how to prevent kidney disease how to make sure you're not going to develop kidney disease that's what we're going to talk about today I'm Dr Paul zel I'm Dr Brad we welcome to talking with docs what we're going to talk about is how to prevent it but also how do you even know if you had have kidney disease and what should you do about it if you're suspicious we have a special guest today Dr sanj pend a nephologist thanks for joining us a pleasure you're in the business of taking care of our kidneys that's right
so tell us H how do I know how do I know something's wrong with my kidneys well it's a very interesting uh uh question because most patients who have kidney disease don't know they have it so um when you have kidney disease they're little or no symptoms that any patient would have that is ominous yeah and so it's really important that you have your regular checkups with your family doctor and have routine blood work and that routine blood work screens both your blood and your urine uh to assess whether or not you have kidney uh
kidney impairment or any other urinary abnormalities which might h have you like have a look into the window of the kidney to say is there disease in these filtering units so when you go to your family doctor he'll check something called your creatinine your serum creatinine creatinine comes from the normal metabolism of your muscles and gets deposited into your bloodstream and it gets filtered out through your kidney now when any filtering unit doesn't work like any plumbing system in your house things that otherwise would get filtered buildup in the system so the blood test if
if you have a higher creatinine than you ought to to it represents lower kidney filtering function okay so one thing's going to measure in your blood is your creatinin we're going to check if your creatinine is very hot your creatine not to be confused some of the other videos we do this supplement cuz I suspect you get that question all the time what I'm taking creatine you're telling me it's elevated oh no that's no good okay so your kattin intin that's elevated might be a problem and then what happens is that the creatinine in nowadays
we we everybody likes numbers right so the creatin goes into a calculator that the lab puts put puts through the calculator that takes your creatinine along with your age and your gender and it produces this number called your GFR called your Glam filtration rate I think for the purposes of understanding it's really your kidney filtration rate and so it's important for people to know what their GFR is uh because that's a key component of assessing your Kidney Health Paul do you know your GFR yeah you do not yeah you're Li youin I can't share it
for privacy purposes but I just keep it in my wallet so you think generally speaking a GFR is a better number or more reliable number than the Katon clearance well people understand GFR because as nephrologists we generally will refer to that as the percent kidney function right and your normal percent kidney function in the population because nothing nobody's ever everybody's not the same is usually between 70 and 100 right uh but as I said there's an age related decline in kidney function as well but knowing your GFR is important the other number that's important is
relates to your urine so we're seeing now more and more over time over the last particularly the last couple of decades how important it is to know whether or not you have protein in the urine and we used to measure that by a 24-hour urine collection which is not really all that you know appealing to people to take a jug and collect their urine uh for 24 hours but now on a spot urine you can get have a value called the urine albumin creatinine ratio which we call the urine ACR and that essentially is a
measurement of how much protein you excrete right why is that important well that's important because no matter where you are uh on the spectrum of kidney disease starting really up high or down the middle or down low the more protein you spill in your urine the more risk factor you have for progressing in your kidney disease in addition to that and this is vital uh it actually increases your cardiovascular risk so your kidneys are really vascular structure yes they get 20% of your heart's blood supply so every pump 20% of that flow goes through these
10 to 12 CM kid self filter they yeah they are but they are selfless at times as well but they filter like 200 l a day okay okay and uh and so it's important to know that they're full chalk full of blood vessels so anything that impacts the kidneys is relates to impacting your whole cardiovascular health okay so they are a good measure of cardiovascular health because they are so vascular themselves and they rely so much on their vasculature to do their function you mentioned protein prot in the year the idea is that when you're
filtering proteins are one of those things you're trying to keep in your body and the waste and other things are the things you're trying to excrete so when you see protein in the urine it's like wait a minute this thing's not filtering properly because we're losing pure protein okay so so say I haven't got the blood test at my family doctors but what if I'm sitting home and now I'm watching this video I say I haven't been to the doctor in really while is there anything that I'm going to experience like living my daily life
that's going to make me think well maybe I have kidney disease are there any signs or symptoms that that they're going to see before the blood work that will give us an indication that hey maybe your kidney function is deteriorating so this would be like a later later onset disase yeah generally so yeah we all we all know these patients who you know usually guys hav been to a doctor for 10 15 years cuz they feel well right and they haven't had any blood work right uh and you know when I see blood work I
usually like to say okay what was their historical blood work and I get patients who are referred to with not having blood work for over a decade and so signs that they may have it they may say okay well I better go see a doctor some ear signs might be fatigue and fatigue is so common it's hard to relate to anything uh you might get swelling particularly swelling in your ankles because you're retaining salt that your kidney should otherwise get rid of that could if it becomes more dramatic you can get shortness of breath if
that salt and water builds up on your lungs okay you can get some sort of symptoms related to your GI tract so things like lack of appetite nausea vomiting if it's extreme itchy skin is another one if the toxins build up it's a lot of like really vague stuff yeah and later stage yeah okay all right so one last question um would you have any symptoms in your urine like would people say you know what I'm either peeing more or I'm peeing less is that an indicator of kidney disease so I would tell you one
might relate to a common cause that I see of kidney uh kidney impairment which would be blockage of the urinary tract and in guys the most common one would be the prostate Y and so if you're peeing a lot particularly getting up a lot at night time it may not just be a normal sort of enlarged prostate but it could mean that you actually have it enlarged enough that it's causing a blockage causing back pressure on your kidneys okay otherwise you know as you as you you have diseased kidneys you can actually have an impairment
in concentrating your urine okay which means you'll have to go more frequently anyway this is without any anatomical issues okay but most of the time you don't not much peing normally asymptomatic yeah okay so you've told us sort of how to know if we have something wrong with their kidneys but here is the million dooll question well I guess it used to be the million dollar question I probably the billion dooll question how do I prevent kidney disease how do I stop myself from getting kidney disease yes I I think it's a really good question
and I think some of that relates to what some of the more main causes of kidney disease are right so the biggest cause of kidney disease is diabetes right so the largest CA caus about half of our endstage kidney disease population are patients on dialysis patients seeing transplantation um mostly type 2 diabetes just because it's more prevalent and then other causes like high blood pressure vascular disease of the kidneys whether big arteries or small right um there could be inflammatory conditions in the kidney what we call GLA nefritis big long word but inflammatory conditions in
the kidneys the list is long as my arm uh recurrent infections in the kidney obstruction of the kidney or um we can have some genetic diseases of the kidney most common one would be polycystic kidney disease so when you look at all of that and say well how do I prevent uh either getting kidney disease or having it progress It's controlling a lot of that right and controlling vascular Health right so eating a hard healthy diet including minimizing your salt intake okay okay let's St there for two seconds CU I guarantee there's going to be
1,000 comments of saying taking insult that doesn't even matter we get this all the time we had it with Dr Hef when we did the cardi stuff saying salt directly relates your but be like oh salt doesn't matter that's a myth so you would say as a neologist someone who makes their living saving people's kidneys salt definitely matters I would say salt definitely matters but if you if you see debates amongst my colleagues about how how effective that is yes uh in populations or if they would they they will make an argument that it might
that might not matter but I would I would probably argue that everybody's not the same in any population and there are people who are really quite salt sensitive yes it also depends on what kind of disease states you have so if you're in the if you in in the heart failure world you want to minimize salt because that salt is going to have you retain fluid most people think that swelling is water yes but swelling is not just water it's salt and water so if you take it more salt and retain more salt you'll retain
water with it so that's important so yeah controversial so but the other things you do is uh obviously avoid smoking okay limit alcohol intake exercise regularly control your weight common themes with what my Cardiology colleagues would say just about every dis um and uh avoid anti-inflammatory agents big one if you can so things like I things like you guys prescribe right every time you're going to do this all day we worry about this nonstop uh ibuprofen uh cbra any of these same that chronic use of these agents can cause chronic kidney disease and can cause
worsening if you have it can put your blood pressure up which secondarily can affect your kidney disease and can cause different biochemical abnormalities as well so you can go and grab these pills off the counter but people don't know that they can be harmful so usually we say if you have pain or fever in my patient's World take Tylenol preferentially and minimize those if you have to take them so those are those are obviously big one lifestyle ones that can have and the other is like to see your doctor get an assessment know your Kidney
Health both your GFR and your ACR and take the medications that your doctors prescribe because they're going to want to control your diabetes with along with your lifestyle with medications control your diabetes control your high blood pressure control your cholesterol so these are all things we're finding where the heart and the kidney are intricately linked and one therapy that helps one organ system is not a oo it helps both organ systems so it so kidney disease then is a strong predictor of cardiovascular health you're saying exactly if you have something wrong with your kidneys odds
are you're going to have something wrong with your heart and your cardiovascular system yeah so if I put it to you this way if we could show a heat map to the audience if you look at a chart that has GFR that goes down along this side and it goes and protein in your urine that goes up along this side as we've me mention higher protein means a higher risk factor for progression of kidney disease so you'll see this heat mat go from Green up at the top left which is like brilliant fantastic to deep
red down at the uh at the bottom on the right yeah indicating that your risk of kidney complications uh increases dramatically but you could take that same heat map for GFR and protein and apply any cardiovascular complication that could be coronary artery disease or things that cause heart attack it could be heart failure it could be hospitalizations related to those it could be mortality related to those so that's how linked they are so really when we're talking about preventing kidney disease we're talking about preventing overall cardiovascular health as well and that's how come the exercise
the no smoking to decrease your appetite that eat well things echo in all the videos we make and that's why that's how you prevent kidney disease as well so question so love that and I think it's important we we talk about this all the time lifestyle modifications this is the way to deal with chronic disease rather than reacting all the time but say you made some bad Health choices over the course of your life and now you go to your doctor you have some early signs of kidney failure not to the point where it's affecting
your urine or your blood pressure a bit you're going to take the medications but but are there any are do those things work to Halt the progression or is there any possibility of reversing kidneys do you ever see patients that have elevated gfrs and protein their urine and they do radical change they lose the weight they exercise they change their diet do they come back and get normal kidney function or do they simply are we trying to Halt the progression of the loss yeah so great question so it this one's a depends question right so
there are some things that are reversible right so if you have if we go just to let's say an obstructed kidney largely reversible but they if if the longer that obstruction would be there the more chronic then more chronic disease you might have damage is done right when you have things that affect um the kidneys by let's say uh let's say medications these anti-inflamm agents that we talked about some of the some of the effect that they have are is reversible okay and some of it may be chronic and it depends on some people who
use these things daily for 10 or 15 years they have a chronic component but if they pull back off of them you'll see some reversibility from that okay and the rest of it is us trying to say okay how do we prevent progression and does it work yeah they work okay they work we see multiple Therapies in uh that have been developed particularly in the last 5 seven years we had a dir like a lack of Medical Science that showed advancements in preventing progression for about 15 years or so okay and so now we've seen
a whole slew of uh classes of medications uh not just alone but in culmination that will help prevent progression and kidney disease and in and and at the same time prevent cardiovascular complications because the big thing for us is that uh one of the things from us is is that we focus on cardiovascular health because if you get in stage kidney disease we can do things like dialysis right we can do things which can be he in the hospital or at home we can do things like transplantation but the cardiovascular risk still stays there right
so we focus on this because our patients no matter where they are in the Spectrum have a higher risk of dying of cardiovascular complications than from their kidneys okay so the kidney disease is more treatable than the cardiovascular uh disease in terms of long-term Solutions well having a stop Gap at the end where we can dialyze people right if you have end stage heart disease heart dialysis there's no heart dialysis yeah okay so that's a lot about how you know something is wrong with your kidneys and how to prevent getting kidney disease but what if
like oh my mom or my dad had kidney disease you know does that mean for sure I'm going to get it is is there a big genetic component to kidney disease yeah so so the the main um cause uh genetic cause of chronic kidney disease and end stage kidney disease is polycystic kidney disease right so that that one you to know because and you could screen for by various techniques because you would have a family history of of polycystic kidney disease you'd have somebody who ended up on dialysis and uh as a result of that
you can get screened because you at different ages depending on whether you use ultrasound or cats can to see whether or not you have cysts in your kidneys okay um however there the world of genetics and genetic testing is now getting like exploding right so there obviously there are genetic tests for polycystic kidney disease um and the world of kidney disease in general for familial kidney disease is expanding in terms of looking at why somebody might have a predisposition right so the number of genetic tests out there for different types of kidney disease is growing
and growing they're not widely used okay because the the trying to find the linkages to particular diseases so usually we'll find the disease and they'll say do you have the genetic risk factors for that disease which you may or you may not just like any disease there's a nature versus nurture right it's what do you what are you come in with with what your parents gave you and then what environmental stuff that we've talked about before okay so there is a component certain types of kidney disease are genetic in nature uh however it doesn't necessarily
guarantee you're going to have kidney disease if your parents had kidney disease right and and the other important part is that the genetic predisposition could be because of the things that cause kidney disease right so your genetic predisposition to diabetes to high blood pressure to vascular disease so your genetic predisposition doesn't just come from your kidney Silo genetics right got it it's all all the others risk factors and and diseases that cause kidney disease okay that's a nice summary I think the take message is a be aware that you got to take care of your
kidneys B there are a lot of things that you can do to help prevent it and even if you've already got it there's things that you can do to help change it and then see that there is an answer even if you end up at the end of K disas thankfully we have things like dialysis and so many different versions of it where 50 years ago there was no answer for these people and unfortunately they passed away so be responsible for your own kidneys if you have an experience with this or with dialysis or kidney
failure please leave a comment share your experience with other viewers to benefit from it if you like this video please like it subscribe to our Channel and remember you are in charge of your own health thanks Dr Pand for joining us that was awesome thanks
