Joey Wahler (Host): March is National Kidney Month, the time dedicated to raising awareness about kidney disease. And so, we're discussing kidney care. Our guest is Dr. Andres Serrano. He's a leading nephrologist dedicated to helping patients prevent, detect, and manage kidney disease. This is the Sinai Chicago Health and Hope podcast where caregivers from Sinai, Chicago share insights, updates, and important advice on the health topics impacting our communities.

From the latest in medical research to practical tips for improving wellness, our doctors, nurses, and health professionals are here to help you and your families take control of your health. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Serrano. Welcome.

Andres Serrano, MD: Hey! Thank you, Joey, for the Invitation. More than happy to participate in this podcast and create awareness about kidney disease.

Host: Yeah. Such an important topic as you well know. So to get us started, for those who may not think often about their kidneys, remind us, please, what the kidneys do in a nutshell and why they're so vital to our overall health.

Andres Serrano, MD: Thank you for the question. You know, kidneys are always forgotten. Everybody's aware about their hearts and other organs, but they forget that kidneyS are also vital organs and are very important for the daily activities of your bodies. Kidneys are pretty much filters in the body. They have three main functions.

The main one is they regulate volume. I refer volume as everything that we drink has to be excreted. So, kidneys are regulating and eliminating the fluid in excess that we have in the body. The second one is regulating salts. In the blood, we have salts that are very important for many activities. And the kidneys regulate and maintain those salts within adequate targets. And finally, it is the filtering part. You know, our body makes a lot of waste products every minute. And this waste product has to be eliminated. Otherwise, they create problems. So, the kidneys are constantly getting rid of these waste products. So, that way, you know, we don't get poisoned by our own products.

So, those are the main three functions. And again, people forget about the importance of the kidneys. And these are important tasks for every day.

Host: To punctuate that, Doc, kidney disease affects some 37 million American adults, that's an eye-popping number. Many of whom who don't even know they have it, because kidney failure is often called a silent disease with symptoms that may not appear until it's in the advanced stages. So that being said, what are the early signs, warning signs, that people shall look out for here?

Andres Serrano, MD: You are correct, Joey. Kidney disease is silent. And we are going to be probably addressing this later on. The main causes of kidney disease remain high blood pressure and diabetes. And these diseases and other causes of kidney disease, they don't damage the kidney immediately. They tend to create damage over time. So, most of the kidney disease progress over many years. And because they progress so slow, our bodies have the capacity to adapt to those damages. Therefore, we don't feel anything until the diseases are very advanced. And at that point, the symptoms come, because the amount of waste products and the amount of damage related to the salts and electrolytes start creating problems in the functioning of other organs.

So typically, when patients have symptoms related to kidney disease is because the disease is very advanced. So, the lack of symptoms do not rule out that you don't have kidney disease. For those who are really interested in knowing what kind of symptoms a patient develops with kidney disease, again, the characteristic one is swelling. So, patients are going to start swelling in their legs or around their eyes. And then, when the waste products have accumulated significantly, then tiredness, lack of energy, lack of appetite. But as you see, those are not specific for kidney disease. Those symptoms can happen with any other medical problem. So, that's why it becomes so difficult to catch up on time because of this characteristic of showing us symptoms or signs only when the disease is very advanced.

Host: Now, as you mentioned, Doctor, with diabetes and high blood pressure accounting actually for nearly 74% of kidney failure cases how exactly do the conditions there damage the kidneys over time? In layman's terms, what's happening to the kidneys because of that?

Andres Serrano, MD: Again, the kidneys, as I mentioned earlier, they are filters. They get bombarded by many things. And when you have diabetes and you have this excess of sugar in your blood, these sugars get trapped in tissues and they create inflammation and damage. So in diabetes, what you typically have is this uncontrolled level of sugar in your body trigger a lot of inflammation. And the kidneys, being a filter, they become collateral damage of their problem.

Similarly with hypertension, what happens in hypertension is that the kidneys get affected by external forces created by high blood pressure. The kidneys are very sensitive organs. And when you have hypertension, you are making them to work harder in a really adverse condition. It's like when you are working outside with a hundred-degree temperature and, on top of that, someone is hitting you. So, this is kind of similarly what is happening in kidneys with high blood pressure and diabetes. So, they become collateral damage of a problem that is affecting every organ.

Host: How about common medications or even over-the-counter drugs that people may not realize can harm the kidneys? Ibuprofen is one if you take too much of it, right?

Andres Serrano, MD: I'm glad that you asked about this, because over-the-counter medication become a common cause of kidney disease. Not as important as diabetes or high blood pressure, but people are very prone to take medication on their own. As you mentioned, ibuprofen or similar medications like Excedrin, ibuprofen, Aleve, they are painkillers that are widely used. And yes, when you use it with caution, we use it for short periods of time, they won't create any problems. But if you use it with no guidance and chronically—means every day, every moment—then, yes, you can expose the kidneys to damage by these medications.

Similarly, I always complain about TV products, products that get advertised on TV late night, they promised to be the cure for everything. A lot of these products, we don't know what is inside of those medications, and people got reaction to this components of these medications. And typically, the kidneys get affected by this reaction.

So, my message is anytime you're taking a medication, get advice from a professional who can guide you. And that way, you know, you are not exposing your kidneys to a potential toxin that can damage and create a problem down the road.

Host: Great advice indeed. How about this, Doctor, I think the common thought on the part of most people is that chronic kidney disease can only be managed but not reversed. So, any exceptions to that?

Andres Serrano, MD: You're correct. Traditionally, when we diagnose kidney disease, we modify the medications or bring medications to the patients who are going to be slowing down the progression of kidney disease or are going to stabilize the progression of kidney disease. However, lately, there have been the introduction of several new medications that if we start the medications early on in kidney disease, sometimes we can reverse or even cure the disease.

So yes, in general, most of the time, we're going to be not curing the disease, but preventing the disease to progress, which is very important. However, as I mentioned, if the disease is diagnosed very early with the new medications, we have the potential impact of stopping definitely, or even cure it. So, that's why it's very important to see your doctor and to be evaluated for kidney disease if you have risk factors for it.

Host: You led me beautifully there into my next question, which is who should be getting screened for kidney disease, and what exactly does that involve? You've already mentioned a few of the type of people that fall into that category, high blood pressure, diabetes, anyone else?

Andres Serrano, MD: Correct. As you mentioned, around 40 million people in the United States are affected by kidney disease, but it doesn't mean that all of us are going to be having kidney disease. So, the screening should be focused on patients who are at risk, which we already mentioned, some of them. So, patients who have history of high blood pressure, patients who have history of diabetes, the Latino community, the Black community, they have a much higher risk of developing kidney disease.

 And another risk, if you have a family history of kidney disease, that puts you at risk also for developing kidney disease. So again, if you have any of these risk factors, you should be discussing with your physician about having a test to see if you have any evidence of kidney disease or early kidney disease.

Host: And so, what does that screening involve exactly? And what's usually the recommended frequency with which it should be done for most people?

Andres Serrano, MD: Thank you for that question. Again, screening for kidney disease is very simple. It doesn't require like imaging studies or sophisticated tests. We need only to test a blood test to measure the kidney function, and a urine test, which will be evaluating for the presence of protein in the urine. Again, this is recommended to be done at least once a year in patients who have risk of kidney disease. And again, very simple, you just need a visit with your physician and they will be collecting these two samples. And then, from that point, you know, repeating as needed based on the findings.

Host: And then, in summary, Doctor, because you've punctuated just how important screening and early detection is, how can those joining us help spread this awareness about good kidney health? And what's your message to them and to the community at large?

Andres Serrano, MD: It's very important to stay aware that this disease exists. And as you mentioned, 40 million people in United States suffer of kidney disease, which is very high. And having kidney disease creates a risk for other problems like cardiovascular disease, strokes. So, don't forget that kidney disease is as important as having heart disease, diabetes, hypertension. And they're part of this epidemic of chronic kidney diseases. Be aware of the disease. If you have risk factors, as we mentioned already, high blood pressure, diabetes, family history of kidney disease, being part of a minority group, be conscious of that. Visit your doctor and ask him for screening. And of course, if you have the symptoms that we mentioned earlier, which again is going to be probably a late manifestation of kidney disease, then you definitely need to seek evaluation by a professional so you can be treated and, hopefully, modify the progression of your disease.

Host: Indeed. Better safe than sorry certainly applies here. So, do stay on top of it. Folks, we trust you are now more familiar with kidney care. Dr. Serrano, important information. No question about that. Thanks so much. Keep up all your great work and we hope to speak to you again down the road.

Andres Serrano, MD: Thank you, Joey, for the invitation. And again, be aware of kidney disease and try to screen if you have one of these risk factors, because you're going to be preventing further complications.

Host: For more information, you can visit sinaichicago.org. And if you found this podcast helpful, please do share it on your social media. Thanks so much again for being part of the Sinai Chicago Health and Hope podcast.