Shining the Light on Kidney Disease, by Dr. Spry

As a long-time practicing physician, I am well-versed on the perils of kidney disease — both academically and anecdotally — so anytime I come across new research urging people to pay attention to the kidneys and kidney disease, I feel compelled to spread the word. Most people know very little about kidney disease, and it’s time for a light bulb moment (and not just a flicker), especially in light of new research that just came out in the National Kidney Foundation’s American Journal of Kidney Diseases.

The American Journal of Kidney Diseases report found that the lifetime risk of moderate — or worse — kidney disease was 59 percent, a risk that outstrips invasive cancer or diabetes. Talk about an eye-opener. As a result of this new research, the National Kidney Foundation recommended that all Americans over 60 should be screened as part of an annual physical. Around the same time this research came out, another group estimated that the government’s tab for treating kidney disease was close to $60 billion. No, that “b” wasn’t a typo.

Taken together, these separate announcements about the scope of kidney disease represent a clarion call to action: We, as a society, need to take kidney disease — which kills more Americans than breast cancer and prostate cancer combined — seriously, or the human and financial costs may become unbearable.

Kidney disease isn’t a hot topic. It’s hard to see and “feel,” particularly at the early stages, and it tends to prey on those whose health is already vulnerable, such as those with diabetes or high blood pressure and seniors. Some even chalk kidney disease up to “an inevitable part of aging” and just ignore it. But that is a naïve and dangerous view.

Kidney disease is significantly underdiagnosed. Screening is cheap, simple and non-invasive: A doctor only needs to perform a quick urine test for excess protein (albuminuria). Usually invisible to the human eye, too much protein in the urine is one of the earliest signs of kidney damage. Unlike colonoscopies or other expensive (and invasive) health screening tests, on average this lifesaving urine test costs less than a tank of gas, but despite its low cost, there’s a widespread lack of testing, even for those at greatest risk. The earlier kidney disease is recognized, the easier it is to treat. Sometimes, simple lifestyle interventions are even enough to keep the disease from progressing.

The kidney is an incredible organ. Kidneys process waste in the bloodstream, produce key hormones and help the body regulate everything from blood pressure (by controlling sodium levels) to muscle-building (by controlling protein absorption). The kidneys wear many hats and unfortunately many people take them for granted until they aren’t working properly. Risk for kidney disease can be reduced by properly managing conditions that damage the kidneys — such as high blood pressure and diabetes, and maintaining a healthy lifestyle and avoiding medications that can harm the kidneys. Once the kidneys are damaged, they begin to work less effectively, and eventually if the kidneys fail, treatment requires a transplant or dialysis. Kidney disease also puts patients at increased risk of heart disease.

But ignoring the kidneys, or assuming that there’s nothing that can be done to prevent kidney disease and its progression, fails not only patients who already have the disease, but everyone else at risk. Kidney disease is not a tragic, untreatable disease. We have many tools at our fingertips to combat it, from dietary interventions to improved treatment of high blood pressure and diabetes. But we can’t use those tools if we don’t know who has suffered kidney damage. One easy way to find out is by speaking up and encouraging your primary care provider to perform this simple urine test for albuminuria. Take this handy kidney checklist with you on your next doctor’s visit and share it with your friends and family.

If you’re over 60, or if you have a family history of kidney failure, diabetes or heart disease, please get screened for protein in your urine during your next annual physical. And don’t stop there. Reduce your risk by controlling blood pressure and blood sugar, maintaining proper weight, stopping smoking, exercising regularly and avoiding excessive use of medications that can harm the kidneys, such as ibuprofen and naproxen.

Widespread awareness is not built overnight (after all, it took Thomas Edison some time to distribute electricity) but let’s at least start by turning on our own lights. Because unlike the fictitious monster under your bed, when it comes to your kidney health, sometimes what you can’t see can hurt you.

Have questions about this research or the new recommendations? Just ask in the comment section below.

For more from Leslie Spry, M.D., FACP, click here.

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