Your last visit to the doctor proved to be worrisome after finding that you are unable to bring down your blood pressure. Compounding your anxiety was the fact your test results confirmed that you have CKD.

What should you do?

You already know that if you have high blood pressure of hypertension you should test for your glomerular filtration rate (GFR) and a blood test for creatinine to determine if you have a kidney disease. The big question is what you should do if these tests show that you do have CKD.

First you need further tests to determine the type of CKD you have which may include an ultrasound to check any problems in size or blockage; and tests to find out the likelihood of developing heart diseases or if you already have heart problems.

Your doctor will make a treatment plan for you based on your CKD stage and sometimes you may need to see a specialist to help develop your treatment plan. Goals for this plan would include lowering your blood pressure less than 130/80; lower your risk for a heart disease; and keep your kidney disease from getting worse.

A lifestyle change is what you primarily need to make your treatment plan work. Change your eating habits and exercise more. It may sound easier said than done, but that’s what you have to do to keep the disease from getting worse.

Highly recommended dietary changes:

• CKD stages 1 -2: doctors may recommend a diet high in fruits, vegetables and dairy. This diet is low in sugar and sodium.
• CKD stages 1-4: sodium should not be more than 2,400 mg/daily; cut down on foods high in cholesterol and saturated fats; carbohydrates should only be 50-60% of your daily calories.
• CKD stages 3-4: control the amount of protein you eat daily; eat fewer foods rich in phosphorus as high levels of phosphorus may lead to bone disease. This mineral is found in dairy products such as milk, cheese and yogurt, and cocoa, beer and dark cola products; reduce potassium in your diet.

Aside from your modified diet, you also need to lose weight if you are overweight; exercise 30 minutes daily; and stop drinking and smoking.

You are right in not taking your HBP diagnosis lightly because it does increase risk to major illnesses. However, HBP can be controlled and that’s where your challenge lies. Controlling your HBP is in your hands, and also with the help of your family.

Protect yourself against a “silent killer” by knowing the facts. Although millions of Americans are afflicted by high blood pressure (HBP) or hypertension, it largely remains as a silent killer because of the absence of symptoms. Thus, you may be walking around with a HBP without even knowing it.

HBP is a known leading cause of heart attacks, strokes and chronic kidney diseases (CKD). On one hand, chronic kidney diseases also cause HBP. The good news is HBP can be controlled! And it follows that if you are in control you minimize the risk of these complications. Recommended measures to control HBP include: losing excess weight, consuming less salt, getting more active, and quitting the cigarettes.

But before going any further let us define HBP. According to MedicineNet HBP occurs when repeated elevated blood pressure exceeds 140 over 90 mmHg (systolic pressure above 140 with a diastolic pressure above 90). It further states that it can cause blood vessel changes in the retina, thickening of the heart muscle, kidney failure and brain damage.

In relation to kidney diseases, HBP speeds up the loss of kidney function. Tests to find out kidney damage as a result of HBP include measuring the amount of protein in the urine and by estimating the glomerular filtration rate (GFR) from a blood test. Normal functioning kidneys keep protein in the body. However, damaged kidneys result to protein leaking into urine. Persistent protein in the urine occurs when two positive tests for protein is detected in the urine over several weeks. Meanwhile, a low GFR means your kidneys are not capable of removing wastes from your body.

These tests are very important because most people who have HBP don’t even know that they are sick because of the absence of symptoms. Sometimes, repeated headaches may occur in people with HBP or they may experience changes in their vision.

The good news is although HBP cannot be cured, it can be CONTROLLED. Here are some suggested measures to help control HBP:

• Lose excess weight and exercise more
• Cut down on salt intake
• Cut down on alcohol intake
• Increase intake of calcium. Prefer low-fat dairy products such as milk and yogurt
• Quit smoking
• Increase potassium intake by eating more nuts, raisins and certain fruits and vegetables. Those with CKD should consult their doctors before changing their potassium intake

Follow lifestyle changes you have discussed with your doctor. However, if these changes do not help lower your blood pressure, your doctor might prescribe medications. At times, a combination of medication is needed to reach the target blood pressure. Those with diabetes or CKD are sometimes given medication that help protect kidney functions. These are called ACE (angiotensin converting enzymes) inhibitors or ARBs (angiotensin receptor blockers).

It helps if you are proactive with your health. See your doctor regularly and have your blood pressure checked. If you have HBP work with your doctor on how to control it. Discuss with him lifestyle changes you need to make in areas of getting active and eating properly. When you are being proactive, you protect yourself from this silent killer.

(The next article will discuss managing your HBP when you have been diagnosed with a CKD or a kidney problem.)*

The 2007 US Renal Data System reports that 43.8 percent of CKD is caused by diabetes, this is followed by high blood pressure, 26.8 percent; Glomerulonephritis, 7.6 percent; Cystic diseases, 2.3% and Urologic diseases, 2.0 percent.

Although factors like age, family history and ethnicity are constant variables, contributing factors specifically lifestyle, is a controllable factor that can help prevent diabetes.  For example, in the United States studies show that African Americans, Hispanics and American Indians are more likely to develop diabetes, CKD and kidney failure than Caucasians.  However, lifestyle changes in diet and increased physical activity are major components in preventing diabetes.  In other words, diabetes prevention is no rocket science. It is simply living a healthy lifestyle.

Technology has drastically changed lifestyles in this millennium. We have PS3, the Xbox, Wii, iPads and other tablets, our laptops, netbooks, notebooks, Netflix, iPhones, BBMs – all intended to break communication and information barriers and uplift our standards of living.  Ironically, these same electronic gadgets and “toys” have tied us down to our couches and homes. It fostered sedentary lifestyles for many, reducing physical activities to the bare minimum. General practitioners recommend that we should engage in 30 minutes of physical activity daily, for at least 5 days every week.  That’s not too much is it?

An improved diet also helps prevent diabetes.  This means consuming more good foods than bad foods (read: low in fat and high in fiber).  Interestingly, the “traditional soul food” which African Americans are fond of, being a significant part of their culture and history, are mostly deep fried meats and rich in gravies. The smart choice is to grill or bake rather than pan fry or deep fry, and to stay away from gravies no matter how they liven up the meat, discard the skin from chicken; consume lots of fruits in their natural or raw state, and eat lots of vegetables.

Indeed, health practitioners have reported that improving physical activity levels and an improved diet notably reduce the risk of type 2 diabetes by 50%. Kidney diseases associated with diabetes take years to develop. Usually it takes 15- 25 years for diabetics to show signs of kidney failure.  To be safe, diabetics need to be screened regularly for kidney disease through eGFR and urine albumin. eGFR (estimated glomerular filtration rate) measures how much blood the glomeruli filters every minute, based on the amount of creatinine in the blood sample. When the eGFR is less than 60 mm/minute then a person has kidney disease. Meanwhile, urine albumin screening measures the amount of albumin against creatinine in a urine sample. Kidney damage is indicated when the urine sample has more than 30 mg or albumin per gram of creatinine.

Blood pressure medicines, in particular angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been effective in slowing kidney diseases among diabetic patients.  Also, those with diabetes and in the early stages of CKD should be able to manage their blood glucose.

As you can see it is more burdensome to manage and care for patients with diabetes, in order to prevent kidney diseases. The better option is to prevent diabetes by living a healthier lifestyle. But most of the time, we tend to ignore this until it hits closer to home. *

Enjoy in moderation! (Photo courtesy Flickr user Muffet)

If you have kidney disease, you need to keep track of mineral levels in your body in ways that people without the disease rarely need to consider. A primary example of this is potassium. This mineral’s levels are usually controlled by healthy kidneys. But when your kidneys aren’t functioning properly, this can change. And with high potassium levels, there could be drastic consequences unless you start controlling potassium levels yourself.

One main role of potassium in the body is to keep the heart and muscles functioning properly. It helps the heart maintain a regular, reliable beat, so this organ can be adversely affected if potassium levels go too high or too low. Too high, for example, and you could suffer a heart attack. You could also experience numbness or tingling.

If you realize that your potassium levels are going too high, one way to address the problem is with diet. You can consult a dietician who specializes in renal patients, and get a lot of input and advice. But you can also help yourself by choosing your foods carefully. While almost all foods have some amount of potassium in them, here are a few guidelines for limiting your intake of the mineral as much as possible.

It helps if you eat moderately. Conservative portions will help both the potassium intake and weight, which can cause other kidney-related problems. But any liquid in which foods have been canned, or which they have produced while cooking, should be avoided. This is because of leaching, a process where liquid pulls potassium out of a food. You can even leach potassium yourself by rinsing foods with warm water, then soaking in water for a couple of hours before cooking.

Your dietician will give you lists of high-potassium versus low-potassium foods. But here are a few common high-potassium foods:

• Apricots, oranges, bananas, melons, dates, raisins, and dried fruits
• Bran
• Broccoli, avocados, brussels sprouts, raw carrots, spinach, vegetable juices
• Tomatoes and tomato products
• Nuts and seeds
• Milk and yogurt

Lower-potassium foods include:

• Most berries
• Cucumber, lettuce, onions, green beans, peppers, zucchini, small portions of asparagus, corn, and celery
• Apples, grapes, cherries, and small portions of peaches, watermelon, pears, and plums
• Rice, noodles, pasta, and bread (not whole grain)
• Only one cup of coffee or two cups of tea per day

Choosing the right foods, cooking properly, and watching portions can go a long way to helping control your potassium levels through diet.

E. Coli isn't the only cause of HUS

Kidney problems can often sideswipe you, hitting when you don’t expect them, as a result of health problems that don’t seem related to the kidneys at all. One of the things that can strike in this unexpected way is Hemolytic Uremic Syndrome, or HUS. It’s one of the conditions that is associated with kidney failure from E. coli bacterial infection, but that’s not the only way it can get its foot in the door.

HUS produces a low blood cell count, resulting in anemia, and destroys the platelets in the blood that allow clotting. It also damages small blood vessels in the kidneys, and sometimes in the heart or brain as well. When it hits the kidneys, the little filters called glomeruli get clogged with damaged blood cells and platelets, and kidney function is impaired. Symptoms to watch for, especially in children, include lower urine output, a loss of energy, and very noticeable pallor.

These symptoms will usually follow a bout with bloody diarrhea, often as part of some illness that affected the bowels. Toxins in the bowels will somehow move from the intestines into the bloodstream, and that’s where the damage begins. So while HUS is most often associated with E. coli, people need to be watchful after any illness involving diarrhea, especially with blood in it.

There’s one thing that’s more positive about this form of kidney problem compared to many others: people who suffer from HUS and endure some degree of kidney impairment will usually see the kidneys recover. Fluid volume control through an IV is very important as a treatment. And in some severe cases, temporary dialysis may be needed while the kidneys regain their health. But most of the time, especially if the person receives medical treatment, the kidneys will recover.

HUS-induced kidney impairment may portend other problems in the future, however. Even those who recover complete function are at a higher risk of kidney problems or high blood pressure in later years. One of the factors in this higher risk is whether other organs were severely affected by the HUS as well.

There aren’t many conditions that impair the kidneys that can be said to have a “positive” outlook, with potentially a complete recovery of the kidneys. Fortunately, HUS is one of them. But as with so many other things involving the kidneys, the key is to watch the symptoms, and get immediate treatment once the problem is discovered.

Possibly the best treatment for children with high blood pressure and kidney disease

Children who experience chronic kidney disease, much like their adult counterparts, can also experience high blood pressure. Unlike adults, though, blood pressure issues aren’t a cause of children’s kidney disease. Instead, the causes may be problems in the urinary tract system, related kidney conditions like glomerulosclerosis, which we’ve discussed before, or an inherited disease such as polycystic kidney disease.

However, once their kidneys are compromised, children are as vulnerable to high blood pressure as any adult. This is why, if a child is diagnosed with this blood pressure problem, their kidneys should be checked immediately. And if it’s discovered that they do have kidney disease, other factors come into play. Here, children face similar health and treatment issues as adults.

Kids may be even more vulnerable when it comes to high blood pressure, because of the growing tendency of obesity in children, in much of western or westernized society, at least. So one recommended treatment may be simple weight loss. Being overweight not only can make high blood pressure worse, but it can increase children’s vulnerability to other possible effects of kidney disease, such as heart disease or diabetes.

One form of treatment that helps with weight loss is also good in its own right: increasing the child’s exercise. This strengthens the cardio-vascular system and helps reduce blood pressure. The stronger the heart gets, and the more easy a time it has as it works, the less chance there is of developing heart disease. So extra exercise can address three potential problems at once.

Another “prescription” may be much harder to enforce with today’s children: the removal of snacks with a high level of salt in them, as well as taking salt in general out of the diet. Of course, the doctor would need to be sure that the child doesn’t have a form of kidney disease that makes the body lose salt. In that case, the removal of these foods may not be recommended. But salt removal is a treatment that would have to be investigated.

Parents should consult a doctor about every aspect of their child’s treatment. Some exercises might be too vigorous, and blood pressure medications may conflict with kidney medicine being taken. But it’s important to watch a child’s blood pressure and address the possible causes if it becomes too high. And if the cause is kidney disease, it becomes absolutely crucial to bring the blood pressure down, to avoid worsening the disease.

Nine years ago, Kapoor had begun a regimen of dialysis. He revealed to the press, in 2006, that he underwent dialysis at least three times a week. In his final days, he experienced other problems that are well-known potential risks of renal failure: he had developed cardiac complications.

Sometime near the beginning of the second week of August, 2011, Kapoor was admitted to hospital in critical condition, with breathlessness, a nagging chest infection, and low blood pressure. He was put on a ventilator but finally, on Sunday August 14th, he passed away. Kidney failure and its complications had finally caught up to him.

Mr. Kapoor’s history was a living illustration of the dangers and possible ultimate consequences of kidney disease. It’s well known that kidney and heart problems can be intimately related. And the outcome of Stage Five renal failure, short of actual transplant, is frequent dialysis to try to purify the blood as the kidneys can no longer do.

Kapoor was a great example of continuing to live a full life, even with kidney disease. This enthusiastic actor was an equally enthusiastic embracer of the Internet and its benefits. He founded the Internet Users Community of India, and helped set up organizations like the Ethical Hackers Association. But his greatest recent work was helping make people aware of kidney disorders. He spoke at patients’ meetings and attended other programs for kidney awareness.

However, his life should also serve as an example of why it’s important to tend to one’s health and detect kidney disease in as early a stage as possible. If such problems are diagnosed at stages one or two, it may be possible to slow or halt the progress of the disease. Shammi Kapoor is a fine example of a kidney patient who made the most of his life. But the goal everyone strives for is to prevent anyone from reaching the stage of kidney disease that he did.

This type of kidney disease needs microscope confirmation

The term “kidney disease” sounds like it refers just to one form of illness, but in fact it covers a wide range of kidney problems. While the symptoms of each are often quite similar, because there are only a certain number of ways kidney impairment will manifest, the underlying causes are often different. Sometimes the kidneys are damaged from high blood pressure, sometimes the problem is polycystic kidney disease, and at other times, the underlying cause of disease is Focal Glomerulosclerosis.

The very name is a mouthful, but it’s derived from the glomeruli, or clusters of very small blood vessels in the kidney that help to filter blood. Sclerosis refers to thickening which, in this case, means scarring from some source. And in the same way as “kidney disease,” the scarring of “glomerulosclerosis” can also have many possible sources. It might have come from an original kidney infection, it could be caused by existing lupus or diabetes, or it might even be genetic in some cases. Even inflammation can cause scarring of these tiny vessels.

The symptoms are much the same as those for everything else we think of as kidney disease. So glomerulosclerosis, therefore, can similarly go undetected in its early stages. It will manifest in the same ways: increased protein levels in urine, possible rise in blood pressure, fatigue, itchy skin, and so on.

Some of the tests are the same as for “ordinary” kidney disease too: primarily blood and urine tests. But the only way to know for sure if a patient has glomerulosclerosis is by taking a kidney biopsy. The tiny kidney sample taken with a needle will reveal scarring of the blood vessels when examined under a microscope.

This condition is treated similarly to other kidney disease, with an extra twist or two. Reduction of blood pressure is very important, as is reduction of cholesterol. Salt and protein intake needs to be lowered. But the patient may also take immunosuppressant drugs, which will help reduce protein levels further.

Unfortunately, though, the scarred blood vessels can’t be repaired, so glomerulosclerosis can’t be cured or reversed. For some, especially if the condition is genetic, it may continue getting worse until a transplant is needed. But for most people, with proper treatment, diet, and other precautions, this version of kidney disease can probably be held almost at a standstill. Taking good care, they can often live many good years with little, if any, worsening of the condition.

Applesauce: one of the emergency fruits for kidney patients

Everyone in society should be aware of what to do in various types of emergencies such as natural disasters or major power outages. But kidney patients, especially those on dialysis, have extra contingencies to plan for. They need to make the same sorts of lists as their neighbors, while providing for extra medical and physical needs.

Kidney patients need supplies such as blankets, medicines, and food for several weeks. Yet even when it comes to stored food, their needs already diverge from those of others. Kidney patients, particularly if they are preparing for or are already on dialysis, have restricted their daily intake of some types of food. These include high-potassium foods (bananas, nectarines, raisins, melons, potatoes, tomatoes, asparagus, beets), products with a high salt content, and high-phosphorus foods such as products made from milk. Kidney patients also have more protein in their diet, as a rule, to help keep up their blood protein levels.

So what happens if they don’t have access to their regular groceries, and need to resort to emergency rations? What sorts of things should they have on hand? Here are a few suggestions:

• Containers of low-sodium fish or meat, no more than three ounces per day
• Single-serve containers of specific fruits (mandarin oranges, peaches, pears, applesauce, pineapple, fruit cocktail); no more than 4 servings per day
• White bread, single-serve containers of dry cereal like puffed wheat, puffed rice, or shredded wheat, and unsalted crackers or graham crackers; kidney patients should have 6-8 servings from this group per day, with a slice of bread counting as one serving
• Fats like small containers of cooking oil, mayonnaise, or margarine, having 6-8 servings a day
• Sweets like jelly, hard candies, white sugar, or jelly, primarily used sparingly, primarily to prevent the crash of blood sugar
• Distilled water, no more than 16 ounces of fluid per day, if at all possible

Puffed rice: one of the emergency cereals for kidney patients

A diet of the above items is more restrictive than a kidney patient’s regular diet, which is understandable because they aren’t getting help from anywhere else in balancing fluids, potassium, sodium, or phosphorus. So liquid intake is severely restricted, for example, to try to prevent swelling and keep waste products from building up in the system. The diet can be followed for several days, after which patients can hopefully get in touch with medical personnel and resume more regular treatments. But every kidney patient should be aware of the potential emergencies, and should take steps to be ready.

Spinach has calcium -- yet can hinder its absorption at the same time

But however the kidney patient takes in calcium, it has to be done the right way, or the body won’t absorb it. You might think that just eating calcium-rich foods — like spinach, yogurt, nuts, or canned salmon — would be sufficient. But spinach contains oxalic acid, which binds to the calcium and prevents its being absorbed in the intestines. Milk contains lots of calcium, yet it’s eaten with spinach, again the absorption is hindered. Compounds in tea might produce a similar effect.

Most of the time, these small hindrances don’t matter much, as a person’s complete, healthy diet usually provides the calcium they need. But two factors come into play with kidney disease is involved. Adults, especially, already tend to absorb less calcium. If they’re not careful, their bodies get to a point where they use up stored calcium in bones and teeth more quickly than it’s replenished. Now add the fact that with kidney disease, the calcium/phosphorus balance is skewed so that, again, calcium drains from the body more quickly than it’s replaced. So how calcium is ingested, and with what, becomes important.

Mmmm...Vitamin D!

First of all, Vitamin D is necessary for absorption of calcium. So foods rich in this vitamin (fatty fish and beef liver, for example) will help produce the intestinal proteins that allow calcium to absorb. Even 15-20 minutes of direct sunlight each day, especially in summer, which allows the skin to create Vitamin D, can be enough. And most calcium supplements add the vitamin for this very purpose.

But it doesn’t hurt to investigate which foods, eaten together, might hinder the intake of calcium. (Too much magnesium may hinder the good work of Vitamin D, for example.) And learning which supplements may be better is also a good idea. For instance, it’s wise to avoid calcium derives from seashells, which may contain high amounts of lead.

Among all the side health issues stemming from kidney disease, calcium levels are very important. Careful monitoring and research into diet can help mitigate the problem.