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Nephrology 101: Kidney Disease

According to the CDC, as many as 30 million people are estimated to have chronic kidney disease.

Here to speak with us about kidney disease and the steps you can take to protect your kidneys is Dr. Eric Yan. He is a Nephrologist with Nephrology Associates Medical Group, and a member of the Medical Staff at Temecula Valley Hospital.
Nephrology 101: Kidney Disease
Featured Speaker:
Eric Yan, MD
Eric Yan, MD is a Nephrologist with Nephrology Associates Medical Group and a member of the medical staff at Temecula Valley Hospital.

Transcription:

Melanie Cole (Host): According to the Centers for Disease Control and Prevention, more than 30 million American adults may have chronic kidney disease. Many people are afraid to learn that they have kidney disease because they think that it leads to dialysis, however many people with kidney disease will not need dialysis. Here to speak with us today, about the steps you can take to protect your kidneys, is Dr. Eric Yan. He’s a nephrologist with Nephrology Associates Medical Group and a member of the medical staff at Temecula Valley Hospital. Welcome to the show Dr. Yan. So, give us a little physiology lesson. What do the kidneys do?

Dr. Eric Yan, MD (Guest): The kidneys do a lot of things. Many people think that they just produce urine, right, because we go to the bathroom and we urinate. But the kidneys actually not only help regulate water balance in our body, but they help regulate blood pressure, eliminate waste products, they actually deal with bone health, acid base balance, heart function with our regulation of electrolytes and probably finally, blood production. So, when your kidney function decreases, a lot of people get anemic.

Melanie: So, they are very busy organs. But what would be some of the most common causes of kidney disease and who would be at risk?

Dr. Yan: The two most common causes are very easy. Diabetes and high blood pressure are the two most common causes worldwide. At risk, those people with these medical issues as we age, that’s another risk factor. Sometimes taking some medications particularly, over the counter medications such as ibuprofen, Motrin, Advil, Aleve. These classes are known as nonsteroidal anti-inflammatory medications can put you at risk for chronic kidney disease.

Melanie: So, how would somebody even know and does early chronic kidney disease have symptoms that would send somebody to see a nephrologist in the first place or once you do exhibit some symptoms, does that mean that your disease is more advanced?

Dr. Yan: Yes, everything you said is true in regard to exhibiting symptoms and having advanced disease. Frankly, most people who come to me don’t even know why they are coming to see me, because they feel fine. And the only way we can tell how their kidneys are working is through blood tests. So, when you get these blood tests done either by your primary care doctor or by another specialist and they say hey, you have got kidney problems and they send you to see me; that is how we can detect any kidney problems, just by the blood tests. What we are looking at on the blood tests is something called the creatinine. So, that creatinine is just a marker that helps us tell how the kidney is functioning and as that creatinine level goes higher, this tells us that the kidneys are no longer filtering out this marker and that is how we know that the kidney is not working so well. By the time you are exhibiting symptoms of kidney disease you are fairly advanced in your disease state and when you have these symptoms, these constellation of symptoms, is termed uremia and that’s the time when we actually have to start dialysis for you. So, we rarely see people who present like this nowadays because the primary care doctor is so good at doing these laboratories and monitoring kidney function.

Melanie: So, if somebody is found to have protein in their urine, early on, would that signal a red flag as well?

Dr. Yan: That can, for sure. It is not normal for us to have a certain amount of protein in our urine and that number is anything greater than 50 milligrams. Beyond that, depending on how much protein you have in your urine, that can certainly accelerate your rate of kidney decline up to 15-fold, if you have several grams of protein in your urine. And a poor man’s way to see if you have a lot of protein in your urine is when you urinate in the toilet, and you see it get really foamy, that can be an early indicator that you have a lot of protein in your urine.

Melanie: Dr. Yan, if you determine that someone has some sort of kidney disease, whether chronic or new-found, what’s the first line of treatment?

Dr. Yan: First line of treatment depends on what is causing the kidney disease. So, oftentimes, people will come in and say you know I drink a lot of water, or someone told me to drink a lot of water and that will help my kidneys and I just explain to them, well that will help if that’s the cause of your kidney disease. So, for example, if you have been running a lot or lost in the woods and dehydrated and your kidneys are suffering from that, yes, the treatment is drinking fluids. However, as we alluded to earlier, the two most common causes of kidney disease are diabetes and high blood pressure. So, if someone presents with those problems, with kidney disease, the treatment for that would be controlling the diabetes and controlling the high blood pressure. So, it just depends on what the etiology of the kidney disease is.

Melanie: Does what we eat in our diet have any effect on kidney disease, whether bad or good, because we have talked about blood pressure a bit, so is sodium content or fat in foods; do any of these affect the kidneys?

Dr. Yan: Sure. All indirectly, though. I would not say that diet will directly affect your kidney function. So, again, going back to what is causing it, if diabetes is causing it, yes, you want to stick to a diabetic diet. If high blood pressure is causing it; yes, you want to stick to a low sodium diet and a diet high in fruits and vegetables. Protein restriction is kind of a hot button topic in regard to kidney disease. If you ask ten different kidney doctors, you know five will tell you one answer, five will tell you another answer. But protein restriction, I would not recommend a very low protein restriction to help your kidney function. If you are going to restrict your diet, I would not recommend anything less than 0.8 grams per kilo to help your kidney function and only if you do not lose protein in your urine.

Melanie: So, when does it get to the point where if their blood pressure is not adequately controlled or their kidney function is starting to see some failure; when does it get to the point of dialysis?

Dr. Yan: Well dialysis is based on symptoms, really. So, number one we are looking at your laboratories to see if you even qualify for dialysis and what that means is if you have a kidney function low enough and that is less than 15% and that would put you in stage 5 kidney disease. Once you are in stage 5 kidney disease, it is not like you cross this imaginary line and we put everyone on dialysis. But what we are looking thereafter for is symptoms of uremia as we discussed earlier. So, these symptoms can be fairly vague. It can be things such as fatigue, mild confusion, but most commonly, people start feeling really nauseated because the toxins are building up, food tastes funny. I will have oftentimes patients say heh, the food is tasting metallic. Sometimes patients often give off an odor with the toxins actually seeping through the skin. So, these are the times when we actually start dialysis. Another time, if you are not having symptoms, but you are in stage 5 kidney disease, again your percent function less than 15%, if your electrolytes are getting very abnormal and we cannot control it with medications, such as your potassium going very high. That’s not good for the heart. Or your acid base balance getting too acidic, not good for your bones. These are another indication of when we would start dialysis.

Melanie: So, is kidney disease a progressive disease? Can they get better? Can they get stronger?

Dr. Yan: Generally, it is progressive. Just like a machine, our parts also deteriorate as we get older. A rule of thumb is after age of 30, we start going down on our kidney function by a percent a year. So, we do expect some natural progression to the kidney disease. That being said, there are some things that can accelerate this progression; the main thing being protein in your urine. If you are a smoker, smoking can accelerate it as well, uncontrolled blood pressure, uncontrolled diabetes. In terms of reversing it; our goal really is to try to stabilize it. Very few times can we actually reverse kidney disease. If it is an acute issue, we can certainly reverse it. If it is an autoimmune issue, this is actually one of the very rare instances where yes, we can also reverse it if it has been present for some time. But this would need very potent medications, often chemotherapy related medications.

Melanie: So, give the listeners some ways to really manage their kidney disease and or steps that they can take to protect their kidneys in the first place.

Dr. Yan: Yeah. So, I think the first thing is to ask your doctor if, ask your primary care doctor if you even have any kidney problems. Because most patients may not even know because it is not something they regularly discuss with their physician. And then if they do, and if anything stage 3 or beyond; then ask if they should see a kidney doctor. And if so, that’s when the kidney doctor can help, shake the tree to see exactly what’s the cause of the kidney disease and depending on what the cause is, treat the underlying cause to really stabilize it, preventing it from getting worse faster than it should.

Melanie: And then wrap it up for us, what you would like people to know about kidney disease and when it might require transplant. When does it get to the point where dialysis is really something that the person doesn’t want to be on every day, whether it is because it’s not home dialysis or because it is becoming very inconvenient or their kidneys just can’t handle it anymore?

Dr. Yan: Well, I would recommend transplant to everyone who is eligible for transplant in today’s world. You know transplants are over 90% successful now and ideally, we would love to transplant every patient before they get on dialysis. But with how many people who have kidney disease and the need for kidneys unfortunately, that is just not possible. So, if your kidney function is less than 20%, and you meet some basic requirements for transplant, these basic requirements I would say are age related as well as other comorbidity related such as advanced heart disease or chronic infections or cancers, I would advise everyone to look into transplant. And if that is not an option for you, and we do have to do dialysis; I would always recommend home dialysis as the modality for the patient. It is just better quality of life, much more independence, much more freedom with diet whereas if you are in-center, you are much more restricted in terms of where you can go for dialysis, what your diet can be, how much fluid you can intake.

Melanie: And tell us about your team at Temecula Valley Hospital.

Dr. Yan: Oh, our team is great here. I mean we have five nephrologists that go to Temecula Hospital to take care of the patients there. We see the patients, day and night and if you get transferred out of Temecula, then our group is fairly large and everyone in our group can see the notes that we write in the hospital and outside the hospital so your care is fairly seamless.

Melanie: Thank you so much Dr. Yan, for being with us today. You’re listening to TVH Health Chat with Temecula Valley Hospital. For more information, please visit www.temeculavalleyhospital.com . That’s www.temeculavalleyhospital.com . Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.