Identifying Kidney Failure Video Transcript

Participants

, Lisa Clark , Jai Radhakrish MD, MRCP (, Leonard Stern MD

Webcast Transcript

LISA CLARK: I'm Lisa Clark. Thank you for joining us for this webcast. The statistics are sobering. An estimated 1 out of every 12 people in America suffers from kidney and urinary tract diseases. Kidney disease is one of the most expensive chronic disease to treat, and partly due to an aging population, it has become the ninth leading cause of death in the U.S., but it is also true that many kidney ailments are preventable and many are treatable. In the next few minutes we'll tell you how you can take an active role in the health of your kidneys.

Joining our discussion this evening, Dr. Leonard Stern, thank you for being here. Dr. Jai Radhakrishnan. Thank you as well.

First, the bad news. Kidney disease is often very hard to diagnose. One of the articles I read stated that you could have a reduction of as much as 75% of normal function before you're even aware that your kidneys are starting to fail. Is that true?

JAI RADHAKRISHNAN, MD: That's absolutely correct, Lisa. There are two issues here. The first is that you have a tremendous amount of reserve in the kidneys before any symptoms manifest, and typically we don't see patients come in with any problems until they're down to about 25 or 30% below normal. The second issue is that the symptoms that accrue from kidney damage are so vague that you might easily ascribe it to something like depression or fatigue from working too hard, and in reality there's a lot of damage being done in the kidney that could lead to a lot of problems like high blood pressure and anemia. Again, it's basically difficult to detect.

LISA CLARK: Now, you are specialists. It would behoove a general practitioner to really acquaint themselves with the symptoms and warning signs of various kidney diseases, and as you say, that's a very difficult thing to do, but let's talk about some of the things that your doctor might look for that you might look for, say, in acute situations.

LEONARD STERN, MD: You might look at it from a slightly different perspective. The general practitioner that sees a patient will typically do screening blood work, and the majority of the time, the patients that we would see would be people whose blood work is abnormal, where some measure of kidney function -- we use a marker called the serum creatinine, which is a general gauge of kidney function. When that number is elevated, then the general practitioner might suspect that there is something awry with the kidneys.

Another screening test the general practitioner could use would be urinalysis, where they look for the presence of protein or inflammatory cells. Sometimes the blood work, in addition to the creatinine, might give the practitioner a clue that there's a problem. The serum protein level, the albumin, might be reduced, or the lipid levels or cholesterol might be elevated. All could be features of subtle kidney disease.

In the early presentations of kidney disease, unless there's a fulminant disorder, the general practitioner will not detect anything. Fulminant disorders are disorders called acute glomerular nephritis, things of that sort, which are systemic illnesses that present with a variety of features -- high blood pressure, swelling of the legs, bleeding in the urine, difficulty breathing -- a major illness requiring hospitalization.

The more subtle forms of chronic kidney failure are very indolent. If the patient told the physician that they're urinating more frequently at night, that might be an early, subtle symptom of chronic kidney failure that would largely be discarded, thinking they drank too much before they went to bed.