Associates In Kidney Disease & Hypertension

There are many reasons why kidneys fail. The two major causes of chronic kidney disease are diabetes and hypertension. Our main goal at AKDH is to help improve or delay the progression of kidney disease over time all the while maintaining a quality of life. Treatment options in kidney disease including a combination of, select healthy diets, exercise, and medications that are beneficial to help stabilize renal function and help improve proteinuria.

Studies have shown that certain types of medications such as angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), SGTL2 Inhibitors can help slow progression of kidney disease in people with diabetes, and even if they do not have high blood pressure. We can help identify patients who may be appropriate to receive these kinds of medications for their kidney health.

Hypertension is defined as elevated blood pressure in the arteries. It is a major cause of kidney failure in the United States. As a person's heart muscle contracts, it pushes blood into the major arteries. It is the pressure within the arteries that is measured in blood pressure readings. The first value of this measurement is called the systolic pressure, which is usually 100 to 130 mmHg (millimeters of mercury). The second value, the diastolic pressure, is normally between 70 and 80 mmHg. A normal blood pressure might be expressed as 110/70 (110 over 70). Generally, a systolic pressure higher than 140 and a diastolic pressure higher than 90 is used to define hypertension in adults.

In some individuals, an underlying cause such as blockage of the blood flowing to the kidney or a tumor in the adrenal gland or hormone imbalance may be responsible for the blood pressure problem. This can be further evaluated and treated by a nephrologist. High blood pressure often has no physical symptoms. It is dangerous and can actually do damage to the body's organs (the heart, the brain, the kidneys) before it is diagnosed. Hypertension can lead silently, but directly, to heart attack, stroke, congestive heart failure, and kidney disease - sometimes requiring dialysis and sometimes transplantation. Patients are considered high risk if they have blood pressures near the top of the normal range, or have a family history of high blood pressure.

Dialysis is a procedure that removes waste products from the body. When the kidneys are not functioning correctly, these waste products build up and remain in the blood. As the quantity of these waste products rise in the blood, the patient becomes sick with symptoms such as progressive nausea and vomiting, lack of appetite, muscle cramps and itching. This is called uremia. Family members may notice that the person with uremia may become sleepy, tired or weak.

Dialysis is a cleansing procedure that removes toxins and excess water from the blood (replacing the job the patient's kidneys were doing before they stopped functioning correctly). This is necessary when the kidneys are no longer able to filter these waste products and remove the extra fluid that accumulates. Dialysis is required when your kidneys are no longer performing enough of their function of cleansing the blood of waste and excess fluid (End Stage Renal Disease [ESRD] has set in). A person can lose approximately 80-90% of their kidney function before its the time for dialysis. There are two types of dialysis, hemodialysis and peritoneal dialysis.

Hemodialysis is done using an artificial kidney machine that directly filters the blood. This occurs by removing the blood from the body via a vein (called a "vascular access," typically in the forearm), running it through the artificial kidney machine (which performs the cleansing step), and reinjecting the blood back into the same vein (but in a slightly different location). Hemodialysis usually occurs either in a dialysis center or in the home. The dialysis center has televisions for viewing. Most dialyzing patients will either watch TV, read a book or magazine or nap. Most folks who dialyze via hemodialysis are placed on a schedule that includes three days per week of dialyzing for approximately 4 hours. This schedule will typically be either Mon.-Wed.-Fri. or Tues.-Thurs.-Sat., and will either occur in the morning or during the afternoon.

Peritoneal dialysis (PD) is a procedure in which the natural lining of the abdominal cavity is used as a filter. This lining, called the peritoneal membrane, is richly supplied with small blood vessels. Types of PD include continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). PD is done by instilling about two quarts of a special fluid (dialysate) through a catheter into the abdominal cavity and periodically draining and replacing the fluid. PD requires that a permanent catheter be placed into the abdominal cavity. This soft plastic tube is about 12 inches long with only 4-5 inches remaining outside the body. It is placed below the level of the umbilicus (belly button) and usually to either side of it. The catheter insertion is performed in the operating room and often with local anesthesia. The main concern with peritoneal dialysis is the risk of infection. Since the catheter is a direct opening into the abdomen, strict guidelines are used to avoid infection. Patients are examined monthly as outpatients and blood work is done to make sure that the dialysis is adequate. CAPD requires no external machine. The dialysis is done by connecting the bag of dialysate to the abdominal catheter and allowing the fluid to flow into the abdominal cavity. At this point, the patient can return to their normal activity. After about 4-6 hours, the dialysate is allowed to flow back out of the cavity into the bag (via gravity). At this point the full bag of removed fluid is disconnected and a new bag of dialysate is attached. CAPD patients perform four exchanges per day, seven days per week. The exchanges are typically done once at wakeup, once at bedtime and two more times during the day.

More than 20 million Americans have kidney disease, and another estimated 20 million are at risk and don't know it. The two major causes of chronic kidney disease are diabetes and hypertension. Some kidney diseases are inherited, while others are caused by pre-existing health conditions. Some additional causes of kidney disease may include glomerulonephritis, nephrotic syndrome, polycystic kidney disease, systemic lupus erythematosus, chronic kidney infections, and kidney stones.

Chronic kidney disease occurs when kidneys have been damaged by diseases such as diabetes and/or hypertension and are no longer able to clean toxins and waste product from the blood and perform their functions to full capacity. This can happen all suddenly or over time. Our kidneys help remove wastes and extra fluid from your body, release hormones that help to: Control blood pressure, promote strong bones, prevent anemia by increasing red blood cells, maintain the correct balance of important minerals and chemicals in your blood, such as potassium, sodium, phosphorus, and calcium.

Since there are generally no specific symptoms in early/moderate kidney disease it is very important to see a nephrologist as early as possible once abnormalities in your kidney function are noted in your lab work so that we can help improve or prevent your kidney function from getting worse. Some symptoms in LATE stages of chronic kidney disease include fatigue with decreased energy, loss of appetite, muscle cramping at night, difficulty sleeping, mental changes such as inability to concentrate, headaches, swelling (edema, swelling of the face, feet, ankles, puffiness around eyes, especially in the mornings), dry, itchy skin, increased frequency in urination.

If your Glomerular Filtration Rate GFR between 30-60 ml/min you should be under the care of a Nephrologist. Early referral to a nephrologist has been shown to slow the decline of chronic kidney disease and to delay or even avoid the need for dialysis.

Our main goal at AKDH is to help improve or delay the progression of kidney disease over time all the while maintaining a quality of life. Treatment options in kidney disease including a combination of, select healthy diets, exercise, and medications. If kidney function is severely impaired, patients may require the assistance of dialysis or a kidney transplant to help maintain good health.

Proteinuria is a condition where there is too much protein in the urine. Some protein is normal in the urine, but most proteins do not make it from your blood to your urine unless there has been damage to the kidneys. It is an early sign of kidney damage and may lead to worsening kidney function over time.

People with diabetes, high blood pressure or certain family backgrounds are at risk for proteinuria. Any kind of kidney injury may result in protein in the urine. Diabetes is the number one cause of end-stage renal disease (ESRD) in the United States – a condition where the kidneys are unable to function at a level necessary for day-to-day life. Usually this leads to dialysis or kidney transplantation. Small amounts of protein (called albumin) is present in the urine as the kidney deteriorates. This is called microalbuminuria. As the kidneys worsen, more albumin in the blood appears, and microalbuminuria becomes full-fledged proteinuria. High blood pressure is the second leading cause of ESRD. Proteinuria in a person with high blood pressure indicates declining kidney function. If the high blood pressure is not regulated, the person can progress to full renal failure. There are usually no symptoms of protein in the urine but can include foamy urine, swelling in your hands, feet, stomach or face, breathlessness due to water around or in your lungs. We can help you identify proteinuria, its cause and devise a treatment plan to help stabilize and improve proteinuria.