Kidney Disease Takes Victims by Surprise

Edition: May 2002 - Vol 10 Number 05
Article#: 1228
Author: Repertoire

Sometimes, we just don't know what ails us until it's right in front of our nose. That seems to be the case with kidney disease. It often takes years for it to surface, and patients may be unaware that they are losing kidney function until the disease is quite advanced.

A disorder that affects one in nine adults in the United States, kidney disease – as with many illnesses – can be prevented or delayed if treated early enough. But, the simple blood test or urinalysis – a basic collection and analysis of urine for proteinuria (the best way to diagnose kidney disease, according to the National Kidney Foundation or NKF) – happens to be less routine than one would guess. Ideally, physicians can collect a urine sample from the patient and analyze it for excessive levels of protein, which may have leaked from the blood into the urine due to faulty kidneys. However, because the test requires sending a sample to the lab for microscopic analysis, it tends to be omitted from routine physical exams.

With over 20 million Americans at increased risk for this disease – particularly those who have diabetes, high blood pressure or a family history of kidney disease – patients should insist on getting a urinalysis at office visits to their physician. When kidney disease is not treated, the consequence can be kidney failure, leading to a kidney transplant and, likely, dialysis. There are two kinds of kidney failure: acute and chronic.

Acute kidney failure results when the kidneys suddenly stop functioning – usually due to end stage renal disease, injury or toxins. Defined as an acute increase of the serum creatinine level, acute renal failure involves a gradual decrease in the glomular filtration rate. This, in turn, causes a reduction in the amount of nitrogenous waste excreted, prohibiting the body from maintaining fluid and electrolyte balances, according to the American Academy of Family Physicians (''Acute Renal Failure,'' Malay Agrawal, M.D., and Richard Swartz, M.D., University of Michigan, An Arbor, MI).

Acute renal failure tends to be asymptomatic, but physicians can detect it through elevations of blood urea nitrogen and serum creatinine levels. The condition is temporary, notes the NKF, and patients can be assisted by dialysis until renal activity resumes.

Chronic kidney failure is the result of a slowly progressing disease, and the patient is not always aware that damage is occurring. Dialysis or a kidney transplant generally are imminent for these patients.

Small, but Vital
The kidneys are a bean-shaped organ about the size of an adult fist and located below the rib cage in the back. But, big things come in small packages, and we can't function without working kidneys.

When the urinary system removes waste – or urea – from the blood, together with water and other bodily wastes, it passes these materials in the form of urine through the nephrons and down the renal tubules of the kidneys. The kidneys, in turn, filter waste and excessive fluid (about 200 quarts, according to the NKF). In addition, they:
• Release hormones to help regulate blood pressure.
• Regulate the production of red blood cells.
• Produce vitamins, such as vitamin D that controls growth.

When the kidneys no longer work and fail to remove waste products and excess fluids from the body, toxins and extra fluids accumulate in the blood.

Kidney failure can often be prevented or deterred by controlling related conditions, such as diabetes or high blood pressure. Exercise and weight loss also are helpful in protecting the kidneys. However, high-risk patients should be aware of the early warning signs of kidney failure, notes the NKF. These include:
• High blood pressure.
• Blood and/or protein in the urine.
• A creatinine blood level over 1.2 in women and 1.4 in men.
• Painful, difficult, or more frequent urination, especially at night.
• Puffiness around the eyes, or swelling of the hands or feet.

Once 85 percent to 90 percent of kidney function is lost, complete renal failure is imminent, according to the NFK. At this point, symptoms can include nausea, vomiting, weakness, fatigue, confusion, impaired concentration, and appetite loss.

Incidence Rates
Nearly 70,000 Americans die of kidney disease each year. More than 260,000 must rely on dialysis or kidney transplantation to continue living with the disease. Kidney disease is a much more pervasive illness in this country than most people realize. The following facts highlight exactly how big a problem it has become:
• About 345,000 Americans currently are being treated for end stage renal failure.
• At least 40 million Americans may be at risk for chronic kidney disease.
• Each month, the number of people waiting for kidney transplants increases. As of last November, the waiting list included nearly 80,000. A new name is added to the list every 13 seconds.
• Minorities are affected in disproportionate numbers by the disease. In 1999, the rates per million population for new cases of renal failure were as follows:
- 953 for African-Americans
- 652 for Native Americans
- 386 for Asian Americans
- 237 for Caucasian Americans.
• Diabetes is the main cause of kidney failure in the United States. It is responsible for over 43 percent of new cases annually and 34 percent of all cases in this country.
• Poorly controlled high blood pressure is the second major cause of kidney failure in America, contributing to 26 percent of all new cases in the country.
• Glomerulonephritis, an inflammatory disease of the kidneys, is the third leading cause of renal failure (responsible for 9 percent of new cases annually). Cystic kidney diseases are other major contributors of renal failure, responsible for 2.4 percent of new cases annually.
• Kidney and urologic diseases are major causes of work loss, doctor visits and hospitalizations in America. Kidney stones are the reason for over one million physician office visits and over 250,000 hospitalizations annually, costing the country $1.8 billion.

(Source: National Kidney Foundation.