Kidney Disease What You Should Know UCLAMDCHAT Webinars

welcome everyone to the webinar today the topic is kidneys what you should know my name is Angie Rastogi I'm a kidney specialist and I'll be going over some information about kidneys and how first of all how you can be involved in your own care and and some other things that you can do to keep your kidneys healthy so with that there will be an option of asking questions as we go along and at the end time permitted I'll try to answer as many questions I can and if I not able to answer questions we'll try to post them on our website as well so with that let's get some information about kidneys as you probably know we have two kidneys they are actually in the back they're below your ribcage ninth 10th and 11th ribs and the size of the kidneys the longest dimension is about 11 centimeters so if you nine to 11 from here and we do look at kidney size when we're looking at the disease states now these these the two kidneys act as filters and they filter your blood the ultra filtrate which eventually becomes urine passes through these two tubes are shaped structures called ureters and and then this urine eventually comes into this bladder and and it stayed here for some time till you urinate and then when you urinate it will come out as as urine so that's that's and this is a cross-section of the kidney the kidney cut open I will be going over that in a bit more detail as well so what your kidneys do so kidneys are very active complex organ one of the most complex organs in your body and they do a lot of functions and lot of things so we normally think of them as the organs that that make urine but it's actually more than just making urine they get rid of waste products they actually involve in acid-base flowed and electrolyte balance as well they're involving drug clearance so along with liver kidneys are one of the main organs that actually process and get rid of drugs and this is important to know because if your kidneys are not working at at full capacity then if the drug is cleared by the kidneys then you have to dose it appropriately and your pharmacist and your physician should be able to tell you that at what dose but if they don't please do let them know that your kidney function is actually not not at full capacity and we'll need to adjust the dose the other function that kidneys do is what we call the hormonal functions so kidneys are involved in a lot of hormone functions one is vitamin D processing so vitamin D that you ingest is actually not active and and it has to go to the kidneys to become active so if you're kidding on working properly then no matter how much vitamin D you take it will not do its work and sometimes you have to give artificial vitamin D which we call active vitamin D they're also involved in blood cell production especially red blood cells so there's a hormone called erythropoietin that's that synthesized by the kidneys and acts on bone marrows and causes RBC production that's red blood cells and if you're keeping a lot of working properly the this hormone goes down and these patients tend to become anemic so anemia is one of the manifestations of chronic kidney disease and the third hormone function that that kidney that involves blood pressure many maintenance so there's a hormone called renin that's synthesized by the cells in the kidneys and it's very central in maintaining blood pressure in the humans so these are some of the functions of the kidneys these are important to keep in mind because when your kidneys don't work properly all these manifestations will come forward now this is a cartoon of a nephron so the nephron is a structural and functional unit of a kidneys each kidney is made about of a million nephrons now there's a term I call myself as a kidney specialist but there's another term that we use for ourselves called the nephrologist so nephrology is the same term as a kidney specialist and and the term comes from nephron we're also called Rina specialist so these are terms used interchangeably renal nephrologist and kidneys so let's look a bit more into the nephron these are blood vessels this red one is the artery this is the vein and this pumps blood into this cup shape structure called glomerulus now the blood vessels are important kidney them of the most vascular organs of a body which makes sense because kidneys act as a filter for the blood but 25 percent of what your heart pumps goes to the kidney so that's a significant one 1/4 of what well it pumps so now why is that relevant if there is not working properly kidneys do get affected so one of the major causes of kidney dysfunction is heart problems so I think that's as important fact to keep in mind the other point that I want to mention over here is this cup shape structure called glomerulus so this is a filter like I mentioned kidneys act as a filter so the filtration happens at this cup shape structure called glomerulus the ultra filtrate then passes through the different segments of the nephron is gets processed and eventually comes out here as urine now here I want to mention is a test that we do for kidney function called GFR which stands for glomerular filtration rate so the term Romero is over here the filter and the filtration rate is how good the kidneys are filtering so that test is is a the best overall Assessor how kidneys are working so it's called GFR and I'll be going over that when we discuss some testing that we do for kidney disease now how do you know that you have kidney problems so you can have different manifestations one is you could have swelling you kind of swelling your face you can have Salling your legs you can have back pain like I mentioned the kidneys are in the back below to 9:00 to 10:00 to 11:00 ribs so if you're complaining of back pain one of the organs that we do look at is if the pain is coming from the kidneys you could have blood in the urine so so a bloody urine is a sign that there might be a problems with the kidneys the other important thing is you can have decreased urine formation frothiness of urine so faulty the view is also important it could happen for a lot of reasons but one of the things that can lead to increased frothiness is protein now this filter that I mentioned tries to retain all the good stuff in the blood and that includes protein so when the filter is not working properly a lot of these protein spills over and this protein in the urine we we use as a marker of kidney disease and we actually follow that on a regular basis to see how one is responding but the most important thing is most of the kidney disease is is asymptomatic it's silent and I think it's a very key point so so the sometimes the only way you can find out that you have kidney problem is by doing a simple blood test or urine test and sometimes even an ultrasound so so this herein lies the importance of your annual checkup so even though if you are having symptoms you'd have your simple blood test simple urine test as every year now how do you assess kidney function like I mentioned its asymptomatic so so in most of the cases so you might not even show symptoms and might even not know there were kidney problems and this is important because early diagnosis and treatments critical so if you find out kidney disease early you can actually revert it but if it's more advanced then it becomes very problematic so a simple blood test a urine test and imaging studies like a simple ultrasound and if needed we do a biopsy in which you take a small chunk of the Gideon tissue and look it under microscope and do different kind of testings on it now in the blood test there is something that that we focus on is called creatinine so creatinine is is comes from creatine it's it's it's actually not toxic but it's a marker of kidney disease and as your kidney function declines you're creating goes up now from the creatinine we check GFR so this is the global filtration rate and this is probably the single most important test that we do for kidney disease and then we check urine test for protein especially so we check you in for any blood any any red blood cells white blood cells but also for protein and and you probably have heard a term called albumin so albumin is a specific and a special kind of protein and we do that on a routine basis whenever the patients come and like I said if needed we do imaging studies and do biopsies so if your kidneys are injured what happens so broadly there are two kinds of injuries one is acute and the others chronic and today I'll be going more with a chronic problem at an acute the acute is you have an insult hopefully you catch it early enough and and since it's an acute there is a pretty good chance that you can recover the kidney function if the insult is removed and you take care of the kidney injury but in the chronic it's a bit different it's like your progressive disease and the goal here sometimes is to just to slow down the progression and hopefully treat that as well but but it's it's it's slowing down the is is our big focus so we spoke about the kidney size we spoke about the so this is how your healthy kidney should look like it's it's about nine to eleven centimeters it's smooth surface now when the kidneys are our disease they tend to get shrunken they get small and the surface gets a bit granular there are a few exceptions to this and one is called polycystic kidney disease in that the disease actually get bigger but those are one of the few exceptions but in most of the chronic diseases that can instant to shrink and get smaller in size this is how we define chronic kidney disease so if you have any abnormality from the kidneys whether it be a low GFR whether it be blood and new urine whether it be cysts whether it be protein and if you have any evidence of this for more than three months that's the cutoff then then you will be qualified and classified as having chronic kidney disease now this slide is important and and here I just want to focus on a few things so when we talk about you know not too long ago there were two big groups of kidney patients for chronic disease at least the dialysis and the pre dialysis and and that actually is not a good normal teacher because what what the Assumption we we are making by calling them pre Dallas's is that they're going to end up on dialysis and our goal is to prevent our patients from getting on dialysis or transplant so what are we can do so we so so this is now called CKD stages so there are five stages starting from here your GFR is normal that is above 90 and then a stage 2 stage 3 stage 4 and this is stage 5 this used to be called ESRD and stage renal disease but now it's called CKD stage 5 and in this stage our goal is to make sure that we have the right options for the patients whether it be the abscess or transplant and provide the best care we can so one thing that I would like you guys to do today is look at your labs look at your creatine look at UGA far and see what stage you fit in because the the management depends upon which stage you're here so if you're in the early stages like stage 1 2 3 and even early for our job or our goal is to to number one slow down operation and hopefully treat it but once you get into stage advanced 4 & 5 our goal is actually to make sure that you have the right replacement therapy which might be dialysis or transplant so it depends upon what stage you're in and also the complication that happened with kidney disease depends upon which stage ons well so now let's look at some of the things that can act with damage your kidneys high blood pressure and diabetes are the two most common causes of patient ending upon dialysis in the US and the Western society they account for more than thirty to seventy percent of all the cases the third one which usually has a very big center is called PKD polycystic kidney disease and that's a third most common cause of patients ending up on dialysis about five to ten percent patients with five to ten percent patient's would end up on dialysis actually have PKD as a cause drugs and medications are actually a very important cause and these are both prescribed and non prescribed medications and I'll be going over that in my next slide in a bit more detail smoking is always a cardiovascular risk factor and what's what's bad for your heart is bad for your kidneys and I think that's a very important and they and the flipside is true as well what's good for your heart is good for kidneys when people say what can I do to improve my kidneys gonna think that we tell them is to improve your cardiovascular status which includes diet exercise and all the good stuff that you want to do infections can affect we have Hep B Hep C and any kind of infection can actually and then a lot of immune problems we have gloom and affright is all this so this is summary but as you can see the the big hitters are the first four ones and actually can put the heart problems as well but high blood pressure diabetes and polycystic kidney disease account for a good chunk of patients ending up now drugs and medications are very important you know they have a purpose my other degrees in pharmacology I'm a pharmacologist by training as well and I always tell my patients to go over their medication list in a lot of detail because all these medications can have potential harm so when we prescribe a medication to a patient it's always a risk versus benefits and the benefits have to outweigh the risk but sometimes you put on medications that you probably don't need now also the other assumption is if the drug is over-the-counter it is it is safe and that's actually not true a lot of the drugs that are over-the-counter or actually can be potentially very toxic not just kidneys but other organs as well so the first one is the drugs that we commonly use for pain or fever call the non-steroidals and this is a whole big class that includes ibuprofen motrin Aleve naproxen so basically any painkiller besides Tylenol that's over-the-counter probably belongs to this this class and this class of drug is potentially harmful to your kidneys is harmful to your heart and also blood pressure so so we actually try to minimize as much as we can a short course is okay but long term is is definitely puts you at higher risk and you should definitely talk to your healthcare provider about these medications the other one that has gotten a lot of attention is called PP eyes these are the proton pump inhibitors these are class of drugs that you take for acid and and if you look at the label there's always it's for a short term unless your healthcare provider gives you it for a longer course so if you're in any of these medications there's a whole bunch of them make sure that there is a good reason why you're taking that because there have been some associations at least that we know between kidney disease and other disease and organs and and this class of drugs so PPI is is a very big class of drug that you have to be careful herbal supplements and a lot of my patients bring their herbal supplements and they said can I can I take it and and my answer to them I don't know because I don't know what's inside them I don't know what what they do so if I'm giving giving you advice I basically not telling you based on what I know and just just trying to to to speculate so so the short answer is be very cautious or anything any herbal supplements there's actually a disease called Chinese herb nephropathy it's actually a disease condition that has happened with some of these herbal medications also these herbal supplements can have have agents or compounds that cause drug interactions so that's also something important to keep in mind we talked about real dosing so so if the drug is cleared by the kidneys and and your kidney is not working at full capacity then the dose has to be adjusted and your pharmacist and your physician should help you with this the other thing that I want to go over is contrast especially the contrast the intravenous contrast so when you do a cat scan CT scan or do angiograms like a cardiac angiogram they inject dyes in here and these dyes have potentially toxic to your kidneys so number one they you should you should try to avoid them as much as you can but if if there's no way to avoid them then then make sure that that your healthcare provider takes due precautions which includes hydration and some of the stuff and minimizing the amount of dye they put in to minimize the toxicity the other one is MRIs the gadolinium contrast that we use so the GAD contrast with with MRIs it's not that much talks through the kidneys but it can cause other problems so if your kidneys are not working properly then you should be very cautious about getting any intravenous contrast with MRIs so once again talk to your radiologist and talk to your nephrologist and healthcare providers what you can do and is it absolutely needed now if your kidneys are not working properly and CK D stands for chronic kidney disease what can happen as I mentioned Epogen is is or a literal protein synthesizing the kidneys the these patients tend to get anemic and they also tend to get iron deficient most of the patient with kidney disease when they become iron deficient it's because they can't absorb iron properly and in these cases we tend to give iron intravenously and what you should check for is and they actually I'll be going with this bone mineral disease malnutrition acidosis cardiovascular disease and hypertension so so let's talk about high blood pressure you should ask your physician what is the goal of your blood pressure is it 140 over 90 is 130 over 80 different patient's have different goals based on the age depend from comorbid conditions but that's the first question you should ask the second thing is the if you think about it the blood pressure readings the the clinic readings are the worst reading you can have the best readings short of the 24 blood pressure monitor is home reading so I strongly most of our patients have blood pressure monitors they're not that expensive you keep them at home and you can check just but just make sure that you know how to take blood pressure properly and if you have any questions you're more than welcome to email me the drugs ACE inhibitors AR B's that's a class of drugs that we prefer salt intake a big culprit and blood pressure and most of the salt is a hidden salt that you don't are not aware of when you go out or or it's in preservatives that's something that you have to be extra cautious about as well so blood pressure control is very important we spoke about anemia iron check your hemoglobin check your your iron status and if you are deficient then your physician or nephrologist will help you get the other point that I do want to mention is which I didn't is when do you refer the patient to a nephrologist as early as you can but specially if you're an advanced stage 3 and definitely by stage 4 you should be seen by a kidney specialist bone disease is highly prevalent so when we say a patient has kidney disease there are two other things that they have bye-bye-bye association one is a heart problem and the other is bone disease and two to monitor your bone disease we check vitamin D levels which are calcium phosphorus and a hormone called PTH parathyroid hormone is also checked and and once again your kidney specialist will be going over these so the reason why I mention all these labs is you should actively follow these labs and I always tell my patients is to get a printout or you can go to my UCLA health and look at the labs and trend them so trends are more important sometimes than absolute values and see and then ask your your health care provider ask your kidney specialist what these labs actually mean so getting more involved in your your own care now acid load the important point over here is that the kidneys get rid of acid and in the kidneys don't work properly as it tends to build up our Western diet that high is high meat tends to have a much higher acid load and this acid load has read negative consequences on your overall health so you have to make sure that you're not and this is not the this stomach acid we're talking about this is the acid in your blood and you have to make sure that that that is taken care of and the the lab that we check for is called the bicarbonate and it's it's TCO 2 if you look at your chemistry panel and the magic number is 22 or above so we definitely want this TCO 2 or serum bicarbonate levels - b22 - and that's one of the single most important thing you can do to do actually - to minimize the damage caused by kidney disease is to make sure the acid load does not build up and this I'll go back to the plant-based diet the animal-based diet is is puts a big acid load on your body so and and and the and the plant-based diet is actually much better in that case electrolytes we should attack potassium most of the kidney patients tend to run high potassium level which cause hyperkalemia but also you have to keep in mind some patients actually might have low potassium and low potassium can be equally bad as high potassium so so you have to make sure that that your potassium is within the normal range and the normal range depends upon your lab so it should not be too low and it's not be too high you should also mentor in sodium calcium and and phosphorus so calcium and the other other electrolyte as not mention over here is magnesium that also should be should be checked on a regular basis fluid we talked about water now here a point that I want to make is so we normally talk about fluid restriction and water restriction but what's more important is salt because salt when you eat too much salt it does two things number one salt tends to retain water in your body and the second thing is that salt excuse to miss thirst so we will drink even more water so so I tend to focus more on salt than limiting water restriction but once again this you should talk to your health care provider and see what guidance they're giving you as far as how much fluid you can drink the other question that we get asked a lot about is clinical research and studies there are a lot of disease states that that don't have a disease specific drug and for that we do a lot of studies UCLA is is a prime site for clinical studies and if you're interested in doing one please do reach out to us if my office is doing a study we can we can see if you qualify if our office is not doing the study but the other studies going on we can connect you with them and and these research studies have the unmet need they advance the field these all these studies are reviewed and have to be approved by you surveys IRB which is an institutional review board and also by FDA and and some of the things that that people don't realize because thing that there have been guinea pigs but they these drugs are once again risk versus benefits and the hope is that there's much more benefit than risk with these drugs and also the care that they get in clinical trials is always exceptional and at the end you're also giving back to society because a lot of drugs are on now somebody went through these clinical research and studies so to summarize the the care that that a kidney patient should get the first one as dr mentioned at the top is is early detection of chronic kidney disease so that that's early diamonds in treatment and in most of the cases it's by simple blood tests and urine tests so getting that done on a routine basis once you you have the diagnosis then the key goal is to delay progression slowing down progression you add drugs like ACE inhibitors blood pressure control blood sugar control protein adequate amount of protein we want to prevent any complications we talk about anemia bone disease acidosis malnutrition treat the comorbid conditions whether it be heart problems vascular disease diabetes and if you've done everything you can and you still advanced then we prepare them for what we call our RT which stands for renal replacement therapy and here we sit down with the patient and give them their options both dialysis and transplant and including living donor transplant and home dialysis so so these are things that we go over in detail with the patients so they have but this takes time and and we want to make sure that this is not something they we rush into now how to keep your kidneys healthy diet is very important eat eat the right diet healthy diet no fried food and stuff like that but also a plant-based diet has been shown over and over again to be more kidney friendly than something that's more meat based water intake is very important and the kidneys don't like to get dehydrated so so talk to your physician if your kidneys are working properly you should drink drink in a fluid but if they're not working properly then talk to your physician and see what what is the right amount of water that you can drink exercise smoking should be inhibited blood pressure and diabetes management very important a healthy heart and then obviously be careful about the medications you're taking because some of these medications can be very toxic to your kidneys now if you're interested in getting more information about transplantation including living kidney donation UCLA is is a very big transplant center if you're interested in home dialysis then then and that's the the other thing that that usually is very big in if you're interested in clinical research and last but not the least if you're interested in supporting the core kidney program in any capacity doing outreach with us please let us know we'll be very happy to get you more involved in in our program this is our contact information this is our website the useful slash core kidney this is our email core kidney at midnight dot UC dot edu and this is a phone number so we'll be very happy to help you and support you in whatever we can and this is what our website looks like as you can see there all the clinical programs the PKD Center the Health Fair our expert team you can ask questions here as well so you can go to this website ask questions and we'll try to get back to you in a reasonable amount of time and this is a core PD website again so in summary learn more about kidneys so you can be your own best advocate be an active participant in your care let us know what you would like to hear more do give us feedback and support our programs as much as you can and I'll end this with a line that I've run in medical school your eyes see what your brain knows and and what you don't know much hurt you and knowledge is power so with that I'll end my talk in I know there's some questions and I'll be very happy to answer them so so the first question is days frequent urination should I be concerned and the answer is is if you're drinking a lot of fluids so if you're drinking a lot of fluid then you you will be you know going to the bathroom a lot but if you're not then then it's important that you let your healthcare provider know now here the the problem might not will be the kidneys it might actually be the bladder or even below that so this definitely needs to be addressed and it's also not how frequent are you actually also have some problems in the urine so a urine test and sometimes this comes from either bladder irritation or bladder infection so those things should be ruled out the next question is interesting is is any alcohol always bad for kidney kidney health tips so the way I answer that is if you don't drink alcohol don't start drinking it there should be no reason but if you do like a glass of wine here and there then it's not a problem if some people say it's like you might be good for your heart and good for kidneys indirectly so that should be okay but anything in excess is bad so and and especially if they dehydrate you the other thing that can happen with too much alcohol is liver problems and liver then indirectly affects the kidneys as well so the short answer is that limit alcohol intake as much as you can it also gives you extra calories the next question some drugs create high potassium can you elaborate more what we should do as there are some drugs that actually some of these drugs are actually beneficial so that's another great question so the drugs that that I think they talking about over here is drugs called ace in a bit of a arby's and your Tencent receptor blockers those are as as nephrologists one of our favorite drugs all of our patients are on those drugs unless there's a good reason so the drug class once again is ACE inhibitors and a arby's but one of the things that can happen with these drugs is high potassium so what we try to do is is if they're high potassium we do want to maintain or keep them on the medication because the benefits are really humongous so so we try to bring down potassium through through diet we also give them diuretics some of the macular potassium there are also potassium binders that you can put them on so we try everything that we can to two minute to bring down the potassium and keep them on the medication and I could titrate them adding up because most of the benefit of these drugs is get at the higher doses so the short answer is that if you're having high potassium on these drugs then talk to your physician and see if there are other things that you can do to bring down the potassium rather than discontinuing and the last resort is always taking you off these or down tightening their medication which I press you don't like and most of the experts in this field don't like it either but if that's the only choice left and we have to do that next question how often should I see my getting doctor so if you are being being to a kidney specialist that means there is some kidney problems unless the kidney specialist sends you back saying there is no kidney issue so if you have some kidney problems then at the minimum you should be seen every year one and all checkup but but after that it depends upon what stage you're in so I mentioned stage 2 3 4 5 and and if yours definite stage 5 you should be seen very frequently almost every month if you're on stage 4 you can be seen every couple of months depend upon what what the issues are so so the frequency will depend upon your stage once again that that underlies the importance of of the kidney stage you're in at what kidney stage should I be referred for a transplant another good question so this and the other thing that I would add over here is at what stage should I be sent to for evaluation by a dialysis unit so for both of them I would say when your GFR so once again the important of lab tests when your dfi is below 20 I refer my patients automatically both through the transplant program and to the dialysis unit the whole thing is planning and our goal is to give you as much information as you can and you can talk to all the healthcare teams and make a decision that suits best your needs so I think that's that's where we're where this early referral comes in now when you get a transplant depends upon a lot of factors if you don't have a living kidney donor then then you probably will need to go on dialysis and and and wait for a few years at the minimum before you get a transplant if you have a potential living donor then then you can actually even bypass what we call pre-emptive kidney transplant and if you have any questions about how to approach for living kidney donor I'll be very happy to to to talk to you or my team and also we have other past living kidney donors that also would be very happy to help you out okay the next question is is a very good one what does the green ribbon stand for so I'm glad this question was asked so we all know pink ribbon stands for breast cancer so green ribbon and some of them are very good friends brandy and and Ravi and a lot of others as well started as green ribbon campaign and and the purpose that winner been campaign is to increase kidney awareness like I said kidney disease is silent most patient's don't even know they have kidney problems and you had to be proactive about that so the purpose of the green ribbon campaign is to increase kidney awareness and to provide support to our kidney patients and and that's a big part of the poor kidney program and the last question that I'll be taking today is if my donor has a different blood group can he still donate and the answer is yes so in the past blood group was important but now we actually have something called paired exchange and you probably have seen these chains so the blood group as long as the kidney donor is is actually healthy enough a donate the blood group should not be a factor they might not be able to go into you directly but they can indirectly donate you and you'll get the same benefit so with that I think my time is up and thank you very very much for joining me in this webinar we have a few more coming up and if there's any questions you have my contact information please email me visit our website and also join our core pd program thank you very very much for joining the webinar today [Music] you