Many people understand very little about one of the hardest-working, most complex organs in the body: the kidney.
They also don’t know much about kidney disease—or that in many cases, they have the power to prevent it.
One in 9 American adults is living with some degree of chronic kidney disease, which is also a major public health problem worldwide, according to the National Kidney Foundation, or NKF. While catching damage in its early stages is critical to avoiding dialysis or transplant, patients often don’t get to a specialist until much later.
“Chronic kidney disease is very common, but it’s also usually silent in its milder stages,” says Dr. Todd Gehr, chairman of the division of nephrology and a professor of medicine at Virginia Commonwealth University in Richmond. “That’s why it’s so important to screen at-risk populations, and to raise awareness in general.”
The kidneys are a pair of bean-shaped organs located at the back of the abdomen, near the waist. Each is about four or five inches long—roughly the size of a fist—and packed with millions of tiny structures that contain tubes and blood vessels tasked with filtering blood.
All blood in the human body passes through the kidneys several times a day. The organs work around the clock to remove waste products and excess fluids, while stimulating red blood cell production and regulating a precise mix of chemicals to keep the entire body running smoothly. As kidneys clean blood, they create urine, funneling that liquid through tubes that drain into the bladder.
When people think of kidney disease, doctors say, they often assume it is rare, mysterious in origin and treatable only with dialysis—the artificial filtering of blood—or a transplant. In honor of March’s National Kidney Month, here are five common misconceptions:
MYTH #1:
Doctors often don’t know what causes chronic kidney disease.
Reality:
Poorly controlled high blood pressure and diabetes are associated with most kidney problems, because both cause damage to tiny blood vessels in the organs.
According to the Centers for Disease Control and Prevention, 1 in every 3 adults with diabetes has chronic kidney disease, along with 1 in 5 adults with high blood pressure. Other common risk factors are smoking, obesity, heart disease, a family history of kidney failure and being part of an ethnic or racial minority population.
High blood pressure is particularly dangerous in people older than 60 when it comes to kidney disease, specialists say. While blood pressure does gradually increase with age, many elderly patients can maintain a normal pressure with a healthy lifestyle or a doctor’s help.
MYTH #2:
People can’t do much to prevent kidney disease.
Reality:
“Strict control of blood pressure and diabetes are probably the two most important things anyone can do to protect their kidneys,” says Dr. John Gretes, a nephrologist (a doctor specializing in kidney care) with Riverside Health System, who practices in Gloucester and Newport News, Virginia. “Both can make a tremendous difference.”
Nearly half of people starting dialysis have kidney failure caused by diabetes, according to the National Institutes of Health. So anything to prevent Type 2 diabetes is good for the kidneys, Dr. Gretes adds:
Watch your weight, stay active and eat fresh foods instead of commercially prepared items. A good rule is that if you didn’t make it, don’t eat it—or don’t eat much of it.”
All of those steps can help preserve remaining kidney function after a diagnosis, too. So can avoiding sodium and not overusing painkillers, especially high-dose aspirin and non-steroidal anti-inflammatory medicines such as ibuprofen and naproxen.
MYTH #3:
People will know when their kidneys begin to fail because they will experience pain or problems with urination.
Reality:
Many patients have no idea they are sick until they have just 10 or 15 percent of their kidney function remaining, according to the NKF.
Kidneys rarely hurt unless there is an infection or blockage, such as a kidney stone, while how much or when people urinate doesn’t say much—if anything—about kidney health or function. Kidneys are resilient and can still produce urine even after they can no longer properly clean blood, Dr. Gehr notes: “Patients can have urinary output if they’re on dialysis or need a transplant.”
As kidney disease progresses, some people may need to urinate more at night or see other changes in their urinary patterns, but many see none at all. Early symptoms can also be subtle and non-specific, such as harder-to-control blood pressure and swelling of the feet and ankles. Others include fatigue, nausea, appetite loss, muscle cramps and shortness of breath or chest pain if fluid builds up around the lungs or heart.
MYTH #4:
Testing for kidney disease is a complicated and costly process.
Reality:
Simple blood and urine tests—readily available at an annual physical exam or an urgent care facility—can do the job. Blood work can measure toxins and waste products in the bloodstream; urine screens can detect a protein that isn’t present when kidneys are healthy.
Since kidneys release hormones to help regulate blood pressure and also help break down insulin, hypertension or diabetes can be red flags. Anyone with either condition, or a family history of kidney problems, should talk to a doctor about regular screenings.
“These are inexpensive, basic tests that can make a major difference,” Dr. Gehr says.
MYTH #5:
Dialysis is the immediate go-to treatment for chronic kidney disease, and it is always very disruptive to daily life.
Reality:
Milder forms of kidney disease may have little to no effect on a patient’s quality of life. People are blessed with extra kidney function—that’s why living donors can do fine with just one kidney.
If doctors catch progressive disease early enough, they may be able to slow damage with non-invasive steps: managing blood pressure and diabetes; overseeing lifestyle changes such as weight loss and quitting smoking; and prescribing medications also used for high cholesterol and other lipid disorders. Many medications now can be taken just once daily, which helps with patient compliance.
“While it’s hard to totally reverse the disease, stabilization is the goal,” Dr. Gehr says.
In a small number of more severe cases, doctors are able to perform a kidney transplant before a patient ever needs dialysis. Thanks to better immunosuppressive drugs, the number of living unrelated donors has increased in the past decade.
Dialysis normally becomes an option only with end-stage kidney failure, once patients have lost 85 to 90 percent of function. And those patients may be able to undergo treatment in a hospital, a separate dialysis unit or at home, based on what they and their doctor decide is best. While dialysis can be time-consuming and uncomfortable at first, many patients experience little pain, can go back to work or school and quickly feel stronger, according to the NKF.
As one NKF publication puts it, “You as a patient have a great deal of control over your treatments.”
And the more everyone knows about kidney health, the better.
