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Kidney 101

Southern Alberta Renal Program Alberta Health Services

Presenter: Janice James RN CNeph ( C )

Nurse Clinician Chronic kidney Disease Clinic

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CONTENTS

1. Overview of Kidney Anatomy and Functions

2. Common causes of declining kidney function

3. Kidney and kidney related diseases

4. Signs to look out for kidney diseases

5. Common tests to assess your kidney health

6. Five Stages of Kidney function

7. Kidney replacement therapy

8. Living well with kidney disease

9. Tips to take control your kidney health

10. Questions and answers

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The Kidneys

Most people have two kidneys, located on either side of the spine.

Each kidney is about the size of your fist.

They are attached to the bladder by ureters.

Urine is stored in the bladder

A Nephron

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The Kidneys Make Urine and Regulate Body Water

The kidneys make one to two liters of urine every day.

Too much water, minerals and waste products get separated from the blood and eliminated as urine.

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What do kidneys do?

Removal of wastes

Maintain fluid balance

Maintain acid-base balance

Balance of minerals and electrolytes

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Kidney produces hormones

These hormones help:

Regulate blood pressure

Make red blood cells

Promote strong bones.

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Common causes of declining kidney function

Diabetes:

Uncontrolled blood sugar

Hypertension (high blood pressure):

Prolonged high blood pressure

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Other Causes

Inherited diseases, such as, polycystic kidney disease .

Immune system disorders : Lupus

Glomerulonephritis: inflammation and damage to the kidney’s filtering units.

Repeated urinary infections.

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Other causes

Obstructions caused by:

- kidney stones

- tumors

- enlarged prostate

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How do we assess kidney health ?

Blood test :

Creatinine : waste product from muscle

breakdown

Urine test:

When kidneys become damaged, protein is

found in the urine.

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Imaging Studies

Ultrasound

(Size and Symmetry of kidneys).

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Estimated Kidney Functions

Estimated glomerular filtration rate (GFR) : a

value that is calculated from creatinine level and

other factors (gender and age) to estimate

remaining kidney function.

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Signs to look out for

High blood pressure

Bloody , cloudy or tea-colored urine.

Protein in urine

Foam in urine

Frequent passing of urine during the night.

Difficulty voiding or passing less urine

Edema (swelling in eyes, hands, legs , feet)

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Five Stages of Kidney Functions

Stage 1: Normal GFR > 90 ml/min

Stage 2: Mild GFR 60-89 ml/Min

Stage 3: Moderate GFR 30-59 ml/min

Stage 4 : Severe GFR 15-29 ml/min

Stage 5 : GFR < 15 ml/min (end stage kidney disease)

Symptoms of Late Stage Kidney Failure

Loss of appetite

Nausea and vomiting

Bad taste in mouth

Chest pain

Fatigue

Cold intolerance

Shortness of breath

Swelling in hands and feet

Persistent

generalised itching

Muscle cramps

Restless legs

Sexual dysfunction

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What Happens Next ? Progressive Renal Insufficiency

(Chronic Kidney Disease stage 1-4)

End stage renal disease ( stage 5) Conservative

Therapy

Renal( kidney) replacement therapy

Hemodialysis

Peritoneal Dialysis

Kidney Transplant (Live or non living donor)

Hemodialysis

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Continuous Ambulatory Peritoneal dialysis

CAPD

Dialysis done every day

Each exchange takes

20-30 min.

4-5 manual exchanges/day of fluid by patient

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Cycler Peritoneal Dialysis

Automatic peritoneal

dialysis (APD) (CCPD)

Automated machine

(cycler) performs

exchanges at night

while patient sleeps

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Kidney Transplantation

Live Donor, a kidney from a donor, often a

blood relative

Paired exchange

Cadaver Donor (

a healthy kidney from

someone who has died,

non living donor)

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Conservative Therapy

Living Well Without Dialysis

Choose not to have dialysis or a transplant

Patient will be managed by a specialized

renal palliative care team

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Tips to keep your kidneys as healthy as possible

1. Keep high blood pressure within target range

2. Control Blood Sugar

3. Cholesterol Management

4. Healthy Food choices

5. Weight Control and exercise

6. Stop smoking

7. Reduce stress

8. Know your medications

9. Know your numbers

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1. Control High Blood Pressure

Target BP

~ < 140/90 for most people

~ < 130/80 for people with kidney disease or diabetes

'chicken and egg' question ?

Sick kidneys cause high BP

Or high BP causes defected kidneys

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Tips to help control high blood pressure

Get it checked !

Measure at home

Cut back on salt and processed food

Control your weight

Limit alcohol

Be active

Be smoke-free

Take time to relax

Take medications as prescribed

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Tips to help control blood sugar level

Get it checked !

Eat a healthy diet

Control your weight

Limit alcohol

Be active

Take medications as prescribed

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2. Control Your Blood Sugar level

Meter readings:

4 - 7mmols – fasting + before a meal

5 – 11 mmols – 2 hours after meal/snack

Hemoglobin A1C

A hemoglobin A1C (also known as glycated

hemoglobin or HbA1c) test gives you a

picture of your average blood sugar

(glucose) for the past two to three months

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Dangers of High Cholesterol

High cholesterol is one of the

risk factors for atherosclerosis

( hardening of the arteries)

Atherosclerosis, like corrosion in pipes, builds

inside the wall of arteries (not veins)

decreasing blood flow through the arteries

4.2-5.2mmol/L

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3. Cholesterol Management

Cholesterol is a soft waxy substance found

among the fats in the blood

Important for development of:

– Cell membranes

– Nerve tissues

– Certain hormones

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Diagnosing High Cholesterol

A lipoprotein profile measures:

Total cholesterol

Low density lipoprotein

(LDL or “bad”) cholesterol

High density lipoprotein

(HDL or “good”) cholesterol

Triglycerides

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Cholesterol Lowering Medications

Atorvastatin (Lipitor), Simvastatin (Zocor),

Rosuvastatin (Crestor), Fenofibrate (Lipidil)

Statins for the prevention of cardiovascular events in patients with chronic kidney disease

Latest research results

Age < 50 Age ≥ 50

GFR ≥ 60 GFR < 60

CAD

DM

Stroke

CV risk

Statin

or

Statin/Ezetimibe

Statin Statin

CKD

Dialysis Patient

Don’t STOP

Don’t START

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5. Weight Control and Exercise

Maintain healthy body weight

Body Mass Index : ratio of weight-to-height.

( BMI 18.5 -24.9 Kg/M2)

underweight (BMI less than 18.5);

normal weight (BMI 18.5 to 24.9);

overweight (BMI 25 to 29.9), and

obese (BMI 30 and over).

Waist circumference

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Abdominal obesity

Waist circumference of:

Men> 102 cm (40”)

Women >88 cm (35”)

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Exercise

Exercise

30-60 minutes of moderate intensity exercise (walking, jogging, cycling or swimming) ,4-7 days a week.

Benefits:

Combat chronic diseases eg. High BP, Type 2 diabetes

Boosts good cholesterol and decreases build up of plaque in arteries

Improve your mood & reduce stress

Helps to manage /maintain healthy weight

Strengthen your heart and lungs

Promote better sleep

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6. Stress Reduction

Identify sources of stress

Stress relief techniques: Deep breathing exercises or positive thinking.

Avoid unnecessary stress.

Alter stressful situations.

Accept things that you cannot

change.

Allow time for fun

and relaxation.

Emotional Well Being

Stages of acceptance

Denial

Anger

Bargaining

Depression

Acceptance

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7. Smoking Cessation

Why should I stop smoking?

1.To reduce the risk of developing chronic

kidney disease and kidney failure.

2.To reduce the risk of heart attack or stroke.

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Smoking Cessation Resources

Family physician

Tom Baker Cancer Centre- group classes

The Alberta Lung Association

AADAC

Web sites

Nicotine anonymous

www.nicotineanonymous.org

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8. Know Your Medications

Diabetes medication : to reduce blood sugar

Insulin : to supplement what our body makes

Oral pills: to help body make more insulin or help the body use insulin more effectively.

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8. Know Your Medications

Blood pressure medications:

ACEI/ARB (Altace/Avapro)

Beta blocker (atenolol, metoprolol)

Calcium channel blockers (eg Norvasc):

reduce BP by dilating blood vessels

Diuretics (eg Hctz, Lasix) : lower blood pressure by reducing excess fluid

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Users Beware!

Long term use of prescription or non

prescription pain relievers and arthritis

medications (Nsaids)

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Pharmacy Tips

Your Pharmacist

Know your medications and carry a current list with you

include any over-the-counter (OTC) and herbal remedies.

Take your meds as directed.

Check with your pharmacist or health care provider before starting any new meds, OTC, or herbal remedies.

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9. Know Your Lab Results

Creatinine

– Waste product of exercising muscle

– Creatinine in your blood increases as your kidney

function decreases

< 120 umoL/L (Men)

< 100 umoL(Women)

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UREA

– Waste product from the protein that you eat

– Urea increases as kidney function decreases

– 2.5-8 mmol/L

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POTASSIUM

– Mineral found in food

– Essential for nerve conduction and muscle

function

– 3.5-5.1 mmol/L

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Calcium

– Mineral required for nerve, muscle and bone

production

2.10-2.55 mmol/L

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Phosphorus

– Mineral found in food

– Elevated levels will leech calcium from the bones

– Foods high in phosphorus will be restricted

– Phosphate binders may be started

– 0.8–1.5 mmol/L

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Self management Toolbox Kidney Care Record

Physical Lifestyle Optimal Values My Records

Weight (every visit) BMI -18.5 -24.9 Kg/M2

Blood Pressure (every visit) 130/80 or less

Foot exam (once a year) -

Eye exam (once a year) -

Dental Exam (once a year) -

Pneumococcal vaccine (once) -

Influenza Vaccine (once a year) -

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Chronic Kidney Disease Toolbox

Supports:

Canadian Hypertension Society

www.hypertension.ca

Kidney Foundation of Canada

(www.kidney.ca)

Canadian Diabetes Association

(www.diabetes.ca)

Living Well with a Chronic Condition

(www.albertahealthservices.ca/livingwellcalgary.asp)

NutritionResources@albertahealthservices.ca

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Living Well Program

Disease Specific Education :

Diabetes Essentials, Pre-Diabetes, Gestational Diabetes,

Hypertension, Cholesterol, Chronic Lung Disease, Chronic Pain,

Falls Prevention, Food & Mood, Congestive Heart Failure.

Supervised Exercise Classes :

Easy Going, Get Going, Keep Going

Better Choices Better Health

Goal Setting, Managing Emotions, Fear & Frustration, Relaxation,

Communication, Coping with Pain/Fatigue.

Call 403- 943-2584 (9-HEALTH) to register

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In Summary: Kidney Health Self Management

Toolbox Blood Pressure Control

Blood Glucose Control

Cholesterol Management

Healthy food Choices

Weight Control and exercise

Smoking Cessation

Stress Management

Know your medication

Know your numbers

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Questions and Answers