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Kidney Disease: What You Should Know | Anjay Rastogi, MD | UCLAMDChat

May 30, 2021
Welcome everyone to today's webinar. The issue is the

kidney

s. What they

should

know

. My name is Anja

rastogi

. I am a

kidney

specialist and I will go over information about kidneys and how they can be involved in yours in the first place. care and some of the things you can do to keep your kidneys healthy, so with that there will be an option to ask questions as we go and at the end of the time allowed, I will try to answer as many questions as I can. I can and if I can't answer questions, we'll try to post them on our website as well for information about kidneys as you probably

know

that we have two kidneys, they're actually in the back, they're underneath. your ribcage, ninth, tenth and eleventh ribs and the size of the kidneys, uh, the longest dimension is about 11 centimeters, so if you are 9 to 11 from here and we look at the size of the kidneys when we look at the

disease

states, now these are the two kidneys act as filters and filter the blood, the ultrafiltrate which eventually becomes urine passes through these two tubes which form structures called ureters and then this urine finally reaches the bladder and remains here for some time until you urinate and then when you urinate, it will come out as urine, so that's it, and this is a cross section of the kidney and the cut kidney.
kidney disease what you should know anjay rastogi md uclamdchat
I'll also go over that in a little more detail,

what

your kidneys do,

what

kidneys do. a very complex organ one of the most complex organs in your body and they do many functions, many things, so we normally think of them as the organs that make urine, but it's actually more than just making urine, they get rid of waste. products, they are actually involved in the acid-base balance of fluids and electrolytes and are also not involved in the elimination of medications, so, along with the liver, the kidneys are one of the main organs that actually process and eliminate medications and This is important to know because if your kidneys are not working at their full capacity, then if your kidneys eliminate the medication, you need to dose it appropriately and your pharmacist and doctor

should

be able to tell you what dosage, but if they don't, let them.
kidney disease what you should know anjay rastogi md uclamdchat

More Interesting Facts About,

kidney disease what you should know anjay rastogi md uclamdchat...

Know that your kidney function is actually not at full capacity and they will probably need to adjust the dosage. The other function that the kidneys perform is what we call hormonal functions, so the kidneys are involved in many hormonal functions, one is the processing of vitamin D, so the vitamin D that you ingest is not actually active and has to go through the kidneys to become active, so if you're kidding, it doesn't work properly, then no matter how much vitamin D you take, it won't do its job and sometimes you'll have to. They give artificial vitamin D, which we call active vitamin D, they also participate in the production of blood cells, especially red blood cells, so there is a hormone called erythropoietin that is synthesized in the kidneys and acts in the bone marrow and causes the production of blood cells red, which are red blood cells and if your kidney does not function properly, this hormone decreases and these patients tend to become anemic, so anemia is one of the manifestations of chronic kidney

disease

and the third hormonal function that involves the kidneys It is the maintenance of blood pressure, so there is a hormone called renin. which is synthesized by the cells of the kidneys and is very important in maintaining blood pressure in humans, so these are some of the functions of the kidneys that are important to keep in mind because when the kidneys do not function properly, all of these demonstrations will disappear.
kidney disease what you should know anjay rastogi md uclamdchat
Go ahead, this is a cartoon of a nephron, so the nephron is a structural and functional unit of the kidneys, each kidney is made up of a million nephrons. Now there is a term that I call a kidney specialist, but there is another term that we use for ourselves. It is called a nephrologist, so nephrology is the same term as kidney specialist and the term comes from nephron. They also call us renal specialists, so these are terms that are used interchangeably renal nephrologist and kidneys, so let's look a little more into the nephron, these are blood.
kidney disease what you should know anjay rastogi md uclamdchat
The vessels, this red one, is the artery, this is the vein, and they pump blood to this cup-shaped structure called the glomerulus. Now the blood vessels are important. The kidneys are one of the most vascular organs in the body, which makes sense because the kidneys act as a filter for the blood, but 25 of what your heart pumps goes to the kidney, so it's a significant quarter of what you pump. pumps, so now why is it relevant if the heart is not working properly? The kidneys are affected, so it is one of the main causes. of kidney dysfunction is heart problems, so I think that is an important fact to keep in mind.
The other point I want to mention here is this cup-shaped hip structure called the glomerulus, so this is a filter, as I mentioned, the kidneys act as a filter, so filtration happens in this cup-shaped structure. Called the glomerulus, the ultrafiltrate then passes through the different segments of the nephron, the gas is processed and finally comes out here as urine. Now I want to mention that there is a test that we do for kidney function called GFR, which stands for glomerular filtration rate, so the term glomerular is here, the filter and filtration rate is how well the kidneys filter, so the test is the best overall evaluator of how the kidneys are working, so it's called GFR and I'll go over that.
When we talk about some of the tests we do for kidney disease now, how do you know you have kidney problems? So it can have different manifestations. One is: you could have swelling. You may have swelling in your face. You may have swelling in your legs. back pain as I mentioned the kidneys are in the back under the 9th, 10th and 11th ribs so if you are complaining of back pain one of the organs we look at is if the pain is coming from the kidneys you can have blood urine, therefore bloody urine is a sign that there could be a problem with the kidneys.
The other important thing is that there may be a decrease in urine formation, the foaminess of the urine, so the number 40 is also important. It could happen for many reasons, but one of the things that can cause increased foam is proteins. Now, this filter that I mentioned tries to retain all the good things in the blood and that includes proteins, so when the filter is not working properly, a lot of these proteins leak out and this protein in the urine. We use it as a marker of kidney disease and we actually follow it regularly to see how you respond, but the most important thing is that most kidney disease is asymptomatic, it's silent and I think that's a very key point.
So sometimes the only way you can tell you have a kidney problem is with a simple blood or urine test and sometimes even an ultrasound, so herein lies the importance of your annual checkup, although if You're not doing it. symptoms, you would do a simple blood test, a simple urine test every year, now how do you test kidney function like I mentioned? It is asymptomatic, in most cases, so you may not even show symptoms and you may not even know that you have kidney problems and this is important because early diagnosis and treatment is essential, so if you discover the kidney disease early, you can reverse it, but if it is more advanced, it becomes very problematic, so a simple blood test, urine test, and imaging studies are a simple test. ultrasound and, if necessary, we do a biopsy in which a small piece of kidney tissue is taken and looked at under a microscope and different types of tests are done.
Now, in the blood test, there's something we focus on called creatinine. Creatinine is. It comes from creatinine, it's not actually toxic, but it's a marker of kidney disease and as kidney function declines, creatine now rises from creatinine, we check for GFR, so this is the rate of glomeric filtration and is probably the most important. test that we do for kidney disease and then we check the urine test for protein, especially to check the urine for blood, red blood cells, scavenger cells, but also protein and you've probably heard a term called albumin, so the albumin is a specific and a special type of protein and we do it routinely every time patients come in and like I said if necessary we do imaging studies and biopsies so if your kidneys are injured what happens in general terms?
There are two types of injuries, one is acute. and the other is chronic and today I will address more the chronic problem instead of the acute one. The acute thing is that you have an insult, hopefully you'll catch it early enough and since it's acute there's a good chance you can recover the kidney. It works if you remove the insult and deal with the kidney injury, but in The Chronic it's a little different, it's actually a progressive disease and the goal here is sometimes just to slow the progression and hopefully treat it as well, but it's So. slowing down the progression is our big focus so we talk about kidney size this is what your healthy kidney should look like it's about nine to eleven centimeters it has a smooth surface now when kidneys are diseased they tend to shrink They become small and the surface becomes a little grainy.
There are some exceptions to this and one is called polycystic kidney disease because the disease actually gets larger, but those are one of the few exceptions, but in most chronic diseases the kidneys tend to shrink and reduce in size, so is how we define chronic kidney disease, so if you have any abnormality in your kidneys, whether it's a low GFR, whether it's blood in the urine, whether it's a cyst, whether it's a protein and if you have any evidence of this during more than three months, that is the limit, then you will be qualified and classified as a patient with chronic kidney disease.
Now this slide is important and I just want to focus on a few things here, so when we talk about you. I know that not too long ago there were two large groups of kidney patients with chronic diseases, at least those on dialysis and those on pre-dialysis, and that's not really a good nomenclature because what is the assumption we are making by calling them pre-dialysis. that they are going to end up on dialysis and our goal is to prevent our patients from receiving dialysis or transplant, so everything we can do, this is now called stages of CKD, so there are five stages, starting from here, your GFR. it's normal for it to be above 90 and then it's stage two stage three stage four and this is stage five this used to be called end stage renal disease esrg but now it's called CKD stage five and at this stage our goal is to make sure that we have the appropriate options for patients, whether it's dialysis or transplant, and we provide the best care possible, so one thing I would like you to do today is look at your labs, look at your creatine, look at your GFR and see what stage you are at.
It fits because the management depends on what stage you are at here, so if you are in the early stages, like stage one, two, three and even the first four, our job or our goal is, number one, to slow down the progression and , hopefully, treat it. but once you get into advanced stages four and five, our goal is to make sure you have the right replacement therapy, which could be dialysis or transplant, so it depends on what stage you are in and also the complications that occur with kidney disease. What stage are you in too, now let's look at some of the things that can really damage your kidneys.
High blood pressure and diabetes are the two most common reasons patients end up on dialysis in the US and Western society. in more than 60 to 70 percent of all cases, the third, which still has a very large center, is called polycystic kidney disease PKD and that is the third most common cause for which patients end up on dialysis, about five ten percent of patients with five to ten percent of patients who will end up on dialysis actually have PKD as the cause. Drugs and medications are actually a very important cause and these are both prescription and non-prescription medications and I'll go into that in a little more detail on the next slide.
It is always a cardiovascular risk factor and what is bad for the heart is bad for the kidneys and I think that is very important and the other side is true also what is good for the heart is good for the kidneys when people say um What can I do to improve my kidneys? One of the things we tell them is to improve their cardiovascular fitness, which includes diet, exercise, and all the good things you want to do. Infections can affect, we have hepatitis B, hepatitis C and any type of Actually, infection can cause many immune problems, we have global nephritis and all this.
This in summary, but asYou see, the big hitters are the first four and you can also include heart problems, but high blood pressure, diabetes. and polycystic kidney disease account for a good portion of the patients ending now. Drugs and medications are very important, you know, they have a purpose. My other degrees in Pharmacology I am also a pharmacologist by training and I always tell my patients to go. Review your medication list in great detail because while these medications may have potential harm, when we prescribe a medication to a patient it is always a risk versus benefit and the benefits must outweigh the risk, but sometimes medications are given that are probably not is necessary now, also the other assumption is that if the drug is sold without a prescription, it is safe and that is actually not true, many of the drugs that are sold without a prescription can potentially be very toxic, not only to the kidneys but also for others. organs too so the first one is the medications that we commonly use for pain or fever called non-steroidal and this is a very large class that includes ibuprofen Motrin Aleve naproxen so basically any pain reliever besides Tylenoso is over the counter probably belongs to this class and this class of medication is potentially harmful to the kidneys, it is harmful to the heart and also to the blood pressure, so we try to minimize it as much as we can.
A short treatment is fine, but long term. This definitely puts you at higher risk and you should definitely talk to your healthcare provider about these medications. The other one that has received a lot of attention is called ppis. These are proton pump inhibitors, these are a type of medication that you take for acid and and if you look at the label, it always says it's for a short period of time, unless your healthcare provider prescribes it for a longer cycle, so if you are taking any of these medications, make sure there is a good reason why you are taking them.
I'm taking it because at least there have been some associations that we know about between kidney disease and other diseases and organs and this class of medications, so ppis is another big class of medications to be careful with, supplements based on herbs and many of my patients. They bring their herbal supplements and said, what can I take? And I don't know my answer because I don't know what's inside them. I don't know what they do, so if I'm giving you. advice, basically I'm not telling you based on what I know and I'm just trying to speculate, so the short answer is to be very careful when taking herbal supplements.
There is actually a disease called Chinese herbal nephropathy. It is actually a disease that has This happened with some of these herbal medicines. Additionally, these herbal supplements may have agents or compounds that cause drug interactions, so that's an important thing too. Please note that we talked about the actual dosage, so if the medication is eliminated by the kidneys and your kidney is not. working at full capacity, then the dose should be adjusted and your pharmacist and doctor should help you with this. The other thing I want to go over is contrast, especially contrast, intravenous contrast, so when you do a CT scan or a CT scan.
Angiograms like cardiac angiography, they inject you with dyes and these dyes are potentially toxic to the kidneys, so first of all you should try to avoid them as much as you can, but if there is no way to avoid them, make sure you do. Have your healthcare provider take proper precautions, including hydration and some things, and minimizing the amount of dye they put in to minimize toxicity. The other one is the MRIs, the gadolinium contrast that we use, so the Gad contrast with the MRIs is not. That speaks volumes about your kidneys, but it can cause other problems, so if your kidneys are not working properly, you should be very careful about receiving any IV contrast with MRIs, so talk again with your radiologist and with your nephrologist and healthcare providers. medical attention. can do and it is absolutely necessary now if your kidneys are not working properly and CKD stands for chronic kidney disease, what can happen, as I mentioned, it is epogen or erythropoietin that the kidneys synthesize, these patients tend to become anemic and they also tend to be deficient of iron. most patients with kidney disease when they have iron deficiency it is because they cannot absorb iron properly and in these cases we tend to give iron intravenously and what they need to verify is that they will actually do it.
I'm going to cross this limit. mineral disease malnutrition acidosis cardiovascular disease and hypertension so let's talk about high blood pressure you should ask your doctor what your blood pressure goal is 140 over 90 it's 130 over 80 different patients have different goals depending on their age depending on comorbid conditions, but that's the first question you should ask, the second thing is if you think about it, clinic blood pressure readings are the worst readings, you can get the best readings less than the 24 hour blood pressure monitor, which It's home reading so I firmly believe that most of my patients have blood pressure monitors, they are not that expensive, you keep them at home and you can check them, but make sure you know how to take blood pressure correctly and if you have any question, you are more than welcome to email me ACE inhibitor medications, arbs, which is a class of medications that we prefer, salt intake is a big culprit and blood pressure and most of the salt is a hidden salt that you are not aware of when you go out or is in the preservatives, that is something you also have to be very careful with, so blood pressure control is very important.
We talked about anemia and iron. Check your hemoglobin. Monitor your iron status. If you are deficient, your doctor or nephrologist will help you. I understand the other point I want to make that I didn't: when to refer the patient to a nephrologist as soon as possible, but especially if they are late stage three and definitely stage four they should be seen. by a kidney specialist, bone disease is very prevalent, so when we say that a patient has kidney disease, there are two other things that they have by association, one is a heart problem and the other is a bone disease, and to control his bone disease we check the vitamin.
D levels are also monitored, which are calcium, phosphorus, and a hormone called parathyroid hormone pth, and again, your kidney specialist will check these, so the reason I mention all of these labs is that you should actively follow them and I always tell them. my patients is to get a printout or you can go to my UCLA health center and see the labs and take trends, so trends are sometimes more important than absolute values ​​and see and then ask your healthcare provider and ask your kidney specialist what these labs really mean. so get more involved in your own care now load up acid, the important point here is that your kidneys remove acid and since your kidneys don't function properly, your acid tends to build up on a meat-heavy western diet. have a much higher acid load and this acid load has really negative consequences on your overall health so you want to make sure that you are not too bad and this is not the stomach acid we are talking about but the acid in your blood and you have to make sure that that is taken care of and the lab that we check is called bicarbonate and it is tco2 if you look at your Chemistry panel and the magic number is 22 or higher so we definitely want this level of tco2 or serum bicarbonate is 22 and That's one of the most important things you can do to minimize the damage caused by kidney disease is to make sure that the acid load doesn't build up and this I'll go back to the plant-based diet, the animal-based diet puts a big acid load in your body, so the plant-based diet is actually much better, in that case electrolytes we should attack potassium, most kidney patients tend to have high levels. potassium levels causing hyperkalemia, but you should also keep in mind that some patients may have low potassium levels and a low potassium level can be just as bad as a high potassium level, so you need to make sure your potassium is within of the normal range and within the normal range.
It depends on your lab so it should not be too low or too high, you should also maintain sodium, calcium and phosphorus so calcium and the other electrolyte not mentioned here is magnesium which should also be checked on a Liquid regularly, now we talk about water. One point I want to make is that we usually talk about fluid restriction and water restriction, but what's more important is salt, because salt, when you eat too much of it, does two things: Salt number one tends to retain water in your body and the second thing is that salt used to makes you thirsty so you will drink even more water so I tend to focus more on salt than limiting chicken water but again you need to talk to your supplier care provider and see what guidance they are giving you regarding how much fluid you can drink.
The other question we get asked a lot about is research and clinical studies. There are many diseases that do not have a specific medication. and for that we do a lot of studies UCLA is a prime site for clinical studies and if you are interested in doing one please contact us if my office is doing a study we can see if you qualify if our office is not doing the study but there are others studies underway, we can connect you to them and these research studies have an unmet need to advance the field. All of these studies are reviewed and have to be approved by UC Rays IRB, which is an institutional review board and also by the FDA and some of the things that people don't realize because they think they're being guinea pigs, but These medications are once again risk versus benefit and the hope is that there is much more to it.
The benefit that the risk with these medications and also the attention that they receive in clinical trials is always exceptional and in the end you are also giving back to society because many of the medications that you are taking now someone went through these research and clinical studies, so To summarize, the care that a kidney patient should receive, the first, as Wright mentioned at the top, is early detection of chronic kidney disease, so it is early diagnosis and treatment and, in most In most cases, it is done through simple blood tests and urine tests. so doing it routinely once you have the diagnosis, the key goal is to slow the progression, slow the progression, add medications like ACE inhibitors, control blood pressure, control blood sugar, protein, adequate amount of protein, we want to prevent any complications, we talk. about anemia, bone disease, acidosis, malnutrition, we treat comorbid conditions, whether it's heart problems, vascular diseases, diabetes and if you've done everything you can and you're still making progress, then we prepare them for what we call rrt, which means renal replacement therapy. , and here we sit down with the patient and give them their options, both dialysis and transplant, including living donor transplant and home dialysis, so these are things that we go over in detail with patients so that they do, but this takes time and we want to do it.
I'm sure this isn't something we're rushing into right now. How to maintain kidneys. A healthy diet is very important. Eat the right diet. A healthy diet. Fried foods and things like that are not allowed, but a plant-based diet has also been shown time and time again to be more kidney-friendly than something that is more meat-based. Water intake is very important and kidneys do not like to become dehydrated, so talk to your doctor. If your kidneys are working properly, you should drink in fluid, but if they are not. working properly, then talk to your doctor and see what is the right amount of water to drink.
Workout. Smoking should be inhibited. Control of blood pressure and diabetes. A healthy heart is very important and then obviously be careful with the medications that you are taking because some of these medications can be very toxic to your kidneys now if you are interested in learning more about transplants including living kidney donation, UCLA is a very large transplant center if you're interested in home dialysis, then, then, and that's the other one. Something that UCLA is very important to, if you are interested in clinical research and last but not least, if you are interested in supporting the central kidney program in any capacity, doing outreach with us, please let us know, we will bevery happy.
To get you more involved in our program, this is our contact information, this is our website, the useless health dot org slash core renal, this is our email core renal at mednet.uc.edu and this is our phone number , so we will be very happy. to help and support you in any way we can and this is what our website looks like, as you can see there are all the clinical programs, the PKD Center, the health fair, our export team, you can also ask questions here so we can go to this. website ask questions and we will try to respond within a reasonable amount of time and this is a new and quirky website so in short learn more about kidneys so you can be your best advocate and be an active participant in your care .
Let us know what you'd like to hear more about. Give us your feedback and support our programs as much as you can. I'll end this with a line I learned in medical school. Your eyes see what your brain knows and what you don't. Not knowing can hurt you and knowledge is power so with that I will end my talk and I know there are some questions and I will be very happy to answer them so the first question is days of frequent urination should I be worried? the answer is uh, if you're drinking a lot of fluids, then if you're drinking a lot of fluids then you know you're going to the bathroom frequently, but if you're not, then it's important that you stop.
Your healthcare provider now knows that the problem might not be in the kidneys, it might actually be in the bladder or even below that, so this definitely needs to be addressed and it's also not about how often you also have some urine problem. a urinalysis and sometimes this is due to bladder irritation or infection so those things need to be ruled out. The next question is interesting: is alcohol always bad for the kidneys? Tips for kidney health, so the way I answer is if you don't. drink alcohol, don't start drinking it, there shouldn't be any reason, but if you like a glass of wine here and there, then it's not a problem if some people say it's like you can be good for your heart and good for your kidneys , uh indirectly. so that should be fine, but any excess is bad, and especially if you get dehydrated, the other thing that can happen with too much alcohol is liver problems and the liver also indirectly affects the kidneys, so the short answer is to limit your consumption of alcohol as much as you can, it also provides you with extra calories.
Next question: Some medications create high potassium levels. Can you explain more what we should do? There are some medications that are actually beneficial. That's another great question. The medications I think they are talking about here are medications called ACE inhibitors or angiotensin receptor blockers. Those are, as nephrologists, one of our favorite medications. All of our patients take those medications unless there is a good reason for that class of medication. Again, it's ACE inhibitors and ACE inhibitors, but one of the things that can happen with these medications is high potassium, so what we try to do is, if they have a high level of potassium, we want to maintain them or keep them on the medication because the benefits are really huge, so we try to reduce potassium through diet, we also give them diuretics, some of them actually reduce potassium, they are also potassium binders that you can put them in, so we try everything we can to reduce it. potassium and keep them on the medication and you could increase the dose of the medication because most of the benefit of these medications is obtained at higher doses, so the short answer is if you have high potassium levels on these medications, talk to your doctor. and see if there are other things you can do to lower the potassium instead of stopping it and the last resort is always stopping them or touching the medication which I personally don't like and most experts in this field don't do.
I don't like it either, but if that's the only option left, then we have to ask the next question: how often should I see my joker doctor? So if you are referred to a kidney specialist, that means there are some kidney problems, unless the kidney specialist sends you back saying there is no kidney problem, so if you have some kidney problems then at the very least, you should go for an annual checkup every year, but after that it depends on what stage you are at, so I mentioned stage two, three, four, five. and if you are definitely in stage five, you should be seen very frequently almost every month.
If you are in stage four, you may be seen every two months depending on what the problems are, so the frequency will depend on your stage. Again, that underlies the importance of what kidney stage you are at, what kidney stage should you be referred for transplant? Another good question, so this and the other thing I would add here is what stage should you be at? sent for evaluation by a dialysis unit, so for both it would say when you have GFR, so again the importance of lab testing when your DFI is less than 20. I automatically refer my patients through both the transplant as well as to the dialysis unit.
It's all planning and our goal is to give you as much information as possible and to be able to talk to all the healthcare teams and make the decision that best suits your needs, so I think that's where this early referral comes in. . When you receive a transplant depends on many factors, if you do not have a living kidney donor, then you will probably need to undergo dialysis and wait a few years at least before receiving a transplant. If you have a potential living donor then you can even avoid what we call preventative kidney transplant and if you have any questions about how to approach a living kidney donor I will be happy to talk to you or my team and we also have other living kidney donors above who would also be happy to help you.
Well, the next question is a very good one, what does the green ribbon mean? So I'm glad this question was asked so we all know about the pink ribbon. it means breast cancer so the green ribbon and some of them are very good friends Brandy and Ravi and many others also started this green ribbon campaign and the purpose of the green ribbon campaign is to raise kidney awareness like I said , kidney disease is Quietly, most patients do not even know that they have kidney problems and you had to be proactive about it, so the purpose of the green ribbon campaign is to increase awareness about kidneys and provide support to our kidney patients and that is a big part of the central kidney program and the last question I will answer today is if my donor has a different blood group, can they still donate?
The answer is yes. In the past, blood type was important, but now we have something called paired exchange. and you've probably seen these chains, so blood type, as long as the kidney donor is healthy enough to donate, blood type should not be a factor, they may not be able to get into you directly, but they can donate you to you and to you indirectly. I'll get the same benefit, so with that I think my time is up and thank you so much for joining me for this webinar, we have a few more coming up and if you have any questions, I have my contact information, email me.
Visit our website and also join our central kidney program. Thank you very much for joining today's webinar.

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