Health & Exercise Forum

Steven Scheinman, M.D.

MARCH IS NATIONAL KIDNEY MONTH!

Guest Author: Steven J. Scheinman, M.D., President and Dean of The Commonwealth Medical College

Your heart counts on normal levels of potassium to maintain normal rhythm. Your muscles produce chemical waste as they work. Sodium influences blood pressure. Excretion of water and salts needs to match intake.  Scores of delicately balanced, intricately interconnected chemical exchanges power a single healthy body. At the center of this exquisite dance, regulating chemical levels and removing the waste, are your kidneys.

March is National Kidney Month and a good time to recognize how important kidneys are to our health and how costly and debilitating it is when they fail. According to the United States Renal Data System, in 2013 Medicare spent $28.6 billion on hemodialysis, the last resort of patients with renal disease. While the monetary cost is enormous, kidney disease also takes a heavy toll on quality of life.  There have been wonderful advances in both dialysis and the kidney transplantation, but both still carry an onerous burden. Dietary and, sometimes, travel restrictions accompany dialysis. Post-transplant patients face a lifetime of meticulous adherence to medication regimens that include multiple, often expensive, drugs.

As is the case with many diseases, prevention of kidney disease is far preferable to treatment. To preserve kidney health, it’s important first to recognize the causes of kidney disease. Long-time use of certain drugs, including NSAIDs like ibuprofen, can cause kidney failure. So can many autoimmune disorders.  There are genetic causes, such as polycystic kidney disease. Certain cancers are also implicated. However, diabetes is by far the No. 1 cause of kidney failure.  Hypertension itself is another major cause.  Further, hypertension will accelerate the progression of renal disease no matter the cause.  Everyone should take their blood pressure very seriously, and particularly if you have signs of kidney problems.

At its advanced stage, signs and symptoms of kidney disease include puffiness around the eyes, swelling of the ankles and blood in the urine. Weakness and fatigue are also common because kidney disease causes anemia. Healthy kidneys produce a hormone called EPO, which stimulates the bone marrow to make oxygen-carrying red blood cells. When the kidneys are diseased or damaged, EPO levels drop and anemia results. Dry and itchy skin, and muscle cramping, may arise from electrolyte imbalances caused by poorly functioning kidneys The National Kidney Foundation (NKF) advises patients to look for foamy urine. This foam, NKF says, “may look like the foam you see when scrambling eggs, as the common protein found in urine, albumin, is the same protein that is found in eggs.”

These signs and symptoms sound dramatic, but most do not occur early on, and kidney disease too often goes undetected until its late stages. That’s unfortunate because once the kidney damage has progressed it is too often irreversible.  There are simple tests to check kidney health that should be part of every adult’s routine health maintenance.

• As the American Heart Association urges, patients should know their blood pressure. High blood pressure is not only a threat to the heart, it also wreaks havoc on kidneys.
• All adults should also know their serum (blood) creatinine level. Creatinine is a waste product produced by muscles, which your kidneys normally remove from blood and excrete through urine. The NKF advises that a creatinine level of greater than 1.2 for women and greater than 1.4 for men may be an early sign that the kidneys are not working properly.
• Another blood test measures levels of blood urea nitrogen (BUN), a byproduct of protein digestion. A normal BUN level is between 7 and 20 and will rise if your kidneys are malfunctioning.
• There are also tests that can find excess amounts of protein, blood, bacteria and sugar in your urine. Your doctor may use urinalysis, not only to detect a variety of kidney and urinary tract disorders, but to detect diabetes as well.
• If kidney disease is suspected, you may undergo a biopsy to identify the specific disease at work, thus identifying a treatment. Biopsies are also used to evaluate the extent of kidney damage.

The purpose of blood and urine tests isn’t to alarm but to arm. Information is a powerful weapon deployed in in the service of prevention. Everyone should strive to maintain a healthy weight and get adequate amounts of exercise, but this advice is particularly important if you have early warning signs of an unhealthy blood pressure or diabetes. The good news is that mild cases of diabetes and high blood pressure respond well to lifestyle changes. If you have high blood pressure or diabetes, it’s vital to follow your doctor’s advice and take medicines as prescribed. Know your numbers, take care of yourself, comply with medical advice and keep your kidneys working properly.

Guest Author: Dr. Scheinman is a nephrologist and president and dean of The Commonwealth Medical College, with campuses in Sayre, Scranton, Williamsport and Wilkes-Barre.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.