Kidney Health
Your kidneys serve as a filtration system for your body, so it's important to keep them healthy. Dr. Bryce Lund, Nephrologist at Nephrology Care, LLC, discusses kidney health.
Featuring:
Bryce Lund, MD
Dr. Bryce Lund, a native of Bassett, Nebraska, attended Hastings College and received his medical degree from the University of Nebraska Medical Center in Omaha, where he also completed his internship and his residency in Internal Medicine. Dr. Lund completed his fellowship in Nephrology at the University of Iowa Hospital and Clinics. He see's patients in Columbus at the Visiting Physician Clinic, located in the Healthpark Medical Office Building, Suite 210. He also helps to provide inpatient hemodialysis services to patients at Columbus Community Hospital through a partnership between Bryan Telemedicine, Dialysis Center of Columbus, and Nephrology Care, LLC. Transcription:
Bill Klaproth (Host): Your kidneys have an important job to do. They filter your blood and help waste and extra water leave your body. When your kidneys aren’t working well; waste can build up in the blood and hurt your body’s ability to function. Joining us now with information on overall kidney health is Dr. Bryce Lund, a Nephrologist at Nephrology Care LLC. Dr. Lund, thanks for your time. So, first off, can you tell us what is a nephrologist?
Bryce Lund, MD (Guest): Yes, thank you, I’d be happy to tell you what a nephrologist is. So, a nephrologist is an individual who focuses on diseases of the kidneys. And to give people a little idea of that, that is anything from kidney damage from things like diabetes, high blood pressure, kidney stones, sometimes it’s even things such as abnormal electrolyte levels and it can even be helping out with dialysis treatments and even kidney transplant.
Host: So, all things kidneys basically.
Dr. Lund: Essentially nephrology is all things kidneys. It can even include a little bit high blood pressure. There are some of these high blood pressure causes that are related to kidneys as well, but it is everything related to kidneys.
Host: And then what are some of the most common kidney conditions you see?
Dr. Lund: By far and wide, the most common thing I deal with is kidney damage but specifically from two things; and the very most common is diabetes. And diabetes is quite prevalent, but it likes to bother several parts of the body including the eyes, and the nerves and the kidneys. Those are the top three and so it’s quite common that we see folks who have kidney damage which another way of saying that is their kidney function has slowed down and no longer works as well as it used to. Behind diabetes is high blood pressure and sometimes, they come together. Individuals may have both diabetes and high blood pressure and those do damage kidneys. So, we do have lot of that.
Host: That’s really interesting. I wouldn’t have thought that high blood pressure would damage the kidneys. I could see diabetes and the over abundance of sugar playing a role, but blood pressure, that’s interesting.
Dr. Lund: Well right. And it does not get a lot of notice and in fact, sometimes high blood pressure has been called the silent killer because it is not something you feel but after it’s around for say ten plus twenty years; it starts bothering things like heart, and brain and kidneys. But again, it’s been silent the whole time. So, by the time it’s bad enough to see something wrong, unfortunately, there’s a lot of time damage and kidneys are involved in that.
Host: Well that’s very good to know. So, when you hear physicians say know your numbers, blood pressure is one of them. Make sure you know your numbers and watch your blood pressure. So, you were mentioning that blood pressure can be a silent underlying condition that someone has; is that true for the kidneys as well? Can someone have reduced kidney function and not even know about it?
Dr. Lund: Yes. In fact, most probably don’t. There’s probably of the folks I see, at least half of them come in not really knowing what’s wrong with their kidneys. They might have heard some vague words in the past like there’s something a little off with your blood tests or your kidneys aren’t quite right but not really good specific descriptions. So, when I see folks, we get into that a little more and there’s ways to measure kidney function such that you can talk about kidney function in percentages. Kidneys may be working 20% of normal or half or 50% of normal. And so most folks probably are not that aware of it until it’s been brought up specifically at a doctor’s visit and possibly at a nephrologist.
Host: So, are there any symptoms then of kidney disease that we should be aware of?
Dr. Lund: There are. But they are subtle until they are somewhat late into the stage of kidney damage. So early on, if kidneys have only lost maybe 30 or 50% of typical function; a person may not feel hardly any change and might have a little fatigue, but you know they might ascribe that to something else as well. So, kidney function usually has to drop quite a bit before people feel bad and then by bad, I mean fatigue is quite severe, they don’t sleep well, they might have itching, they might develop fluid retention or swelling on the legs and that generally happens when oh you’ve probably lost maybe 70 to 80% of kidney function, so fairly advanced unfortunately.
Host: Yeah, absolutely. That’s what it sounds like. So watch out for fatigue, you said itching and possible fluid retention as well.
Dr. Lund: That’s correct. And unfortunately, there’s also a little bit of a feedback into blood pressure. Once kidneys start slowing down; kind of a maladaptive response they tend to increase blood pressure so folks may even see their blood pressure worsen over time.
Host: Yeah, that’s good to know. So, when it comes to kidney disease; are there certain populations that are more at risk?
Dr. Lund: Absolutely. Individuals with diabetes are probably the highest risk. And then of course, as we talked about high blood pressure are probably right behind that. And then behind that is probably inherited such as there are family groups or clusters that probably there’s some genes there that we haven’t completely identified but do tend to have more troubles with kidney damage through life. So, it’s hard to pick out those but individuals with diabetes, high blood pressure, we can pretty easily find those folks of course by checking those values blood pressure and blood tests.
Host: Right. So, we’re looking at as you said diabetes, people with high blood pressure, family genetics so; if someone falls into one of those categories; should they get screened?
Dr. Lund: And the answer is yes. But there is some variation on basically how soon and how frequent you would do some of that screening. For diabetes, of course we have two types of diabetes. There’s type one which tends to bother kidneys kind of later into the illness. So, if there is type one diabetes; you tend not to have to worry about the kidneys maybe until say five years after the diagnosis, but you would want to start monitoring at some point. For type two diabetes; we worry about that pretty much right away. So, as soon as someone has type two diabetes; they should have a check of their kidney function. For high blood pressure; it’s recommended that there is a check done at least once but after that; it’s really up to the individuals how often that needs to be done.
Host: So, what is involved in a screening?
Dr. Lund: Yeah, so the screening normally is going to consist of two things. Almost for everyone, it’s going to include a urine test and the urine test essentially is showing us what we’re looking for is blood or protein in the urine. If those are showing up in the urine; it’s a sign that there probably is a problem with the kidneys. The other part of screening is a blood test. So, the blood test tells you how well kidneys are working at that moment. And in the blood work, there’s essentially two parameters we watch. One is called the creatinine level and normal is around one and as that number starts to increase; that’s a bad sign, it means kidneys are working less. And the other is called a GFR and so that’s the abbreviation for what’s called a glomerular filtration rate and that essentially can give you an estimate of what kidney function is.
Host: Okay so basically through a urine test that’s how you screen for the creatinine level and GFR as you were saying.
Dr. Lund: That’s correct so it does take both urine testing and blood testing.
Host: Okay. Got you. So, then if you are found to have kidney disease; what are the treatment options that are available?
Dr. Lund: Oh good question. So, any time you have kidney disease there are groups of medications that should be considered. And the name of the two groups are called ace inhibitors and angiotensin receptor blockers or ARBs as they are called. All physicians know of these medications. Essentially, they are blood pressure medications, but they help specifically with blood pressure and kidney damage. So, any time someone has had kidney damage, those sort of medications should be considered as treatment. On top of that, for diabetes; there’s a new group of medications that’s been out in the last few years. They’re called SGLT2 inhibitors and they seem to slow diabetic kidney damage specifically for diabetes.
So, there are medications and it depends on essentially the level of the kidney function, which medicine you are going to use.
Host: So, we’ve all heard of kidney dialysis. When does that enter the picture and how does kidney dialysis work?
Dr. Lund: Yes. So, dialysis enters the picture when kidney function no longer is sufficient to help the individual to essentially sustain life. So, that typically happens when kidney function is about 10% or less. So, what happens is dialysis is a way to essentially replace some of the function of the kidneys. It does not help them work any better, but the treatment itself can remove some of the waste products and fluids and balance the electrolytes, things that the kidneys used to be able to do. And that’s what dialysis is. There’s about three different types of dialysis that can be done so there’s several variations. But they all work the same way to kind of help balance the electrolytes and fluid levels in the body.
Host: So, once you are on dialysis, is this a long term tool you can use to manage kidney failure? My perception is once you are on dialysis, you are basically in line for a kidney transplant.
Dr. Lund: Well that is pretty correct. Kidney transplant tends to be a little easier on the body, makes people a little healthier and they tend to live a little longer. So, it is the preferred treatment. But for individuals who may be a little bit older say 75 or 80 or if they have multiple health problems where a big surgery like transplant may not be feasible, dialysis is still going to be something that can get them by for hopefully many years. So, they can remain on it for quite an extended period of time and I think the record out there is somewhere around 30 plus years of being on dialysis. So, it can be pretty extensive, but kidney transplant is the preferred option if possible.
Host: Well thank you for explaining that to us. I appreciate it and Dr. Lund; you’ve been fantastic so perhaps maybe the most important question as we wrap up what can we do to take care of our kidneys? We want to keep that kidney function high.
Dr. Lund: Yes. Well that’s good. The simple answer there is be healthy. So, kind of what you hear from other sources, diet, and exercise those sort of things help keep blood pressure down, they help keep diabetes away. Once you are actually worried about kidneys there’s a little bit more you can do. Less salt tends to be easier on kidneys. So, avoiding salt is helpful. Also a little bit less protein or red meat in the diet tends to help. So, those are specific interventions for helping out kidneys.
Host: So, it all comes back to pay attention to diet and exercise and if you take care of your body; it’ll take care of you.
Dr. Lund: It is till the best thing to do and like they say, an ounce of prevention is worth a pound of cure.
Host: Well this has been very informative Dr. Lund. Thank you so much for the education about our kidneys and thank you so much for your time.
Dr. Lund: You’re welcome. I appreciate it. You have a good day.
Host: That’s Dr. Bryce Lund and for more information on kidney health and the services offered through Nephrology Care and Columbus Community Hospital; please visit www.columbushosp.org or follow us on Facebook, Twitter and Instagram. And if you found this podcast helpful; please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcast from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Your kidneys have an important job to do. They filter your blood and help waste and extra water leave your body. When your kidneys aren’t working well; waste can build up in the blood and hurt your body’s ability to function. Joining us now with information on overall kidney health is Dr. Bryce Lund, a Nephrologist at Nephrology Care LLC. Dr. Lund, thanks for your time. So, first off, can you tell us what is a nephrologist?
Bryce Lund, MD (Guest): Yes, thank you, I’d be happy to tell you what a nephrologist is. So, a nephrologist is an individual who focuses on diseases of the kidneys. And to give people a little idea of that, that is anything from kidney damage from things like diabetes, high blood pressure, kidney stones, sometimes it’s even things such as abnormal electrolyte levels and it can even be helping out with dialysis treatments and even kidney transplant.
Host: So, all things kidneys basically.
Dr. Lund: Essentially nephrology is all things kidneys. It can even include a little bit high blood pressure. There are some of these high blood pressure causes that are related to kidneys as well, but it is everything related to kidneys.
Host: And then what are some of the most common kidney conditions you see?
Dr. Lund: By far and wide, the most common thing I deal with is kidney damage but specifically from two things; and the very most common is diabetes. And diabetes is quite prevalent, but it likes to bother several parts of the body including the eyes, and the nerves and the kidneys. Those are the top three and so it’s quite common that we see folks who have kidney damage which another way of saying that is their kidney function has slowed down and no longer works as well as it used to. Behind diabetes is high blood pressure and sometimes, they come together. Individuals may have both diabetes and high blood pressure and those do damage kidneys. So, we do have lot of that.
Host: That’s really interesting. I wouldn’t have thought that high blood pressure would damage the kidneys. I could see diabetes and the over abundance of sugar playing a role, but blood pressure, that’s interesting.
Dr. Lund: Well right. And it does not get a lot of notice and in fact, sometimes high blood pressure has been called the silent killer because it is not something you feel but after it’s around for say ten plus twenty years; it starts bothering things like heart, and brain and kidneys. But again, it’s been silent the whole time. So, by the time it’s bad enough to see something wrong, unfortunately, there’s a lot of time damage and kidneys are involved in that.
Host: Well that’s very good to know. So, when you hear physicians say know your numbers, blood pressure is one of them. Make sure you know your numbers and watch your blood pressure. So, you were mentioning that blood pressure can be a silent underlying condition that someone has; is that true for the kidneys as well? Can someone have reduced kidney function and not even know about it?
Dr. Lund: Yes. In fact, most probably don’t. There’s probably of the folks I see, at least half of them come in not really knowing what’s wrong with their kidneys. They might have heard some vague words in the past like there’s something a little off with your blood tests or your kidneys aren’t quite right but not really good specific descriptions. So, when I see folks, we get into that a little more and there’s ways to measure kidney function such that you can talk about kidney function in percentages. Kidneys may be working 20% of normal or half or 50% of normal. And so most folks probably are not that aware of it until it’s been brought up specifically at a doctor’s visit and possibly at a nephrologist.
Host: So, are there any symptoms then of kidney disease that we should be aware of?
Dr. Lund: There are. But they are subtle until they are somewhat late into the stage of kidney damage. So early on, if kidneys have only lost maybe 30 or 50% of typical function; a person may not feel hardly any change and might have a little fatigue, but you know they might ascribe that to something else as well. So, kidney function usually has to drop quite a bit before people feel bad and then by bad, I mean fatigue is quite severe, they don’t sleep well, they might have itching, they might develop fluid retention or swelling on the legs and that generally happens when oh you’ve probably lost maybe 70 to 80% of kidney function, so fairly advanced unfortunately.
Host: Yeah, absolutely. That’s what it sounds like. So watch out for fatigue, you said itching and possible fluid retention as well.
Dr. Lund: That’s correct. And unfortunately, there’s also a little bit of a feedback into blood pressure. Once kidneys start slowing down; kind of a maladaptive response they tend to increase blood pressure so folks may even see their blood pressure worsen over time.
Host: Yeah, that’s good to know. So, when it comes to kidney disease; are there certain populations that are more at risk?
Dr. Lund: Absolutely. Individuals with diabetes are probably the highest risk. And then of course, as we talked about high blood pressure are probably right behind that. And then behind that is probably inherited such as there are family groups or clusters that probably there’s some genes there that we haven’t completely identified but do tend to have more troubles with kidney damage through life. So, it’s hard to pick out those but individuals with diabetes, high blood pressure, we can pretty easily find those folks of course by checking those values blood pressure and blood tests.
Host: Right. So, we’re looking at as you said diabetes, people with high blood pressure, family genetics so; if someone falls into one of those categories; should they get screened?
Dr. Lund: And the answer is yes. But there is some variation on basically how soon and how frequent you would do some of that screening. For diabetes, of course we have two types of diabetes. There’s type one which tends to bother kidneys kind of later into the illness. So, if there is type one diabetes; you tend not to have to worry about the kidneys maybe until say five years after the diagnosis, but you would want to start monitoring at some point. For type two diabetes; we worry about that pretty much right away. So, as soon as someone has type two diabetes; they should have a check of their kidney function. For high blood pressure; it’s recommended that there is a check done at least once but after that; it’s really up to the individuals how often that needs to be done.
Host: So, what is involved in a screening?
Dr. Lund: Yeah, so the screening normally is going to consist of two things. Almost for everyone, it’s going to include a urine test and the urine test essentially is showing us what we’re looking for is blood or protein in the urine. If those are showing up in the urine; it’s a sign that there probably is a problem with the kidneys. The other part of screening is a blood test. So, the blood test tells you how well kidneys are working at that moment. And in the blood work, there’s essentially two parameters we watch. One is called the creatinine level and normal is around one and as that number starts to increase; that’s a bad sign, it means kidneys are working less. And the other is called a GFR and so that’s the abbreviation for what’s called a glomerular filtration rate and that essentially can give you an estimate of what kidney function is.
Host: Okay so basically through a urine test that’s how you screen for the creatinine level and GFR as you were saying.
Dr. Lund: That’s correct so it does take both urine testing and blood testing.
Host: Okay. Got you. So, then if you are found to have kidney disease; what are the treatment options that are available?
Dr. Lund: Oh good question. So, any time you have kidney disease there are groups of medications that should be considered. And the name of the two groups are called ace inhibitors and angiotensin receptor blockers or ARBs as they are called. All physicians know of these medications. Essentially, they are blood pressure medications, but they help specifically with blood pressure and kidney damage. So, any time someone has had kidney damage, those sort of medications should be considered as treatment. On top of that, for diabetes; there’s a new group of medications that’s been out in the last few years. They’re called SGLT2 inhibitors and they seem to slow diabetic kidney damage specifically for diabetes.
So, there are medications and it depends on essentially the level of the kidney function, which medicine you are going to use.
Host: So, we’ve all heard of kidney dialysis. When does that enter the picture and how does kidney dialysis work?
Dr. Lund: Yes. So, dialysis enters the picture when kidney function no longer is sufficient to help the individual to essentially sustain life. So, that typically happens when kidney function is about 10% or less. So, what happens is dialysis is a way to essentially replace some of the function of the kidneys. It does not help them work any better, but the treatment itself can remove some of the waste products and fluids and balance the electrolytes, things that the kidneys used to be able to do. And that’s what dialysis is. There’s about three different types of dialysis that can be done so there’s several variations. But they all work the same way to kind of help balance the electrolytes and fluid levels in the body.
Host: So, once you are on dialysis, is this a long term tool you can use to manage kidney failure? My perception is once you are on dialysis, you are basically in line for a kidney transplant.
Dr. Lund: Well that is pretty correct. Kidney transplant tends to be a little easier on the body, makes people a little healthier and they tend to live a little longer. So, it is the preferred treatment. But for individuals who may be a little bit older say 75 or 80 or if they have multiple health problems where a big surgery like transplant may not be feasible, dialysis is still going to be something that can get them by for hopefully many years. So, they can remain on it for quite an extended period of time and I think the record out there is somewhere around 30 plus years of being on dialysis. So, it can be pretty extensive, but kidney transplant is the preferred option if possible.
Host: Well thank you for explaining that to us. I appreciate it and Dr. Lund; you’ve been fantastic so perhaps maybe the most important question as we wrap up what can we do to take care of our kidneys? We want to keep that kidney function high.
Dr. Lund: Yes. Well that’s good. The simple answer there is be healthy. So, kind of what you hear from other sources, diet, and exercise those sort of things help keep blood pressure down, they help keep diabetes away. Once you are actually worried about kidneys there’s a little bit more you can do. Less salt tends to be easier on kidneys. So, avoiding salt is helpful. Also a little bit less protein or red meat in the diet tends to help. So, those are specific interventions for helping out kidneys.
Host: So, it all comes back to pay attention to diet and exercise and if you take care of your body; it’ll take care of you.
Dr. Lund: It is till the best thing to do and like they say, an ounce of prevention is worth a pound of cure.
Host: Well this has been very informative Dr. Lund. Thank you so much for the education about our kidneys and thank you so much for your time.
Dr. Lund: You’re welcome. I appreciate it. You have a good day.
Host: That’s Dr. Bryce Lund and for more information on kidney health and the services offered through Nephrology Care and Columbus Community Hospital; please visit www.columbushosp.org or follow us on Facebook, Twitter and Instagram. And if you found this podcast helpful; please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Hospital Healthcast from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.