Frequently Asked Questions about Nephrology

What is a nephrologist?

Nephrologists are physicians that trained in internal medicine, internists, and then pursued additional training in kidney disease. Nephrologists help take care of patients with weak or failed kidneys. They are the only physicians trained to provide dialysis for kidney failure. Nephrologists also are part of the kidney transplant team though they don’t operate.

Is there a special diet that is good for the kidneys?

Doctors often recommend a diet low in protein to help preserve kidney function, or a low-sodium diet to help lower blood pressure. If you have weak kidneys talk to your doctor before starting any diet.

What are the kidneys and what do they do?

The kidneys are essential organs that filter the blood in order to remove waste and regulate the various chemicals in the blood. In addition, the kidneys secrete hormones that regulate blood pressure, prevent anemia, and promote bone strength.

What diseases affect the kidneys?

The most common causes of kidney disease are hypertension and diabetes. These two diseases can affect every organ in the body. If not well controlled, either of these conditions can result in kidney failure and dialysis. Other diseases that attack multiple organs including the kidney are lupus, HIV and viral hepatitis.

What are the symptoms of kidney disease?

Symptoms can include blood in the urine or urine that is foamy, fatigue, high blood pressure, weight loss, ankle swelling from retained fluid, anemia, nausea or vomiting. Kidney disease is often silent until late in the course and after severe damage has occurred.

My doctor told me I have weak kidneys, how do they know that?

Kidney function is most commonly determined by measuring the level of creatinine in the blood. The kidneys clean the blood and creatinine is a waste product made by muscles. As kidney function decreases the level of creatinine rises. One way to look at it is to think about your house and garbage collection. If you live in a city with daily garbage collection, very little trash will accumulate in your house. If the city cuts garbage collection to once a week, the amount of garbage that accumulates in your house will rise. If they cut back to once a month the level will rise even further. Kidney function is like the frequency of garbage collection and the blood level of creatinine is the amount of trash that accumulates prior to garbage day. The higher the creatinine is, the weaker the lower the kidney function.

What can I do to protect my kidneys?

Stop smoking, maintain a healthy weight, and exercise. Talk to your doctor about ways to adjust your diet. Other important aspects of kidney therapy are careful regulation of blood pressure if you have hypertension, and tight control of your blood sugar if you are diabetic.

What is the difference between urologists and nephrologists?

Nephrologists are internists and use medicines to treat patients, whereas urologists are surgeons that have specialized in the kidney, bladder and prostate. While urologists do use medicines to provide therapy they are uniquely trained to operate on the kidneys to correct various problems.

What is the best blood pressure for someone with kidney disease?

The Joint National Commission (JNC7) report on hypertension recommends patients target a blood pressure less than 130/80. Another panel of experts who specialize in kidney disease agree with the JNC recommendations except in patients with a lot of protein in their urine. They recommend more aggressive blood pressure reduction to 125/75.

Is drinking a lot of water good for the kidneys?

Despite widespread belief, there is no evidence that drinking 8 glasses of water is good for your kidneys. The one exception is patients who have recurrent kidney stones. In this population drinking water is among the most effective therapies to prevent the recurrence of kidney stones.

What type of tests does the nephrologist use to learn about my kidneys?

The most common tests are on the blood. Other blood tests are used to determine the cause of kidney damage or to look for problems resulting from the kidney failure. Nephrologists also use ultrasound to look at the size and shape of the kidneys. Ultrasound is the same technology used to look at fetuses in the womb. It is safe, painless and quick.

What are the risks of a kidney biopsy?

The most common side effect is some pain. Rarely patients can get an infection. The most serious side effect is bleeding. If the bleeding doesn’t stop on its own surgery will be required to stop the bleeding.

What should I do to get ready for my kidney biopsy?

Patients are allowed to eat prior to a kidney biopsy but since patients must lie on their bellies and often are nervous, we recommend eating only a very light meal. Since many medications increase the risk of bleeding make sure you give your nephrologists a complete and up-to-date list of your medications including over-the-counter medications such as aspirin or ibuprofin (Motrin™, Advil™). Aspirin, even a baby aspirin, can increase the risk of bleeding. All aspirin products must be stopped for one week before and three days after the biopsy. Patients on coumadin or Warfarin need special treatment to get a biopsy. If you take this medication make sure you tell your nephrologists prior to your biopsy.

What happens if my kidneys completely fail?

Patients whose kidneys have completely shut down can live productive lives for years using a renal replacement therapy. The kidney is the only organ that modern medicine has been able to successfully replace with long-term success. There are three types of renal replacement therapy: hemodialysis, peritoneal dialysis and kidney transplantation.

What is polycystic kidney disease (PKD)?

Polycystic kidney disease is a genetic condition that causes s large number of cysts to form in the kidneys. These cysts are filled with fluid and profoundly enlarge the kidneys. This change to the kidneys' structure causes reduced kidney function and eventually leads to kidney failure.

What is creatinine?

Creatinine is a waste product made by muscles that kidneys remove from our blood. The level of creatinine rises as kidney function decreases. Thus, kidney function is most commonly determined by measuring the level of creatinine in the blood.

What is peritoneal dialysis?

In peritoneal dialysis, special fluid is introduced into the abdomen through a plastic catheter in the abdomen. The fluid remains in the abdomen and draws excess fluid and waste products from the blood. After a prescribed period, the fluid (with the waste products) is drained and discarded. Patients repeat this process 3-6 times a day. Peritoneal dialysis is done by the patient or family member at home and requires some training.

How does high blood pressure affect the kidney?

High blood pressure (also called hypertension) damages the kidney's blood-filtering units so the blood doesn't get cleaned. Eventually, this type of damage can cause irreversible shutdown of the kidneys

What is Phosphorus?

Phosphorus is a mineral found in many foods. You absorb phosphorus into your bloodstream every time you eat. Phosphorous is used by muscles for energy and combines with calcium to form bones. Any excess phosphorous is removed from the blood stream by the kidneys and excreted in the urine.

What happens when blood phosphorus is too high?

Over time, a high PTH and high phosphorus can cause bone and blood vessel disease. This can cause bone pain, muscle weakness and broken bones. The blood vessels can harden and this may contribute to high blood pressure, strokes and heart attacks.

What are phosphate binders?

Phosphate binders are prescribed to patients that need additional help controlling phosphorus. Taken with every meal, these medications prevent the body from absorbing the phosphorus in food.

I was told that I need a kidney biopsy. What is that?

A kidney biopsy is done by nephrologists to determine what is damaging your kidneys. 95% of kidney biopsies reveal the cause of the kidney disorder.
A biopsy is a diagnostic test that involves collecting small pieces of tissue, usually through a needle, for examination under a microscope. The patient lies on her belly for the entire procedure, sometimes a pillow is placed under the belly to arch the back and put the kidneys in a more accessible position. An ultrasound machine is then used to locate the kidneys. Local anesthetic (lidocaine) is used to numb the skin and the surface of the kidneys. Then a needle is inserted into the kidneys and removes a tiny sample, called a core. Usually doctors need three of these cores to fully evaluate your kidney disease. The whole procedure usually takes less than an hour and most of that time is spent locating the kidneys and preparing the biopsy site to prevent pain and infections.
Following the procedure patients are monitored either for a number of hours or overnight. During that time the nephrology team looks for signs of bleeding or other complications. The final results are usually done by a week after the procedure.

Why are African Americans at increased risk for chronic kidney disease?

Diabetes (the leading cause of chronic kidney disease) and high blood pressure (the second leading cause) occur more often in African Americans than other ethnic groups. Many experts believe these groups may have an inherited tendency to develop these diseases. Thus, staying at a normal weight and getting enough exercise is very important for African American patients to help prevent diabetes and high blood pressure.

Tell me about hemodialysis.

In hemodialysis, the patient's blood is pumped from the body, through an artificial kidney and then returned to the body. The artificial kidney works by pumping the patient's blood through thousands of tiny tubes that are bathed in a special solution, called the dialysate. Waste products in the blood float across the tubes into the dialysate, purifying the blood.
In order for hemodialysis to work patients need a way to get blood out of the body into the artificial kidney and back in to the body. This pathway is called a "vascular access," or simply an "access." Patients must have a vascular access surgically placed prior to starting hemodialysis. Hemodialysis is generally done three times a week, and takes between three and four hours per session at a dialysis center.

 

 

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