Understanding Kidney Disease
Dr. Rajeev Raghavan is a nephrologist practicing in Kingwood, TX. Dr. Raghavan specializes in the care and treatment of the kidneys. As a nephrologist, Dr. Raghavan most typically treats conditions like kidney stones, chronic kidney disease, acute kidney failure, gout, polycystic kidney disease, protein in the urine, and... more
Chronic kidney disease (CKD) is common, easy to diagnose, and treatable. The term CKD refers to patients with a decline in estimated GFR (eGFR) to below 60 ml/min/1.73m2 or the presence of kidney damage (e.g. protein in the urine) for at least 3 months. I encourage patients to think of the eGFR as a percentage: 100 ml/min means the kidney is working 100%. CKD can be detected easily in clinical practice from simple laboratory tests (blood creatinine or cystatin C, urinalysis) or a kidney ultrasound. It is estimated that about 13% of the adult population in the United States has some form of kidney disease, and nearly 70% are unaware. Similar prevalence data from other countries confirm the worldwide burden of CKD. Diabetes Mellitus is the most common cause of CKD. Hypertension is both a cause and a complication of kidney disease. For these reasons, strict blood pressure control is paramount. Common blood pressure goals are < 120/80 mm Hg in the general population or < 130/80 in patients with CKD and protein in the urine (proteinuria).
CKD is a progressive disease culminating in the need for dialysis or transplantation. But even at advanced stages of CKD (eGFR < 45 ml/min; Stages 3b, 4, 5), the majority of patients can maintain stable kidney function for decades by following a healthier lifestyle and initiating medications to minimize proteinuria. Normal aging results in the loss of 1% kidney function per year after age 40. With optimal treatment, the rate of CKD progression in a patient with diabetic kidney disease may be reduced to 2% per year.
An important aspect in the care of advanced CKD is preparation for renal replacement therapy (RRT). A conversation about this should begin when patients reach eGFR of 15 to 20 ml/min. This includes patient and family education, choosing the most appropriate modality and location of dialysis facility, elective placement of dialysis access, and if appropriate, referral for kidney transplantation. Timely preparation can improve patient outcomes with fewer hospital days and reduced costs.
The first successful kidney transplant between identical twins was performed on December 23, 1954. Currently, more than 200,000 patients in the U.S. have functioning transplanted kidneys and more than 14,000 transplants are performed each year. Multiple studies have shown improvement in mortality and quality of life with kidney transplantation when compared with all the other modalities of RRT. Unfortunately, there is a shortage of donated organs and a growing wait list for transplantation; hence, kidney donation by friends or family is strongly encouraged.
