go to those primary care visits, get your blood pressure and cholesterol checked, and prevent the onset of diabetes and high blood pressure.”
Since its two leading causes are, generally speaking, preventable issues, Patel said the simplest way of decreasing the chance of kidney disease is lifestyle management. A healthy diet and exercise are two key methods to maintain body health and avoid becoming part of the country’s rampant obesity, which leads to many cases of diabetes and hypertension. Patel also suggests refraining from excessive use of inflammatory pain medications such as Motrin, Advil and Excedrin, which decrease blood flow in the kidney and can cause progressive chronic kidney disease over time.
If patients are diagnosed with diabetes or hypertension, Patel said controlling these ailments aggressively through medications and routine checkups reduces the chance that they will lead to kidney disease. Patel explained that kidney disease typically requires a laboratory diagnosis because it does not show obvious symptoms in its early stages. Only nondescript issues like fatigue, poor appetite, weakness and a metallic taste in the mouth, symptoms common with many mild ailments, are clues that someone may be experiencing kidney disease.
Blockages in the body in the form of kidney stones, scars or tumors can also cause kidney disease if left untreated, according to Dr. Shahrad Aynehchi, a urologist and senior attending surgeon at Lakewood Regional Medical Center. He explained that kidney stones, which are hard deposits of minerals and salts, form and can lead to pain and infection, increasing the risk of kidney disease.
One of the most common causes of kidney stones is dehydration, Aynehchi explained. He said the risk of kidney stones increases in the summer months and is particularly prevalent in the southeast part of the country due to excessively hot weather. High levels of sodium and a lack of citric acid intake also increase the risk of kidney stone formation. Staying hydrated, reducing the use of table salt with meals and adding some lemon juice to daily water are simple steps a person can take to avoid kidney stones, according to Aynehchi.
“We have a number of different tools at our disposal to destroy the stones or break them up to get the kidneys back to their normal function,” Aynehchi said. “Some of them could be treated with diet changes but, [with] the vast majority of them, it is not possible to completely eradicate them with diet changes or medication. So we do need a surgical procedure to have them treated and removed.”
Once a stone has formed, Aynehchi said treatment is determined by the size of the stone. Small stones have an 85% to 90% chance of being passed by the patient in their urine. Larger stones can be broken down utilizing a special laser or by using extracorporeal shock wave lithotripsy, which breaks up stones using sound waves traveling through the body.
For larger stones, Aynehchi said a percutaneous nephrolithotomy is performed, which is a small centimeter-sized incision on the patient’s back to go in and physically remove the stone. These three methods are all minimally invasive, according to Aynehchi.
Prolonged kidney disease without treatment can lead to issues with other organs such as the heart, lungs and nervous system, according to Tran. For example, she explained that unfiltered blood can create calcium buildups in blood vessels, which may lead to stroke or heart attack. Additionally, she said an imbalance of electrolytes may cause neurological symptoms such as confusion.
Once kidney disease has set in, if it is not caused by a blockage and cannot be treated with medication or modifying the patient’s lifestyle, a regimen of dialysis begins. This is a process in which patients are hooked up to a machine that extracts and filters their blood and removes excess fluid from the body three times per week for several hours.
“Dialysis is a very good replacement therapy for the loss of the native kidneys,” Patel said. “A kidney transplant is superior to dialysis in that it is able to clear the toxins and excess fluids out of the blood. But there are not really scenarios where we’re not able to adjust the dialysis to provide the necessary clearance that the patient needs.”
While many patients undergoing dialysis are among the more than 95,000 people on the kidney transplant list, some have accepted their weekly regimen of dialysis, Tran said. She explained some patients decide the weekly treatment is preferable to undergoing the invasive transplant surgery.
When a transplant becomes the proper course of action for the patient’s health, the best case scenario is when a family member or friend is a match and donates a kidney. However, if this is not possible, patients must be deemed a candidate for a transplant and placed on the wait-list, which has strict criteria and works on a point system, according to Aynehchi.
When it comes time for a kidney transplant surgery, the donor is sometimes a person who recently died or a living person who has decided to donate. In the case of a live donor, two surgeries must occur, often simultaneously: one for the donor and one on the recipient. According to Aynehchi, the donor surgery has made great advances and is often done laparoscopically, meaning a small incision and minimal blood loss, with most people going home the next day.
“The person who receives the kidney, that is done as an open operation,” Aynehchi said. “The surgery is mostly unchanged for the past 10 or 20 years. The real progression has been that the medications are much better, so the body can tolerate that kidney.”
According to Patel, roughly 193,000 Americans are living with a functioning kidney transplant.