>> Welcome to the ABCs of kidney disease
I'm Daphne Knicely and in today's video
we're gonna talk about the effects of kidney disease
on the body.
This video is part of the Johns Hopkins
Nephrology Patient Education Program.
We'll like to thank our sponsors,
the Ed Kraus Endowment and the Shah Foundation.
So how does the kidney affect your body?
Well in a lot of different ways.
One, it can affect your heart and blood vessels.
It can cause anemia.
It can lead to bone damage.
You can become malnourished
and sometimes depression is associated with it.
And yes, kidney disease can progress to kidney failure.
Which we'll talk about in another video.
When you have kidney disease,
it actually puts you at risk
for having cardiovascular events,
strokes,
and circulation problems.
So,
just having kidney disease does this
but most of the time people have other diseases,
like diabetes or high blood pressure
that increases their risk.
So as a kidney doctor, I take these risks seriously.
So if you came into my clinic and told me
you had chest pain or shortness of breath,
then I would wanna know, well is it your heart?
Because you're at such high risk.
But,
it could be something like heartburn or reflux
but I definitely wanna rule that out.
Or maybe you come into my clinic and you tell me,
it really hurts when I walk
really long distances.
Or maybe I have a wound on my leg that's not healing.
Well then I'm gonna be like, well,
is there circulation problems?
Cause when you have kidney disease
you're at high risk for those.
In another video I talked about some hormones
that kidneys can make.
Well some of those hormones affect your blood pressure.
Which in the normal function
when I have a low blood pressure,
my kidneys recognize that.
And so I have an increase in hormone
that raises my blood pressure.
But also as my kidney disease gets worse,
those hormones can go out of whack
and actually my blood pressure can worsen over time.
Which is kind of a vicious cycle
because high blood pressure can cause kidney disease
and that I'm telling you that kidney disease
as it gets worse, worsens your blood pressure.
So what does this mean?
We have a lot of different guidelines
on blood pressure control.
The internal medicine docs and the cardiologists
have guidelines and the nephrologists have guidelines.
Through all the guidelines, we definitely know
that blood pressures
higher than 150 over 190 are bad.
But with kidney disease we're actually
a little bit more stringent.
So if you have protein in your urine,
we actually wanna control your blood pressure
a little tighter to less than 130 over 80.
If you don't have protein in your urine,
then we wanna control it to less than 140 over 90.
And these guidelines change all the time
so, when you have a question just ask your doctor.
Another thing the kidneys can do
is they can affect your red blood cell count
and cause anemia.
So what really is anemia?
So it's a low red blood cell count,
a low hemoglobin
or a low hematocrit.
And some symptoms of this are maybe
you could feel tired all the time,
or short of breath or not have energy
or feel really cold of dizzy or have a fast heartbeat.
So, when I hear one of my kidney patients tell me
that maybe they're fatigued a lot, really tired,
or really cold, I think, do they have anemia?
I better check their blood counts.
And what the kidney is, normal kidney function
it's make a hormone called erythropoietin.
And it basically tells the bone marrow,
hey make red blood cells.
So as my kidney functioning gets worse over time,
I might not make enough of this hormone
and I can start to develop anemia.
There are a lot of different causes for anemia.
So when somebody has kidney disease
I don't just assume there's a low erythropoietin level,
I wanna rule out other causes.
And one of those is a low iron level.
And a lot of times when you have chronic kidney disease,
your diet's really restrictive.
So maybe you don't get enough iron in your diet
so actually having kidney disease
and having low iron levels is pretty common.
So, whenever somebody has anemia
I'm gonna check their iron levels at the same time.
Because,
iron is needed to make red blood cells.
So as kidney function gets worse
if you don't have enough iron
and you have a low erythropoietin levels,
it can lead to anemia as well.
So what do I do if you come into my clinic
and you tell me that you're feeling really cold
and maybe really tired.
And I check your red blood cell count
and you're actually anemic.
Well, I'm gonna check other causes.
One, I'm gonna check your B12.
And then I'm gonna check your folate,
and I'm gonna make sure you're not bleeding.
If your B12 or folate are low,
I'm gonna give those back to you
cause they're important for making red blood cells.
If for some reason you're bleeding,
I'm gonna work really closely
with your primary care doctor to figure out why.
Next I'm gonna check to see if your iron level is adequate.
If it's low I'll give you back iron.
We typically give it in the form of a pill,
but sometimes with pills
you don't really tolerate it cause it upsets your stomach
or causes constipation.
And so I end up giving you IV iron.
Well, if all of those are normal
and you have significant kidney disease
then I have to think that may be
that you're not making enough erythropoietin
to make red blood cells.
So what do I do?
I give it back to you.
We have something called erythropoietin simulating agents
which are injections.
Most people get them like once every two weeks
or once a month.
And we actually shoot for a goal hemoglobin of 10 to 11.
We don't shoot for perfect,
but because most studies have shown us
if we go above 11, sometimes you can have
worsening in blood pressure, risk of strokes,
or blood clots.
So another thing that the kidneys do
is they're really important for bone health.
So in normal kidney function,
my kidneys help hold onto calcium.
My kidneys help get rid of phosphorous.
And my kidneys convert vitamin D from the non-working form
that I get from food and the sun
to the working form.
But when I have kidney disease,
these things go out of whack.
So with kidney disease, I might not be able to
absorb the calcium like I should.
So I have low calcium levels in my blood.
Or I might be able to not get rid of the phosphorous
like I should and I have high phosphorous levels
in my blood.
Or I'm not converting the vitamin D
from the inactive form to the working form.
Well when all these go out of whack
it affects one of my bone hormones,
my parathyroid hormones.
And that can lead to bone damage over time.
And the reason why I care
is it puts you at risk for fractures.
So what do I do?
Well, as a kidney doctor I look at all these levels.
If your calcium is low, I give it back to you.
Usually in the form of calcium carbonate.
If your phosphorous is high,
firs thing I do is we try to restrict it in your diet.
So most of the time it's processed foods
that have a lot of phosphorous in them
cause it's one of the preservatives.
Then if that doesn't work, maybe it just doesn't
control it enough.
I can give you a medicine called a phosphate binder.
And what that does is it basically binds the phosphorous
in your gut and it goes out through your GI tract.
A common example is calcium acetate.
Well what about vitamin D?
So with the vitamin D I do actually check
the inactive vitamin D level.
If it's low, I'm gonna give it back to you.
So our common forms are ergocalciferol or cholecalciferol,
or vitamin D3.
Well if the inactive vitamin D is normal
but that parathyroid hormone or PTH
is way out of whack,
then I have to assume that's from
the inactive vitamin D not being converted
to the active form.
So I give it back to you.
I give you something call calcitriol,
which is the active vitamin D.
Also important for healthy bones is regular exercise.
So a lot of times when people have kidney disease
we have to restrict a lot of things in their diet.
If their potassium is high, we start telling them
to avoid potassium foods.
If their phosphorous is high, we tell them
to restrict their phosphorous.
Then if they have other medical problems like diabetes,
they're controlling their carbs.
Maybe they have gout and they have to avoid red meats.
After a while, you run out of stuff to eat.
So, we're really worried about people getting malnourished.
And so what it means to have malnutrition or be malnourished
is where the body can't function properly
or stay healthy because it lacks the nutrients
and energy it needs.
So as kidney doctor I pay attention to this.
So what I typically look at for your nutrition,
is your albumin level.
It's kind of a marker for being well nourished.
Sometimes it can be low if you have
a lot of protein in your urine as well.
The reason I also care about this
is it can lead to other problems if you're malnourished.
You can then be at higher risk of infections
or have poor wound healing.
So what do I do?
Well I always encourage my patients
to eat a well-balanced diet.
But they may have to restrict things.
So sometimes I try to help them with that.
I might recommend doing a food diary
or using one of those electronic apps
to track their food.
And it's important that whenever you start
restricting a lot of things in your diet
that you might need help.
And so meet with a dietician to help you figure out
what are the foods I can eat.
So kidney disease doesn't actually cause depression,
but as I've mentioned in another video,
kidney disease is really silent.
And so most people don't know they have it
until somebody checks their labs.
And then they're told that they have kidney disease
and the worst thing that they think of
is they're gonna have to be on dialysis
which isn't the case.
Our job as the kidney doctor is to slow the progression
of kidney disease. But a lot of times we're like,
well I already have these other medical problems
and now it's one more thing I have to think about.
So as a kidney doctor we actually pay attention
to symptoms that could make us think
that the person's becoming depressed.
So symptoms I look for is like,
feeling of sadness, if they're irritable,
crying all the time, they don't enjoy the things
that they used to.
Maybe they're sleeping all the time
or maybe they're awake all the time
or they just feel overwhelmed.
And we work really closely with the primary care doctor
to work out medications that the patient can take
with kidney disease and maybe talk to them about counseling
or maybe a combination of both.
For more information on the effects
of chronic kidney disease on the body,
take a look at our resources.
Or if you're interested in learning
about normal kidney function,
treatment of kidney failure, check out our videos.