ABC's of Kidney Disease

Dr. Daphne Nicely introduces the monthly kidney disease education class at Johns Hopkins, explaining the program's structure and content. The class is divided into two halves, with the first addressing normal kidney function, causes and stages of kidney disease, and its impact on the body. The second half, led by Dr. Sue Thibaux, covers treatment options when kidneys fail, including dialysis and transplantation. The kidneys' role in balancing water, chemicals, and hormones in the body is also discussed.

The script differentiates between acute kidney injury, which can be reversible, and chronic kidney disease, characterized by a slow loss of kidney function over three months or more. Chronic kidney disease is further divided into five stages based on the glomerular filtration rate (GFR), with stage five indicating end-stage renal disease. The importance of early detection through urine tests and blood tests, and the risk factors for kidney disease, are also highlighted.

The paragraph explains the significance of creatinine levels and GFR in assessing kidney function. Creatinine is a waste product that healthy kidneys excrete; elevated levels indicate reduced kidney function. GFR measures the amount of blood filtered by the kidneys and is a more accurate indicator of kidney health. As GFR decreases, kidney function worsens, and the need for dialysis or transplantation is considered.

The leading causes of kidney disease, including diabetes and high blood pressure, are discussed. Other causes range from autoimmune conditions like lupus nephritis to inherited diseases such as polycystic kidney disease. The impact of kidney disease on other organs, particularly the heart and blood vessels, is also covered, emphasizing the increased risk of cardiac disease in those with kidney problems.

The relationship between kidney disease and anemia is explored, as the kidneys produce erythropoietin, a hormone that stimulates red blood cell production. When kidney function declines, anemia may result. The doctor will check for anemia and consider various causes, including iron, B12, and folate deficiencies, before attributing it to kidney disease. Treatment may involve supplements or erythropoietin-stimulating agents.

Kidney disease affects bone health by disrupting calcium, phosphorus, and vitamin D balance, which can lead to conditions like renal osteodystrophy. Management includes monitoring and supplementing calcium, phosphorus, and vitamin D levels, as well as using phosphorus binders and active vitamin D when necessary. Regular exercise is also recommended to maintain strong bones.

The importance of a balanced diet for kidney health is emphasized, with a focus on limiting sodium, processed foods, and sugar. Dietary restrictions on potassium and phosphorus may be necessary depending on kidney function levels. Protein intake should be moderated to reduce the workload on the kidneys. Nutritionists can provide guidance on maintaining a healthy diet despite these restrictions.

Depression is not a direct result of kidney disease but is commonly associated due to the additional burden it places on patients. Doctors work closely with primary care physicians to monitor and treat depression in patients with kidney disease, using a combination of medication and counseling.

End-stage kidney disease, characterized by uremia, requires treatments like dialysis or kidney transplantation. There are no medications to reverse kidney damage, so the focus is on slowing progression and managing complications with medications. General recommendations include a low sodium diet, watching fluid intake, and being an advocate for one's own health by informing other healthcare providers of kidney issues.

Hemodialysis involves filtering the blood using a machine. Access for hemodialysis can be through a fistula (a connection between an artery and vein), a graft (using synthetic material), or a catheter (a large IV line). Each method has its advantages and risks, particularly regarding infection. The choice depends on individual vascular health and personal suitability.

Home hemodialysis offers flexibility in scheduling and can be performed more frequently for shorter durations. Training is required and the machine must be accommodated at home. Peritoneal dialysis uses the abdominal lining as a filter and can be done manually or with a cycler at night. It is suitable for individuals who cannot undergo hemodialysis and offers the convenience of being performed at home without a partner's assistance.

The choice of dialysis modality depends on lifestyle and personal comfort. Individuals can transition between different types of dialysis. Kidney transplant is an option for end-stage kidney disease, involving the implantation of a new kidney in the lower abdomen. Evaluation for transplant involves a multidisciplinary team and一旦 the individual is medically cleared, they are placed on the transplant list and wait for a matching kidney to become available.

The presentation concludes with advice on monitoring progress through lab work, understanding medications, and staying engaged with the healthcare team. It also provides resources for further information, including websites recommended by the National Kidney Foundation and other government or organization-based sites for reliable information on diet, recipes, and navigating the transplant process.