I Love You.. With all my Kidney

There is a reason we do not usually express our love this way.  That is, because we can actually spare one kidney.  With a few exceptions, we are born with two kidneys; yet a healthy adult could have a normal life with just one of them.   Or, we may lose a significant amount of kidney function, and not need dialysis in our lives.

Chronic kidney disease is for the most part a result of other chronic health problems.   With some exception, the rate of progression of kidney disease can significantly be impacted by several factors, such as life style, prescription and over the counter drugs, and progression of the underlying illness.  Good communication in a patient-physician relationship will likely be the most important factor in understanding kidney disease, preventing progression, and increasing compliance.

Normal kidney function is measured indirectly by obtaining a blood sample to measure a substance called creatinine, which comes from muscle.  While creatinine is not considered a toxin, a high level correlates to a higher level of toxins accumulated in the blood due to low kidney function.   Kidney function is expressed as Glomerular Filtration Rate, or GFR, in milliliters per minute.  For simplification purposes, I like to express this GFR in terms of percentages; a normal kidney function, reflecting function of both kidneys, would be theoretically 100%.  Most of us, will not have this magic number, but can live a perfectly normal and healthy live with less than 100%.  At the other extreme, less than 15% will cause symptoms associated with the high accumulation of toxins, and dialysis becomes necessary.  That means, we could lose 85% of our kidney function, and never see the need for dialysis.

Chronic kidney disease is linked to other problems which can affect quality of life.  Anemia of chronic kidney disease is associated with increased fatigue, shortness of breath, and lack of motivation; vitamin D deficiency is not uncommon in chronic kidney disease, leading to hyperparathyroidism and subsequent bone problems.  With advanced kidney disease, acid and potassium in the blood may accumulate.  Addressing and treating these problems can have a great impact in improving quality of life and a sense of well being, without the need for dialysis.


The stability of our kidney function is more important than the kidney function itself.  This is the reason why knowledge of those powerful modifications to preserve kidney function is imperative.  The most common cause of kidney disease is diabetes, which in turn, is tightly associated with obesity.  Hypertension is also known to be a cause of kidney disease, and certain medications could not only control blood pressure, but also reduce the rate of progression of kidney disease.  Autoimmune problems, such as Lupus or vasculitis, can silently cause rapid decline of kidney function; early intervention can prevent complete loss of kidney function.  Over the counter pain and anti-inflammatory medicines may worsen existing kidney disease.   Heart disease is also closely associated with a potential decline in kidney function, and therefore, optimizing the health of your heart may actually prevent or stabilize your kidney function.

Once chronic kidney disease has been diagnosed, the most important intervention from a patient’s perspective is acquiring knowledge.  From the physician’s perspective, empowering a patient with this knowledge about kidney disease, will likely have the greatest impact on achieving those difficult modifications in life-style.   We have all been there at some point in our lives, attempting to achieve our ideal body weight, following a healthy diet in a society surrounded by delicious high calorie temptations, smoking cessation, and compliance with even a daily vitamin.

The challenge is much more difficult, and the changes much more commendable, in those who are expected to lose more weight in the presence of arthritis or a missing limb; to follow multiple diet restrictions where food becomes almost non palatable; to stop smoking while suffering debilitating psychiatric ailments such as anxiety and depression; to remember to take 20 plus pills three times per day.

A good patient-physician relationship can improve each other’s understandings of the challenges faced by the patient and the changes recommended by the physician, respectively.   This in turn, will likely have the greatest impact in the modifications necessary to achieve stabilization of chronic kidney disease.