“We simply can’t live without at least one of our kidneys functioning properly,” said Dr. Saatiah Jaffry, a nephrologist in Sebastian, noting that kidney disease is on the rise.
The kidneys are two small but mighty organs located on either side of the spine just below the ribcage, and while they are only about the size of an adult fist, they are working 24/7 to keep the rest of the body in balance. It’s the kidney’s job to remove waste and excess fluid from the body and filter the blood, keeping some of the compounds while removing others. With their complex filtration process, they help regulate blood pressure, red blood cells and the amount of certain nutrients in the body such as calcium and potassium.
Blood enters the kidneys through an artery from the heart and passes through millions of tiny blood filters that cleanse it. Waste materials are passed through the ureter to be stored in the bladder as urine, and the newly cleaned blood returns to the bloodstream by way of veins.
Once the bladder becomes full, the urine passes out of the body through the urethra. About 200 quarts of fluid is filtered through the kidneys every 24 hours, with about 2 quarts being eliminated from the body in the form of urine and about 198 quarts retained in the body.
“Unfortunately, kidney disease is on the rise in the United States, with diabetes and high blood pressure being the leading causes of the disease,” said Dr. Jaffry. “The epidemic of obesity is increasing, which causes diabetes, which in turn leads to kidney disease. A staggering 1 in 3 diabetics end up with some kind of kidney disease which may result in their requiring dialysis to sustain life.
“Diabetes is a disease in which your blood glucose or blood sugar levels are too high, and it causes multi-organ damage,” Jaffry explained. “It causes macro and micro vascular disease, especially when uncontrolled. On a microscopic level, the blood vessels are small, and it causes neuropathy. Diabetes can affect every organ in the body, and if it’s poorly controlled it can cause multiorgan failure, cardiovascular disease and chronic kidney disease. The first sign of kidney disease is hyperfiltration, a condition when the blood sugars are so high it increases urination. The kidneys have to work overtime to drive out the sugar in the urine and they start to break down.”
This leads to the leaking of protein into the urine. Generally, a primary care doctor will find this during a routine yearly exam. A simple dipstick test can test your urine for protein and blood. If the blood is positive, it’s an indication of kidney problems.
“Early detection is so important,” said Dr. Jaffry. “Everyone should go for their routine yearly checkup and get a metabolic blood panel. This simple blood test will detect early kidney disease, and if it’s caught early enough there are medications and dietary changes that can control it. Diabetics should get tested every three months to keep track of their A1C1 so that intervention can be done as soon as a problem occurs.”
When a kidney function declines to 10 percent or 15 percent it is no longer compatible with life because the toxins and fluids start building up in the body. Once it reaches that point, the only way to live is to get a kidney transplant, which is not always possible, or go on dialysis.
Dialysis is, quite simply, an artificial kidney that utilizes a machine to filter the toxins out of your blood. There are two different types of dialysis: hemodialysis and peritoneal dialysis.
Hemodialysis is a procedure where an artificial kidney, or dialyzer, filters blood through thousands of tiny tubes. To get your blood into the dialyzer, the doctor will make an access or fistula into your blood vessel, usually through the arm. As the blood passes through it is bathed in dialysis fluid. The dialysis fluid is going in one direction at about half a liter per minute, and the blood is going through at about the same amount in the opposite direction through the tubes. A thin membrane separates these two parts. Blood cells and protein remain in your blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid, pass through the membrane and are washed away.
“People who come to dialysis and get hooked up to the machine are usually here for three to four hours, three times a week,” said Dr. Jaffry. “The process cleans the blood of toxins and excess fluids, and it enables them to live. Some patients prefer to do dialysis at home on a smaller machine, but they will have to do it five days a week because the home dialysis machine is not as effective as the ones in the lab. You and your doctor will decide which treatment is best for you based on your medical condition and your wishes.”
In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles. A soft plastic tube is placed in your belly by surgery. A sterile cleansing fluid is put into your belly through this catheter, and it washes in and out for about five cycles. After the filtering process is finished, the fluid leaves your body through a catheter.
“Most patients on peritoneal dialysis will hook themselves up the machine before they go to sleep and let it do its cleansing as they sleep,” she further explained. “Peritoneal dialysis needs to be done for about 10 hours every night for six or seven nights a week.”
The only cure for chronic kidney disease is to get a kidney transplant, but people are waiting five years or more for a transplant in Florida. “We encourage people to become donors because there is such a shortage,” Dr. Jaffry revealed. “You can live with one kidney for the rest of your life and there are many people in the population who don’t have diabetes or high blood pressure who would be good candidates for donating a kidney. If they come forward they go through intensive testing to make sure they are good candidates and only then will they be considered for a match.”
Obviously, no one wants to be hooked up to a dialysis machine or endure a kidney transplant, so it is fortunate there are things that can be done to prevent chronic kidney disease.
Most importantly, get a yearly blood screening once a year. Control high blood pressure by keeping a good weight, exercising regularly and eating a healthy diet rich in whole fruits and vegetables. Smoking is a big contributing factor, so, if you smoke … quit. Certain over-the-counter medications are also toxic to the kidneys. Anti-inflammatory drugs like Aleve, Advil and Ibuprofen should be taken in moderation and not as a daily routine. Tylenol is a safer choice for the kidneys. Kidney disease is known as a silent killer, so preventative steps and checkups is your best defense.
Dr. Saatiah Jaffry received her medical degree from Aga Khan University in Pakistan and completed her fellowships at the University of Connecticut and the University of Massachusetts Medical Center. She is an independent physician with offices in Sebastian and Palm Bay with privileges at Sebastian River Medical Center. She can be reached at 772-918-8487.