Kidney Disease

What's the Problem?

Kidney disease occurs when the kidneys become damaged and lose their ability to filter the blood. Kidney disease can happen quickly as the result of severe illness, injury or poisoning, but most often develops slowly and silently until the kidneys have nearly failed. The two most common causes of kidney disease are diabetes and high blood pressure. Left untreated, kidney disease can lead to kidney failure. People with severe kidney failure must undergo dialysis or have a kidney transplant to stay alive.

More than eight million Americans have a major loss in kidney function. Of those, nearly 400,000 require dialysis or a kidney transplant to stay alive. Kidney disease is increasing at an alarming rate such that the number of kidney failure patients is expected to more than double to 650,000 by 2010 at a projected cost of $28 billion. A significant portion of this increase is because of the growing number of people with undiagnosed or uncontrolled diabetes in this country.

Because there may be no symptoms until the kidneys have nearly failed, many people do not know they have kidney disease. The only way to find out is to have a urine or blood test. Even among people known to have kidney disease, only a small fraction receive proper treatment.

Who's at Risk?

People at greatest risk for kidney disease are those who have diabetes, high blood pressure, or a family history of kidney failure. Certain racial and ethnic populations are particularly vulnerable to kidney disease – African-Americans, American Indians, Asian and Pacific Islanders and Hispanics.

Can It Be Prevented?

There is no cure for kidney disease, but effective treatments exist to slow or prevent progression to kidney failure. Blood pressure control, and blood glucose control for people with diabetes, can prevent kidney disease or reduce further damage in people who already have kidney disease. The angiotensin-converting enzyme (ACE) inhibitor class of blood pressure drugs is especially helpful in slowing kidney damage. In addition, low protein diets seem to slow its progression. One of the challenges for people facing kidney disease is adhering to the dietary restriction of salt and protein, taking daily medication and following up with their health care provider.

For people whose kidneys have completely failed, kidney transplant or dialysis are both effective in sustaining life. Many dialysis patients are often plagued by fatigue, anemia, bone disease, dietary restrictions, and infections of the blood and dialysis access areas. Kidney transplants offer a better quality of life for many, but the demand for kidneys far outweighs the supply. In 2000, about 100,000 people developed kidney failure but only about 14,000 transplants were done.

The Bottom Line

• Risk factors for kidney disease include diabetes, high blood pressure and a family history of kidney failure;
• people with any of these risk factors should get tested for kidney disease on an annual basis;
• most people who develop kidney disease lack symptoms until their disease is at an advanced stage;
• left untreated, kidney disease can progress to kidney failure and death;
• kidney disease can be treated to slow or prevent kidney failure; and
• people who receive treatment for kidney disease can live long and productive lives.

Case Examples

1. Joe, age 48, works at a construction site. He gets hurt on the job and goes to the emergency room for treatment of his broken leg. His medical history is unremarkable except for 15 years of high blood pressure. In the past, he had taken medicine for his high blood pressure but did not continue with the medication. Following routine bloodwork and urinalysis, he receives treatment of his leg, but learns that his history of uncontrolled high blood pressure has led to kidney complications. Joe had been very fatigued and noticed swelling in his ankles lately but attributed it to his long hours on the job. His kidneys have almost completely failed and soon he will need to either find a kidney donor or start dialysis treatments. Joe's choice of treatment is transplant. He was reluctant to ask any of his friends or relatives for their kidney but when he did ask, some were hesitant and others did not have the right match. Now Joe goes to the dialysis center three times per week to get his treatments. The treatments are costly, time-intensive and leave him exhausted after each session. He is on the waiting list for a donor organ. He wishes he paid more attention to his blood pressure.
2. Nina, age 28, is a computer analyst who has had type 1 diabetes since the age of 7. She sees her doctor 3-4 times a year. When she was 24, her doctor told her she had a small amount of protein in her urine and advised her to eat one meatless meal a day. Her doctor also found Nina's blood pressure to be slightly elevated and started her on an ACE inhibitor drug. During subsequent visits, her blood pressure was within the normal range. Nina recently started using an insulin pump because she travels over time zones frequently and her glucose control is the best it's ever been. During her next visit, her doctor tells her she no longer has protein in her urine and congratulates her for taking such an active role in her self-management. He reminds her that monitoring of her kidneys will continue every year.

Spanish Version of Kidney Disease