Kidney Disease Underdiagnosed

Posted on Wed, Apr. 04, 2007

By Dr. Oliver Graham

BY THE TIME patients come to the county's Chronic Kidney Disease Clinic, they're usually quite sick, and likely to become permanently disabled. But it doesn't always have to be that way.

Kidney disease (also called "renal failure" or "renal insufficiency") is one of the most underrecognized and underdiagnosed chronic diseases. Some 60 percent to 80 percent of people with significant kidney disease don't know they have it. The illness usually doesn't cause symptoms until it has become irreversible. (Note that kidney disease almost never causes back pain.)

Unfortunately, the current rise in obesity is causing an increase in both high blood pressure and diabetes, common causes of kidney disease. And, our aging population's increasing use of over-the-counter painkillers to treat arthritis and other inflammatory conditions also leads to worsening kidney function.

As a result, health experts predict that in the next 10 to 20 years there will be a substantial rise in the number of people with serious kidney disease.

What is kidney disease?

The kidneys have a variety of functions: They filter the blood, getting rid of water-soluble toxins; they make hormones that cause red blood cell production; and they regulate the balance of water and salt in the body. In addition, the kidneys help eliminate most medicines from the body.

So, as the kidneys stop functioning effectively, salts and toxins build up, leading to swelling and fatigue. The patient becomes anemic. By the time someone has symptoms, which include severe nausea, vomiting, fatigue and swelling, the damage is usually irreversible.

Who is at risk?

People at higher risk include those who:

Have high blood pressure
Have diabetes
Have a family history of hypertension or diabetes
Take anti-inflammatory painkillers that include ibuprofen (Advil and Motrin), Naprosyn and Celebrex, as well as Tylenol (acetaminophen). Taking large amounts of these medications, or even regular doses over a prolonged period, can cause or worsen kidney disease.
Are of African or Latino ethnicity.

How is it treated?

The progression of early stage kidney disease can be slowed by taking medicines known as ACE inhibitors (lisinopril, Altace, etc.).

Most other medication dosages or frequency must be reduced because poorly functioning kidneys don't eliminate them from the body efficiently.

Eventually, if the kidneys stop working, their function must be replaced by dialysis or a transplanted kidney. Dialysis usually involves thrice weekly trips to a clinic to be hooked up to a machine that filters and cleans the blood.

Alternatively, nightly hookups (while sleeping at home) to a machine that filters fluid in the space inside the abdomen known as the peritoneum can replace some failed kidney functions.

A kidney transplant can replace dialysis, but involves the lifelong taking of medicines to prevent the body from rejecting the transplanted kidney.

How is it prevented?

Most important is for high-risk individuals to get checked and treated for high blood pressure and diabetes, before kidney disease develops. Also, avoid high doses or prolonged use of over-the-counter painkillers. A diet low in protein may help slow kidney failure.

Assessing kidney function involves testing both the urine and blood, and sometimes an X-ray or ultrasound. A checkup with your doctor can determine how your kidneys are functioning, and whether you are at risk for kidney disease.

Graham is co-director of the Chronic Kidney Disease Clinic at Contra Costa Regional Medical Center.