Here's How To Keep Those Kidneys Healthy

June is Men’s Health Month. Here are just one of the vital concerns for Black men and what you can do to keep your kidneys in order.

WHAT IS KIDNEY DISEASE?

Kidney disease is the loss of normal kidney function.

Chronic kidney disease, commonly also referred to as chronic kidney failure or chronic renal failure, refers to the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine.

WHERE ARE YOUR KIDNEYS, HOW MANY DO WE HAVE, HOW MANY DO WE NEED AND HOW DO THEY FUNCTION?

Most people are born with 2 kidneys. However, a small percentage of individuals are born with just one solitary kidney. Our native kidneys are located high, one on each side, in our retroperitoneal spaces (in our flank areas) which are areas protected by our lower posterior rib cage on each side.

People can function with one normal kidney. This is the reason why people with two normal kidneys can safely donate one of their kidneys to give to another person during a living donor kidney transplant. Thus, in normal situations, people only need one kidney to function.

The kidneys function by filtering toxins and excess fluid out of our bloodstream. These toxins and excess fluid are excreted by the kidneys in the form of urine which is then transported down the ureters to the bladder where the urine is then stored until the individual voids.

HOW DO WE KEEP OUR KIDNEYS HEALTHY AND HOW OFTEN SHOULD WE GET OUR KIDNEYS CHECKED?

It is very important that we keep our kidneys healthy. Ways in which to maintain good health of our kidneys is to eat a healthy diet, drink plenty of water, avoid excessive alcohol consumption and smoking, exercise and maintain a healthy blood pressure and avoid the onset of high blood pressure and diabetes.

If we develop high blood pressure and/or diabetes, it is critical that we take our medication to control these conditions so that chronic kidney disease does not develop as a result of hypertension (high blood pressure) or diabetes. Hypertension and diabetes damage the small and large blood vessels which supply blood to our kidneys.

We should routinely have our blood pressure checked, several times per year, and if we have a family history of high blood pressure and/or diabetes we should even more often get checked for the presence of hypertension and diabetes.

Both of these conditions can exist without any early signs or symptoms, thus the importance of undergoing routine screenings for high blood pressure and diabetes.

Nowadays, more than ever, it is easy for us to routinely get our blood pressure checked. Many locations in communities are available to check our blood pressure for free, including at local pharmacies. A normal blood pressure in an adult is now considered to be less than 120 mmHg systolic and less than 80 mmHg diastolic.

WHAT ARE SOME SYMPTOMS OF KIDNEY DISEASE?

Most early stages of kidney disease present with NO symptoms whatsoever. However, the earliest signs are detected during laboratory blood testing ordered by your doctor when an elevated serum creatinine blood test is measured and elevated.

Also signs of kidney disease are finding of protein in the urine on a routine urine test called a urinalysis.

Some symptoms of chronic kidney disease (later stage kidney disease) include a combination of lower extremity swelling (swelling of your legs), weight gain, nausea and/or vomiting, shortness of breath, lethargy/malaise (feeling tired or weak), decreasing volumes of urine, dry and itchy skin, foamy urine and sometimes other symptoms.

IS KIDNEY DISEASE GENETIC?

Kidney disease can have genetic causes. Patients who are found to have early stage kidney disease often undergo kidney biopsies to help determine the etiology or cause of their kidney disease.

Doctors also take family medical histories of patients with kidney disease to help determine if their kidney disease is known to occur in their family. Knowing if there is a hereditary cause of a patient’s kidney disease is important. It can help direct early interventions in the attempt to treat, reverse or slow the progression of disease, depending upon the result of the biopsy. It can also predict, in some cases, the advisability of whether a given patient’s disease may or may not allow them to safely receive a kidney transplant and determine the timing of such a kidney transplant.

However, most cases of kidney disease are not genetic in origin for kidney disease but related to higher rates of high blood pressure and/or diabetes, both of which have strong genetic components in family members.

However, just because one has a strong family history of high blood pressure and/or diabetes does not automatically mean that a given individual is destined or pre-determined to develop hypertension, diabetes or kidney disease themselves.

African American’s have 4-6 times greater incidence of developing kidney disease compared to Caucasian Americans, largely because of much greater incidence rates and rates of untreated hypertension and/or diabetes.

CAN KIDNEY DISEASE BE SUCCESSFULLY TREATED?

Not all cases of kidney disease progress to kidney failure of chronic kidney disease. However, most cases of kidney disease do progress to chronic kidney disease but not all cases of chronic kidney disease progress to kidney failure and the need for dialysis or kidney transplant.

If a patient has developed chronic kidney disease as a result of high blood pressure and/or diabetes, tight control of their high blood pressure and/or diabetes can significantly slow the progression of their chronic kidney disease and prevent them from developing kidney failure. This is good news.

WHEN IT GETS TO THE POINT WHERE SOMEONE NEEDS A TRANSPLANT – WHAT STEPS DO YOU RECOMMEND?

Kidney transplantation is the preferred therapy for kidney failure compared to maintenance dialysis. There are two different types of kidney transplantation: deceased donor kidney transplantation and living donor kidney transplantation. Outcomes at all-time points are far superior following living donor kidney transplantation compared to deceased donor kidney transplantation.

Patients, in order to qualify for a kidney transplant, must first be referred to a kidney transplant center to undergo a formal pre-kidney transplant evaluation. Patient’s primary care providers and nephrologists commonly are the doctors referring patients for pre-kidney transplant evaluations, but patients can refer themselves (and ADVOCATE for themselves to be referred) to under pre-kidney transplant evaluations by transplant centers.

There is an advantage for patients to be evaluated by more than one kidney transplant center to increase their chances of receiving a kidney transplant from the deceased donor list. For patients with chronic kidney disease, it is advisable that they seek a kidney from a living person, either a blood relative or non-blood living individual, because results/ outcomes following living donor kidney transplantation are superior to outcomes of kidney transplantation from deceased donors.

Patients should read and learn as much as they can about kidney transplantation, the risks and benefits, the process to undergo kidney transplantation evaluation and the process of receiving a kidney transplant and process following a kidney transplant.

Patients need to demonstrate to transplant centers that they are compliant with taking their prescription medications, fluid restrictions if they are on fluid restrictions, and compliant with showing up and undergoing their dialysis treatments if they are on dialysis.

Transplant candidates will need to demonstrate that they have a social support system to assist them in getting to and keeping post-kidney transplant follow-up appointments and that they have resources to receive their post kidney transplant medications necessary to prevent post kidney transplant rejection.

Kidney transplant centers have social workers who are available to work with patients regarding medical and prescription medical insurance financial considerations regarding kidney transplantation and post-transplant medications.

When undergoing pre-kidney transplantation evaluations, patients should be prepared to ask questions and receive answers regarding the transplant evaluation and what is expected of them to complete the kidney transplant evaluation process, get approved to receive a kidney transplant and be activated on the kidney transplant waiting list or undergo evaluation of a living donor kidney transplant.

Importantly, patients considering, undergoing kidney transplant evaluation or on the waiting lists for kidney transplantation, whenever possible, unless for emergency situations, should avoid receiving blood transfusions prior to their kidney transplant because blood transfusions can increase their levels of antibodies which can make if much more difficult for them to be matched with an acceptable kidney for transplantation.

A great source of information for patients with kidney disease is the National Kidney Foundation website.

FOR PEOPLE WILLING TO BE DONORS, WHAT SHOULD THEY DO?

For people considering of becoming a living kidney donor, they should first visit their primary care provider and have a general physical examination to screen for high blood pressure and/or diabetes, obesity, heart disease, kidney disease, protein in the urine, high cholesterol and lipids, Hepatitis C or other conditions as well as determination if they have two normal kidneys with a kidney ultrasound.

Likewise, if a patient in need of a kidney transplant is already undergoing a pre-kidney transplant evaluation at a kidney transplant center, that center can evaluate a prospective living kidney donor at no charge to the person willing to donate one of their kidneys for transplantation.

For people interested in registering on the organ donor registry to donate their organs after their death, one can register online at the National Kidney Foundation website or other website, at their local bureau of motor vehicles or at their local organ donor procurement agency or by calling any transplant center or in other ways.

ARE THERE DIFFERENT TYPES OF KIDNEY DISEASE?

Yes, there are different types of kidney disease. There is kidney disease caused by “medical causes”, such as diabetes and/or high blood pressure or heredity causes such as a variety of “glomerulonephritis” causes.

In addition, there are “Urological” causes or structural causes that cause kidney disease as a result of bladder outlet obstruction as a result of having a benign, noncancerous enlarged prostate, prostate cancer, stroke and urinary retention, chronic kidney reflux, chronic kidney stones or chronic recurrent urinary tract infections.

Patients can also be bore with kidney disease or kidney anomalies which can progress to chronic kidney disease and the need for dialysis and/or kidney transplantation.

WHY DOES KIDNEY DISEASE IN AFRICAN AMERICANS GO UNDETECTED UNTIL THE LAST STAGES?

African-Americans most commonly develop kidney disease from high blood pressure and/or diabetes. Diabetes and high blood pressure in early stages often present with no signs or symptoms and many African-Americans do not undergo routine physical examinations or health screenings.

Many African-Americans are not aware that they need to undergo such routine examinations or health screenings and many do not access to care due to lack of health insurance or because of poverty and other social determinants of health.

Therefore, due to relative lack of routine preventive health screenings, African-Americans often are not diagnosed with chronic kidney disease until they are in the very late or advanced stages of chronic kidney disease.

WHAT’S YOUR RECOMMENDATION FOR THOSE NEEDING TO BE EVALUATED, LISTED AND TRANSPLANTED?

My recommendation for those who have been diagnosed with chronic kidney disease that they seek early evaluation for a kidney transplant at more than one kidney transplant center.

I advise that if their own primary care physician, urologist or nephrologist has not discussed with them their options to receive a kidney transplant that they proactively contact the kidney transplant centers themselves and self-refer themselves to undergo pre-kidney transplant evaluation.

Additionally, those with chronic kidney disease, I advise that they avoid undergoing routine blood transfusion (unless in an emergency situation) because blood transfusions can interfere and prevent them receiving a kidney transplant.

In addition and very importantly, I advise that anyone considering to undergo a kidney transplant actively seek to identify several potential living individuals to agree to undergo an evaluation to be considered as a potential living kidney donor.

Proactively provide potential living donors with information regarding living kidney donation and provide them with the phone numbers of the living kidney donor offices of their kidney transplant centers.

Also, note that for potential living donors who are not compatible with the person to whom they wish to donate their kidney to, there are paired donor exchange programs that allow such prospective donors to donate to others and in turn the incompatible donors of others can donate to the person they had wised to donate to.

I encourage individuals who need kidney transplants to start their pre-kidney transplant evaluation as early as possible, even before they require starting dialysis. I advise also that people become creative and even use their social media, churches, community connections and other networks to let others know of their need for a kidney transplant. Doing so may result in them finding a prospective living donor whom they may have never considered. I have seen this happen numerous times.

Dr. Modlin answers your ‘Text Tom’ questions on the next page.

My husband has high BP, but no diabetes. He drinks liquor, but it’s times when he drinks about 50oz of water and Gatorade and won’t be able to pass urine for about 5-6 hours. Those are signs of kidney disease, correct?

Thank you for your question. High blood pressure is a leading cause of kidney disease and this is a risk factor for kidney disease in your husband. Also drinking an excessive amount of alcohol is a risk factor for developing high blood pressure (known as hypertension) and consequently kidney disease.

Drinking water is good for kidney health but drinking excessive amounts of Gatorade and sugary drinks are not healthy. If your husband is having difficulty voiding, passing his urine/emptying his bladder, this may be a sign that your husband may be experiencing bladder outlet obstruction from an enlarged prostate, which is called BPH, benign prostatic hyperplasia.

Prostate cancer can also cause men to have difficulty emptying their bladders. While I am in no way indicating that your husband has prostate cancer, he should be evaluated by a urologist to determine the causes of his urination difficulties.

It is my believe that “Every Man Needs A Urologist, In Addition To A Primary Care Doctor”. Urologists are physicians and surgeons who are specifically trained to address medical issues and concerns in men. Please schedule your husband to have a consultation with a urologist and have your husband get a PSA (prostate specific antigen) blood test which is a screening test for prostate cancer.

Can you reverse damage done to a kidney?
There are certain instances when acute kidney disease (known as acute kidney insufficiency) can be reversed. However, kidney disease resulting from diabetes and/or high blood pressure is usually a slowly progressive disease that cannot be reversed.

However, the progression of kidney disease can be slowed down so that not all cases of kidney disease will progress to advanced kidney disease or kidney failure.

Careful control of blood pressure and blood sugar (diabetes) can halt the progression of kidney disease. There are urological conditions, such as bladder outlet obstruction caused by an enlarged prostate, kidney stones and urinary tract infections that can contribute to the onset of acute kidney disease. If these conditions are diagnosed and treated early then the kidney disease can be reversed.

My mother and her mother were both dialysis patients prior to death. Is kidney disease hereditary?

There are instances where kidney disease can be hereditary; however, the vast majority of cases do not represent hereditary kidney disease. However, high blood pressure and diabetes can be hereditary conditions that predispose patients to developing kidney disease.

It is important for us to be aware of what are our own personal family medical histories so that we will know which diseases and conditions are more prevalent in our families which are more likely to also afflict us.

Does kidney disease stem from not drinking a lot of water to cleanse out the kidneys?
Significant and severe dehydration can definitely contribute to people developing kidney disease. It is important that we remain well-hydrated to help us remain our kidney health. The general rule of thumb is that we should drink water to hydrate and not sugary drinks and that we should drink to thirst.

We should routinely check our weight and monitor our general urine volume and if we note that we are developing retention of fluid in our lower extremities (legs) and that the amount of urine we are making is decreasing that this may be a sign of kidney disease and evaluation by our primary care doctor and/or urologist is indicated.

My kidneys are at 40% How can I improve their function?
The main thing you must do since your kidney function is reduced is to maintain strict control of your blood pressure, blood sugar, weight and cholesterol and lipid blood levels. These steps can help reduce the rate of deterioration of your kidney function.

In addition, I would recommend that you seek referral to a kidney transplant center for a pre-kidney transplant evaluation to determine if kidney transplantation is an option for you. I am happy to speak directly with you regarding matters related to kidney transplantation. You can call my office 216-445-7550 and/or email for further discussions: ModlinC@ccf.org

After you have the kidney transplant do you take medication?
Following kidney transplantation, patients are required to take anti-rejection (immunosuppression) medications for life in the overwhelming majority of situations.

Additionally, patients must generally take antibiotics, antiviral and anti-fungal medications and many patients will need to take blood pressure medications and diabetes medications if they have diabetes.

It is critically important that patients following kidney transplant do comply and take all of the medications they are proscribed and at proper times. This is important to prevent rejection and infections and necessary to maintain the health and survival of the kidney transplant.

I have never heard anything to keep a kidney healthy or cure a kidney that is starting to show signs of high creatinine. What helps?
he creatinine level is a blood test that doctors measure to assess a patient’s level of kidney function. There are other variables, such as one’s state of hydration and body mass and even one’s race that can influence one’s creatinine level.

If a person has an elevated creatinine and is evaluated by a physician and determined to have kidney disease, the rate of deterioration of one’s kidney function can be significantly slowed down by tight control of one’s blood pressure and control of their diabetes and cholesterol and control of one’s weight.

I have Polycystic Kidney Disease. I am 53 years old. I am on 3 blood pressure medications. I am not having any problems, I live a good full normal life. My nephrologist just told me about a new drug Jynarque. Is this drug worth taking?

A recent study of this new medication called Jynarque did indicate that in patients with kidney disease (stages 1-3) as a result of autosomal dominant polycystic kidney disease the rate of deterioration of kidney function can be slowed compared to that seen in patients not taking this medication.

This medication is “the first and only medication that is FDA approved treatment to slow kidney function decline in adults who are at risk for rapidly progressing autosomal dominant polycystic kidney disease (ADPKD).

Before you take any new medications or embark upon any new treatment plan(s), it is critically important that you speak with your personal physician, in your case your nephrologist who is a specialist in the diagnosis and treatment of kidney disease, to make sure you fully understand he risks and benefits of such treatment recommendations.

Also, I always advise patients and their families that every patient has the right to seek second and even additional opinions from additional doctors to ensure that they make the best informed decisions.

Can taking too many supplements with good intentions be over tasking to the kidneys?
Yes, taking too many supplements with good intentions can in fact potentially damage and be deleterious not only to our kidneys but to our other organ systems. Often times, what is actually contained in many of these supplements is not fully known. It is always advisable to consult with your physician and/or pharmacist prior to starting any supplements.

Can the keto diet cause damage to your kidney? If so, how can it be done and keep kidneys safe?
The keto diet is a diet that is low carbohydrate diet and ingesting a diet low in carbohydrates can actually be beneficial to kidney health. High carbohydrates in the diet can contribute to kidney disease. Prior to undertaking any new diet, I recommend that you seek advice from your primary care physician and nutritionist.

It is important that on any diet that you maintain your electrolytes by also ingesting vegetables. For patients already afflicted with kidney disease I stress even more that it is extremely important for you to seek medical advice prior to undertaking any new diet.

I’ve been diagnosed with MGUS – does this eliminate me from receiving a kidney transplant?

MGUS is Monoclonal Gammopathy of Undetermined Significance. There is research of the outcomes of patients with MGUS who have had kidney transplantation and that research has suggested that kidney transplant remains an option and appears safe for patients with MGUS.

Again, it is very important that patients follow up very closely with their kidney transplant and primary care physicians and nephrologists following kidney transplantation to detect the early presence of any complications that might potentially occur following kidney transplantation.

Are people with lupus eligible for kidney transplants?
Yes, people with Lupus are definitely candidates to receive a kidney transplant. However, kidney transplant centers will not transplant patients who are experiencing active flare-ups of lupus because lupus that is clinically active is more likely to put the new kidney transplant at risk for reoccurrence of the lupus in the transplant kidney, which can cause the kidney to fail.

Patients with Lupus should seek kidney transplantation evaluation, as the transplant evaluation process can take a considerable amount of time. During the evaluation process the transplant team will advise the patient of when kidney transplant will be most appropriate for them—which would be at a time point during which their Lupus is not active.

HOW CAN SOMEONE FIND YOU TO GET MORE INFORMATION?

Dr. Charles Modlin welcomes anyone to contact him at:

Dr. Charles Modlin Email: ModlinC@ccf.org

Office Phone: 216-445-7550

Twitter: @MMHCenter

Website: www.clevelandclinic.org/mmhc

www.clevelandclinic.org/mmhf

Dr. Charles Modlin, M.D., MBA, is a Kidney Transplant Surgeon & Urologist, Executive Director Minority Health and Cleveland Clinic Physician Lead for Public Health.

He founded & directs Cleveland Clinic’s Minority Men’s Health Center (MMHC) and in 2003, established Cleveland Clinic’s Annual Minority Men’s Health Fair. In, 2011 he was named by The Atlanta Post as one of the Top 21 Black Doctors in America.

Modlin graduated from Northwestern University and Northwestern University Medical School, completed a six-year residency in Urology at New York University, a three-year fellowship in kidney transplantation surgery at Cleveland Clinic and joined the Cleveland Clinic Staff in 1996.

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