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ABCs of Kidney Disease | The Effects of Kidney Disease on the Body

ABCs of Kidney Disease | The Effects of Kidney Disease on the Body

>>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.

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