Kidneys are extraordinary organs. They filter a person’s entire volume of blood about 60 times daily. Put another way, kidneys filter about 180 liters of blood per day. They regulate blood pressure, synthesize hormones, and create red blood cells. For National Kidney Month, learn more about kidney diseases—including the surprising medical mystery of an emerging kidney disease in Central America.
Chronic Kidney Disease
Chronic kidney disease (CKD) can be devastating. CKD is when the kidneys become so damaged that they struggle to effectively filter blood. It is a slow burn of an illness, often called a “silent disease,” as kidney damage accumulates asymptomatically over the decades. About 15% of Americans have CKD, but many do not know it.
CKD is part of a constellation of comorbid chronic diseases that are often found together. For example, CKD patients are far more likely than those without CKD to suffer from diseases such as diabetes, hypertension, cardiovascular disease, and anemia. As a patient’s CKD progresses, their risk of other chronic diseases increases. For this reason, CKD has been termed a “disease multiplier.”
Risk factors for CKD include diabetes, high blood pressure, obesity, age, being African-American, Hispanic, Native American or Asian, and having a family history of kidney disease. As the number of young people with conditions like diabetes and obesity increases, so too does the number of young people at risk for CKD. Patients at risk for CKD should regularly get their kidney function tested.
Treatments exist for CKD, but there is no cure. And the treatments that do exist for serious chronic kidney disease—dialysis, and ultimately, kidney transplants—are no walk in the park. This makes prevention especially important. To lower their risk of CKD, your patients should:
● Achieve and maintain a healthy weight
● Quit smoking, if they smoke
● Eat a healthy diet low in sodium and exercise regularly
● Manage their diabetes, if they have diabetes
● Keep their blood pressure within a healthy range
Acute Kidney Disease
Acute kidney disease, also called acute renal failure or acute kidney failure, is when the kidneys become damaged in a matter of hours or days. Acute kidney failure is generally caused by one of three things: impaired blood flow to the kidney, direct damage to the kidney, or a blockage of the ureters, the tubes that channel waste from the kidney to the bladder. Acute kidney failure generally requires hospitalization.
One cause of acute kidney failure can be overuse of over-the-counter pain medications such as acetaminophen (Tylenol, others), naproxen sodium (Aleve, others) and ibuprofen (Advil, Motrin IB, others). Remind your patients to follow the instructions for how and when to take these medications, and explain why. Remember: just because over-the-counter painkillers don’t require a prescription does not mean they are harmless!
Mesoamerican nephropathy: an emerging medical mystery
Over the last decade, chronic kidney disease rates have soared in Central America. Mysteriously, this form of kidney disease—which has been termed Mesoamerican nephropathy— affects healthy young men, without diabetes or any other common risk factors for CKD. However many of these men do have something in common: they are often agricultural laborers, working physically demanding jobs in hot conditions. There is no known cause of Mesoamerican nephropathy, but one hypothesis is that it is caused by a combination of recurrent dehydration and painkiller use. Although it is called Mesoamerican neuropathy, a similar kidney disease has been found in Sri Lanka.
What does this mean for you, as a clinician? The United States is not exempt from global health trends. Keep an eye on the news, and keep an eye on your patients. If you practice in a hot area—such as Texas, Arizona, Florida, or California—the research suggests that your patients who work agricultural jobs or otherwise labor outdoors may be vulnerable to Mesoamerican nephropathy.
With these tips in mind, go forward and help your patients keep their kidneys in top shape!
https://www.ajkd.org/article/S0272-6386(13)01568-0/abstract - “medical enigma”