Thursday, March 12, 2015 marks the 10th annual World Kidney Day. Organized by the International Society of Nephrology and the International Federation of Kidney Foundations, it is the most widely celebrated event focused on kidney health across the globe.
And kidneys should be celebrated. They are perhaps, next to the brain, the most fascinating organ(s) we have in our physiology. Some may argue the heart or the lungs, some the skin. Many more may argue our sex organs, and none of them would be mistaken. But for me, a clinician and someone who has stage 3 chronic kidney disease (CKD), I am certain that the kidneys are the most amazing little engines within our large machine.
Ten percent of the population worldwide have some form of kidney damage, with predictions of up to 17% in the next decade, and is now recognized by the World Health Organization (WHO) as a global public health issue. For those of you in the healthcare industry, or those of you who know someone with diabetes, perhaps even someone on dialysis, you see firsthand the compromise insufficient kidney function produces in someone’s life.
For me, I had no idea that I had chronic kidney disease until recently. The fact that I had no idea is what made the kidneys even more sensational to me. Were you to look at me, I am what you might call “the picture of health.” I have good body composition, good color and tone, and wit the exception of the occasional and unfortunate zit on my face, clear and healthy skin. I don’t swell, I don’t get short of breath, I’m not run down, I don’t have recurrent infections. I workout, I eat right, I have oddly strong muscles and bones. I don’t hydrate as I should but I’m working on that, and I’m a fan of those things not on the kidney friendly food list – aged cheeses, wine, caffeine, hot dogs (high sodium). Still, even to look at my blood work, there’s – historically – been little to no indicators of kidney dysfunction.
My creatinine, a waste product of protein metabolism that the kidneys are charged with clearing from our system, and thereby becomes a decent indictor of kidney function, has been on the high end of normal to trace abnormal for as long as I can remember (1.2 or 1.3 mg/dL, like clockwork – something I have to explain to every new doctor I see), but that’s it. Other indicators of kidney function have always been normal: potassium, sodium, protein, blood urea nitrogen (BUN), glomerular filtration rate (GFR). In fact, my potassium has even been low, which for kidney dysfunction typically elevates. Even as recently as 2008, I had a 24-hour urine study conducted during my pregnancy that indicated no problems, which is the most accurate GFR reading – and GFR is considered the best indicator of overall kidney function.
Well, my GFR sold me out this past year. While everything else remains equal, my GFR is now it the toilet (no pun intended). It took me a few hours after the doctor’s appointment to come to grips with having a GFR that landed me a stage 3 CKD diagnosis, and I didn’t keep a stiff upper lip when I did. I have been an emergency services nurse for many years and I’ve seen downright horrors inflicted with severe kidney dysfunction. Eventually I came to focus on the same question my doctor had – WHY? I look fine, I feel fine, my other labs are fine, my urine is fine, so what the hell, man?! As he said to me, and I say to you… You never want to be the “interesting” patient.
Boy, I went through it all after that. Every test imaginable right up to kidney biopsy and we were turning up nothing. Once the data was collected, I was referred to a nephrologist and braced myself for a kidney biopsy order. Well, the news he gave me wasn’t grand, but then again I already knew something was clearly wrong, but I didn’t have to have my kidney tissue punched into, which is a small relief. After reviewing my kidney ultrasound, he determined that it was the scarring I have in both my kidneys that is causing the impedance in filtration. I was born with a significant J-turn in my right ureter. I was a sick kid, frequently fevers and urinary tract infections, even put into isolation as a 5-year-old because they couldn’t figure out what was wrong with me. Finally, at age eight, a lovely urologist found the issue and it was surgically corrected. Unfortunately, the reflux of urine for those years growing up caused scarring in BOTH kidneys. And now that my GFR has tanked approaching age 40, I’m having difficulty forgiving the idiots who couldn’t find the problem for the first eight years of my life.
Notwithstanding, the fact that I have gone 30+ more years without any indications of kidney dysfunction – except for a high but still normal creatinine – is a real testament to their astounding ability to adapt and compensate. Take the stand alone fact that you can live with ONE kidney! But also understand that one may never have any signs or symptoms of kidney problems until they get as low as 25% functional. One-quarter of their normal capacity! What other major organ can you live a normal life with only functioning at 25%? You can live with one lung, or part of your liver (which actually can regenerate to some extent), though probably not 1/4 of them. People do actually live with only 25% of their cardiac tissue healthy, but even in the case of partial livers and lungs, life isn’t normal. But the kidneys, man, they still soldier on madly under these conditions.
So, what now? Well, now I am on an antihypertensive; not for my blood pressure but for my kidney pressure. The objective from this point forward is to protect what I have left, and the hope is that I don’t have to be on a kidney transplant list or dialysis, or die young. A silver lining is that I’ve already lined up a couple people with the same blood type who would be willing to give me one of their kidneys. *grin* (Please note that the same blood type does not always indicate a tissue/organ compatability, but it is a necessary start, and relatives are typically good matches.) So, now instead of explaining creatinine to my doctors, I have to explain that I do not have hypertension – the blood pressure medication is for my CKD.
What else? Celebrate your kidneys. Take care of them. Avoid urinary tract irritants whenever possible, monitor your sodium intake, beware that you’re not abusing them with Motrin (ibuprofen) or Aleve (naproxen), don’t consume excessive protein, control your hypertension if you have it, and control your diabetes. Lastly, drink plenty of water. For World Kidney Day, drink to your kidneys! And give your family and friends water, too. A symbolic gesture and a conversation starter to raise awareness that we should look out for our kidneys like we look out for our hearts. After all, there isn’t a compensatory mechanism or other system in our bodies that the kidneys don’t affect. They play the essential role in filtering out wastes, yes, but many may not know that they also play a vital role in maintaining blood pressure, overseeing blood cell production, maintaining adequate intravascular volume, and contributing to skin and bone health.
My GFR has improved since I started the antihypertensive, started hydrating better, and monitoring what I eat. I’m not out of stage 3 yet, and I may never be, but I’ll drink to preventing stage 4. MARCH 12 – Happy World Kidney Day, everyone!
NEXT… Plain language announcements?
Creatinine 0.6 – 1.2 mg/dL (for decades it was <1.0, but this changed in the last few years)
BUN 7 – 20 mg/dL (adults)
Potassium 3.5 – 5.0 mEq/L
Sodium 135 – 145 mEq/L
GFR about 100 mLs/min/1.73m2 (though it’s typically just written >90, and differs for African Americans)
Stages 1 & 2 CKD = GFR >60
Stage 3 CKD = GFR 30-59
Stages 4 & 5 CKD = GFR <30
Urine should be free of excess protein (proteinuria) and blood (hematuria), among other elements
**For more information and insight into how truly awesome the kidneys are (for example, we didn’t even talk about their intricate microstructures which is mind boggling), there are many websites you can visit including the National Kidney Foundation (www.kidney.org), the Renal Association (www.renal.org), and My Kidney (www.mykidney.org), or even good general health information sites like the Mayo Clinic (www.mayoclinic.org), the Centers for Disease Control and Prevention (www.cdc.gov), The Cleveland Clinic Health Information Center (http://my.clevelandclinic.org/health/default.aspx), and MedLine Plus (www.medlineplus.gov).