Cheryl Martin (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

It's so important to keep our kidneys as healthy as possible. Here to tell us how to do that in every stage of life and to educate us about our kidneys is Dr. Eugene De Guzman, a Nephrologist at Skagit Regional Health.  

This is Be Well with Skagit Regional Health. I'm Cheryl Martin. Dr. De Guzman, so glad you're here to discuss kidney health.

Eugene De Guzman, MD: Oh, my pleasure. Thanks for having me.

Host: First, what are the kidneys main functions and why are they so vital to overall health?

Eugene De Guzman, MD: So, simply put the main functions of the kidney, essentially are to remove wastes and remove extra fluid, but it has host of other functions that people don't usually are aware of. And, some of them are regulating your electrolytes, your sodium, potassium in the body. And it also produces a hormone that stimulates your body to make blood.

Host: What are some of the early signs or symptoms of kidney problems that people should not ignore? 

Eugene De Guzman, MD: That's a difficult question to answer because the severe symptoms that can usually present are also only present towards the end stages of kidney disease. And because the kidney, I would say the kidneys are very much resilient a lot of the symptoms don't usually show up until your kidney function is like around, below like 20%.

Possibly the earliest, maybe most observable sign that it can associate with kidney disease would be an elevated blood pressure or leg swelling, but even for example, leg swelling, it can, can occur in early stages of kidney disease. If let's say you have an inflammation of the kidney, whether it be like a medication or on indium associated.

Host: Are there some blood tests that you can take that would indicate there may be a problem? 

Eugene De Guzman, MD: Oh, absolutely. So kidney disease primarily is diagnosed with lab tests. And if you go to your physician regularly, it can be as simple as a blood test and a urine test. Those are the two things that we at least check to identify individuals who have kidney disease or are at risk for kidney disease.

And it's a blood test called creatinine. And it's a waste product in the blood. It gets plugged into a formula and it gives us an estimate of the kidney function. And then the other test is a urine test for protein. Those are the two tests that we would usually require to say if one has kidney disease or not.

And it typically entails doing serial lab tests. You can't just diagnose kidney disease with one lab test. That abnormality should be at least present for at least three months. ,

Host: So, are these blood tests typically in that panel, or should a person ask the doctor for them, even if they don't have any symptoms?

Eugene De Guzman, MD: Oh yes, the creatinine is typically part of your basic metabolic panel. That's the most basic lab test that usually your physician would order, if, you present with different complaints. The urine test is something that's more specific. Typically, you would ask for it or your primary care physician would order it,

let's say if you have leg swelling, for example, or if they already know that you have abnormal kidney function based on your lab tests. 

Host: What are risk factors for worsening kidney function?

Eugene De Guzman, MD: So the most common, risk factors for kidney disease are diabetes and hypertension. By far, they make up about at least almost two thirds of all the causes. Diabetes is by itself, almost 40 to 50 percent of all the risk factors, but certain conditions, chronic infections, things like HIV, hepatitis, which are not as common as, before. Also things like chronic use of some medications like ibuprofen or over-the-counter pain relievers, even over-the-counter medications for acid reflux, for example. So chronic intake of those medications have been linked to kidney disease.

Host: Okay, any other health problems that kidney disease can cause?

Eugene De Guzman, MD: I would say that health problems that can be, are associated with dysfunction. So because it regulates your body's regulation of salts and fluid, then if there's a kidney problem, you usually would develop hypertension and uncontrolled hypertension will eventually lead to more kidney disease.

Towards the late stages of kidney disease, people develop anemia because it's the kidneys produce that hormone that stimulates your body to make blood. And it also helps regulate bone health because the kidney plays a part in your calcium and phosphorous metabolism that if, let's say, when towards late stage of kidney disease, your phosphorous level builds up, which in turn leads to a state of weakening your bones.

Host: So, what treatments are available?

Eugene De Guzman, MD: Treatments in terms of if you reach end stage, of course, then of course dialysis is what we offer. Dialysis can take place in a center or at home. There are two forms of dialysis. There's hemodialysis, where you actually see your blood getting cleaned from a machine with a pump.

And there's peritoneal dialysis, where there's a catheter that will be put in the abdomen. And we teach you how to do this at home. Of course, kidney transplantation is also another option, although not everyone can get a kidney transplant. Still, the best treatment would be prevention.

Host: I'm glad you brought that up because we want to know how can healthy lifestyle choices impact kidney health and what are those choices?

Eugene De Guzman, MD: So, certainly, healthy lifestyle choice can slow down kidney disease, especially if you already have kidney disease. Making sure that you maintain close to your ideal body weight, your body mass index and that's something that you need to discuss with your primary care physician.

Quitting smoking, certainly is going to be helpful, not just for the kidney disease, but also for cardiovascular health in general. Because the kidneys are made up of very small blood vessels, that the smoking damages blood vessels, essentially. Limiting your sodium intake because it contributes to hypertension and the usual recommendation from the CDC is limiting it to less than two grams a day.

Making sure that you get a healthy and balanced diet, making sure that you have enough plant sources in your diet, not just animal protein. And of course, maintaining regular activity, staying active, engaging in exercise. Again, it's hard, but the CDC recommends at least 150 minutes of exercise per week, which a lot of us can't do, but we should always try to achieve.

Cheryl Martin (Host): And what about your water intake?

Eugene De Guzman, MD: Water intake, I think even like water intake was a fad a few years ago, but water intake, at least from my standpoint, typically, 48 to 64 ounces is adequate on a daily basis. Of course, drink to thirst. I have met individuals who drink at least, you know, a gallon a day.

I don't think they necessarily have to drink that much. There are certain groups of individuals who have, for example, kidney stones, who would need to drink a little bit more, anywhere from 70 to about 80 ounces of fluid, but usually 48 to 64 ounces is usually more than enough. As a general rule, you know, you always look at your urine too. If your urine is pale or clear, that usually means that you're adequately hydrated. Darker usually means that you're not.

Host: What are some common misconceptions about kidney disease?

Eugene De Guzman, MD: Kidney disease, some people say that it's curable, but it's not. When you have kidney disease, you have kidney disease, but the things that physicians at least guide you through it to slow down the progression. A common question actually that I always get when I see patients in my kidney clinic is when they have back pain and they almost always associate it with kidney disease. And I want to try to educate them that back pain, although it can be a symptom kidney disease, there's very, very specific etiologies that would cause it. For example, like kidney stones, which is a, more of like a sharp, colicky pain in the back that usually migrates as the stone tries to pass through your system. Cysts can sometimes cause pain, but usually those are big cysts. If there's an infection, in the kidney as well, that can cause an infection, but in general, the symptoms are, like I said earlier, would present very late into the stage of kidney failure.

Host: So that's even more of an incentive to develop a healthy eating lifestyle.

Eugene De Guzman, MD: Absolutely.

Host: Throughout your entire life, since this is detected so much later.

Eugene De Guzman, MD: Exactly, and again, it's also important to make sure that you maintain your regular health maintenance with your primary care physician so that we can identify early.

Host: Because apparently, once on dialysis, you're always on dialysis unless you get a kidney transplant?

Eugene De Guzman, MD: Yes, yes, unfortunately, yes.

Host: And that definitely changes your lifestyle, right? Because typically, you're on dialysis, what, three days a week?

Eugene De Guzman, MD: Three days a week, typically four hours every treatment.

Host: Dr. Eugene De Guzman, thank you so much for sharing your expertise on kidney health and just your education on what we can do to remain healthy, at least do our part. Thank you so much.

Eugene De Guzman, MD: You're welcome.

Host: To learn more, visit SkagitRegionalHealth.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for other topics of interest to you.

Thanks for listening to Be Well with Skagit Regional Health.