National Kidney Month Expert Q&A
March 19, 2021
And we're excited to have some of our experts in kidney function and kidney disease join us today. Let's start the program with Dr. Chapman and Dr. Reddy as they kick off this special edition of At the Forefront Live.
Welcome. I am Dr. Arlene Chapman, Chief, Section of Nephrology at the University of Chicago. And this is--
Dr. Bharathi Reddy, Director of Nephrology, Ambulatory Clinic at University of Chicago Medicine.
We welcome you today as part of National Kidney Month and share with you our efforts with increasing kidney awareness. It is surprising when people find out that kidney disease is the ninth most common cause of death in this country and that more than 35 million people suffer from chronic kidney disease.
What is so difficult is that kidney disease is silent. People do not feel differently in the early stages of kidney disease. There is no pain, no headache, or warning sign. With all the other parts of life to deal with, it is complicated to need medical help when everything seems to be all right. So when something can be done to prevent loss of kidney function and the need for dialysis or transplant, people are unaware and often do not have the help they need from a nephrologist.
While we are working through research and innovation to provide cures for kidney disease, we continue to partner together with patients to protect their kidneys from losing function and their needing dialysis and assure their best quality of life.
At the University of Chicago Medicine, our ambulatory clinic in kidney disease has multiple choices of care and support for our patients. We partner with patients to choose the right medications, to have the best social support, to meet the right people on their kidney team that include dietitians, social work, pharmacy, psychology, transplant nephrologists, home dialysis nephrologists, and getting the right type of access needed should they need dialysis.
To show you our kidney care program, it is my pleasure to introduce you to the members of our team, including Dr. Tipu Puri, along with our dietician, Melanie Betz, and our social worker, Akilah King, and our transitional nephrology support team doctors, Sam Gunning, Michelle Josephson and Orly Kohn.
And Dr. Reddy just did a nice job of introducing everyone to our guests that are going to be on the program. We do want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Dr. Puri actually joins us on set. We're starting to kind of gradually get back to normal. But we are social distancing. And we both have been vaccinated, as well. I do want to point that out to our audience.
So let's start with each of our guests, introducing themselves, telling us a little bit about what you do here at UChicago Medicine. And Dr. Puri, since you are on set, we're going to start with you.
Tim, thanks for having me. Hello, everyone. I'm Tipu Puri. I'm a general nephrologist here at University of Chicago, which means I'm a kidney doctor that takes care of pretty much all sorts of kidney disease.
All right. And we'll go to our triple box set up and we'll see who is-- looks like Akilah is actually-- it's my other side. It's always the opposite. Akilah, you're to my left, I guess. Let's have you introduce yourself and tell us a little bit about what you do here at UChicago Medicine.
Yeah. My name is Akilah King. I am the outpatient nephrology social worker. So I work with our patients before they get started on dialysis or a transplant. And I also do a little bit of research related to kidney education for our inpatient patients.
All right. Melanie, you are up next.
Thanks. Hi, everyone. My name is Melanie Betz. And I am the dietician here in the nephrology or kidney department at the University of Chicago. So I work with patients who have kidney disease who are not on dialysis and help them learn a little bit about what they should be eating to help preserve their kidney function and help their life be as comfortable as possible.
Great. And Dr. Puri, I want to start off with you just with kind of the most basic questions. We heard some of the statistics that were quoted by Dr. Chapman and Dr. Reddy in that opening piece. And they're pretty startling. Talk to us a little bit about kidney disease and just explain what exactly it is, if you will, please.
Yeah, great question, Tim. I think to understand kidney disease it's important to understand what kidneys do. It's an organ that maybe not everyone completely understands. Most people up two of them. They're located in the upper part of our lower back. So if you think about the curve in the small of your back, at the upper part of that curve, you have two kidneys, one on either side. They're probably about the size of your fist.
And their major job is to filter and clean our blood. You could think of them a little bit like the spaghetti strainer of the body. They're supposed to let things out that you don't want and keep things in that you do want. So when people have kidney disease, it's basically the kidneys not working as well as they should. That can happen all of a sudden. We call that acute kidney disease or acute kidney injury. That might happen because someone is sick or they-- as a complication after a surgery.
But what we deal with a lot more of is what we call chronic kidney disease. This is a kidney disease or a lower kidney function that develops over time. There are major risk factors for it, like diabetes being number one, high blood pressure being number two. Heart disease is also a risk factor, sometimes older age, family history. And there's a number of other ones, but diabetes and high blood pressure are the two most common.
That doesn't mean that everybody with diabetes and everybody with high blood pressure is going to get kidney disease. But certainly everyone that has those risk factors should get tested.
And here are some of the risk factors up on the screen. Let's talk a little bit about the symptoms, too, because a lot of the challenge, I guess, with kidney disease is sometimes you don't know you have it.
Yeah, as Dr. Chapman mentioned in the introduction, I think that's the biggest challenge with kidney disease. If you have heart disease, often you get chest pain or you get short of breath. Lung disease, similarly, some shortness of breath or symptoms. With kidney disease, there's typically no symptoms.
That needs to be separated from what we call kidney failure. Kidney failure is when someone needs dialysis or a kidney transplant. There are symptoms of kidney failure, but kidney disease, up until our kidneys get really weak, typically doesn't have symptoms. Sometimes people think, well, I'm urinating, so my kidneys must be fine. But that's really not always the case.
Well, that's kind of scary then.
It is a little scary, yes.
So I'm going to bring in our other two guests who were kind enough to join us via Skype. And Akilah, I'm going to start with you, because as a social worker, you do some pretty interesting work and pretty critical work with our patients. Can you describe what your role is as far as when somebody is diagnosed and comes in for help? How does that work out?
Right. So I see patients for a variety of reasons. One could be they just received a diagnosis of chronic kidney disease and they're needing to start dialysis right away. And so a lot of times, these patients are emotionally burdened pretty quickly because, like Dr. Puri has mentioned, like Dr. Chapman mentioned, there aren't a lot of symptoms that can pinpoint, hey, my kidneys are not working. What could I have done to prevent this? And what can I do so that I don't have to start dialysis?
So it's really working through those emotional hurdles that come pretty quickly for the patients. In other cases, I address socioeconomic issues, because as we can use the pandemic for an example, this past year, a lot of people have been burdened. They have experienced different disparities based on where they live and just access to different resources. So my role is really completing the holistic approach.
We have wonderful doctors who address the medical needs of the patient. And then we come in and finish with, what can we do to support the patient emotionally, find financial resources to really alleviate those day-to-day, necessary life needs, like where am I going to sleep? How am I going to eat? Taking some of that pressure off so that the patient is able to process and do what they can and take that front seat role in their health.
And I think that's really important to point out, because that's one thing that I love when I talk to physicians and caregivers here at UChicago Medicine. We hear over and over again about how things are-- it's a team effort. And it's not just when you come in here with an illness or something that needs to be treated, it's not just a one-and-done kind of thing. You see a whole team. And I think that's just so critical.
Melanie, I've got a quick question for you. Then we're going to start getting to viewer questions because we're already getting viewer questions coming in, which is awesome. Talk to me a little bit about your job as a nutritionist and what some of the-- as a dietician. I'm sorry-- and some of the recommendations you would have for somebody that might have kidney disease. What would you suggest to them?
Yeah. That's a really great question. And it's a very complicated question to answer, because a healthy diet for kidney disease is very, very individual to each person. Literally every single person that I see is going to have different dietary needs. So a healthy diet is going to vary based on the stage of kidney disease you have. So people who have very mild kidney disease have a very different diet than what would be ideal for someone with more advanced kidney disease. And then it actually is totally different if that person ever requires a dialysis or a transplant.
So it's really, really important to work with a dietician to know what is best for you. Not only is it different based on the different stages, but it also is going to be different based on your lab values. So it's really very individualized. I will say the one recommendation that is true across the board is that everyone with kidney disease, no matter what stage, generally should be eating a lot of fruits and vegetables, so aiming for at least five servings of fruits and vegetables a day is a really great place to start, and also limiting sodium.
So paying really close attention to the amount of sodium in your foods, checking those food labels, because we know that most of the salt that we eat is not necessarily what we add with the salt shaker, but it's more what's already in our food, like potato chips or French fries or salad dressing and those types of things. So those are my general recommendations.
And that's a tough one, particularly in our fast food culture, but great advice. I do want to get to some viewer questions, because I did promise we would do this. In fact, we had one gentleman that actually wrote a question in yesterday. So I want to make sure I get to that one first. And Dr. Puri, I'm going to aim this one at you.
In February, I had a biopsy done on my kidney. And it came back citing I have severe arterial intimal fibrosis. I don't have a family member donor to get a kidney, nor do I want dialysis. What other medical options are there for a person such as myself?
So hopefully this person has a kidney doctor, a nephrologist, that ordered that biopsy. And it's certainly an important discussion to have with them. That biopsy finding might have been the result of long-standing high blood pressure. And so controlling blood pressure is hopefully still an option for slowing down and preserving the remaining kidney function that that person has, and hopefully putting off dialysis or the need for a transplant for as long as possible.
Unfortunately, if his kidneys were to fail, then the only life-saving treatments are dialysis or a transplant right now. There's a lot of exciting research being done. So hopefully five years from now, 10 years from now we'll have other options. But I think having a frank discussion with his nephrologist is the first step.
And we do want to also let people know that second opinions are always important. And of course, you all would provide something like that--
--if it was needed. So we have a couple of sound bites. We were fortunate enough-- and John did the heavy lifting on this one. John, thank you. He did the interviews with a recipient and a donor. And this was kind of neat. So we're going to talk with the recipient first. And she's going to talk about the need for donors. And then we're going to hear from the donor, who happens to be her sister.
Man, they are needed. They are needed. If it's family, that's best. But if it's not, then that's still good, because it really saved my life. I would still be on dialysis and I would still-- I wasn't-- I was getting smaller and smaller on dialysis, you know? So the transplant, I feel, saved my life.
And let's go ahead and hear from the donor, because this is her sister. And she had some, I think, some really interesting things to share about the experience and how really, it was pretty easy for her. So let's roll that one, John.
That it's really not as bad as you might think. I had actually had surgery in the past, years ago. So I kind of compared it to that. I was like, well, if I can go through that, I can go through this. But the main thing was my temporary inconvenience, my temporary pain that I will go through as I recovered from surgery, and the time that it took was just temporary. But it would provide a lifelong experience, lifelong improved health for my sister.
So I would say think about the other person and what it would mean to them. And know that the feelings, the nerves, the questions, or even the pain that you might experience as a donor is only temporary. And it's really-- it was not as bad as I thought at all.
That's great. And Dr. Puri, we have another question from a viewer. And this one is, how do you get tested for kidney disease?
Great question. So kidney disease can be evaluated with a very simple blood test and urine test. And anyone with those risk factors we put up ahead of time should be screened for kidney disease at least once a year, if not once or twice a year.
Fantastic. So Melanie and Akilah, I've got one more for each one of you. And then we've got to go to our break. So Melanie, I'm going to start with you on this one. Are there things that a person can do with their diet as a preventative measure for helping prevent have kidney disease?
Yeah, absolutely. So if you do not have kidney disease, I would say the best thing that you can do to prevent it is to just honestly eat a general, healthy diet, keeping your sodium down, eating lots of fruits and vegetables, avoiding very, very high protein intakes, just kind of eating healthy, lean proteins, generally following being active, doing exercise, keeping your blood pressure down, all of those things are going to really, really help protect your kidneys.
The other really important thing that you might not think about is really avoiding any sort of kidney cleanse or detox. I know that those are very, very common out there and I see them all the time. And those things can actually be harmful to your kidneys. So I would say steer clear of anything that claims to be a really quick fix, too.
Interesting. So Akilah, we're going to talk a little bit more in the next segment about dialysis. But I want to get your thoughts on just kind of dialysis in general because I think a lot of times people look at that and they think, I can't go to work anymore. I can't do the things I want to do anymore. Can you talk to us a little bit about that?
Absolutely. So there are different types of dialysis. And really initiating those conversations with patients, getting their preferences, what's most important to them. So you absolutely can travel. You can work while on dialysis. And most dialysis facilities and nephrologists at those facilities kind of encourage you to still keep an active lifestyle. So there are accommodations that can be made. There are changes within the shifts that can be made. If you choose an in-center dialysis, hemodialysis. There's home dialysis, as well, to consider. So it's really just about what fits your lifestyle and your needs.
OK. We're going to take a quick break now. When we return, we'll have three new guest joining us to discuss even more about kidney health and treatments. And we'll take more of your questions. We'll be right back.
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And welcome back. We have a whole new set of guests for this segment of the program. And Dr. Samantha Gunning is actually on set with us. Thanks for being here today.
And we have Dr. Michelle Josephson and Dr. Orly Kohn, who will join us via Skype here in just a moment. We're going to start with you Dr. Gunning. Just tell us a little bit about what you do here at UChicago Medicine.
Absolutely. I'm Samantha Gunning. I'm a general nephrologist here at University of Chicago Medicine. And I mainly take care of people in their later stages of kidney disease and helping them prepare for dialysis or transplant, if needed.
And let's go with-- thank you, Dr. Gunning-- let's go with Dr. Josephson now, if we have our -- there we go.
My name's Michelle Josephson I'm a transplant nephrologist. And what I do is that I evaluate people for kidney transplant. I evaluate donors who may want to donate a kidney for transplant. And then I take care of people after they get their kidney transplant.
OK. And Doctor Kohn?
Hi. My name is Dr. Kohn. I'm an Associate Professor of Medicine [INAUDIBLE] Nephrology. I see patients at the University of Chicago Hospital and [INAUDIBLE]. My [INAUDIBLE] both hemodialysis and [INAUDIBLE]. I've been to medical [INAUDIBLE] for 15 years.
OK. And Dr. Gunning, I'm going to start with you. We're working on a few audio issues with our other two doctors. So let's start with you. And we already have, actually, a question from a viewer. So I'm going to throw this one at you first.
This one is I meet with a surgeon on Monday to insert a catheter in my abdomen for dialysis. What are good questions to ask?
Absolutely. So I think it's important to have questions prepared for all of your doctors. Certainly before going into a surgery, are there any complications after the surgery that you might expect, risk of infection or bleeding, and how you might expect to manage your pain after the surgery. Those are important things to talk about beforehand.
And it's interesting. We had the-- Akilah working as a social worker on and Melanie as a dietician. So those are folks that at some stage in the journey you might also speak with, I would imagine.
Absolutely. Absolutely. And having a team approach and many different people to reach out to with your questions is extremely important.
So what does my CKD stage mean?
Absolutely. That's a great question. So as the filter for your body, it's important to know how much of the filter is still working. And your CKD stage really tells you what percentage of your kidney filtering function you have left. CKD stage three would be the most mild form of kidney disease. And CKD stage five would be the most severe. And knowing where you're at just helps you have an understanding of the risks of developing kidney failure, needing dialysis, or needing a transplant.
And so talk to us just about some of the general complications of kidney disease, because there are quite a few and they're pretty significant.
Absolutely. Absolutely. There are three main complications that I discuss with my patients with kidney disease. The first is their cardiovascular health. The second is their bone health and the risk for bone thinning or bone loss over time. And the third is anemia or low blood counts. The important thing for people to know is that we have ways of treating these conditions and helping prevent them from getting worse.
Great. And let's go with Dr. Josephson on this next question. We'll talk a little bit about transplant. And that's obviously a hot topic. We heard a little-- we heard a question that referred to it in the first segment. So does a kidney transplant cure kidney disease? Once that patient receives that transplant, are they good for life?
So that's a great question. And I wish I could say yes. But kidney transplantation, just like dialysis, is a form of kidney replacement therapy. So it's actually not a cure, but it's a management. And for many patients, it's the preferred approach, because when it [INAUDIBLE], it's almost as close to having normal kidney function as one can get.
Great. And Dr. Kohn, let's talk about home dialysis for a moment, too, because that's also something that we're hearing more and more about. Who qualifies for home dialysis, and how does it work?
So there's [INAUDIBLE] patients with kidney failure who [INAUDIBLE] start dialysis who would qualify for home dialysis. This specific requirement are that the patient has a stable home environment-- that is, has enough storage room for supplies. The dialysis [INAUDIBLE] and then the [INAUDIBLE] come once a month. And the amount [INAUDIBLE] will depend on if the patient [INAUDIBLE].
So we continue to have some audio problems. I apologize for that. We do have an interview with a home dialysis patient. I believe her name was Angela. And she's going to talk a little bit about the home dialysis process. And I think she had some nice things to say about one of our doctors, as well.
When you first start, you're fearful. You're nervous. You have to learn and get trained on the machine, learn and train how to get cannulated. But it is something that you can do. You don't do it alone. You have a nurse that trains you. You are not rushed. They're patient. And you don't go home until you're completely trained. So I would say take a chance on it.
Dialysis is nothing that anyone really wants to do. But if you have to do it, make it doable for you. I had a good nephrologist who told me in advance that my kidneys were failing and how much time I would have before going on dialysis. And then he referred me to Dr. Orly Kohn, who has been my doctor for the last 13 years.
If you can love a doctor, I love Dr. Kohn. She's wonderful. She allows me to speak up. She is not intimidated by asking questions. She educates you. She's available and accessible. And I think she's a wonderful doctor. And I would refer every kidney patient to Orly Kohn.
That's very nice. Got a couple more questions from viewers. And Dr. Gunning, I'm going to throw these to you, if I can.
First one is, where can I be evaluated for a kidney transplant?
So University of Chicago is a great place to be evaluated for a kidney transplant.
We have an excellent team here, skilled surgeons, doctors, nutritionists, pharmacists. Please come get evaluated here.
So another question-- and this is an interesting one. If I have a family member with kidney disease, how can I help support them?
That's a great question. And support in the setting of chronic kidney disease as well as kidney failure is vitally important. It's a vulnerable time, especially during that transition to dialysis. Being a sounding board, being open and honest with your family member about how much you love them, and also helping them ask questions, because it can be quite scary and intimidating to talk with your doctors and members of your care team about questions that nag at you most. So having your family members sometimes put themselves out there and do that for you can be wonderful.
One more question. Can someone ever come off dialysis?
That is another great question. Most often in the setting of chronic kidney disease, once dialysis starts, it doesn't stop, unless, of course, a patient undergoes a kidney transplant. Then usually they do come off of dialysis. In the setting of an acute kidney injury, there are some instances where dialysis is temporary.
Well, we are out of time. And I do apologize for some of the audio issues. It's a live program and we're at the mercy of the internet and all that good stuff. And some of these things, we just-- we don't have control over. So again, doctors, all of you, thank you very much for being on the program. And I'm sorry we couldn't get to more questions with you. It was just really difficult to hear you. We are out of time. Thank you for sharing the information with the viewers.
Also thank you to those of you who watched the program and participated today. Please remember to check out our Facebook page for our scheduled programs coming up in the future. To make an appointment, go online at uchicagomedicine.org. Or you can call 888-824-0200. Thanks again for watching and have a great week.
March is Kidney Awareness Month. Join UChicago Medicine nephrology experts for a live Q&A to learn about the latest advances, findings and insights on the different types of kidney disease, kidney disease screenings and treatment plans.
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