What you need to know about kidney disease, kidney transplants and kidney failure

infographic of kidneys

Approximately 14% of people live with a mild form of chronic kidney disease and don’t know it. In mild cases, there are no symptoms and no pain, and the body can still function well. Problems begin to occur when people don’t take care of their health, worsening the disease.

The kidneys stop functioning properly, causing fluids and toxins to build up in the body. This can lead to heart disease, stroke, high blood pressure, anemia and bone disease.

Kidneys play an essential role in the body’s function. They remove excess fluids, clean the blood of toxins and produce hormones that regulate blood pressure and the production of red blood cells. Patients with advanced kidney disease lose these functions, either partially or completely.

That’s why it’s so important for people to understand what kidney disease is, how to prevent it and what conditions can lead to kidney failure. Here are answers to common questions:

How do I know if I have kidney disease?

Mild kidney disease is asymptomatic, so it often goes undetected until it’s in the late stages. For a patient with a mild disease, the only way to know would be to have a routine blood or urine test, which can be done by a primary care doctor. If a person with kidney disease starts exhibiting symptoms – swollen legs, skin rashes, itching, nausea, lack of appetite or severe anemia – that means their kidneys are not functioning properly. When they’re functioning at less than 15 to 20%, then dialysis or a kidney transplant will be necessary.

What causes kidney disease?

The most common cause is diabetes. That’s why it’s important to make sure that people keep their blood sugar levels under control. Other factors are high blood pressure, obesity, smoking, kidney stones, heart or liver failure and other genetic diseases. These conditions damage the kidneys and prevent them from filtering blood the way they should.

How long can you live with kidney disease?

It depends what’s causing it. As long as the patient is taking care of their health – seeing their doctor and managing their risk factors – they can live with it for their entire life. Most patients don’t require dialysis or transplant. Even when the kidneys are running at 30% or 40%, patients can feel fine. The kidneys have a lot of reserve.

How do you prevent kidney failure?

The best thing to do to prevent it is to eat a healthy low sodium diet, stay well hydrated, maintain normal blood sugar and blood pressure, avoid smoking, get regular exercise, avoid unprescribed supplements or excessive use of over-the-counter pain killers like ibuprofen, and see your doctor regularly for urine and blood tests. If you have diabetes, high blood pressure or obesity, you need to manage those conditions. Controlling risk factors can prevent kidney disease and slow down its progression.

How important is diet in managing kidney disease?

Very important. A poor diet can add to fluid build-up. Salt is not good for kidney health, so avoid added salts, canned foods and fast food. Patients with advanced kidney disease may have high potassium in their blood, so they should avoid foods with high potassium – things like bananas, potatoes and oranges.

When is dialysis or kidney transplant necessary?

A mix of symptoms and numbers help us decide what the patient needs. When the kidney filtration levels drop to 20% or less, that’s when we can evaluate and list a patient for a kidney transplant. Dialysis can be done as a bridge to kidney transplantation, depending on laboratory tests and development of symptoms like nausea, vomiting, lack of appetite and fluid build-up in the body.

How long do donated kidneys last?

It depends on the donor and many other factors, but typically 10 to 12 years. I’ve had several patients who have had them for more than 20 years. As long as a patient takes care of their health and takes their medications, the kidneys will last longer than average.

What trends are you seeing in patients with kidney disease?

I’ve been seeing a lot of obesity-related complications. It often begins with uncontrolled diabetes, uncontrolled high blood pressure, or high cholesterol that leads to kidney disease. We try to manage these risk factors hoping to prevent kidney disease. There’s a lot of talk about using bariatric surgery to reduce weight and fix the problem.

What are some ways UChicago Medicine excels at treating kidney disease and kidney transplant patients?

We not only have an excellent kidney team, but an excellent support services team. We take a holistic approach, so we not only address a patient’s medical needs, but also provide emotional and social support. That’s especially important for a patient with advanced kidney disease or a complicated case. We take care of a lot of patients whose cases are so complex that other hospitals have rejected them. We do multi-organ transplants, and outperform most programs in the city and the country.

Are there any new treatments for kidney disease on the horizon?

There’s a lot of research going on looking at blood and urine markers in the early stage of kidney disease. If we can detect it in the early stages, that will prevent patients from having to go to dialysis or need kidney transplants.

Do people with kidney disease need the COVID-19 vaccine?

We encourage people with kidney disease to get the COVID-19 vaccine because they are immunocompromised and vulnerable to severe types of infection. There’s concern that the virus can injure the kidneys, which is being studied now. We’ve had several patients who had advanced kidney disease, and their kidney transplant failed either directly or indirectly due to COVID-19.

Yousuf Kyeso, MD, and Sambhavi Krishnamoorthy, MD, are both transplant nephrologists at the University of Chicago Medicine.

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