Patient Education

Where are the Kidneys and what do they do?

There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule. When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body’s needs, the final product being the urine we excrete.

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.

What is Chronic Kidney Disease?

Chronic kidney disease (CKD), also known as chronic renal disease, is a persistent and potentially progressive condition characterized by a gradual loss of kidney function over time. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease.

What causes CKD?

The three most common causes of CKD are diabetes mellitus, hypertension, and glomerulonephritis. Together, these cause approximately 75% of all adult cases.

Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes.

High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Glomerulonephritis is a disease that causes inflammation of the kidney’s tiny filtering units called the glomeruli. Glomerulonephritis may happen suddenly, for example, after a strep throat, and the individual may get well again. However, the disease may develop slowly over several years and it may cause progressive loss of kidney function.

Other causes of CKD:

Polycystic kidney disease is the most common inherited kidney disease. It is characterized by the formation of kidney cysts that enlarge over time and may cause serious kidney damage and even kidney failure. Other inherited diseases that affect the kidneys include Alport’s Syndrome, primary hyperoxaluria and cystinuria.

Kidney stones are very common, and when they pass, they may cause severe pain in your back and side. There are many possible causes of kidney stones, including an inherited disorder that causes too much calcium to be absorbed from foods and urinary tract infections or obstructions. Sometimes, medications and diet can help to prevent recurrent stone formation. In cases where stones are too large to pass, treatments may be done to remove the stones or break them down into small pieces that can pass out of the body.

Urinary tract infections occur when germs enter the urinary tract and cause symptoms such as pain and/or burning during urination and more frequent need to urinate. These infections most often affect the bladder, but they sometimes spread to the kidneys, and they may cause fever and pain in your back.

Congenital diseases may also affect the kidneys. These usually involve some problem that occurs in the urinary tract when a baby is developing in its mother’s womb. One of the most common occurs when a valve-like mechanism between the bladder and ureter (urine tube) fails to work properly and allows urine to back up (reflux) to the kidneys, causing infections and possible kidney damage.

Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and “street” drugs such as heroin and crack can also cause kidney damage

Anyone can get CKD at any age. However, some people are more likely than others to develop kidney disease. You may be at risk for kidney disease if you:
• Have diabetes
• Have high blood pressure
• Have a family history of kidney failure
• Are older
• Belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.

Stages of CKD:

GFR—glomerular filtration rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Our doctors can calculate it from the results of your blood creatinine test, your age, race, gender and other factors.

The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.

Stage & Desicription

Glomerular Filteration Rate

Kidney damage (e.g. protein in the urine) with normal GFR

90 or above

Kidney damage with mild decrease in GFR

60 to 89

Moderate decrease in GFR

30 to 59

Severe reduction in GFR

15 to 29

Kidney failure

Less than 15

What happens if my test results show I may have CKD?

Our doctors will want to pinpoint your diagnosis and check your kidney function to help plan your treatment. Calculate your Glomerular Filtration Rate (GFR), which is the best way to tell how much kidney function you have. You do not need to have another test to know your GFR. Our doctors can calculate it from your blood creatinine, your age, race, gender and other factors. Your GFR tells your doctor your stage of kidney disease and helps our doctors plan your treatment.

Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. A great deal of research is being done to find more effective treatment for all conditions that can cause chronic kidney disease. At SRMG our doctors will work with you personally to determine the best approach to your treatment.

SRMG provides two levels of education on chronic kidney disease and renal replacement options:

  • Level 1 consists of educating patients about what chronic kidney disease is. To give them an understanding about the renal regiment: such as diet, managing their fluid balance, understanding lab values, and knowing how to maintain their levels within acceptable parameters so as to slow the progression of the disease process.
  • Level 2 is about understanding the renal replacement therapy options available to later stage patients. These options include: hemodialysis, peritoneal dialysis, and kidney transplantation. The patient is given all the information they need to decide which option best suits their lifestyle.
  • Level 3: We at SRMG recognize that patients generally like to have a choice of modality. Patients who choose peritoneal dialysis as a treatment choice are already familiar with the lifestyle advantages that this modality brings such as having the freedom to travel, less restriction on diet and fluid intake and ability to perform the dialysis treatment in the comfort of their own home. Furthermore, performing peritoneal dialysis at night (called automated peritoneal dialysis or APD), patients enjoy the benefit of dialysis-free days.

Aside from lifestyle benefits, peritoneal dialysis offers unique clinical advantages. From studies, we also recognize that patients are living longer when dialyzed longer. This observation has prompted a general increase in time in the dialysis prescription.

Level 3 session involves a more detailed look into peritoneal dialysis modality such as introduction to performing an exchange, peritoneal catheter care, nutrition, preventing infections and other complications.

What is Acute Kidney Failure?

Acute Kidney failure or sometimes called Acute Kidney Injury (AKI) occurs when the kidneys lose their ability to function. To treat kidney failure effectively, it is important to know whether kidney disease has developed suddenly (acute) or over the long term (chronic). Many conditions, diseases, and medicines can create situations that lead to acute and chronic kidney disease. Acute kidney failure is more commonly reversible than chronic kidney failure.

What is the difference between acute kidney failure and CKD?

Acute Kidney Failure is usually caused by an event that leads to kidney malfunction, such as dehydration, blood loss from major surgery or injury, or the use of medicines.

Chronic kidney disease (CKD) is usually caused by a long-term disease, such as high blood pressure or diabetes, which slowly damages the kidneys and reduces their function over time.

What is ESRD?

End-Stage Renal Disease (ESRD) is the complete or almost complete failure of the kidneys to work. This is the kind of kidney failure that is permanent and you will need dialysis or a kidney transplant to live.
It cannot be fixed. Most cases of ESRD are caused by diabetes or high blood pressure. Some problems you are born with, some reactions to medicines, and some injuries can also cause ESRD.

What is the difference between ESRD and CKD?

Chronic kidney disease (CKD) is when there is permanent damage to your kidneys. Your kidneys may still work well enough for you to live, even if they have some damage. If your kidneys keep getting worse, CKD can lead to kidney failure (ESRD). This is when the kidneys do not work well enough for you to live. If this happens, you will need dialysis or a kidney transplant to live.

What can be done if my Kidneys Fail?

Dialysis and kidney transplantation are procedures to replace lost kidney function.

What is dialysis?

Dialysis is a treatment used when the kidneys do not work well. It removes harmful substances from the blood when the kidneys cannot.

There are different types of kidney dialysis:

Hemodialysis (HD)

Hemodialysis removes blood from the body and sends it across a special filter with solutions. The filter helps remove harmful substances. The blood is then returned to the body. This is done using an “artificial kidney”, or dialyzer, and a machine.

If you have hemodialysis, a surgical procedure is done to change a vein into a fistula or graft. This is called access. You may need this for a little while (temporary) or for a long time (permanent).

• In-center hemodialysis:
• Is performed 3 times a week for usually 3 to 4 ½hours
• In-center nocturnal dialysis is usually 3 times a week for eight hours depending on the physicians prescription
• Nurses and technicians perform the treatments

Home Hemodialysis

• You and a partner learn the procedure to perform the treatments at home
• The number of treatments and the time on dialysis is similar to in-center hemodialysis and dependent on your physician’s orders
• After you are trained, you come to the clinic usually once a month for a routine doctor’s appointment.

Peritoneal Dialysis (PD)

• Peritoneal dialysis may be done at home individually and or with a partner
• Uses your peritoneum as a dialyzer.
• The peritoneum is a space in your abdomen.
• A thin lining called the peritoneal membrane covers this space inside your body.
• The peritoneal membrane acts as a dialyzer for your blood.
• A special fluid called dialysate is put into the peritoneum.
• The dialysate stays there for several hours.
•  Waste products and extra water move through the peritoneal membrane into the dialysate.
• Then the used dialysate is drained away and replaced with fresh dialysate.
• Peritoneal Dialysis Access
• Dialysate goes in and out of your peritoneum through a small tube called a catheter.
• The catheter is about the size of a straw.
• It is put into your lower abdomen in a minor surgical procedure.
• Your clothing covers the catheter when you are not using it.

Transplantation

A successful transplant can help return you to a state of good health. A transplant is a treatment option, not a cure.

Kidney transplants are one of the most common transplant operations in the United States.
One donated kidney is needed to replace the work previously done by your kidneys.

The donated kidney may be from:
• Living related donor — related to the person receiving the transplant, such as a parent, sibling, or child
• Living unrelated donor — such as a friend or spouse
• Deceased donor — a person who has recently died and who has no known chronic kidney disease

Our doctors are experts in transplantation and we will evaluate all the treatment options available to you.

Our doctors are experts in dialysis and transplantation and will work with you to find the best treatment option available to you. No matter which form of treatment or therapy you and our doctors choose, SRMG will have a team of healthcare professionals to meet your needs. Support will include:

  • Our Physicians
  • Our Support Staff
  • Dialysis Nurses
  • Dietitian
  • Social Worker