DRHOOK- Not kidneying: When they slow, you slow

the handsome doctor John Hong of Charlottesville

Pâté is not politically correct food because of what is done to poor Mrs. Goose. Personally, I think eating liver is like eating toenails or something. But then again some people eat pig's feet, so we all have our preferences. 

Back in Kenton, Ohio, my terrorizing classmates would ridicule me when I told them I ate foods like octopus and squid. (I should have told them I ate calamari. Ah, what's in a name!) (By the way, Sarah– my best friend from Kenton– told me there is a Chinese restaurant in Kenton! I immediately bought a lottery ticket upon hearing this news because miracles do happen.)

Another food I cannot swallow is kidney pie. It sounds like apple pie, my favorite pie, but kidneys.... What would we do without our kidneys?

Chronic Kidney Disease (CKD) affects about 1 in 9 American adults– that's 20 million. Many people are unaware that they have CKD, but it is important to have it managed well, managed now. 

The majority of people with CKD have diabetes, and with the increasing rate of obesity more people are becoming diabetic, an un-sweet fact. High blood pressure, another risk factor for CKD, usually doesn't have any symptoms, so many people don't take their BP meds. But that is kind of like thinking, "Well, my car is running fine, so I won't change the oil." (An ounce of new oil is worth a pound of bills to fix your damaged car.) 

Other risks include family history of kidney disease, autoimmune diseases like lupus, kidney stones, toxic drugs to the kidneys, and older age. Also CKD is seen more in US minorities compared to Caucasians. African Americans, American Indians, Hispanics, and Asian or Pacific Islanders have a higher prevalence of CKD, perhaps because of hypertension and the unbelievable increase in diabetes seen in these groups of people.

The kidneys need to be healthy to keep you healthy. So when they are not working well, quality of life tends to decrease. A complaint I hear quite often is, "Doc, I just don't have the energy I used to have." Studies have shown those with CKD are hospitalized more often. Life expectancy is not as good with CKD. 

For those who progress to End-Stage Renal Disease (ESRD), there is a Medicare-funded program. In 1973, there were 10,000 beneficiaries and by the end of 2004 there were... 472,099 beneficiaries. The number is higher not so much because dialysis patients are living longer but because new patients are entering the program. In 2004, it was estimated about $32.5 billion was spent on the Medicare ESRD program, and by 2010 it might be $28 billion more. That's a lot of kidney failure!

In CKD, the diseased kidneys let proteins slip into the urine too much, so a urine test shows high albumin. Also in CKD the kidneys don't filter the blood as fast. This glomerular filtration rate (GFR) is estimated by a simple blood test. 

So for those with CKD, a kidney specialist (nephrologist) is highly recommended. A nephrologist will find out the underlying cause and work to keep the kidneys functioning for as long as possible. Also medications usually need to be adjusted in CKD because things tend to float around longer in the blood when the kidneys aren't filtering them out as well.

I would eat kidney pie if served to me, but with my luck I would break a tooth biting into a kidney stone. But I do take my BP and cholesterol medicines everyday to protect my kidneys and overall health.

For more information, try www.kidney.org and www.kidneyva.org.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.