What to do if your filters fail
Kidney disease is becoming more and more common
WHO’S AT RISK
Kidney disease doesn’t often make headline news, but it’s increasingly common — the CDC estimates that 1 in 10 adults have chronic kidney disease, and that 50% of the population currently between 35 and 65 will develop kidney disease in the course of their lifetime. “What happens with kidney disease is that the kidney stops filtering the wastes and excess fluids from the body, which should be excreted as urine,” says Lapsia. “As a result, all the toxic substances build up and make the person very sick.”
There are two main types of kidney disease. “Chronic kidney disease is the progressive, gradual loss of kidney function, which accounts for the majority of cases,” says Lapsia. “Acute kidney injury is when the kidney all of sudden stops functioning, but may recover and return to previous function — this happens most often when the patient is hospitalized for another condition.”
Doctors have identified four major risk factors for kidney disease. “Diabetes, high blood pressure, heart disease, and a family history of kidney disease are the most important signs that you are at elevated risk of developing kidney disease,” says Lapsia. “African-Americans, Hispanics, and Native Americans are all at particularly high risk of kidney disease.” High cholesterol, physical injuries, and other health conditions can also contribute to your risk.
“Based on the U.S. data, most patients’ risk goes up after the age of 50,” says Lapsia. “End-stage renal failure, when the kidneys have stopped functioning enough to support the body, is more common after the age of 70.”
SIGNS AND SYMPTOMS
One of the challenges presented by kidney disease is that it is insidious. “It’s usually a subtle and slowly progressing disease, so many people don’t even realize that they have it,” says Lapsia. “Some patients have symptoms early on, but many others are effectively asymptomatic.”
When patients do experience early symptoms, they can be fairly nonspecific. “One warning sign is frothy or bubbly urine, especially if that is a change from the past — that’s usually a sign that the kidneys are leaking protein,” says Lapsia. “Patients can also have sleep problems, fatigue, weakness, persistent itchiness, or retention of fluid, especially swelling of the feet and ankles.”
In later stages of kidney disease, the symptoms can become more pronounced. “As the disease progresses, patients can experience a loss of appetite, weakness, nausea, vomiting, severe sleep problems, and a dramatic decrease in the amount of urine produced,” says Lapsia.
TRADITIONAL TREATMENT
When kidney disease is detected early, the first line of attack is usually a conservative approach that begins with lifestyle modifications. “The first steps are often weight reduction, improved blood pressure and diabetes control, and some dietary changes — do they need to take in less protein or salt, or take in more fiber, fruit, and vegetables?” says Lapsia. “Lifestyle changes and exercise may keep early stage kidney stage stable for a long long time.”
Kidney disease is rated from stages 1-5, with most patients diagnosed at 2-3 and 4-5 counting as advanced. “Treating patients in the later stages usually means that we change our emphasis from reversing the disease to buying time before dialysis or transplant,” says Lapsia. “Transplant is the preferred option, because then you get a new kidney, and one functional kidney is enough to support a healthy lifestyle.” However, not all patients are candidates for a transplant, and there aren’t enough kidney donors to match every would-be recipient.
There are several different options for dialysis, a process that uses various kinds of technology to filter the blood to replace lost kidney function. “Dialysis can be done at home up to six times a week or in a dialysis center three-to-four times a week,” says Lapsia. “Hemodialysis removes blood from the body, filters it through a machine, and then returns it to the body, while peritoneal dialysis places a tube in the abdomen, uses a fluid to flush toxins, and then removes them from the body.” Doctors encourage patients to start with peritoneal and home dialysis if at all possible.
While dialysis is daunting, once its effects kick in, patients usually start feeling much better.
RESEARCH BREAKTHROUGHS
The treatments available for kidney disease have improved dramatically in the past generation, and some very exciting projects are underway. “Researchers are working toward the goal of being able to build a kidney in the laboratory, which would be made to the individual’s specifications,” says Lapsia. “There is also work being done to make a dialysis machine so tiny that it could be implanted in your body. These innovations will take some time, but patients could be benefiting from them in the next decade.”
QUESTIONS FOR YOUR DOCTOR
Upon receiving the diagnosis of kidney disease, the first question that comes to mind is often, “How bad is the damage?” Follow up with the twopart question, “How long has it been there?” and “How fast is it worsening?” Another crucial thing to ask is, “What caused this kidney damage?” Don’t hesitate to ask, “Should I see a kidney specialist?” “The good news is that the kidneys have a lot of resilience and excess capacity,” says Lapsia. “Taking common-sense steps can go a long way toward preventing kidney disease in the first place or toward keeping it in check once you’ve been diagnosed.”