Keeping Up with Your Kidneys

Transcription:

Joey Wahler (Host): What is kidney disease? How can you recognize its signs and how is it treated? We're discussing keeping up with your kidneys. This is Riverside Radio HealthCast, a podcast from St. John's Riverside Hospital. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Mark Samarneh, attending nephrologist for St. John's Riverside Hospital. Dr. Samarneh, thanks for joining us.

Dr. Majed Mark Samarneh: Thank you for having me.

Joey Wahler (Host): So first simply put, can you explain what nephrology is and what basically is the kidneys function?

Dr. Majed Mark Samarneh: Absolutely. So nephrology is a branch of internal medicine that deals with diseases of the kidneys and the kidneys have various functions in the human body. Some of which include filtering the blood and removing waste from the body. They also control some of the electrolytes of our bodies, such as sodium and potassium amongst others. They also help control blood pressure. These are just some of the kidneys' functions.

Joey Wahler (Host): Gotcha. So when we talk about symptoms of kidney disease and how you test for it, tell us about that.

Dr. Majed Mark Samarneh: Excellent questions. So as far as the symptoms of kidney disease, initially there may not be any symptoms. The kidneys do a great job at kind of maintaining homeostasis in the body, even when they don't work so well. But some of the symptoms that patients may present with are swelling in the ankles or in the legs. This is a term that we call as edema. Some patients may present with elevated blood pressure. Some patients may have swelling in their whole body. Weakness and fatigue are common symptoms. As kidney function worsens, patients may have decreased appetite, which can develop later in kidney disease. Foamy urine is another sign of kidney disease. And that's one of the things that is significant when there's protein in the urine. And of course, decreased production of urine. These are some of the signs and most common symptoms that patients have.

Joey Wahler (Host): And the way you test for that is?

Dr. Majed Mark Samarneh: Yeah. So usually we do urine tests and blood tests. So the blood test, we look for something called creatinine and that tells us, if it's elevated, that there's an abnormality in the kidneys. And we use a calculation called GFR, which tells us how bad the kidney function is. We also look at the urine in order to see if there's any blood spilling out of the kidneys or if there's any protein leaking out of the kidneys. And sometimes we require some imaging such as ultrasounds or CAT scans.

Joey Wahler (Host): Now, there are other diseases that are associated with kidney disease. What are some of those?

Dr. Majed Mark Samarneh: So some of the most common diseases that are associated with the kidneys would be diabetes and high blood pressure. For example, the leading cause of patients developing end-stage kidney disease and dialysis would be diabetes.

Joey Wahler (Host): So how do conditions like diabetes and high blood pressure affect the kidneys?

Dr. Majed Mark Samarneh: Well, the kidneys, they're what we call vascular organs. They have many small blood vessels in them. And when there's diabetes or high blood pressure, these small blood vessels are affected and they can cause protein leakage out of the kidneys, that can in turn cause more kidney damage. This is the essence of the problem in many of the kidney diseases. So controlling the blood pressure, controlling the diabetes many times will help control the kidney function.

Joey Wahler (Host): And you led me beautifully there, doc, because I was going to ask you next what does it mean if there's blood or protein in your urine?

Dr. Majed Mark Samarneh: So if there is blood or protein in the urine, it tells us that there is active kidney disease. It means there's something going on in the kidney that's causing this blood to leak out or the protein to leak out. Red blood cells in the urine usually signify. That there's a problem from the bladder or from the kidneys. And depending on the blood tests and the urine tests, it'll help us differentiate where the issue's coming from.

Joey Wahler (Host): How about the risk factors for developing chronic kidney disease? And how is that progression followed by a doctor?

Dr. Majed Mark Samarneh: So the risk factors for developing chronic disease would be uncontrolled diabetes, okay? Diabetes is typically followed by following A1c levels, blood sugar levels. If the diabetes is poorly controlled typically and there is kidney disease, it makes it harder for the kidneys to work. High blood pressure that's uncontrolled also can affect the kidneys in the long run.

There are other medications known as NSAIDs, which are very common, they're over-the-counter medications. These are non-steroidal anti-inflammatory drugs, such as ibuprofen or Naproxen. These medications when used frequently can tie in the blood vessels in the kidneys and essentially choke the kidneys. So this is one thing that will worsen kidney progress.

Poor diet is another factor that can worsen kidney progression and also recreational drugs, as some of the preservatives in these drugs can be toxic to the kidneys as the drugs themselves.

Joey Wahler (Host): How about a kidney biopsy? What is that exactly?

Dr. Majed Mark Samarneh: So many times in, for example, patients who have diabetes and have kidney disease, you know, we can attribute the kidney problems to the diabetes. However, depending on the blood work that we do and the findings that we find, we may need to investigate further. And the kidney biopsy is where we take a needle and we get a little sample of tissue from the kidney with the needle. And we look at it, we analyze it under the microscope to help identify causes of kidney problems other than diabetes and high blood pressure that perhaps we can treat; things, for example, such as lupus and diseases of that nature that have other treatment modalities.

Joey Wahler (Host): And what if you have cyst on your kidney?

Dr. Majed Mark Samarneh: Kidney cysts can be common in people. However, there are some diseases, a group of diseases called polycystic kidney diseases, where patients develop many, many cysts in the kidneys. And these cysts really distort the parenchyma of the kidneys and the structure of the kidneys and they worsen kidney function. Some of it is more aggressive and it presents earlier on in age. And there's a form that's a bit milder that presents later on in age. So if there is many cysts, we would be concerned for a disease called polycystic kidney disease. If it's an isolated one or two cysts, what we would do is typically follow them with ultrasounds to make sure that they don't change.

Not all cysts are cancerous and not all cysts are pre-cancerous. There are some variations in the cysts that may make them suspicious for a malignancy. And those, we would follow with further imaging. But some patients do get cysts along the way.

Joey Wahler (Host): How about medication? Which ones help treat kidney disease and do any of them harm the kidneys?

Dr. Majed Mark Samarneh: Yes. Excellent question. So as far as the medications that harm the kidneys, I previously alluded to NSAIDs, which are the non-steroidals. These are one of the major culprits for kidney problems that we have in the community, because people buy them over-the-counter and they think that they're safe to be used every day when they're really not and they should be used very carefully and in conjunction with the physician.

Now, as far as medications that help treat kidney disease, we have several. There's the ACE inhibitors and the ARBs. And this stands for angiotensin-converting enzyme inhibitor and the angiotensin receptor blockers. These are medications such as lisinopril enalapril, olmisartan amongst others. And what they do is they help decrease the pressure within a segment of the kidney called the glomerulus. The kidney's made up of many nephrons, which are functional units that filter the blood. And part of the nephron is called the glomerulus. These meds help decrease the pressure within the glomerulus. This in turn helps decrease the amount of protein that's spilling out. These medications also help decrease blood pressure. So they're very beneficial.

There's another group of medications called the SGLT2 inhibitors, and that stands sodium-glucose co-transporter-2 inhibitors. These are medications that were developed for diabetics. However, we use them in both diabetics and non-diabetics that have proteinuria. And these are very useful medications and the results are promising as well.

Joey Wahler (Host): When is a fistula or a shunt used?

Dr. Majed Mark Samarneh: So when patients have kidney failure that progresses to a very advanced form of chronic kidney disease, which would be CKD stage V, where the kidney function is less than 15%. And typically, when patients approach the 7% to 8% kidney function range, they need renal replacement therapy or a kidney transplant.

Now, renal replacement therapy, basically, it's a modality that would function as a kidney. So either we would do hemodialysis or something called peritoneal dialysis. Hemodialysis is when we take blood out of the body, clean it, run it through a filter and bring it back to the body. Now, we need a way to do this, okay? And the best way to do this is via something called an AV shunt, which is an AV fistula.

Now, as far as the AV fistula, it's a connection of an artery and a vein. It's a procedure that's done by a vascular surgeon. It's usually ambulatory, meaning the patient comes in in the morning, gets the procedure done and would leave later in the day. And what we do is we take a vein in the arm and reconnect it to an artery. The blood starts to shunt from the artery over to the vein. And the vein is what we use to access the body in order to get the blood out, clean it, purify it and bring it to the body. So that's what an fistula is.

As far as the other modality of dialysis, the peritoneal dialysis, that's a little bit different. With peritoneal dialysis, we use the blood vessels that are in the belly in the omentum. With peritoneal dialysis, we will instill the dialysate fluid into the belly, we'll allow it to sit for four to six hours, then we will empty it. This is called an exchange. Several exchanges are done over the course of a day and that's how dialysis is done.

So these are our two options for dialysis. The hemodialysis requires the AV shunt to be placed in the arm. This way, we can get blood out of the body, clean it and bring it back to the body. If a patient chooses to do peritoneal dialysis instead, we would put a PD catheter in the belly and take that modality on.

Joey Wahler (Host): Now, if none of the previous options work, when would you say is the right time for a kidney transplant evaluation?

Dr. Majed Mark Samarneh: So kidney transplant evaluation is a very important initiative that we highlight in all clinic visits when patients have advanced kidney disease. So I typically start to talk to my patients about kidney transplant when their GFR, which is that kidney function range, is about 30. And we refer patients over to kidney transplant evaluation when the GFR roughly is down to about 20 to 22.

Now, kidney transplant requires some work before it's done. There's a transplant list that the patient has to get on. And we have several clearances, for example, cardiac clearance, and making sure the patient has age-appropriate cancer screenings that are done. All these things have to occur before a patient goes onto the transplant list. So getting patients over to the kidney transplant team early on for the evaluation is very important. It doesn't mean if someone was sent for kidney transplant evaluation, that they're going to be going on dialysis right then and there. I send most of my patients for kidney transplant before we even get to dialysis. And it's the better thing to do because you accrue time on the transplant list before starting dialysis and the most optimal thing would be to get a kidney transplant before getting any dialysis at all, and that can be achieved by early referral.

Joey Wahler (Host): Certainly makes sense. Finally, let me ask you, can kidney disease be cured or not?

Dr. Majed Mark Samarneh: Well, it depends on the cause. So we've touched on a few things, mostly diabetes and high blood pressure and we can slow the progression by controlling them. However, there are many other diseases that can be cured. So previously, we had discussed kidney biopsy. So the reason we do a kidney biopsy is to find out if there's a curable disease.

So say for example, we did the kidney by biopsy and the biopsy comes back and there's a disease called minimal change disease. So this is a disease that presents with a lot of protein spilling out into the urine. And this particular disease, for example, has a favorable outcome and can be easily treated with steroids. So the answer to that is, yes, we can cure it and reverse the findings, but it depends what it is that's happening. And things like lupus, for example, lupus can affect the kidney and cause many different things in the kidney that are treatable. So the answer is it depends on the etiology or the cause.

Joey Wahler (Host): Understood. Well, folks, we trust you're now more familiar with how to keep up with your kidneys. Dr. Samarneh, thanks so much again.

Dr. Majed Mark Samarneh: My pleasure. Thank you for having me.

Joey Wahler (Host): And for more information, please call our physician referral service at 914-964-4DOC. Again, that's 914-964-4DOC. Or you can email at This email address is being protected from spambots. You need JavaScript enabled to view it. . Again, that's findadoc, D-O-C, @riversidehealth.org. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Riverside Radio HealthCast, a podcast from St. John's Riverside Hospital. Hoping your health is good health, I'm Joey Wahler.