Learning about chronic kidney disease and how to keep kidneys as healthy as possible
By Alison Stanton
As we get older, our kidney function will naturally begin to decline.
“After the age of 40, kidney function will commonly decrease, due to the loss of kidney cells called nephrons,” says Mandip S. Kang, M.D. FASN, a nephrologist with Southwest Kidney Institute and author of the Gold Award winning book “The Doctor’s Kidney Diets.”
In addition to age, Dr. Kang, who is affiliated with nearby Banner medical centers, says a number of health conditions can also negatively impact the kidneys.
“Diabetes is the No. 1 cause of kidney disease in the United States, and high blood pressure is second,” Dr. Kang says, adding that an acute type of nephritis called glomerulonephritis can also cause chronic kidney disease (CKD), along with urinary tract infections, blood infections, smoking and undergoing certain medical procedures like angiograms and surgery.
“We also tend to see more chronic kidney disease in certain races, including African Americans, Pacific Islanders, Asians and Hispanics.”
In order to measure kidney function, Dr. Kang says he uses an eGFR, or estimated glomerular filtration rate. This is a computerized number that shows how much volume the kidneys can filter each minute. A healthy kidney should be able to filter 120 ml/minute, he says.
According to Dr. Kang, CKD is divided into five stages. In stage 1, patients will have a GFR of 90 ml/minute or higher, along with some evidence of damage to the kidneys as diagnosed with an ultrasound and/or evidence of blood in the urine.
Patients in stage 2 will have a GFR of 60-89 ml/minute along with the aforementioned evidence of kidney damage, and those in stage 3 will have a GFR of 30-59 ml/minute.
“Stage 3 is what we call moderate chronic kidney damage and it’s also about the time we start to see other issues like anemia,” Dr. Kang says.
Stage 4, or severe CKD, involves a GFR of 15-29 ml/minute, and stage 5 is end-stage kidney disease or kidney failure.
“Stage 5 is when we start dialysis or look into a kidney transplant,” Dr. Kang says.
Overall, 30 million Americans, or 15 percent of adults in the United States, have some form of CKD, which Dr. Kang notes is higher than the prevalence of diabetes.
“The symptoms of CKD vary,” Dr. Kang says. “They include fatigue, a lack of energy, trouble sleeping at night, difficulty concentrating, dizziness, feeling cold, restless legs and nausea.”
In order to keep their kidneys functioning as well as possible, Dr. Kang suggests that people keep the acronym DAME in mind:
“ ‘D’ refers to diet and getting healthy nutrition and ‘A’ is the activity part. People should aim to be physically active and join a gym, play golf or tennis—whatever they like doing,” he adds.
“ ‘M’ refers to medication and knowing if what they are taking can hurt their kidneys. This includes over-the-counter medicines like anti-inflammatories and herbal remedies. And ‘E’ means to educate themselves about chronic kidney disease and how to prevent it.”
According to Dr. Kang, if someone has been diagnosed with one of the early stages of CKD, the top priority is to determine the cause.
“For example, is it because of diabetes, high blood pressure or a surgical procedure? Once we know the cause, we can remove it or help improve it and delay further decline of the patient’s kidney health,”
he says.
