Some kidney facts you need to know

In previous articles, we have talked about a lot of topics related to kidney and its functioning, but there are a lot of information around this you need to know and understand for this vital organ.

In this article, we will see significant facts and statistics about the renal system and other concerning information of kidney and its diseases. These stats are very important because it lets us to comprehend in a better way how this vital organ is in the United States, giving us important insights about it.

Before talking about renal statistics and other facts, it is important to describe barely some kidney functioning information and its illnesses for a better insights appreciation.

Kidney and its disease

As we have said in other articles, the kidney is the organ what regulates the body’s fluid levels, cleaning it from multiple toxins and wastes. In other words, the kidney is in charge of filtering and cleaning the blood from multiple impurities. Besides its main function, the renal system releases a vital hormone to regulate blood pressure and produce red blood cells, keeping it in the perfect balance and with the needed minerals, like sodium, phosphorus, and potassium

The kidney is the principal figure for the renal system, being who regulates and controls everything in it. It is in charge for filter impurities in every piece of blood presented in the body. In resume, it is the organ who take all the blood from the body and cleans it to keep it with the correct fluid levels.

Currently, in the United States, there is one in three Americans with risk for suffering some kidney disease, due to their food habits or other conditions, like diabetes, hereditary illnesses, elevated blood pressure, smoking, obesity and alcohol drinking. Presently, in the United States, there are more than 26 million people with some renal failure, where more than the 60% of these affectations is caused by diabetes or elevated blood pressure. These failures are considered one of the deadliest causes in this country, killing approximately 55.000 persons per year, most of them men.

How to detect kidney failure?

Those persons who are at risk for suffering some kidney disease must take periodically blood and urine tests to check if they have renal problems. In addition, those people who have painful urination, dark urine, swollen hands, and feet or elevated thirst, could be at risk for suffering some renal sickness and should take some of the mentioned exams to verify if they have problems or not.

Principal kidney diseases facts

Kidney stones

As we have mentioned in other posts, kidney stones are produced for the accumulation of different minerals in the renal system, producing intense pain for the person who are suffering this illness. Renal stones are formed most of the times for bad food habits or kidney failures.

In the United States, more than 500.000 persons per year are treated in hospitals due to this affectation and more than 60% of them are men. According to some medical studies, one in ten Americans will suffer from kidney stones during their lives.

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Nephropathy

This is one of the most serious kidney diseases because it makes that the person who suffers it, requires dialysis processes for the rest of its life. Currently, from the more than 600.000 persons with some renal failure, the 65% of them must live with dialysis. Moreover, the 35% of them have a kidney transplant.

In the United States, there are more than 100.000 individuals waiting for a kidney transplant and just the 20% of these people receive a newly transplanted kidney per year. Every day, more than 10 persons die due to Nephropathy and waiting for a kidney replacement.

dialysis

Image courtesy of Frank DiBona at Flickr.com

Related: Dialysis: When and what it is by Joe Cosgrove

Principal kidney disease causes

As we mentioned before, elevated blood pressure and diabetes are the two principal reasons for kidney failures, being this last one the main cause among the two of them.

The diabetes is responsible for more than 50.000 kidney failures per year in the United States and there are more than 250.000 persons living with these failures due to diabetes. Presently, more than 30 million people in the United States have diabetes, which means a high risk for suffering a kidney disease.

The another principal reason for kidney diseases is the elevated blood pressure, which is been responsible for more than 30.000 kidney failures per year in the United States. Today, there are more than 170.000 persons with some renal illness produced for high blood pressure.

In the United States, there are more than 70 million people with elevated blood pressure, where approximately the 20% do not know it has it.

The facts mentioned in this post are just a little sample of what kidney diseases mean for Americans and what we must expect for these illnesses in the future. These affectations are increasing more and more and we must know and understand them to deal with them in the right way.

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Conservative Care and Types of Donors

Joe Cosgrove has spoken widely about kidney malfunctions and the alternative treatments that exist and serve as a different approach to addressing common kidney diseases.  Kidney failure is something that can be treated using different approaches — like dialysis, for instance. When to start dialysis and when to start dialysis can be easily assessed after having a quick look at kidneys that are currently failing.

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Image courtesy of John Campbell at Flickr.com

In order to understand this in more detail, readers should be aware of how kidneys work exactly: it is often talked about balance and health, where the kidneys are the ones responsible for that first word: balance; whether it is food or body chemistry or blood pressure, the kidneys work alongside other major organs to keep this equilibrium, or balance for this matter, going and functioning on a daily basis while eliminating and filtering out all the waste byproducts and products created by the body’s metabolism. If kidneys start to fail, meaning they cannot longer hold this balance, the body starts to struggle at keeping such equilibrium and is more likely to retain fluids, or food, or could result in having abnormal potassium and sodium levels, or could rise blood pressure, etc. which will result in increasing the risk for a serious kidney illness. If this were to happen, the body would absolutely need another way to filter and balance all these fluids and electrolytes, and this, as readers might have already guessed, is where the decision of dialysis or kidney transplant comes in.

Although the need for a kidney transplant or a dialysis might be imperative, it, nonetheless, takes a time to plan it. A person’s primary physician will likely star planning either a transplant or a dialysis when a person’s GFR (which stands for Glomerular Filtration Rate) is around 20, which is the equivalent to a 20% kidney function, in case readers want to have something to have a deeper understanding; nevertheless, this does not necessarily mean that a dialysis or a kidney transplant is immediately needed as most people start dialysis when their GFR is around 13 or so. Actually, doctors and physicians have started questioning whether it is necessary to start dialysis based on just a number since the people who started dialysis this earlier did not seem to show a major improvement in their condition. Now, doctors and kidney specialists are leaning towards starting dialysis once the patient has already shown symptoms of kidney failure like severe fatigue, nausea, decreased appetite, shortness of breath, etc. This symptoms assessment might be a little tricky and deceptive, mostly if the patient is suffering from something else, which is why now doctors in charge of assessing a patient should include a nephrologist in their teams to recognize the symptoms that would improve after dialysis.

Moreover, people often start thinking about their plausible treatment options a year before they need to start dialysis since it takes three to six months to make dialysis happen, which is why there are several dialysis options instead of just one. One option would be actually doing nothing: patients might feel this way because of where they are in life. They might feel that perhaps their best choice would be letting their kidney failure run its course, which is the attitude that describes the “Conservative Care”. Conservative Care suggests that patients should aim at maintaining their kidney function for as long as possible through diet and medication, knowing that the decline of their kidney function will not stop, and will ultimately lead to death. This option is generally considered by people who are also suffering from other severe medical conditions who are candidates for transplants and feel that the liability and discomfort caused by dialysis outrun the potential benefits.

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Image courtesy of Karol Franks at Flickr.com

The next option would be to acquire a donated kidney, either from a living person — generally a relative or a friend — or from a deceased donor. As readers might imagine, not everyone is a candidate for receiving a donated kidney, which is why doctors and physicians might take some time to find out whether the transplant is the most suitable option for patients. Since there are two types of kidneys, deceased donor kidneys are not immediately available; in fact, up to 20% of people who are on dialysis are waiting for a kidney transplant, which is why it takes five up to 8 years to have one. If the having a transplant is possible after prior assessment, it is definitely the best options as it allows receivers to live longer and better than if they were on dialysis, which is why it is advisable to start thinking on the other type of kidney donor: the living donor. People usually consult their friends or relatives first since the likelihood of them matching the receiver are higher; they will last longer unlike kidneys coming from a deceased donor and the transplant can happen earlier: even before dialysis.

Kidney transplantation as an alternative treatment for chronic kidney disease

Kidney transplantation as an alternative treatment for chronic kidney disease

In this post, we’ll make a thorough review of kidney transplantation as a treatment alternative for patients with ESRD.

Kidney transplantation in the treatment of CKD

Kidney transplantation as an alternative treatment for chronic kidney disease

Courtesy of Alan Turkus at flickr.com

Numerous studies have shown that renal transplantation is a therapy that improves long-term survival when compared with maintenance dialysis.

Transplantation in a predialysis situation is an attractive option because it improves graft survival and reduces costs. It’s associated with a 25% reduction in graft failure and 16% in mortality, compared with the recipients that are transplanted after entering dialysis; although it is not possible to do this in every case, as it will depend on the blood group of the patient and the donor supply.

An appropriate kidney transplant is, therefore, the treatment of choice for patients with terminal IRC because it offers a better evolution of the disease and due to its lower costs.

Without there being any exact rules, once the chronic nature of the process of kidney disease appears, and once the decreased renal function is established -usually when the glomerular filtration rate reaches values of about 30 ml / min-, it is necessary to present the different options renal replacement therapy (RRT) to which we must resort when kidney function values are close to being truly insufficient. At that time, the patient should be evaluated by nephrologists in specific predialysis or clinical nephrology consultations, in which the different options of TRS will be presented. Among them, the techniques of peritoneal dialysis and hemodialysis and the two types of kidney transplantation: living donor and deceased donor.

Contraindications for kidney transplantation

Kidney transplantation as an alternative treatment for chronic kidney disease

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Absolute

  • Recent malignant neoplasm with metastatic activity
  • Active infections
  • Irreversible extrarenal disease with no rehabilitation or life expectancy of less than a year
  • Psychiatric disease with loss of autonomy or competence
  • Repeated therapeutic failure
  • Addiction to drugs or alcohol without potential for rehabilitation

However, today, it is difficult to speak of absolute contraindications, and each patient should be assessed individually and according to their particular situation.

Relative

  • Age, over 75 years
  • Cardiovascular disease
  • Advanced chronic liver disease
  • Urinary tract abnormalities
  • Previous malignancies
  • Underlying disease

Risk factors linked to the recipient

Age

There is no formal age limit for excluding a patient as a candidate for a transplant.

Age is one of the criteria that has been most relaxed by the aging of the general population and the dialysis. There are many studies that provide evidence of results in patients over 70, but those obtained in recipients over 60, are better than those that would be achieved by staying on dialysis, achieving an acceptable degree of long-term renal functions.

Elderly patients have higher morbidity with higher rates of hospitalizations for younger recipients and increased risk of cardiovascular disease, cancers, and infections, so the evaluation must be very rigorous. However, they also experience less rejection and require less aggressive immunosuppression.

Some groups consider very elderly patients as preferred to receive kidneys from cadaveric donors with criteria such as age, obtained in asystole, among others, or be double transplant recipients with this kind of donors.

Living donor transplantation in people over 65 poses special problems that must be solved with a strict respect for underlying ethical factors.

Obesity

Patients with a BMI (body mass index) greater than 30 kg / m2 have a higher incidence of surgical complications, delayed healing, which leads to longer hospital stays.

There are conflicting results regarding the association of obesity with decreased graft survival. However, obesity is a risk factor for the development of diabetes, cardiovascular disease, and post-transplant hyperfiltration.

So a significant weight loss before inclusion on the waiting list is recommended.

Cardiovascular disease

Ischemic heart disease is the leading cause of death in transplant patients and graft loss with appropriate functions.

The risk of cardiovascular disease is higher in patients with previous cardiovascular disease, diabetes, smokers, obese (BMI over 30), carriers of classic factors of cardiovascular risk, very prolonged evolution of renal failure, and in those who have a poorly controlled hypertension and left ventricular hypertrophy.

The evaluation of ischemic heart disease is very important, especially in diabetics, in whom the coronary disease is often asymptomatic. Asymptomatic, low-risk patients should have their modifiable factors treated before including them in lists, high-risk ones (previous infarction, old age, diabetes) even if they are asymptomatic, should be tested for stress tolerance (stress tests, ultrasound with dobutamine, dipyridamole thallium scintigraphy, MRI or CAT scan). Patients with positive, noninvasive tests and those with symptoms will be studied with coronary angiography.

Patients with severe and diffuse coronary artery disease not amenable to revascularization or severe heart failure, are not good candidates for renal transplantation, and according to the case, they may be assessed for double heart / kidney transplant.

If there is a previous history or presence of risk factors for cerebrovascular disease, carotid doppler and surgery should be performed if necessary. The Doppler is also used to assess peripheral circulation in diabetic patients or patients with intermittent claudication.

Related content

Read Joe Cosgrove’s “How you can know if you will suffer from kidney failure.”