Martha Jefferson HealthWise--March 26th

Dr. Connie Christ, a Nephrologist affiliated with Martha Jefferson Hospital explains that kidneys act as a filter to clear toxins that can accumulate in the blood. They also help to regulate electrolytes, such as the sodium, potassium, chloride, calcium and others. The kidneys also are the long term regulators of the acid-base balance in the blood. They play a key role in regulating volume (fluid) and in assisting with blood pressure control. Further, they help regulate bone metabolism and secrete a hormone that helps regulate anemia. They also help clear other things in the blood that, if found in high amounts, can in turn cause damage to the kidneys.

Some ways chronic kidney disease is treated is blood pressure control, glucose control and cholesterol control. An attempt is made to treat the underlying cause of the kidney disease. For example, if a patient has Lupus contributing to their kidney disease, the Lupus is aggressively treated. There are interventions that help with most people who have kidney disease, regardless of the cause. One is to optimize blood pressure control, glycemic (blood sugar), and lipid control. Another is to optimize cardiac output as the kidneys are totally reliant on the heart to pump blood to them to receive their "nourishment." Another is to avoid medicines that are harmful to the kidneys, such as non-steroidal containing products.

Historically, two byproducts of metabolism that are cleared by the kidneys and can be measured in the blood (BUN and creatinine) have been used as markers of kidney function. However, these measures can be within the normal laboratory range, yet the patient can still have lower than normal kidney function. Therefore, an effort to establish a more sensitive marker of kidney function was sought. The most current and widely accepted method of estimating kidney function (GFR) is using a prediction equation that takes into consideration: age, race, gender, the two blood measures of kidney function (BUN & Cr) and a marker of nutrition. There are shorter versions of the equation if information for all the variables is not available.

Dialysis is a way to treat kidney disease. Ideally, we would like to see the patients early to evaluate whether there is a reversible component of the decline in their kidney function and to put into place a treatment plan that will attempt to curtail the decline in kidney function over time. Unfortunately, there are patients whose kidney function declines to the point where some form of renal replacement therapy (RRT) is needed.
The options at that point, for some, are transplant, or one of the dialysis modalities. The goal, however, is to work diligently with the patient and their primary care provider to prevent the patient from ever reaching the point where RRT is required.

Patients should talk to your doctor GFR Microalbuminuria Blood in urine Patients can ask their doctor what is their GFR (glomerular filtration rate), and whether it is within the normal range. They can also inquire whether they have microalbuminuria, a small protein (microalbumin) that can be detected in the urine that is an early indicator of kidney disease. Further, microscopic blood in the urine may be an early indicator of kidney disease.

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