National Kidney Foundation is a lifeline for all people affected by kidney disease. As pioneers of scientific research and innovation, NKF focuses on the whole patient through the lens of kidney health. Relentless in our work, they enhance lives through action, education, and accelerating change. The NKF Board of Directors consists of leaders in their communities who have been affected by kidney disease. They are nephrologists, kidney healthcare professionals, living donors, transplant recipients, care partners, top executives with diverse business experience, and civic leaders. We hope you enjoy visiting their site and find it a useful extension of your relationship with us. (Information also in Espanol)
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OUR NEPHROLOGY SERVICES
Medical Care Solutions With a Focus on Nephrology
CKD
Chronic kidney disease, also known as chronic renal disease or CKD, is a condition characterized by a gradual loss of kidney function over time.
CKD includes conditions that damage your kidneys and decrease their ability to keep you healthy by filtering wastes from your blood. If kidney disease worsens, you may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health, and nerve damage.
Kidney disease also increases your risk of having heart and blood vessel disease. Early detection and treatment can often keep CKD from getting worse.
We will check your kidney function to help plan your treatment by performing blood and urine tests
Diabetic Kidney Disease
Diabetic kidney disease is a decrease in kidney function that occurs in some people who have diabetes. High blood pressure, poor sugar control, and diet are the risk factors linked to an increased risk of developing kidney disease.
The diagnosis is based on the presence of abnormal amounts of protein in the urine. Various tests can be done to tell if a person has kidney disease. The most widely used are serum creatinine and BUN (blood urea nitrogen). Other more sensitive tests are: creatinine clearance, glomerular filtration rate (GFR) and urine albumin. Estimated of glomerular filtration rate (eGFR) is considered a better measure of kidney function compared to creatinine. Urinary albumin-to-creatinine ratio (UACR) is also used to check for high protein in the urine (albuminuria), which is a sign of kidney disease.
Acute Kidney Injury
Acute kidney injury (AKI), also known as acute renal failure (ARF), is when your kidneys suddenly stop working properly. AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right fluid balance in your body. AKI can also affect other organs such as the brain, heart, and lungs.
Depending on the cause of your acute kidney injury, your healthcare provider will run different tests. It is important that AKI is found as soon as possible because it can lead to chronic kidney disease or even kidney failure. It may also lead to heart disease or death.
The following tests may be done: Measuring urine output, Urine tests, Blood tests, GFR (glomerular filtration rate), Imaging tests, Kidney biopsy
End Stage Renal Disease and Dialysis
End-stage renal failure, also known as end-stage renal disease (ESRD), is the final, permanent stage of chronic kidney disease, where kidney function has declined to the point that the kidneys can no longer function on their own. A patient with end-stage renal failure must receive dialysis or kidney transplantation in order to survive for more than a few weeks.
Doctors can diagnose the disease with blood tests, urine tests, kidney ultrasounds, kidney biopsies, and CT scans.
Protein or blood in the Urine
Blood in your urine can come from your kidneys or can come from other parts of your urinary tract, such as your: Ureters (the tubes from your kidneys to your bladder), Bladder (which stores urine), Urethra (the tube from your bladder to the outside of your body).
A small amount of protein in your urine is normal, but too much can signify kidney disease. When kidney disease damages them, proteins such as albumin may leak from your blood into your pee.
To diagnose protein or blood in the urine, your doctor will ask about your medical history and send a sample of your urine or blood or both for lab tests. If you have diabetes or high blood pressure, your doctor will help create a treatment plan to keep it under control.
You may also need other tests including a CT scan, Kidney ultrasound, Cystoscopy, and renal biopsy.
Cystic kidney disease and Polycystic Kidney disease
Polycystic kidney disease (also called PKD) causes numerous cysts to grow in the kidneys. These cysts are filled with fluid. The kidneys can become damaged if too many cysts grow or if they get too big. PKD cysts can gradually replace much of the kidneys, reducing kidney function and leading to kidney failure.
PKD is the fourth leading cause of kidney failure. It is found in all races and occurs equally in men and women. It causes about 5% of all kidney failure.
Ultrasound is the most reliable, inexpensive, and non-invasive way to diagnose PKD. Occasionally, a CT scan and MRI may detect smaller cysts that cannot be found by an ultrasound. MRI measures and monitors the volume and growth of kidneys and cysts.
Congenital Kidney disease
Congenital kidney abnormalities occur when a baby’s kidneys and urinary tract do not form adequately while developing in their mother’s womb. These problems are present at birth, and one or both kidneys can be affected.
In many cases, the abnormalities will not have significant health effects on the child.
Symptoms will vary due to the wide range of congenital kidney abnormalities and their impacts on a child’s health. Many of the conditions can be detected before the baby is born and symptoms are visible. Others may not cause symptoms or problems until adulthood.
Kidney abnormalities are typically inherited and passed down through families.
Kidney disease and Liver failure
Hepatorenal Syndrome (HRS) is a life-threatening condition that affects kidney function in people with advanced liver disease. HRS is most common in people with advanced cirrhosis and an abnormal buildup of fluid in the abdomen that is often related to liver disease. But the syndrome can also occur in people with acute liver failure and other types of diseases of the liver.
There are two types of HRS: Type 1 (Acute) involves a rapid decline in kidney function and can quickly progress to life-threatening kidney failure. Type II involves a more-gradual decrease in kidney function.
Medical professionals conduct a thorough clinical evaluation; take a detailed patient history and order various tests. By doing so, they seek to determine whether certain conditions exist — including advanced liver failure with portal hypertension and to rule out other causes of kidney impairment, One of the tests used to diagnose HRS is a common blood test known as a serum creatinine test.
KIDNEY DISEASE AND HEART FAILURE
Having chronic kidney disease (CKD) means you are more likely to get heart disease. CKD can cause heart disease, and heart disease can cause CKD. In fact, heart disease is the most common cause of death among people on dialysis.
The best way to prevent heart disease is to prevent or treat the problems that can cause it, such as diabetes, high blood pressure, and anemia.
Heart disease can include:
– Coronary artery disease (CAD)
– A blood clot that blocks the flow of blood to your heart
– Heart attack
– Problems with your heart’s muscles, valves, or heartbeat
If you have heart disease and CKD, your doctor may prescribe medicines to treat your heart disease and can help you to lower your chance of heart disease if you have CKD.
Kidney disease and anemia
Anemia happens when your red blood cells are in short supply. Red blood cells carry oxygen from your lungs to all parts of your body, giving you the energy you need for your daily activities.
Your kidneys make an important hormone called erythropoietin (EPO). Hormones are chemical messengers that travel to tissues and organs to help you stay healthy. EPO tells your body to make red blood cells. When you have kidney disease, your kidneys cannot make enough EPO. Low EPO levels cause your red blood cell count to drop and anemia to develop.
Anemia can happen early in the course of kidney disease and grow worse as kidneys fail and can no longer make EPO. Anemia is quite common if you have diabetes, are African-American/Black, have moderate or severe loss of kidney function (CKD stage 3 or 4), Have kidney failure (stage 5), or are female.
Not everyone with anemia has symptoms. If you have kidney disease, you should have a blood test to measure your hemoglobin level at least once a year to check for anemia.
Your treatment will depend on the exact cause of your anemia. If your anemia is due to kidney disease, your healthcare provider will treat you with different types of medications, such as Drugs called erythropoiesis-stimulating agents or Extra iron.
Kidney stone
A kidney stone is a hard object that is made from chemicals in the urine. There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. A kidney stone may be treated with shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, or nephrolithotripsy. Common symptoms include severe pain in lower back, blood in your urine, nausea, vomiting, fever and chills, or urine that smells bad or looks cloudy.
Possible causes include drinking too little water, exercise (too much or too little), obesity, weight loss surgery, or eating food with too much salt or sugar. Infections and family history might be important in some people. Eating too much fructose is associated with an increased risk of developing a kidney stone.
Your doctors will start with starts with your medical history, physical examination, and imaging tests and will want to know the exact size and shape of the kidney stones. This can be done with a high-resolution CT scan or an x-ray called a “KUB x-ray” (kidney-ureter-bladder x-ray) which will show the size of the stone and its position.
Second, your doctors will decide how to treat your stone.
Later, your doctor will want to find the cause of the stone, so they will test your blood for calcium, phosphorus and uric acid.
Kidney disease in Lupus or autoimmune disease
There are two types of lupus. Systemic lupus erythematosus (SLE) is the form of lupus that can harm your skin, joints, kidneys, and brain and may be fatal. The other form of lupus is called “discoid” lupus erythematosus, which involves only your skin. When systemic lupus erythematosus (SLE) affects the kidneys, it is called lupus nephritis. Lupus is an “autoimmune” disease, meaning your immune system, turns against the body. This causes harm to organs and tissues, like your kidneys.
No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants may play a role in causing the disease. Men and women of all ages and races get lupus. However, about 90 percent of people diagnosed with lupus are women.
Lupus nephritis can cause many signs and symptoms and may differ for everyone. Signs of lupus nephritis include:
Blood in the urine, Protein in the urine, Edema, Weight gain, High blood pressure.
Your doctor will do a physical examination, get your medical history, and do special tests. These tests include a Urine test to check for protein and blood, Blood tests, Kidney biopsy.
HTN and resistant hypertension
Resistant hypertension is high blood pressure that does not respond well to aggressive medical treatment. Hypertension is considered resistant when all of the following are true:
– Someone is taking 3 different blood pressure medications at their maximally tolerated doses
– One of the blood pressure medications is a diuretic (removes fluid and salt from the body)
– Blood pressure remains above your goal (usually 130/80 mmHg, discuss it with your doctor)
– If hypertension requires four or more medications to be controlled, it is also called resistant hypertension.
Resistant hypertension substantially increases the risk of heart attack, stroke, and kidney failure.
Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure, and other heart conditions; cause damage to your kidneys, memory, and vision; and contribute to erectile dysfunction.
Some common secondary causes of hypertension that affect kidneys include:
Renal (kidney) artery stenosis, a narrowing of the artery that sends blood to the kidneys and Kidney failure.
Hyponatremia and hypernatremia
Hyponatremia occurs when total body water is in excess of sodium, and hypernatremia develops when body water is relatively decreased in relation to sodium. Both disorders may be present in patients with various disease states in which total body sodium is either decreased, normal or increased.
The symptomatology in both disorders is related to the disturbance in the central nervous system due to brain edema in patients with hyponatremia and brain dehydration, and cerebrovascular hemorrhages in patients with hypernatremia. The treatment of hypo and hypernatremia is achieved by correcting the abnormalities in body water content.
Hypokalemia and hyperkalemia
Potassium is the primary intracellular electrolyte, and its positive charge is considered the primary intracellular cation.
Having too little potassium is called hypokalemia while having too much is called hyperkalemia. Even minor variations in serum potassium levels can have a significant impact on cardiovascular and neuromuscular function.
Adequate renal function is necessary to maintain normal potassium levels.
Hypokalemia is one of the most common electrolyte disorders. The signs and symptoms of hypokalemia are nonspecific and depend on the individual patient. As hypokalemia progresses, the cardiovascular system may become involved.
Hyperkalemia is generally caused by decreased or impaired renal excretion, the addition of potassium to the extracellular space, or transmembrane shifts of potassium. Simply increasing the dietary intake of potassium rarely causes hyperkalemia, as it is rapidly excreted by the kidneys.
Urinary tract infection
Urinary Tract infections or UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis).
Kidney infection (pyelonephritis) is another type of UTI. They’re less common but more serious than bladder infections.
Some people are at higher risk of getting a UTI. UTIs are more common in females because their urethras are shorter and closer to the rectum. This makes it easier for bacteria to enter the urinary tract.
Symptoms of a bladder infection can include: Pain or burning while urinating, Frequent urination, Feeling the need to urinate despite having an empty bladder, Bloody urine, Pressure or cramping in the groin or lower abdomen.
Symptoms of a kidney infection can include: Fever, Chills, Lower back pain or pain in the side of your back, Nausea or vomiting.
Talk with your healthcare professional if you have any questions about the recommended medicine to help lessen the pain or discomfort.
Hypertension and hypertensive kidney disease
High blood pressure (hypertension) is a leading cause of kidney disease and kidney failure (end-stage renal disease).
Hypertension can cause damage to the blood vessels and filters in the kidney, making removing waste from the body difficult. Once a person is diagnosed with end-stage renal disease, dialysis or kidney transplantation is necessary.
The symptoms of kidney disease include: High/worsening blood pressure, Decrease in the amount of urine or difficulty urinating, Edema (fluid retention), especially in the lower legs, A need to urinate more often, especially at night
Kidney disease caused by high blood pressure affects every group and race. However, certain groups are at higher risk, including:
African-Americans, Hispanic-Americans, Native Americans, Natives of Alaska, People who have diabetes, People with a family history of high blood pressure and kidney disease
The most important treatment for patients with high blood pressure and kidney disease is to control their blood pressure through lifestyle changes. Some medications lower blood pressure and can protect the kidneys from further damage, especially in people with diabetes. However, treatments need to be individualized.
Edema
Edema occurs when fluid builds up in your tissues, often in your feet, legs, and ankles. Edema can affect anyone, especially people who are pregnant and adults age 65 and older. Treatment involves lifestyle changes, including diet and exercise.
Edema will cause parts of your body to increase in size (swell), which might prevent you from completing your daily tasks. Simple lifestyle changes like elevating the swollen part of your body or moving around if you were sitting or standing for a long period of time can reduce swelling and help you feel better. Sometimes edema is a symptom of an underlying health condition, so contact your healthcare provider if you experience symptoms of edema.
After your healthcare provider makes an edema diagnosis, their next step is identifying what caused fluid to build up in your tissues.
Your healthcare provider will give a physical examination to diagnose edema, followed by diagnostic tests to find the cause
Nutrition?
Making healthy food choices is important to us all, but it is even more essential if you have kidney disease (CKD).
A well-balanced diet gives you the right amounts of protein, calories, vitamins, and minerals each day. Eating a healthy diet, staying physically active, and taking all your medicines as prescribed are all important parts of keeping you healthy and feeling well.
Your kidneys help keep the right balance of nutrients and minerals in your body. But if you have kidney disease, your kidneys may not do this job very well. You may need to make some changes to your diet.
Ask your doctor about meeting with a Registered Dietitian with special training in kidney disease. A dietitian can:
Teach you to make the best food choices based on your lifestyle and lab tests
Make changes in your diet to help you better control diabetes and high blood pressure
Help you to keep your kidney disease from getting worse
Meeting with a dietitian is a covered service by Medicare and may also be covered by other types of insurance.
OUR RENAL CARE CENTER
We offer many specialized tests and nephrology services in our office to diagnose whether a person has kidney disease and how it is affecting them.
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