Frequently Asked Questions
How many kidneys do I have?
Healthy people have two kidneys. A normal kidney can fit in the palm of your hand. Fortunately, if one organ stops working, or if both are partially damaged, the remaining kidney is usually able to perform adequately on its own. Unfortunately, many people suffer from loss of function of both kidneys resulting in total kidney failure.
What do my kidneys do?
Your kidneys serve several vital functions, including:
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Remove waste from the body in the form of urine
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Filter toxins from the blood
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Help to regulate blood pressure and the balance of certain important nutrients, including potassium and calcium.
Because the kidneys perform several essential functions, treatment of kidney failure is complex and should be performed by a qualified nephrology specialist.
How do kidneys work?
Kidneys are essentially blood-cleansing organs. An artery from the heart brings blood into the kidneys to be cleaned by a network of millions of tiny units called nephrons. The nephrons filter out toxins, excess nutrients and body fluid and excrete them in the form of urine into the bladder. The remaining cleaned and filtered blood then passes through veins back into circulation.
What happens when the kidneys stop functioning?
If both kidneys stop functioning due to disease, patients experience end-stage renal disease (ESRD), or total kidney failure. Because the kidneys perform so many critical functions, people whose kidneys fail face an immediate life-threatening condition. Kidney failure means that the body can no longer rid itself of certain toxins and cannot properly regulate blood pressure and critical nutrients. Unless those experiencing kidney failure are treated, they can die within days due to the build-up of toxins and fluid in their blood. More than 300,000 Americans today have ESRD and are dependent on artificial dialysis to stay alive.
What are the different types of kidney disease?
There are four types of kidney disease, which are as follows:
· Diabetes: accounts for more than 40% of all new cases of ESRD;
· High Blood Pressure: (Hypertension) accounts for 26% of all new cases of ESRD;
· Glomerulanephrities and
· Cysts.
What is dialysis?
Dialysis is a life-saving process that artificially replaces the functions of the kidney. There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves removing blood from the body and filtering it in a machine. The patient is connected by a tube to the dialysis machine, which continuously draws blood out, cleanses it and removes excess fluid and then returns the blood back to the patient. Hemodialysis must be performed for 3 to 4 hours at least three times a week. It is usually performed at a dialysis center, though home dialysis is also possible. Peritoneal Dialysis is internal or in-body dialysis. Peritoneal dialysis entails use of a blood-cleansing solution called "dialysate" that is injected into the peritoneal cavity, the region of the abdomen that is lined by the peritoneum. While in the peritoneal cavity, the dialysate works to extract toxins and excess fluid from the blood. After a period of time, the solution is then drained from the body cavity. Peritoneal dialysis may be done during the day or at night. Continuous ambulatory peritoneal dialysis (CAPD) is the name given to this procedure when it is performed at five-hour intervals four times a day during waking hours.
Is dialysis a cure?
No. While dialysis is life sustaining and allows most patients to work and perform many normal activities, dependence on dialysis is strenuous, costly and is accompanied by severe dietary and lifestyle restrictions. Dialysis patients must continuously monitor and regulate their body's levels of salt, protein, potassium and calcium. ESRD patients are also highly prone to fatigue, especially immediately prior to dialysis treatment.
What about kidney transplants?
Many ESRD patients benefit greatly from a kidney transplant. After successful transplantation, patients no longer require dialysis. Today there are approximately 53,042 Americans on waiting lists to receive a kidney transplant. The development of effective anti-rejection drugs means that the prognosis for five-year survival for most of these patients is high. To avoid rejection, the best possible source of kidney donation is a close relative whose blood and tissue type match the patient's. Donated organs from cadavers also have high success rates. A growing source of kidneys for transplantation comes from living donors who are not blood relatives, but with whom the patient has an emotional tie, such as a spouse, friend or co-worker. Due to improved anti-rejection drugs, this promising type of donation has demonstrated success rates close to that of blood relative donation. There were 14,152 transplant operations performed in 2001. Of those, 5,949 of the organs came from living donors.
What causes kidney disease?
Diabetes and high blood pressure are the two leading causes of ESRD, accounting for more than 60 percent of new cases. Kidney disease can also develop from infection, inflammation of blood vessels in the kidneys, kidney stones and cysts. Other possible causes include prolonged use of pain relievers and use of alcohol or other drugs (including prescription medications).
Who is most prone to kidney disease?
Anyone can develop kidney disease. However, people over the age of 50 and certain minority populations, including African Americans, Native Americans, Hispanics, Asians and Pacific Islanders are disproportionately affected by ESRD. Approximately 360,000 Americans suffer from ESRD, and this number increases by about 7 percent each year.
What are the warning signs of kidney disease?
The warning signs of kidney disease include:
· High blood pressure
· Swelling of the face and ankles y
· Puffiness around the eyes
· Frequent urination (especially at night)
· Rusty or brown colored urine
· Back pain just below the rib cage.
If any of these symptoms develop, see a physician right away and ask to be referred to a nephrologist.
Should I consult a specialist?
If you experience any of these warning signs, you should see your health-care provider right away. In addition, you should consult a nephrology specialist as early as possible. Treatment of ESRD and kidney diseases is complex, so if you or someone close to you has kidney disease, be sure to consult a qualified nephrologist. Studies show that your chances of surviving kidney failure are best if you are under the care of a nephrology specialist.
Is ESRD expensive to treat?
Yes. Due to the large and growing number of patients faced with long-term dependence on dialysis, ESRD is among the most expensive diseases to treat on a per capita basis. Fortunately, since 1972 the cost of dialysis and kidney transplantation for most Americans is covered through Medicare. In 1997, the total combined direct medical payments for ESRD by public and private sources was estimated at more than $15 billion (latest year for which figures are available).
Where do we stand in the fight against kidney disease?
As the population ages and as other at-risk populations increase, ESRD incidence is sharply on the rise. In fact, the U.S. incidence rate is the highest in the world -- 210 per million. While dialysis and improved treatments keep most ESRD patients alive far longer than we were able to just two decades ago, these developments also mean that more people are living with this debilitating and costly disease.
The best hope for ESRD patients, and those who care about them, is research. Through research in basic science and genetics, nephrologists today are beginning to unlock the root causes of many kidney diseases. The National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) provides funding for most of the kidney disease research in the United States. Other organizations, including the American Society of Nephrology, also fund grants for kidney research. A commitment to research is our best hope to reduce the enormous costs and human suffering imposed by ESRD.
What can I do to help fight kidney disease?
You can do a lot to help fight this life-threatening condition. First become familiar with the warning signs of kidney disease. To maintain kidney health, you should:
· Drink plenty of fluids
· Exercise regularly
· Don't smoke
· Maintain your proper weight
· Get checked regularly for diabetes and high blood pressure.
You can also help by becoming an organ donor. Becoming a donor is as easy as taking the time to speak with your family and let them know of your wishes. You can also contact the United Network for Organ Sharing at 1-800-243-6667 to request a uniform organ donation card. Finally, voice your support of funding for the NIDDK and other organizations that provide money for kidney disease research.
Reprinted with permission by ASN www.asn-online.org