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Your kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage. The kidneys are sophisticated trash collectors. Every day, your kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The waste and extra water become urine, which flows to your bladder through tubes called ureters. Your bladder stores urine until you go to the bathroom.
The wastes in your blood come from the normal breakdown of active muscle and from the food you eat. Your body uses the food for energy and self-repairs. After your body has taken what it needs from the food, waste is sent to the blood. If your kidneys did not remove these wastes, the wastes would build up in the blood and damage your body.
The kidneys are the master chemists of the body. They filter and remove waste products from the blood, remove extra water from the body, adjust levels of minerals and chemicals in your body and produce hormones that help control your blood pressure and help make red blood cells.
There are a number of ways you can protect your kidneys and slow the progression of CKD.
Good blood pressure control, diet modifications, smoking cessation and if you are a diabetic, keeping your blood sugar in a safe range are all ways you can positively affect your kidney function. In addition, keep informed about your test results, ask questions, and be involved in your treatment plan.
You are the most important member of your health care team.
A nephrologist is a doctor who treats patients with kidney problems and related hypertension or high blood pressure. Once you have been diagnosed with kidney disease, early referral to a nephrologist is important in preserving and protecting your kidney function. As a specialist in kidney disease, your nephrologist has the knowledge and skill to work with you in developing a plan of care specific to your needs.
CKD is chronic kidney disease. CKD is defined as a decreased level of kidney function or the evidence of kidney damage for greater than three months. Individuals at risk for developing kidney disease are those with diabetes, high blood pressure or a family history of kidney disease.
Once CKD is diagnosed it is important to determine the level of kidney function. The National Kidney Foundation has identified 5 stages of chronic kidney disease. Each stage represents a level of kidney function as defined by a creatinine clearance.
The 5 stages are:
- Stage 1 — CrCl > 90
- Stage 2 — CrCl 60-89
- Stage 3 — CrCl 30-59
- Stage 4 — CrCl 15-29
- Stage 5 — CrCl < 15 or Dialysis
Blood Tests – Zerum creatinine, Electrolytes, & BUN
Urine Tests – Microalbumin, Glomerular Filtration Rate (GFR)
Imaging Tests – A renal ultrasound may be recommended to assess the size, shape and anatomy of your kidney. In addition, a CT scan, MRI or MRA may be recommended to determine possible reasons for your kidney disease.
Kidney Biopsy – A kidney biopsy is a test where a small piece of kidney tissue is removed by a needle. The tissue is examined under a microscope to determine the cause of kidney disease.
Diabetes is the most common cause of chronic kidney disease (CKD) in the United States. High blood sugar levels can damage the blood vessels and affect the filtering ability of the kidney. Controlling your blood sugar can help slow the progress of your kidney disease.
High blood pressure damages the blood vessels and reduces blood supply to the kidney. High blood pressure can cause kidney problems and kidney problems can cause high blood pressure. Uncontrolled high blood pressure can cause a decrease in kidney function and irreversible kidney damage.
High blood pressure may be controlled with a combination of weight loss, exercise, changes in diet, stress reduction and smoking cessation. If these steps do not control your blood pressure then medications, often a combination of medications is recommended. Each type of blood pressure medication you take provides a different benefit for controlling your blood pressure and slowing the progression of kidney disease.
One way to preserve your kidney function is to modify your diet. Proper nutrition can reduce the workload of the kidneys and preserve or delay further progression of your kidney disease. A renal dietitian can help you make good choices with the foods you normally eat and make suggestions on foods to add and foods to moderate in your diet. The dietitian is an important part of your healthcare team and can assist you in living well with chronic kidney disease.
Common medications to avoid are NSAIDS (anti-inflammatory medications), enemas and laxatives — unless ordered by the nephrologists, any “cure-all” remedies and various food supplements, herbal medicines and vitamins. It is a good idea to check with your nephrologist prior to starting any new over the counter or prescription medications.
Anemia is a decrease in red blood cells. Red blood cells carry oxygen throughout the body and a decrease in red blood cells can result in fatigue, shortness of breath, depression, poor appetite and heart disease.
The kidneys make a hormone called erythropoietin which helps form red blood cells. With CKD there is a decrease in the production of this hormone and thus a decrease in red blood cells. The treatment for anemia related to CKD is injections with the man-made form of the hormone erythropoietin and with iron pills or iron infusions (intravenous iron).
Hemodialysis, peritoneal dialysis and kidney transplant are all treatment options. Kidney transplantation surgically places a healthy kidney from another person into your body. The donated kidney does the work that your failed kidneys used to do. One additional option is to refuse or withdraw from treatment.
For many people dialysis and transplantation extend and improve quality of life. For others these treatment options may seem a burden and only to prolong suffering. You have the right to refuse or withdraw dialysis if you feel there is no hope of improving your quality of life or a life with dignity and meaning.
Dialysis is a process that cleans and filters your blood. There are two types of dialysis, hemodialysis and peritoneal dialysis.
Hemodialysis – Hemodialysis cleans your blood using a machine with a special filter called a dialyzer. During a hemodialysis treatment blood travels from your body through tubes to the dialyzer which filters out wastes and extra water. The cleaned blood flows through another set of tubes back into your body.
Peritoneal Dialysis – Peritoneal dialysis removes wastes and extra water from your body using the lining of your abdomen (peritoneum) to filter your blood. A special solution travels through a soft tube into your abdomen. The solution draws wastes and extra water from tiny blood vessels in your peritoneum back into the solution which is then drained from your abdomen through the soft tube.
For hemodialysis it is necessary to create a vascular access or pathway to your blood. The access is usually created in your arm during a short surgery. One type of access is a fistula, another type of access is a graft. In some cases an external catheter may be inserted into a vein in your chest or neck. A catheter is usually temporary and replaced by a fistula or graft.