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Your Kidneys Your Health

Columnist: Sal Iaquinta, M.D.
September, 2019 Issue
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Sal Iaquinta, M.D.
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Stevie Wonder created a media stir this summer when he announced he was halting his tour to have a kidney transplant. Then, adding mystery to the surprise, he didn’t tell us his diagnosis. Odds are, Mr. Wonder has a case of chronic kidney failure. Kidney failure can occur acutely, but many of these conditions are things that require quick treatment and involve hospitalization.

Kidney failure involves one of three mechanisms—either direct damage to the kidneys, something causes decreased blood flow to the kidneys, or something prevents urine from exiting the kidneys. Infections, damage from drugs, or trauma can cause direct damage. One of the dangers of aspirin or ibuprofen overdose is that it causes inflammation of the filtering elements of the kidneys. Blood flow to the kidney can be caused by severe dehydration, heart failure, massive blood loss, sepsis, and some medications can prevent blood from flowing to the kidneys. Lastly, urine outflow can be blocked by a large prostate gland, kidney stones, or tumors that block outflow. Obviously some of these causes can overlap. Kidney stones can be caused by chronic low-grade dehydration.

Symptoms

Kidneys are incredibly efficient and can compensate for slowly accumulating damage without causing any symptoms. Given that Stevie was touring when he made his announcement, he probably does not have an acute cause of kidney failure. Some of the acute problems, like a large prostate, can contribute to kidney damage chronically. However, the most common causes of chronic kidney failure are far more insidious as they typically have no symptoms.

The two top causes of chronic kidney failure are diabetes and high blood pressure, with diabetes accounting for more than 40 percent of the cases of kidney failure in the U.S. What’s more, diabetes and high blood pressure account for about two-thirds of the cases of chronic kidney disease. Currently, 20 million Americans have kidney disease due to these two diseases. People can have both for years, even decades, without significant symptoms.

High blood pressure is best diagnosed by a test, rather than waiting for symptoms to arise. A few years ago the threshold for high blood pressure was lowered to 130/80. The number was lowered due to studies that show people with a systolic value between 130 and 139 have double the risk of heart attack, stroke, heart failure, and kidney failure, compared to people with lower blood pressures. Everyone should know where their blood pressure runs and then modify their diet, or take medication to control it. It’s one of the easiest diseases to treat as most people can find a daily medicine that has minimal side effects.  

Diabetes is more work to control. The kidneys filter our blood all day long, making urine at a rate of about a milliliter per minute. Excess blood sugar damages the filtering capability of the kidneys. It requires constant vigilance, and often medications, along with a carefully chosen diet to control diabetes.

The signs of kidney failure are initially subtle. Urine output decreases, but sometimes, counter-intuitively, there can be an increase of frequency and urgency to urinate. Arms and legs can swell due to retained fluid. People feel fatigued. There can be increase bruising and itchy skin.

Kidney failure

Once the kidneys fail, there are only two choices of what to do. Dialysis is a synthetic kidney. It requires hours of filtering blood, usually three times a week. It is a lifesaver for certain, but it doesn’t function as well as a real kidney.

The alternative is a transplant. Currently there are about 500,000 people on dialysis and 100,000 people on the transplant list. The average wait for a deceased donor kidney is about 5 years. Living donors can be faster, however there are only about 6,000 living donor kidney transplants done per year. Deceased donors account for about 12,000 transplants per year. Keep in mind deceased donors can donate both kidneys, so of the 2.8 million people who died in 2017 in the U.S., only 6,000 of them donated their kidneys. We can do better—about 5,000 people per year die, while waiting for a kidney transplant.

Despite a severe shortage of donors, it has been found that earlier transplant is better for patients. Transplant patients live longer than dialysis patients and have more freedom as they don’t spend so many hours going through dialysis. Typically, recipients feel great as for the first time in years the waste in their bloodstream is being adequately filtered. All of this means we hope see Stevie on tour again soon and hopefully his story will motivate his fans to register to be an organ donor at www.organdonor.gov.

The best thing you can do as a future organ donor to keep your kidneys healthy is to stay hydrated and keep your blood pressure and blood sugar in check. It’s that easy, they’ll take care of the rest.

Salvatore Iaquinta, M.D., is a head-and-neck surgeon at Kaiser Permanente. He is also the author of The Year They Tried to Kill Me.

 

 

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