"If you already have kidney disease or think you may be at risk, avoid high-protein diets, such as the popular Atkins diet."

"Non-invasive x-ray technology can now allow doctors to examine the kidneys closely and locate kidney disease earlier, possibly even before symptoms appear."]

James and Clara, as brother and sister, share not only half of their genes, but a pair of kidneys. Clara, a type 1 diabetic since age 12, lost the function of both of her kidneys several years ago, becoming dependent on dialysis for the rest of her life unless she could find a donor for a new kidney.

Luckily for Clara, her brother James was a compatible donor who was willing to give up one of his own kidneys. Thanks to a kidney transplant plus a regimen of anti-rejection pills, she has successfully accepted her brother’s kidney.

Clara is not alone in her struggle with kidney disease. In the United States, more than 79,000 people begin dialysis for end-stage renal disease every year. Diabetes is the most common, although certainly not the only, cause of renal failure.

The kidneys play a vital role, removing toxins, waste products and excess fluid from the body. The kidneys also regulate body levels of salt and potassium and produce hormones that help regulate blood pressure, control calcium metabolism and stimulate the production of red blood cells.

While the body contains two kidneys, both are usually affected by kidney disease. Fortunately, however, a person with two healthy kidneys, such as Clara’s brother, can donate one to a person in need.

Causes of Kidney Failure
Disease often develops in the bundles of capillaries in the kidneys known as glomeruli. Like filters or sieves, the glomeruli retain elements the body needs (such as protein) while extracting the waste as urine.

Diabetes, over time, stretches the holes in the kidneys’ sieve, allowing protein into the urine. In diabetes, as well as kidney disease caused by other factors, hallmark symptoms are microalbuminuria (small amounts of protein in the urine) or proteinuria (large amounts of protein in the urine).

Approximately 30 percent of individuals with type 1 diabetes develop kidney disease. In type 2 diabetes, ethnic heritage plays a role. White men and women with type 2 diabetes have about a 10 percent risk of developing kidney disease, while Native Americans have a 40 to 50 percent risk. African-Americans and Latinos have a 20 to 30 percent chance.

Another major cause of kidney disease is uncontrolled hypertension. And kidney disease in turn can increase blood pressure.

Hereditary disorders that can cause kidney disease include polycystic kidney disease. This is one of the most common hereditary diseases, occurring in 1 of every 1,000 Americans. Those who inherit the dominant gene for polycystic kidney disease typically begin to notice renal decline sometime in their adult life, although childhood problems are also possible.

In this disease, renal failure is caused by the growth of cysts in the kidney. As the cysts grow over the course of years, they impair kidney function and the patient slowly approaches end-stage renal failure. By the age of 70, 77 percent of patients have died or have reached end-stage disease.

Kidney disease can also be caused by excessive use of pain-killing medications over many years, by street drugs such as heroin or by exposure to certain toxins and pesticides.

Keeping Your Kidneys Healthy
If you’re diabetic, have high blood pressure or a family history of kidney disease, it’s important to pay attention to your kidneys, even if you don’t have any symptoms. Take the time to get tested regularly.

Diabetics should do so yearly. If the downward slope towards renal failure is detected early, options for treatment will be better, and with early treatment, renal failure can be significantly slowed.

A recent development, known as “fast CT” screening, has made testing more pleasant. Non-invasive X-ray technology can now allow doctors to examine the kidneys closely and locate kidney disease earlier, possibly even before the patient experiences symptoms.

Avoid smoking. It raises your blood pressure and taxes the blood vessels that keep your kidneys going strong. Smokers also have a higher chance of developing proteinuria.

Inform your doctor of over-the-counter medications and herbal remedies that you take. Although generally safe in small doses, anti-inflammatory painkillers like aspirin, ibuprofen, and acetaminophen can aggravate the kidneys.

Several herbal remedies have been known to cause kidney problems. Cat’s claw, a Peruvian remedy for arthritic symptoms, has been linked to acute renal failure. Several Chinese herbal remedies, including those containing the flavonoids cianidanol or sciadopitysin and those containing aristolochic acid and mefenamic acid, have also been known to cause renal failure. These compounds have been found in mixtures of Chinese herbs and in Tung Shueh pills.

Diuretic herbs, (parsley herb, white sandalwood, watercress, juniper berry, and asparagus root) and those causing electrolyte imbalance (aloe, rhubarb root, senna leaf) may also put your kidneys at risk. And for those already on medication for kidney problems, anticoagulants (danshen, ginkgo biloba, garlic, ginseng, green tea) and antihypertensives (licorice root, ephedra) can adversely alter the effects of your kidney medication. The greatest danger is that not all producers of herbal remedies provide a complete list of ingredients (or side-effects of those ingredients) on the label.

The kidneys can also be affected by many otherwise beneficial treatments, including antibiotics.

If you already have kidney disease or think you may be at risk, avoid high-protein diets, such as the popular Atkins diet. The American Diabetes Association recommends that diabetics allow .6 to .8 grams of protein per kilogram per day (as opposed to the U.S. Recommended Daily Allowance of .8 g). Although researchers have not yet established the long-term effect of a high-protein diet on the kidneys, extra protein means extra work for the filtration system. For those with already weakened kidneys, this could mean an acceleration of disease.

A new light on the horizon of kidney treatment is the emergence of ACE inhibitors, drugs traditionally used to treat high blood pressure. Researchers recently found that ACE inhibitors may slow the progress of kidney disease. Because hypertension fuels renal failure, ACE inhibitors help both by controlling blood pressure and by decreasing proteinuria or microalbuminuria.

Unless a transplant can be performed, patients who progress to end-stage renal disease face dialysis–essentially using a machine to clean the blood for them. Those undergoing dialysis generally receive treatment–typically lasting three to four hours at a time–three times or more a week. At this point, end-stage renal disease means a lifetime of treatment.

The good news is, with ACE inhibitors and proper lifestyle adjustments, many patients can delay end-stage renal disease significantly, if not prevent it entirely.

REFERENCES:
Laurie A. Badzek et al, “Inappropriate Use of Dialysis for Some Elderly Patients: Nephrology Nurses’ Perceptions and Concerns,” Nephrology Nursing Journal, October 2000, p. 462.
Terri D’Arrigo, “Kidney Care 101,” Diabetes Forecast, November 2000, p. 62.
Nick Hateboer et al, “Comparison of Phenotypes of Polycystic Kidney Disease Types 1 and 2,” The Lancet, January 9, 1999, p. 103.
Margaret J. Myhre, “Herbal Remedies, Nephropathies, and Renal Disease,” Nephrology Nursing Journal, October 2000, p. 473.