If you have kidney disease, you need to keep track of mineral levels in your body in ways that people without the disease rarely need to consider. A primary example of this is potassium. This mineral’s levels are usually controlled by healthy kidneys. But when your kidneys aren’t functioning properly, this can change. And with high potassium levels, there could be drastic consequences unless you start controlling potassium levels yourself.

One main role of potassium in the body is to keep the heart and muscles functioning properly. It helps the heart maintain a regular, reliable beat, so this organ can be adversely affected if potassium levels go too high or too low. Too high, for example, and you could suffer a heart attack. You could also experience numbness or tingling.

If you realize that your potassium levels are going too high, one way to address the problem is with diet. You can consult a dietician who specializes in renal patients, and get a lot of input and advice. But you can also help yourself by choosing your foods carefully. While almost all foods have some amount of potassium in them, here are a few guidelines for limiting your intake of the mineral as much as possible.

It helps if you eat moderately. Conservative portions will help both the potassium intake and weight, which can cause other kidney-related problems. But any liquid in which foods have been canned, or which they have produced while cooking, should be avoided. This is because of leaching, a process where liquid pulls potassium out of a food. You can even leach potassium yourself by rinsing foods with warm water, then soaking in water for a couple of hours before cooking.

Your dietician will give you lists of high-potassium versus low-potassium foods. But here are a few common high-potassium foods:

• Apricots, oranges, bananas, melons, dates, raisins, and dried fruits
• Bran
• Broccoli, avocados, brussels sprouts, raw carrots, spinach, vegetable juices
• Tomatoes and tomato products
• Nuts and seeds
• Milk and yogurt

Lower-potassium foods include:

• Most berries
• Cucumber, lettuce, onions, green beans, peppers, zucchini, small portions of asparagus, corn, and celery
• Apples, grapes, cherries, and small portions of peaches, watermelon, pears, and plums
• Rice, noodles, pasta, and bread (not whole grain)
• Only one cup of coffee or two cups of tea per day

Choosing the right foods, cooking properly, and watching portions can go a long way to helping control your potassium levels through diet.

Kidney problems can often sideswipe you, hitting when you don’t expect them, as a result of health problems that don’t seem related to the kidneys at all. One of the things that can strike in this unexpected way is Hemolytic Uremic Syndrome, or HUS. It’s one of the conditions that is associated with kidney failure from E. coli bacterial infection, but that’s not the only way it can get its foot in the door.

HUS produces a low blood cell count, resulting in anemia, and destroys the platelets in the blood that allow clotting. It also damages small blood vessels in the kidneys, and sometimes in the heart or brain as well. When it hits the kidneys, the little filters calledglomeruli get clogged with damaged blood cells and platelets, and kidney function is impaired. Symptoms to watch for, especially in children, include lower urine output, a loss of energy, and very noticeable pallor.

These symptoms will usually follow a bout with bloody diarrhea, often as part of some illness that affected the bowels. Toxins in the bowels will somehow move from the intestines into the bloodstream, and that’s where the damage begins. So while HUS is most often associated with E. coli, people need to be watchful after any illness involving diarrhea, especially with blood in it.

There’s one thing that’s more positive about this form of kidney problem compared to many others: people who suffer from HUS and endure some degree of kidney impairment will usually see the kidneys recover. Fluid volume control through an IV is very important as a treatment. And in some severe cases, temporary dialysis may be needed while the kidneys regain their health. But most of the time, especially if the person receives medical treatment, the kidneys will recover.

HUS-induced kidney impairment may portend other problems in the future, however. Even those who recover complete function are at a higher risk of kidney problems or high blood pressure in later years. One of the factors in this higher risk is whether other organs were severely affected by the HUS as well.

There aren’t many conditions that impair the kidneys that can be said to have a “positive” outlook, with potentially a complete recovery of the kidneys. Fortunately, HUS is one of them. But as with so many other things involving the kidneys, the key is to watch the symptoms, and get immediate treatment once the problem is discovered.

Children who experience chronic kidney disease, much like their adult counterparts, can also experience high blood pressure. Unlike adults, though, blood pressure issues aren’t a cause of children’s kidney disease. Instead, the causes may be problems in the urinary tract system, related kidney conditions like glomerulosclerosis, which we’ve discussed before, or an inherited disease such as polycystic kidney disease.

However, once their kidneys are compromised, children are as vulnerable to high blood pressure as any adult. This is why, if a child is diagnosed with this blood pressure problem, their kidneys should be checked immediately. And if it’s discovered that they do have kidney disease, other factors come into play. Here, children face similar health and treatment issues as adults.

Kids may be even more vulnerable when it comes to high blood pressure, because of the growing tendency of obesity in children, in much of western or westernized society, at least. So one recommended treatment may be simple weight loss. Being overweight not only can make high blood pressure worse, but it can increase children’s vulnerability to other possible effects of kidney disease, such as heart disease or diabetes.

One form of treatment that helps with weight loss is also good in its own right: increasing the child’s exercise. This strengthens the cardio-vascular system and helps reduce blood pressure. The stronger the heart gets, and the more easy a time it has as it works, the less chance there is of developing heart disease. So extra exercise can address three potential problems at once.

Another “prescription” may be much harder to enforce with today’s children: the removal of snacks with a high level of salt in them, as well as taking salt in general out of the diet. Of course, the doctor would need to be sure that the child doesn’t have a form of kidney disease that makes the body lose salt. In that case, the removal of these foods may not be recommended. But salt removal is a treatment that would have to be investigated.

Parents should consult a doctor about every aspect of their child’s treatment. Some exercises might be too vigorous, and blood pressure medications may conflict with kidney medicine being taken. But it’s important to watch a child’s blood pressure and address the possible causes if it becomes too high. And if the cause is kidney disease, it becomes absolutely crucial to bring the blood pressure down, to avoid worsening the disease.

The term “kidney disease” sounds like it refers just to one form of illness, but in fact it covers a wide range of kidney problems. While the symptoms of each are often quite similar, because there are only a certain number of ways kidney impairment will manifest, the underlying causes are often different. Sometimes the kidneys are damaged from high blood pressure, sometimes the problem is polycystic kidney disease, and at other times, the underlying cause of disease is Focal Glomerulosclerosis.

The very name is a mouthful, but it’s derived from theglomeruli, or clusters of very small blood vessels in the kidney that help to filter blood. Sclerosis refers to thickening which, in this case, means scarring from some source. And in the same way as “kidney disease,” the scarring of “glomerulosclerosis” can also have many possible sources. It might have come from an original kidney infection, it could be caused by existing lupus or diabetes, or it might even be genetic in some cases. Even inflammation can cause scarring of these tiny vessels.

The symptoms are much the same as those for everything else we think of as kidney disease. So glomerulosclerosis, therefore, can similarly go undetected in its early stages. It will manifest in the same ways: increased protein levels in urine, possible rise in blood pressure, fatigue, itchy skin, and so on.

Some of the tests are the same as for “ordinary” kidney disease too: primarily blood and urine tests. But the only way to know for sure if a patient has glomerulosclerosis is by taking a kidney biopsy. The tiny kidney sample taken with a needle will reveal scarring of the blood vessels when examined under a microscope.

This condition is treated similarly to other kidney disease, with an extra twist or two. Reduction of blood pressure is very important, as is reduction of cholesterol. Salt and protein intake needs to be lowered. But the patient may also take immunosuppressant drugs, which will help reduce protein levels further.

Unfortunately, though, the scarred blood vessels can’t be repaired, so glomerulosclerosis can’t be cured or reversed. For some, especially if the condition is genetic, it may continue getting worse until a transplant is needed. But for most people, with proper treatment, diet, and other precautions, this version of kidney disease can probably be held almost at a standstill. Taking good care, they can often live many good years with little, if any, worsening of the condition.

Everyone in society should be aware of what to do in various types of emergencies such as natural disasters or major power outages. But kidney patients, especially those on dialysis, have extra contingencies to plan for. They need to make the same sorts of lists as their neighbors, while providing for extra medical and physical needs.

Kidney patients need supplies such as blankets, medicines, and food for several weeks. Yet even when it comes to stored food, their needs already diverge from those of others. Kidney patients, particularly if they are preparing for or are already on dialysis, have restricted their daily intake of some types of food. These include high-potassium foods (bananas, nectarines, raisins, melons, potatoes, tomatoes, asparagus, beets), products with a high salt content, and high-phosphorus foods such as products made from milk. Kidney patients also have more protein in their diet, as a rule, to help keep up their blood protein levels.

So what happens if they don’t have access to their regular groceries, and need to resort to emergency rations? What sorts of things should they have on hand? Here are a few suggestions:

• Containers of low-sodium fish or meat, no more than three ounces per day

• Single-serve containers of specific fruits (mandarin oranges, peaches, pears, applesauce, pineapple, fruit cocktail); no more than 4 servings per day

• White bread, single-serve containers of dry cereal like puffed wheat, puffed rice, or shredded wheat, and unsalted crackers or graham crackers; kidney patients should have 6-8 servings from this group per day, with a slice of bread counting as one serving

• Fats like small containers of cooking oil, mayonnaise, or margarine, having 6-8 servings a day

• Sweets like jelly, hard candies, white sugar, or jelly, primarily used sparingly, primarily to prevent the crash of blood sugar

• Distilled water, no more than 16 ounces of fluid per day, if at all possible

A diet of the above items is more restrictive than a kidney patient’s regular diet, which is understandable because they aren’t getting help from anywhere else in balancing fluids, potassium, sodium, or phosphorus. So liquid intake is severely restricted, for example, to try to prevent swelling and keep waste products from building up in the system. The diet can be followed for several days, after which patients can hopefully get in touch with medical personnel and resume more regular treatments. But every kidney patient should be aware of the potential emergencies, and should take steps to be ready.

One thing that’s closely associated with kidney disease is a concern about calcium levels. The concern more accurately relates to calcium and phosphorusworking together, since these electrolytes are responsible for helping muscles contract and signals pass along the nerves. But as kidney disease progresses, one of the casualties is often calcium, and a deficiency may develop. If this happens, one way of boosting this mineral is by increasing intake, either through food or supplements.

But however the kidney patient takes in calcium, it has to be done the right way, or the body won’t absorb it. You might think that just eating calcium-rich foods — like spinach, yogurt, nuts, or canned salmon — would be sufficient. But spinach contains oxalic acid, which binds to the calcium and prevents its being absorbed in the intestines. Milk contains lots of calcium, yet it’s eaten with spinach, again the absorption is hindered. Compounds in tea might produce a similar effect.

Most of the time, these small hindrances don’t matter much, as a person’s complete, healthy diet usually provides the calcium they need. But two factors come into play with kidney disease is involved. Adults, especially, already tend to absorb less calcium. If they’re not careful, their bodies get to a point where they use up stored calcium in bones and teeth more quickly than it’s replenished. Now add the fact that with kidney disease, the calcium/phosphorus balance is skewed so that, again, calcium drains from the body more quickly than it’s replaced. So how calcium is ingested, and with what, becomes important.

First of all, Vitamin D is necessary for absorption of calcium. So foods rich in this vitamin (fatty fish and beef liver, for example) will help produce the intestinal proteins that allow calcium to absorb. Even 15-20 minutes of direct sunlight each day, especially in summer, which allows the skin to create Vitamin D, can be enough. And most calcium supplements add the vitamin for this very purpose.

But it doesn’t hurt to investigate which foods, eaten together, might hinder the intake of calcium. (Too much magnesium may hinder the good work of Vitamin D, for example.) And learning which supplements may be better is also a good idea. For instance, it’s wise to avoid calcium derives from seashells, which may contain high amounts of lead.

Among all the side health issues stemming from kidney disease, calcium levels are very important. Careful monitoring and research into diet can help mitigate the problem.

“Which came first, the kidney disease or the high blood pressure?” This is a chicken-and-egg question that can’t always be answered, yet the interrelation of the two is well-documented. What we know is that once you have one condition, you’re in danger of triggering the other. And when you have both high blood pressure and kidney disease, you’re caught in a vicious cycle as each condition makes the other worse. But dealing with these health issues as a family can make a surprising difference in either prevention or treatment.

One of the ways people can try to prevent kidney disease is to alter their lifestyle in ways that reduce the risk of high blood pressure. And as a side benefit to such change, their family is also bound to become healthier. For example, simply altering the kind of food one eats can do a lot to bring blood pressure down.

Reducing or eliminating sodium, for example, creates one of the greatest effects on blood pressure. Extra sodium upsets the sodium-potassium balance so that the kidneys aren’t able to excrete as much water, which causes bloating and raises the blood pressure. So reducing sodium can quickly help the body get balanced again. And if it’s taken out of the whole family’s diet, it’s a preventive measure for the sake of their blood pressure too.

Exercise is another way to keep the kidney-blood pressure cycle from starting and getting out of hand. When the cardio-vascular system is in good shape, it pumps the blood more easily and efficiently. This helps the exchange of wastes that the kidneys excrete to occur more easily and efficiently as well, so the kidneys, too, function under much less stress.

This is something the whole family can benefit from. And in fact, getting healthy exercise doesn’t have to be a chore, when the family does it together. Riding bikes, playing beach volleyball – many forms of exercise are a lot of fun, yet they help reduce everyone’s risk of both high blood pressure and kidney disease in the future.

The family can also offer other forms of encouragement for someone who already has either high blood pressure or kidney disease. They can give reminders about medication, help create a less stressful atmosphere, or serve as advocates with the health care system. Blood pressure and kidney disease may be linked, but family links can go a long way to help in the prevention or treatment of both conditions.

If you think the kidneys have little to do with the composition of your blood, think again. There are reasons why anemia (a lack of sufficient red blood cells) is a problem that plagues kidney disease patients. It isn’t just that kidneys filter wastes from the blood and flush them from the body. The fact is that the kidneys themselves are partly responsible for the blood’s very composition.

Kidneys play an active role in maintaining the body, and one way is to produce a hormone called erythropoietin, or EPO. This hormone signals your body to create more red blood cells. But of course, when the kidneys become compromised, they are less able to make the hormone. And virtually inevitably, those with kidney disease will develop anemia as a result.

How severe the anemia will be, and how early it becomes noticeable, depends on several other factors:

• whether the person is female;
• whether the person is of African descent;
• whether they have diabetes;
• which of the five stages of kidney disease they are currently in.

As soon as someone shows slight signs of kidney problems, it’s a good idea to have blood tests as well, to find out if there’s already an issue with anemia. In fact, regular blood tests are a good idea anyway, because sometimes anemia is someone’s first sign that they even have kidney disease in the first place. But whether the kidney problems were diagnosed first, or the anemia, this problem can’t just be left untreated. A lower supply of red blood cells makes the heart work harder, and this can lead to heart disease. And that’s the last thing someone needs when they’re already dealing with kidney disease.

Treatment for anemia needs to happen in conjunction with treatments for the kidney disease. Usually the doctor will prescribe drugs called erythropoiesis-stimulating agents, or ESAs. These injections made under the skin help the body create more red blood cells. And since iron is also needed for making the cells, the patient will need iron pills, and might also want to eat more iron-rich foods.

Nobody should have to fight through the lethargy and weakness of anemia while engaged in a primary fight against kidney disease. And nobody should add heart disease to that battle either, by ignoring the anemia. These three conditions are closely intertwined, so if the anemia can be dealt with, it can only help both the heart and the kidneys as well.

Father’s Day isn’t just a time when fathers are acknowledged and appreciated for their paternal roles. As a dad, you can use this special day not just to evaluate your accomplishments but to reflect on your responsibilities. And if your child has been diagnosed with kidney disease, you know you’ll have a few more of those than some other fathers might. But it’s part of being a dad, to help your son or daughter face the disease as well as possible.

One thing you’ll learn quickly is that most things go better when you treat your child with respect, and let them understand and participate in their own care as much as you can. Give them matter-of-fact explanations about the disease, the instruments used in the hospital and doctor’s office, and about what the treatments actually do. This helps remove fear of the unknown. They may still not like the discomforts of the treatments, but their fear will be considerably diminished.

You should naturally learn as much as possible about your child’s disease and condition, and participate in the care as knowledgeably as you can. But there are ways to allow the child to participate too. For example, encourage them to ask any questions that occur to them, and answer clearly, with as much information as they can handle and understand. Give them a chance to ask the doctor about foods they can and can’t eat, or about the best ways to take their medicine. The more in control they feel, the more able they’ll be to deal head-on with their illness and treatments.

Developing a regular routine and sticking to it as much as possible is another way you can help your child deal with kidney disease and its treatments. Even unpleasant moments, like taking medicine, can seem less fearsome if the child knows it will happen at this time of day, matter-of-factly, and then they’ll move on.

You yourself will need to project confidence, so your child has a rock to stand on. If you are constantly worried or project fear, the child will sense it, and their own fear will be magnified. That’s probably your biggest responsibility: to let your son or daughter sense that they can feel safe even when dealing with illness. If you can help your child face kidney disease directly and confidently, you won’t merely deserve one special day of acknowledgement a year, as a father. You’ll deserve a medal of honor.

The recent E. coli outbreaks in Europe have serious implications for people who already have kidney problems, but also for those who want to avoid them. We usually hear about the initial severe symptoms of E. coli infection – the gastroenteritis and bloody diarrhea – but reports don’t always mention one of the potential deadly side effects: kidney failure. Yet this is something that can haunt a person for years after the initial infection has passed.

E. coli (proper name Escherichia coli) is a form of bacteria, and most strains are fairly harmless. In fact, every person carries a certain amount in their system already. But the nastiest strains produce toxins that can cause serious digestive problems. Even worse, they can result in Hemolytic Uremic Syndrome (HUS), in which the vascular system (that is, the blood delivery system), becomes severely damaged. The result can be high blood pressure, but also damage to various organs, including the kidneys, which often leads to renal failure.

E. coli infection may stem from a few possible causes. For example, if one consumes undercooked ground beef, where the inside of a burger is pink, that may allow transmission of the bacteria. Cattle are the prime carrier, so even working with cows may put a person at risk. But one may also encounter the bacteria by drinking contaminated water or unpasteurized milk.

The latest incidence of E. coli contamination underscores how important it is to eat and live in as sanitary a way as possible. Proper food preparation is very important, yet the first and best place to start is simple hygiene. Washing one’s hands after they’ve been soiled in some way can do a lot to keep them bacteria-free. We should also thoroughly wash our fresh fruits and vegetables, and try to ensure that we’ve gotten them from a safe source. And if we find ourselves around someone who is already dealing with E. coli, giving them their own utensils and engaging in thorough hygiene can prevent the bacteria from being passed on.

After the worst E. coli outbreaks, kidney disease is always a prevalent legacy. Kidney health is so important that when we know something like this bacteria can destroy it, we must take the steps that will protect us from it. Most cases of food poisoning are relatively benign, but all it takes is contact with one very bad strain of this bacteria, and our lives could change forever, and for the worse.

If a person’s kidneys become compromised, one of the first steps often taken is to alter their diet. Good exercise and a healthy lifestyle are also vital. But as they plan how to eat and exercise, many people forget another important element in trying to keep their kidneys healthy: common, everyday painkillers.

The labels on these painkillers, with suggested dosages and durations for use, are on the containers for a reason. In general, no painkiller should be taken for more than three days for a fever, or for longer than ten days for pain. This is why doctors recommend that even if a person’s kidney function is normal, they should take as low a dose of painkillers as possible, and should take them for the shortest possible time.

Yet some people have conditions for which painkillers are actually recommended: for example, a heart condition for which they take aspirin. Are these patients now doomed to choose between heart problems and kidney problems? Fortunately, that doesn’t seem to be the case. The aspirin dose is usually low enough that it doesn’t affect kidney function.

Aspirin, in fact, seems to be the painkiller that does the least harm, at least when taken in moderate amounts. Yet the characteristic that makes them most useful with heart problems (blood thinning) can cause other health issues. So the user still must be careful about potential stomach bleeding or ulcers, and if their liver is compromised, even aspirin could be off the table as a painkiller.

Some painkillers, the NSAIDs (non-steroidal anti-inflammatory drugs), can actually cause a form of kidney disease called chronic interstitial nephritis, if taken for too long. Ibuprofen and naproxen are the main culprits for this. They should be avoided by anyone who knows their kidneys have impaired function, and should be used with a doctor’s guidance if the patient has other issues like liver disease or high blood pressure.

Acetominophen seems to be the only relatively safe painkiller if the patient can’t tolerate aspirin. Doctors warn against drinking alcohol while taking this drug, but kidney patients should be treating alcohol moderately anyway. And even this medicine should be taken under a physician’s guidance.

People inevitably need painkillers from time to time. But the more they know about how these medicines affect the kidneys, the less casually they may take them. Convenient and effective as they are, these drugs can still have devastating side effects, especially when it comes to kidney health.

As millions of families in North America celebrate Mother’s Day, it shows that the majority of us truly do appreciate our mothers. Most of us give flowers or food as gifts, or we take this day to give our mothers the chance to have some time off. But one thing we could do for them, whether it’s on this sort of special commemorative day or merely on a miscellaneous Tuesday sometime, is give them information that can help them stay healthy. After all, the longer we can keep our mothers with us, the gladder we’ll be.

The good news is that women generally tend to experience chronic kidney disease at a lower rate than men. This discrepancy vanishes if the woman is diabetic, in which case her likelihood rises. But what is known as the “female advantage” in kidney disease may also be one of the reasons women are left undiagnosed longer than men are, if they do end up with this disease.

In a study she did of almost 900 patients in Oregon, Doctor Maya Rao learned that women’s chronic kidney disease goes undiagnosed longer than men’s, unless it has reached quite an advanced stage. One of the reasons it gets missed is the very test used to detect it: a blood test for creatinine levels, which are normally filtered out of the body by the kidneys. Higher levels indicate reduction in filtering capacity. This test needs to be part of a more extensive test for the glomerular filtration rate (eGFR), which gives a more accurate result.

But even then, says Rao,

Women have a lower eGFR than men for the same level of serum creatinine. Thus, the same serum creatinine level that initially appears normal for both a man and a woman can translate into depressed kidney function for the woman, making her at higher risk for undetected kidney disease.

So even if a woman has tests for this more detailed calculation, she still needs to insist that her doctor take into account the differences in the eGFR. If the result is something that would be “normal” for a man, the doctor can factor in the difference and realize that the “real” result is higher.

Even this small factor could result in detection of early stage kidney disease for women. If they can get more accurate blood test results during their yearly physicals, we can be more certain of having our mothers with us that much longer.

Why is it so important to detect kidney disease in its early stages, even if it’s rather hard to diagnose? Because when you reach Stage 4, you are likely past the point of living without serious medical intervention or even a transplant. And by the time you arrive at Stage 5, you have virtually no other option. There is nothing else to do but plan for a transplant.

In Stage 5, the kidneys have only about 15% of function left – or less. At this point, if left on their own, they would be completely unable to keep the patient alive. Dialysis now becomes very important to filter the blood of impurities the kidneys can’t remove.

Most symptoms are the same as for Stage 4 or earlier, but multiplied considerably. The person experiences the same tendency to hypertension (high blood pressure) because of the inability to expel fluids. And because the heart is working that much harder as a result, the person may suffer pericarditis, which is an inflammation of the lining around that organ. There would now be very high levels of creatinine and urea, which the kidneys can’t filter out. And susceptibility to infections would also increase.

The inability to absorb calcium or for the kidneys to produce the chemical that stimulates production of red blood cells worsens. And therefore the reduction in bone density and the tendency toward anemia would continue to be a problem. Added to these symptoms would come others that might seem comparatively “minor,” but which could be aggravating. These include difficulty sleeping, shortness of breath, increased itching, or frequent vomiting.

Certain treatments can attempt to bring down blood pressure or reduce anemia, while dietary adjustments may allow more absorption of calcium. But now with such reduced filtering capacity, dialysis is usually the only way to cleanse the bloodstream of impurities. Some patients can survive for a long time with dialysis treatments, though the most common form of dialysis takes several hours, three days a week, and therefore restricts their lifestyle. But for others, dialysis may lose its effectiveness relatively quickly. And the best hope in both cases is for a kidney transplant.

There are usually signs of kidney disease well before things reach Stage 5. To maintain good health and never allow themselves to arrive at this stage, the wisest course for everyone is to have yearly, thorough checkups with detailed blood work, and to investigate even the most nebulous symptoms that might indicate kidney disease.

In previous entries, we’ve examined symptoms and effects of Stages One and Two of kidney disease, and then Stage Three, where things finally become noticeable and serious. In Stage Four of kidney disease, the symptoms start to be debilitating, and kidney function is severely impaired. In fact, at this stage, there is only 15-29% kidney function. The body may have disguised its condition for quite a while, but now the disease becomes drastically apparent.

The symptoms magnify things that had begun appearing in Stage Three: fatigue increases considerably, the appetite keeps declining, and an earlier phenomenon of itching might become much worse. High blood pressure continues to be problematic, because of course the kidneys have lost much of their capacity to excrete unneeded fluid, so it is retained in the body, making the heart and blood vessels work harder. And the kidneys may have trouble producing erythopoietin, which stimulates blood cell production, so anemia is another problem.

At Stage Four, a cascade of effects may produce other effects, all of which contribute to an increasing weakness and a worsening of symptoms. As the kidneys become less able to filter phosphate, the levels of that electrolyte increase. In turn, this makes it more difficult for the body to absorb calcium. And since it’s the proper interaction of phosphorous and calcium that strengthens bones, bone density itself may gradually decrease. This may produce aching in the bones, but it also leaves the person more prone to fractures, which take longer than usual to heal.

People can go on for a long time with such reduced kidney function, because some of the initial symptoms — tiredness and changes of appetite — are so vague that they could be caused by many other things. But when they are combined with other symptoms like itching, water retention, and anemia, this is when the pieces slowly fall into place. As the kidneys become less able to filter fluids and remove them from the body, more fluids are retained, and the person may experience swelling and puffiness. Even their urine may become more clear, because fewer impurities are being excreted.

Naturally this contributes to higher blood pressure. But the blood itself becomes more anemic, because it’s when the kidney releases the hormone erythropoietin (EPO) that red blood cells can be created. When the kidney can’t release as much EPO as it’s supposed to, the blood cell count goes lower and the patient becomes more anemic. In turn, the blood carries less oxygen and the body has to work harder in order to function. As a result, the person experiences greater and greater fatigue.

Stage One leaves the patient with 90% kidney function. The person can survive at this level, but it’s still necessary to detect the problem so causes and treatments can be addressed. If they don’t take steps at this point, the disease is very likely to progress to the next level. Stage Two leaves only 60-89% kidney function, as the damage to these organs has increased.

The difficulty is that there are no obvious symptoms of kidney dysfunction at either stage. This may lead to a lack of detection at a crucial time when the disease could have been nipped in the bud, or curtailed before it got much worse. So it’s essential that the person have their regular yearly physical checkups, including urine tests and extensive blood work. Even with no other physical symptoms, these tests can detect:

1. elevated creatinine levels (which indicate how well the kidneys are filtering out wastes)
2. elevated protein levels (another indication of inefficiency in filtering wastes)
3. elevated blood urea nitrogen levels (kidneys take urea from the blood and expel it in the urine, but if the blood levels are high, this is another hint of failing kidneys)

In addition to the potential for early detection with blood and urine tests, high blood pressure is a well known hint of problems with kidney function. The most often mentioned symptom is high blood pressure, which can either cause kidney disease, or be caused by it. So if a person’s blood pressure rises, this can be a spur to doing the urine and blood tests, either to detect kidney disease or rule it out. And all steps (medication, exercise, alterations in diet) must be taken to bring the blood pressure down.

If blood and urine tests indicate a possible problem, doctors can go further and take a kidney biopsy, do a CT scan, or perform an MRI. So even at these early stages, while it’s more difficult, it’s still possible to detect incipient kidney disease. What it takes is vigilance, and thorough, regular checkups.

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Potassium and Sodium form another electrolyte pair that relate to each other and face connected problems when affected by kidney disease. First of all, these two chemicals form a specific balance of fluids inside and outside of the cells of the body. Potassium is highly concentrated inside cells, while sodium is more highly concentrated outside.

While sodium regulates fluid levels throughout the body itself, the sodium-potassium inside-outside chemical balance of the cells is very important. This balance creates an electrically charged potential at the cell membrane. And it’s this electrical potential that is crucial to such things as heart function, muscle contraction, and the transmission of nerve impulses. If these chemicals are thrown out of balance, it’s clear that people could suffer anything from heart problems to weak muscles or even nerve problems.

The kidneys serve a vital function in keeping these electrolytes balanced, excreting excess amounts so the body stays regulated. But what happens if there is more of a particular chemical in the body than the kidney can possibly eliminate? We see this question coming more and more to the forefront as the North American diet, in particular, is increasingly swamped with sodium. Excess sodium can lead to fluid retention, high blood pressure, and kidneys that become so overworked that they start to falter or even fail.

At the same time, if the kidneys aren’t able to function at full strength, and can no longer eliminate potassium in the way they are supposed to, people can begin to experience a condition known as hyperkalemia. This promotes further buildup of fluid in the body, but its worst effects have to do with the heart. It may result in a weak or irregular heartbeat, and a difficulty controlling the muscles. At its worst, it can lead to problems with breathing, weakness, or cardiac arrest. But like so many conditions related to kidney function, it often shows no symptoms at all until the kidneys are already severely compromised.

Doctors need to be careful in trying to rebalance sodium and potassium. When patients receive diuretics that promote urination, to remove excess sodium, they sometimes experience depleted potassium, which creates further nerve, heart, and muscle problems. Yet a lack of balance can damage the kidneys – and damaged kidneys can throw the balance even further out. It’s far better to eat a healthy diet and promote kidney health to begin with, than scramble to try to fix these electrolyte imbalances after they arise.

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It’s been established that when a person has kidney disease, one of the big concerns becomes the balance of their electrolytes – that is, the electrically charged elements that move through the blood to help the body perform vital functions. Keeping the calcium and phosphorus balanced in the body becomes especially important, because these two electrolytes play a major role in building bones and teeth, and also in conveying energy throughout the body. So what happens if they do go out of balance? How does this imbalance manifest itself?

Diseased kidneys can’t get rid of excess phosphorus, nor can they activate Vitamin D, meaning calcium levels drop. The thyroid triggers more calcium both to bring those levels up and to balance the excess phosphorus. This extra calcium is often leeched from the bones, making them weaker. And calcium phosphate deposits, made from all this extra material, begin latching onto soft tissue, including in the arteries, heart, lungs, and joints. Eventually these deposits start to harden, creating health problems related to the lungs and heart.

Electrolytes float through the blood and perform various functions in people’s bodies. Calcium, Sodium, and Potassium, for example, work together to help the muscles of the body contract. And the work of some of these electrically charged substances is controlled or at least affected by the kidneys.

This means that when the kidneys are diseased, the electrolytes may also function in an unhealthy way. Serious problems can arise that might, at first, seem unrelated to the kidneys at all. But to understand how these issues develop, we first need to know how electrolytes function when everything works properly.

Let’s take a look at two electrolytes – calcium and phosphorus – which often work together, each substance relying on the kidneys to keep it in balance with the other. The first function of the two is probably obvious: to help build up bones and teeth. Almost everyone knows that calcium is good for building bones, but few are aware that phosphorus is just as important. In fact, while about ninety-nine percent of the calcium in the body is concentrated in the bones, as much as eighty-five percent of the body’s phosphorus may also be found there.

One topic that frequently comes up in connection with kidney disease is electrolytes. They play an important role in the body, and relate particularly to kidney malfunction. But what are they, and what do they actually do? We will explore this topic in several installments, to try to explain how electrolytes work, and why their levels are important to monitor when you have impaired kidneys.

Electrolytes are substances that are electrically charged, or ionized. Because of this charge, they can carry electrical impulses along the nerves and muscles. These substances are, in fact, what make most parts of the body function at all. And if they aren’t present in proper levels, or certain types are out of balance, the body begins to suffer the consequences.

So for example, you may have some electrolytes carried along in the blood, and they would pass through membranes and cell walls into muscle tissue, to transmit impulses that make the tissue contract. Muscle contraction depends on the presence of three electrolytes in particular: Calcium (Ca2+), Sodium (Na+), and Potassium (K+), with the plus or minus values indicating what sorts of ions they are. Lower the levels of these three too much, or put them out of balance, and muscle function suffers.

It’s well-known that Chronic Kidney Disease (CKD) reduces the ability of the kidneys to help make red blood cells. As a result, people with diseased kidneys can often become anemic. And since red blood cells carry oxygen through the body, this may then lead to oxygen starvation, causing all sorts of symptoms from shortness of breath to cardiovascular problems.

For this reason, doctors have always been encouraged to use stimulating agents to help raise the hemoglobin levels of kidney patients. But the latest guideline offered by Great Britain’s National Institute for Health and Clinical Excellence (NICE) adds a cautionary note about the levels of hemoglobin doctors should aim for. The reason, they say, is that in this case, there can actually be too much of a good thing.

Anemic kidney patients obviously receive considerable benefit from having their hemoglobin levels brought back up. But according to NICE researchers, there is a specified upper limit above which these levels should not go. If hemoglobin rises above them, rather than experiencing even greater health benefits, these patients could face certain new risks. Such risks might include strokes or blood clots.

The new guidelines released by NICE on February 9, 2011, address many issues about managing anemia in kidney patients. For example, doctors need to take into account how active the patients might be in their daily work. They might also accept slightly higher than recommended levels of hemoglobin if no other factors suggest a risk of cardiovascular problems.

But on the whole, the NICE guidelines recommend that physicians stay pretty much within the suggested upper and lower hemoglobin levels. Doctors need to take  into account the conditions their patients have already developed and risks they know already exist; Keeping these in mind, they must then should monitor their hemoglobin treatments to ensure new health risks are not introduced into the lives of the patients.

(National Institute for Health and Clinical Excellence, on the new Guidelines, February 9, 2011)

Kidney disease is related to a great many other diseases and conditions, the most common being high blood pressure and heart and stroke problems. But another condition it’s often linked with is lupus. And for those who have both lupus and kidney disease, the prognosis is unfortunately not good.

Systemic lupus erathymatosus, usually just called lupus, causes damage to the skin, joints, brain, and also to the kidneys. In fact, according to an article on the HealthDay website (Kidney Disease Could Be More Deadly for Kids With Lupus, Friday December 17, 2010), about eighty percent of children with lupus also suffer kidney damage. But whether it’s adults or children who have end-stage kidney disease caused by lupus, all have a higher likelihood of death from any cause than those who have the same kidney problems stemming from a different source.

Researchers from both Johns Hopkins University and the Children’s Hospital of Philadelphia studied the cases of 98,000 children, and this conclusion is what the evidence suggested. Children were 2.4 times more likely to die, when suffering from kidney disease caused by lupus, than children whose disease was caused by something else. Adults had a slightly better record, yet they were still almost twice as many times more likely to die.

While many causes seemed to lead to death for people with kidney disease caused by lupus, the most common cause, according to the study, seemed to be cardiovascular disease and cardiac arrest. For this reason, the researchers suggest that patients with the lupus-kidney combination probably need extra monitoring for atherosclerosis, or the thickening of the walls of the arteries. And when kidney patients are also diagnosed with lupus, that should send up a red flag of warning, so doctors can be more alert to the increased risks of death.

The study, entitled Increased risk of death in pediatric and adult patients with ESRD secondary to lupus, is published in the January 2011 issue of the journal, Pediatric Nephrology.

The idea seems straightforward when you think of high blood pressure: if you lower your salt intake, you will help to lower the blood pressure, or at least prevent it from getting worse. But the systems in our bodies don’t operate in isolation, and the good you do for one of them is bound to have positive effects in others. This was demonstrated yet again by a review conducted by the Cochrane Collaboration Renal Group.

This group reviewed thirteen studies relating to salt intake in diabetic patients. What they found was not entirely surprising, but the implications of their conclusions are widespread. First of all, they confirmed once again the connection of high salt intake and blood pressure issues. So clearly, diabetics would do well to reduce salt levels in their diet for that reason alone, because this reduction lowers the risk of strokes, heart attacks, and heart failure.

But the evidence gathered in the same studies also reinforces the understanding that high blood pressure is just as hard on the kidneys as on the heart. The studies also suggested that even for people whose blood pressure hasn’t yet inched into the “high” range, lowering salt intake will still have a positive effect on heart and kidney health.

This isn’t necessarily a rule condemning people to a life of tasteless food, however. Removing salt from one’s diet provides the opportunity to discover the natural, intrinsic tastes of food, and to combine these tastes into something that as delicious without needing a salty boost. While easing the blood pressure and helping the heart and kidneys, the lessening of salt might open up a whole new culinary world.

(View the Cochrane Renal Group Summary: Suckling RJ, He FJ, MacGregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD006763. DOI: 10.1002/14651858.CD006763.pub2)

(Further reading: PulseToday, December 9, 2010; Nursing Times, December 10, 2010)

Sometimes a person’s kidneys are adversely affected not just by their own lifestyle, but by illnesses they have little control over. One example was recently discussed in an article in the online version of the British Medical Journal. Several researchers analyzed information from the Walkerton Health Study. This study followed the  health of citizens of the Canadian town of Walkerton, Ontario, after their municipal water system was infected with E. coli O157:H7 in May of 2000. Almost two thousand people who had contracted gastroenteritis at the time were monitored for several years.

The results indicated a higher likelihood of experiencing high blood pressure, heart problems, and renal impairment for those who had been infected and developed gastroenteritis symptoms than for those who had not. The risk of high blood pressure was 1.3 times higher, the chance of having either a stroke or heart attack was almost twice as high, and the likelihood of kidney problems was about three times higher.

This analysis is not only pertinent in cases like that of Walkerton, in which E. coli contamination hits an entire community. Most warmblooded organisms have forms of E. coli in their systems, and it is also found in many environments. Most strains are not harmful, but those like O157:H7 can be deadly. The presence of E. coli  often indicates fecal contamination, yet it also enters an environment in other ways.

What this means is that people can contract gastroenteritis from E. coli in ways apart from disasters like that which struck Walkerton. So for those who do encounter these bacteria, whether through mass contamination or in less obvious ways, it is important to monitor their health carefully from that point on. As well as being at a higher risk for blood pressure or heart problems, they will need to be on the watch for potential kidney problems as well.

(Further reading: British Medical Journal, reference BMJ 2010; 341:c6020, November 17, 2010; Medical News Today, November 21, 2010)

Most of the kidney disease people experience is caused by factors such as high blood pressure or as a complication of conditions like diabetes. But Polycystic Kidney Disease (or PKD) is a type of kidney disease that is of a completely different order. This is a condition that results from a person’s own genetic makeup.

The disorder, as its name suggests, causes multiple cysts to form mainly in the kidneys, although they can appear in other parts of the body too. These cysts are filled with fluid, and often enlarge the kidneys, sometimes until they weigh several pounds. The cysts take up space normally available for filtering purposes, which can ultimately lead to kidney failure. They also create higher blood pressure, which can go on to do other damage to the kidneys as well.

Symptoms of PKD, apart from high blood pressure, can include back pain, blood in the urine, an increase in abdomen size, and kidney stones. Cysts may also be found in other parts of the body such as the liver or pancreas, and they may even cause aneurysms in the brain.

Diagnosis is often not made until this condition has progressed quite far, but if a family member is known to have PKD, a person’s own chances of having it are increased. Blood and urine tests often don’t detect the problem early either, but ultrasound imaging, at least, can detect cysts greater than a half inch in size. Genetic tests can discern whether a person has the gene for PKD.

There is no prevention or cure available for PKD, but detection of the gene does give a person a chance to take some control. Regulating diet and blood pressure can help, and there are treatments for results of PKD such as pain, kidney stones, and headaches. As with all other forms of kidney disease, a healthy diet and blood pressure control are some of the most helpful steps to take.

(Further reading: Mayo Clinic – Polycystic Kidney Disease; MedicineNet.com – What is Polycystic Kidney Disease?)

High blood pressure is one of the risk factors for kidney disease. This doesn’t mean that blood pressure problems always lead to problems with the kidneys, but high blood pressure is certainly one of the things that can cause them damage. But how exactly does it do that?

According to MedicineNet.com, the damage from high presure is caused not just to the kidneys, but to a person’s blood vessels in general. The measurement of one’s blood pressure involves how much force the blood exerts against the walls of the blood vessels as the heart pumps. Various factors like retention of fluid or clogged vessels can make the heart work harder and increase the pressure as it works to push blood through.

One reason high blood pressure can lead to kidney problems is that it damages the blood vessels there as well as in other parts of the body. This sometimes results in substances collecting along the inside walls of the blood vessels, thickening them so that the blood pressure goes up.

And a vicious cycle can often be created, in which the kidneys can’t remove all the wastes carried in the blood vessels, which leads to a higher fluid volume in the blood vessels, which leads to higher blood pressure.

As is the case with other physical causes of kidney disease, the root issue is frequently that the kidneys are simply made to work much harder than they should. Eventually they simply wear out, and stop being capable of filtering wastes out of the blood. Damage caused to blood vessels by high blood pressure is one of the insidious ways kidneys can be harmed.

People most often think of strokes and heart attacks as dangers people can face if they have high blood pressure. But kidney failure is another major risk, and demonstrates another reason why it is absolutely necessary to keep one’s blood pressure under control.

(Further reading: MedicineNet.com; Wikipedia – Hypertensive Nephropathy)

There are different types of kidney disease, and different ways that the kidneys can begin to fail. In some cases, the cause of disease in someone’s kidneys stems from genetic factors that are out of the control of the sufferer. But the vast majority of causes are things that a person has some control over.

One of the well-known conditions that can lead to kidney disease is diabetes, but not everyone understands how a diabetic condition might eventually produce problems with the kidneys. As blood flows to the kidneys, impurities are filtered out while the healthy, more useful material, such as protein or blood cells, continue through the blood stream. But as sugar levels in the blood increase, the kidneys find themselves filtering more and more material.

What eventually occurs is that protein cells, too, begin to “leak” into the kidneys and get discarded in the urine. This happens because as the kidneys find themselves working much harder to filter the blood properly, eventually they start wearing out, and will become permanently damaged if the process is not somehow reversed. In the early period, this condition is called microalbuminuria, and it’s at this stage — when extra protein starts showing up in the urine, indicating a problem — at which the process may be stopped. If it progresses to macroalbuminuria, a high level of protein, the kidneys are damaged enough that complete failure is the most likely result.

Regular testing of protein levels in the urine can help a diabetic guard against the development of this problem. But the best way to try to prevent kidney disease in diabetics is to keep the blood sugar levels carefully controlled, and to control blood pressure as much as possible. Diabetes may be a condition that is inevitable for some people, if their bodies are unable to produce enough insulin. But kidney disease as a result of diabetes doesn’t have to be equally inevitable.

(For more detailed information, check the American Diabetes Association.)

It’s well known that there’s a relationship between kidney disease and diabetes, but usually that connection is thought of as a causal one. That is, people with diabetes are at higher risk of developing kidney disease, because high glucose levels and high blood pressure can damage the kidneys. But now researchers from Indiana University-Purdue University Indianapolis, along with fellow researchers from the Mayo Clinic, have uncovered a connection between the two that’s a bit more positive.

Polycystic Kidney Disease (PKD) is somewhat different from other types of kidney disease in that it is caused by genetic factors. These lead to the growth of cysts in the kidneys, gradually reducing kidney function. But the researchers have now discovered that pioglitazone, a substance that treats diabetes by making the body more sensitive to insulin, does other things as well. One of those is to inhibit what is called a “chloride channel.”

This made the researchers sit up and take notice, since excessive chloride and water, which helps kidney cysts expand and multiply, is a characteristic of PKD. Pioglitazone is already approved for use for other conditions, and has a “good safety profile,” according to researcher Bonnie L. Blazer-Yost. This drug may be just what is needed to treat PKD and stop cyst progression, because at the moment, there are few other options for treating PDK.

Blazer-Yost and her other colleagues have published their paper in the online medical journal, PPAR Research. They hope that human trials for the use of this drug on PKD can be conducted in the not-too-distant future. It could mean real hope for effective treatment for many who have no other realistic hope at the moment.

(Further reading: Medical News Today, November 15, 2010)

You’d think it would be completely straightforward. Since one of the things that sometimes results from kidney disease is higher blood pressure, a kidney disease sufferer with hypertension problems would naturally take their medication. But a recent report has suggested that one-third of these patients actually don’t maintain their blood pressure treatments.

Researchers from the University of Cincinnati and the Cincinnati Veterans Affairs (VA) Medical Center have just published a report that describes this problem. They took two years’ worth of data from 7,227 patients at the VA who had chronic kidney disease (CKD), and who also suffered from hypertension. And this was when they uncovered the astonishing fact that about thirty-three percent of these patients either didn’t take their blood pressure medications, or had what was described as “poor medication adherence.”

The consequence appears to be a twenty-three percent higher likelihood of a worse outcome for those CKD patients themselves, when it comes to the progression of the disease. Doctor Charuhas Thakar, associate professor at the university and chief of the renal division at the VA, points out that high blood pressure is “probably the most important modifiable risk factor in chronic kidney disease.” This means that if patients are able to regulate their blood pressure and reduce the strain on the kidneys, they can do much better at improving their kidney health and, incidentally, lowering medical costs.

The report has just been published in the November 2nd online edition of the American Journal of Nephrology. Doctor Thakar points out that the results of this analysis need further confirmation, since all of this data came only from one place. But certainly this news suggests that people with CKD should not neglect their blood pressure medication if they suffer from hypertension.

(Further reading: UC Academic Health Center News Release, November 3, 2010)

The Centers for Disease Control and Prevention (CDC) has just released a report on the rates of End-Stage Renal Disease (ESRD) in persons diagnosed with diabetes. ESRD is the stage of kidney failure where the only possible treatment is either dialysis or a transplant, and according to this report, the rates of ESRD among diabetics went down thirty-five percent between 1996 and 2007. That’s good news — sort of. But unfortunately, there’s more to the story than that apparent decline.

The problem is that the number of people with ESRD actually went up over that period. In 1996, a total of 32,716 began ESRD treatments, while in 2007, that number had risen to 48,712. The only reason the total percentages were lower is that the number of patients diagnosed with diabetes skyrocketed even more over that decade. So while it’s a good thing that a lower percentage of diabetics are ending up with ESRD — at the moment, anyway — there are still more people with drastic kidney failure than there used to be.

The main test currently used to detect CKD is a test for creatinine in the blood. Unfortunately, though, creatinine only noticeably accumulates after the kidneys have already lost much of their function. If the new study’s results can be reproduced and further validated, they will provide ways of detecting CKD much earlier, meaning treatment can also begin earlier, thereby possibly saving the kidneys and preventing further damage.

The 2,300 study participants gave blood samples between 1995 and 1998, with normal kidney function. The odd thing was that since the study was mainly concerned with the heart, the focus was not at first on kidney disease at all. Yet when 9.5 percent of participants had developed CKD within a decade, with another eight percent having reduced kidney function, researchers examined six blood markers from the original samples to check for correlations. Two of these – homocysteine, which builds proteins, and aldosterone, dealing with how kidneys handle salt, had elevated levels, as did B-type natriuretic peptide, which also can indicate heart damage.

This doesn’t mean doctors can now simply test for these markers and immediately predict CKD. For one thing, the study must be replicated, widening beyond the largely European-descended group originally tested. But if these results hold true in future clinical studies, they may provide a way both of testing early for CKD, and taking steps to prevent and treat it.

(Further reading: Times of India, October 22, 1010; Medscape Today, October 21, 2010; My Health News Daily, October 21, 2010)

This Reuters article, Moderate kidney disease linked to hearing loss, describes the findings:

In the study, of adults aged 50 years and older, 54 percent of people with moderate kidney disease had some extent of hearing loss, while 30 percent of those with the disease suffered severe hearing loss.

One reason this is significant is that for the general population in the same age range, the rate of hearing loss is only 18 percent. But even recognizing some kind of connection between kidney disease and the loss of one’s hearing, the next question is whether this link is causal, or merely coincidental.