World Diabetes Day Link To Kidney Disease

diabetes52Diabetic Nephropathy is the #1 cause of kidney failure

Almost a third of people with diabetes develop kidney disease.

People with diabetes often have other chronic conditions, such as high cholesterol, high blood pressure and blood vessels disease, as well as nerve damage to their bladder, bladder infections and nerve damage, which means kidney disease is either already present or likely to be on the horizon.

Diabetes comes in two main types and each one requires different treatment.

There are two types of kidney disease in people with diabetes. In type 2 diabetes, the kidney disease may already exist by the time they’re diagnosed with diabetes.

About 90% of people with diabetes have the Type 2 version. In this case their bodies don’t produce enough insulin naturally or work well. Diet and exercise are critical for them.

Symptoms of Diabetes

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Symptoms of diabetes include: always feeling tired and hungry, frequent urination, blurry vision, numbness or tingling in hands or feet, always thirsty, wounds that won’t heal, sudden weight loss, sexual problems, vaginal infections. See your medical provider to get tested if you recognize these symptoms in yourself.

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In type 1 diabetes, diabetic nephropathy develops a decade post diabetes diagnosis.

Type 1 sufferers need to regularly inject themselves with insulin or use an insulin pump. It may develop at any age.diabetes8

Symptoms of Diabetic Nephropathy

Early onset of diabetic nephropathy has no symptoms. As kidney function worsens, symptoms may include:

  • Poor appetite
  • Weakness
  • Trouble concentrating
  • Trouble sleeping
  • Swelling of hands
  • Swelling of feet
  • Swelling of face
  • Nausea
  • Itching (a sign of end-stage kidney disease)
  • Extremely Dry Skin
  • Drowsiness (a sign of end-stage kidney disease)
  • Muscle twitching
  • Irregular heart rhythm (a sign of increased potassium in blood)

It’s a condition known as uremia that’s extremely dangerous as people can become confused and occasionally comatose.

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Diagnosing Diabetic Nephropathy

Specific blood tests and urine tests can diagnose kidney damage. It also can be detected early by finding protein in the urine.

If you have diabetes, make sure to have your urine tested annually.

Treatment for Diabetic Nephropathy

Treatments are available that can help slow the progression of kidney failure.

It’s important to maintain blood sugar control to lower blood pressure. Some medicines called angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage.

Although ACE inhibitors — including ramipril (Altace), quinapril (Accupril) , and lisinopril (Prinivil, Zestril) — are usually used to treat high blood pressure and other medical problems, they are often given to people with diabetes to prevent complications, even if their blood pressure is normal.

If a person has side effects from taking ACE inhibitors, another class of drugs called angiotensin receptor blockers (ARBs) can often be given instead.

If not treated, kidneys will continue to fail and larger amounts of proteins can be detected in the urine.

Advanced kidney failure requires treatment with dialysis or a kidney transplant from a cadaver donor. The waiting list for a kidney is currently close to 100,000 people. The other option is finding a living donor that is a match–a family member (they’re not always a match), spouse, friend or a stranger willing to give you the gift of life.

A kidney specialist is called a nephrologist and you need to find one as soon as your kidneys begin to fail so they can help you with diet and treatments.

With medical guidance and dietary changes, symptoms can be eased, and progression of the disease can be slowed.

FLOOD SISTERS KIDNEY FOUNDATION  is an excellent resource if you’re experiencing kidney failure or are in need of finding a living kidney donor.

Jennifer Flood and her sisters founded the foundation after finding a total stranger to be a living donor for her father ten years ago. It began with her tenacious use of social media (on Craigslist) that caught broadcast media attention nationwide.

The awareness not only saved her dad’s life, but left her and her sisters with an abundant supply of willing living kidney donors, which then sparked the idea to start a foundation to help other people.

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“Upon kidney failure, a lot of people end up on dialysis and then enter themselves on the long waiting list without realizing we have resources available to help them understand their best option is to find a living kidney donor.”

“Our foundation helps by actively seeking perfectly healthy strangers who are willing to donate their kidney now.”  

Jennifer Flood, President/CEO, Flood Sisters Kidney Foundation

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Dolly Parton with (left to right) Jennifer Flood’s daughter, Heather Flood and their Mom Roseann Flood

Flood Sisters Kidney Foundation has gained the attention and support from celebrities like Jon Bon Jovi, Barbara Corcoran, Dolly Parton, Geraldo and many more who helped a loved one find a non-related living kidney donor through their foundation.

“For us today, it starts with a commitment to provide trusted MDTV compliant education and awareness. Working with MDTV select hospitals to navigate through the clutter and ultimately providing an altruistic living donor for our client in need.”- Jennifer Flood, President/CEO, Flood Sisters Kidney Foundation 

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Rachel Ray, Barbara Corcoran with friend matched with living kidney donor

But Flood sisters are not stopping there because as Jennifer says:

“Almost one-third of people with diabetes develop kidney disease. Kidney failure is not just for the rich and famous. It’s actually even more pervasive in poor communities.”

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Since 1972, poor people who get stuck on dialysis automatically become covered by medicare insurance and the dilemma is they lose all hope or just don’t know about the living kidney donor transplant option.

According to MDTV it costs over $75,000.00 to educate a community and find just one altruistic living kidney donor. It seems such a small price to pay to save a life, especially since the cost of dialysis is $84,000.00 per year (paid for by Medicare).

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Paul Argen
, CEO and Executive Producer of MDTV says, “Flood Sisters broke the code for people who are stuck on dialysis and want the best option to return to some normalcy. I am so impressed with the great work of Flood Sisters Kidney Foundation that we now have formed an exclusive partnership of collaboration to fund this effort with a long-term commitment to penetrate hundreds of these communities nationwide. Our partnership not only will give people renewed hope and save lives, but deliver a unified channel of education for families, hospitals, caregivers, providers, public health and the media to embrace. We are getting ready to move the needle in this disease state –a much-needed Angelic Gift for society. Stay tuned. Coming soon.”

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Jon Bon Jovi with his good friend and attorney Jerry who found a living donor match

Remember, only people with end stage kidney disease can be listed for deceased donor transplantation. But living donor transplants can be “pre-emptive” taking place before the need for dialysis. This has a lot of health advantages.

People who choose pre-emptive transplantation have a lower risk of death and loss of kidney transplant function, compared to those who spent time on dialysis beforehand.

The good news is according to 26 studies involving almost 500 kidney donors, 95% of kidney donors in the United States, rate their experience as good to excellent.

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Chuck Scarborough with 3 sisters (twins Cynthia & Jennifer and Heather on rt) and their dad, Daniel Flood

 

We support the work of Flood Sisters Kidney Foundation as the best resource for matching people with living kidney donors and raising awareness about it.

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You’re not a celebrity, non-celebrity or number to them. You’re family.
Anthony

Other complications of diabetes include:

  • dental and gum diseases
  • eye problems and sight loss
  • foot problems, including numbness, leading to ulcers and untreated injuries
  • nerve damage, such as diabetic neuropathy

Fatal complications include heart disease, stroke and kidney disease.

In the case of kidney disease, this complication can lead to kidney failure, water retentionwhen the body does not dispose of water correctly, and a person experiencing difficulties with bladder control.

Regularly monitoring blood glucose levels and moderating glucose intake can help people prevent the more damaging complications of type 2 diabetes.

For those with types 1 diabetes, taking insulin is the only way to moderate and control the effects of the condition.

Meantime, everyone in the world can benefit from paying attention to their nutrition and how it affects them.

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Here Are Nutritional Tips for People With Diabetes and Kidney Disease

Sodium

Sodium can build up when kidneys start to fail, causing fluid to accumulate in tissues. It’s called edema, and will show up as swelling in hands, face and lower extremities.

Most organizations recommend limiting sodium to 1,500-2,300mg/daily.  Besides table salt itself, other high sodium foods you want to avoid are: bacon, ham, canned or instant soups, canned vegetables, cheese, crackers, salted nuts, olives, potato chips, processed foods, soy sauce, barbecue sauces, bottled sauces, pickles, bouillon cubes, dehydrated soups.

Read sodium content on all labels.

Reduce or eliminate processed foods.

Potassium

 

When kidneys can’t filter out potassium, too much can circulate in your blood.

An excess of potassium can be very dangerous because it can cause irregular heart rhythm, which could become severe enough to cause your heart to stop working.

Restricting high potassium foods can help prevent this from happening.

Regular blood tests to monitor your potassium levels can alert your doctor to potential problems. If you must restrict your potassium levels, most people need to limit their intake to ~2000mg/daily.

If you are someone who has diabetes and often experiences low blood sugar, you’ll want to avoid treating with orange juice and will want to use glucose tablets instead.

High-potassium foods include bananas, broccoli, raisins, tomatoes, apricots, baked beans, beets, cantaloupe, collard and other greens, molasses, mushrooms, nuts, oranges, peanut butter, potatoes, dried fruit, salt substitute, and chocolate.

Phosphorus

Hyperphosphatemia (high phosphorus levels in the blood) does not typically become evident until stage 4 chronic kidney disease.

When kidneys start to fail, phosphorus can start to build up in your body. This causes an imbalance with calcium, which forces the body to use calcium from the bones.

It’s important to keep phosphorus levels close to normal to prevent weakening bones.

Reducing high phosphorus foods you eat is one way to keep phosphorus levels down. If you must, most people benefit from restricting phosphorus to 800-1000mg/daily.

Reducing phosphate additives includes eliminating foods that contain ingredients such as, sodium acid pyrophosphate or monocalcium phosphate.

Other foods rich in phosphorus to avoid include beer, bran cereals, peanut butter, caramel, cheese;, cocoa, cola, dried beans, ice cream, liver, milk and milk products, nuts, and sardines.

Carbs

If you have diabetes and kidney disease you still want to include carbohydrate sources, but from vegetables, fruit, and whole grains.

You want to avoid beverages and sugars with sucrose and high fructose corn syrup.  .

If you are someone with advanced kidney disease you may have to discuss reducing intake of high potassium and high phosphorus sources of carbohydrate with your dietitian.

Protein

Too much protein can be bad for your kidneys if you’re living with kidney disease.

When choosing proteins, aim to include lean sources of protein, such as white meat chicken, fish, turkey, and lean beef.

Fats

Focus on incorporating healthy fats into the diet such as oils, and fatty fish and avoid saturated fats and trans fats – processed meats, full-fat cheese, and desserts.

It seems like there’s almost nothing left to eat after you see this list. Fear not.

See “The 20 Best Foods For People With Kidney Problems” by Jillian Kubola, MS, RD at: https://www.healthline.com/nutrition/best-foods-for-kidneys

Discuss your nutrition with your dietitian as it can vary depending on your treatment plan. 

Again, symptoms of kidney damage are:

Urinary issues, anemia, itchy skin, feeling excessively cold, chills, nausea, vomiting, swelling in ankles, legs or face, shortness of breath, metallic taste in mouth or bad breath.

See your physician for a blood and urine test to check the wellness of your kidneys if you’re concerned. They don’t automatically check this. You need to ask.

Stay informed.  Stay healthy.

 

 

 

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15 Subtle Symptoms of Kidney Disease

kidneytransplant2Here are subtle symptoms you should be aware of so you can see your health care provider for blood and urine tests if you experience many of them and are concerned.

  1. 1. Fatigue – being tired all of the time

    Why this happens:

    Healthy kidneys make a hormone called erythropoietin (a-rith’- ro-po’- uh-tin), or EPO, that tells your body to make oxygen-carrying red blood cells. As the kidneys fail, they make less EPO. With fewer red blood cells to carry oxygen, your muscles and brain tire very quickly. This is anemia, and it can be treated.

    What patients said:

    “I was constantly exhausted and didn’t have any pep or anything.”

    “I would sleep a lot. I’d come home from work and get right in that bed.”

  2. 2. Feeling cold – when others are warm

    Why this happens:

    Anemia can make you feel cold all the time, even in a warm room.

    What patients said:

    “I notice sometimes I get really cold, I get chills.”

    “Sometimes I get really, really cold. It could be hot, and I’d be cold.”

  3. 3. Shortness of breath – after very little effort

    Why this happens:

    Being short of breath can be related to the kidneys in two ways. First, extra fluid in the body can build up in the lungs. And second, anemia (a shortage of oxygen-carrying red blood cells) can leave your body oxygen-starved and short of breath.

    What patients said:

    At the times when I get the shortness of breath, it’s alarming to me. It just fears me. I think maybe I might fall or something so I usually go sit down for awhile.”

    “I couldn’t sleep at night. I couldn’t catch my breath, like I was drowning or something. And, the bloating, can’t breathe, can’t walk anywhere. It was bad.”

  4. 4. Feeling faint, dizzy, or weak

    Why this happens:

    Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to feeling faint, dizzy, or weak.

    What patients said:

    “I was always tired and dizzy.”

    “It got to the point, like, I used to be at work, and all of the sudden I’d start getting dizzy. So I was thinking maybe it was my blood pressure or else diabetes was going bad. That’s what was on my mind.”

  5. 5. Trouble thinking clearly

    Why this happens:

    Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to memory problems or trouble with concentration.

    What patients said:

    “I know I mentioned to my wife that my memory—I couldn’t remember what I did last week, or maybe what I had 2 days ago. I couldn’t really concentrate, because I like to work crossword puzzles and read a lot.”

    “I would get up to do something and by the time I got there I couldn’t remember what I was going to do.”

  6. 6. Feeling very itchy

    Why this happens:

    Kidneys remove wastes from the bloodstream. When the kidneys fail, the build-up of wastes in your blood can cause severe itching.

    What patients said:

    “It’s not really a skin itch or anything, it’s just right down to the bone. I had to get a brush and dig. My back was just bloody from scratching it so much.”

    “My skin had broke out, I was itching and scratching a lot.”

  7. 7. Swelling in hands or feet

    Why this happens:

    Failing kidneys don’t remove extra fluid, which builds up in your body causing swelling in the legs, ankles, feet, and/or hands.

    What patients said:

    “I remember a lot of swelling in my ankles. My ankles were so big I couldn’t get my shoes on.”

    “Going to work one morning, my left ankle was swollen, real swollen, and I was very exhausted just walking to the bus stop. And I knew then that I had to see a doctor.”

  8. 8. Swollen or puffy face

    Why this happens:

    Failing kidneys don’t remove extra fluid, which builds up in your body causing swelling in the face.

    What patients said:

    “My sister, her hair started to fall out, she was losing weight, but her face was really puffy, you know, and everything like that, before she found out what was going on with her.”

    “My cheeks were always puffy and tight. Sometimes they would even hurt.”

  9. 9. Food tastes like metal

    Why this happens:

    A build-up of wastes in the blood (called uremia) can make food taste different and cause bad breath. You may also notice that you stop liking to eat meat, or that you are losing weight because you just don’t feel like eating.

    What patients said:

    “Foul taste in your mouth. Almost like you’re drinking iron.”

    “I don’t have the appetite I had before I started dialysis, I must have lost about 10 pounds.”

  10. 10. Ammonia breath

    Why this happens:

    A build-up of wastes in the blood (called uremia) can cause bad breath.

    What patients said:

    “My husband always tells me I have fish breath.”

    “Sometimes my breath smells like urine and I need to brush my teeth more often.”

  11. 11. Upset stomach, nausea, vomiting

    Why this happens:

    A severe build-up of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.

    What patients said:

    “I had a lot of itching, and I was nauseated, throwing up all the time. I couldn’t keep anything down in my stomach.”

    “When I got the nausea, I couldn’t eat and I had a hard time taking my blood pressure pills.”

  12. 12. Getting up during the night to make urine

    Why this happens:

    Kidneys make urine, so when the kidneys are failing, the urine may change. How?

    • You may urinate more often, or in greater amounts than usual, with pale urine.
    • You may feel pressure or have difficulty urinating.

    What patients said:

    “My urine is what I had started noticing. Then I was frequently going to the bathroom, and when I got there, nothing’s happening. You think, ‘Hey, I’ve got to go to the john,’ and you get there, 2 or 3 drops.”

    “I would get up two or three times at night and had lots of pressure each time.”

  13. 13. Foamy or bubbly urine

    Why this happens:

    Kidneys make urine, so when the kidneys are failing, the urine may change. How?

    • Urine may be foamy or bubbly.
    • This can lead to an above-normal amount of protein in the urine.

    What patients said:

    “The bowl would be filled with bubbles.”

    “Sometimes I would notice my urine being very foamy, so I made an appointment with the doctor.”

  14. 14. Brown, red, or purple urine

    Why this happens:

    Kidneys make urine, so when the kidneys are failing, the urine may change. How?

    • You may urinate less often, or in smaller amounts than usual, with dark-colored urine.
    • Your urine may contain blood.

    What patients said:

    “I was passing blood in my urine. It was so dark it looked like grape Kool-Aid. And when I went to the hospital they thought I was lying about what color it was.”

    “I thought I had a urinary infection when I first saw blood in my urine.”

  15. 15. Pressure when you make urine

    Why this happens:

    Kidneys make urine, so when the kidneys are failing, the urine may change. How?

    • You may feel pressure or have difficulty urinating.

    What patients said:

    “When you go to use the restroom, you couldn’t get it all out. And it would still feel just like tightness down there, there was so much pressure.”

    “The pressure was so great, yet it would come out so slow. Like 2-3 minutes slow. I thougth what is going on here.”

    If you have one or more of the 15 symptoms above, or worry about kidney problems, see a doctor for blood and urine tests. Many of the symptoms on this list can be caused by other health problems.

    The only way to know the cause of YOUR symptoms is to see your doctor.

    NOTE: Low back pain is not a sign of kidney disease. Your kidneys are above your waist in the back of your body. If you have pain there, tell your doctor.

    For more information visit: http://www.lifeoptions.org

     

    Here’s a visual of where male kidneys are located

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    When kidney failure happens people have 3 options: 

    1. Go on dialysis with a life expectancy of 5 to 10 years (some live longer) and a cost of 89K per year. Most medical insurance covers this cost, but still.

    2. Go on a waiting list for a kidney transplant. Current waiting list has over 100K people on it. Basically, you’re waiting for someone who is an organ donor to die, and even then your body could reject the transplanted organ.

    3. Get what’s called an Altruistic Living Donor to donate a kidney to you. This can be a family member, friend, colleague or complete stranger. People who are strangers and do this are absolute Angels.  Matching people in need with altruistic donors is an area of expertise of The Flood Sisters Kidney Foundation atSite:

    www.floodsisterskidneyfnd.org

     

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    Educating yourself on taking good care of your kidneys and preventing chronic kidney disease is vital today.  Be aware of what foods and beverages are harmful to your kidneys. Even over-the-counter pain medication harms your kidneys.

    I’ll blog again about what foods, beverages and other things to avoid. Until then,

    healthyweekendBlog contact: maria.dorfner@yahoo.com

    Have you experienced symptoms not listed here? Let us know in comments.

Hidden Global Epidemic: Kidney Disease

Raising Awareness: Kidney disease is a “hidden epidemic” affecting more than 850 million people worldwide, renal experts say.

That’s twice the number of diabetics (422 million) and more than 20 times the number of people with cancer (42 million) or HIV/AIDS (36.7 million).

But most people don’t realize that kidney disease is a major health issue.

“It is high time to put the global spread of kidney diseases into focus,” says David Harris and Adeera Levin of the International Society of Nephrology.

Harris is the group’s president and Levin is past president. They note kidney diseases often cause no early symptoms.

And many people aren’t aware of their increased risk for heart problems, infections, hospitalization and kidney failure.

Chronic kidney diseases (ones lasting more than three months) affect 10 percent of men and nearly 12 percent of women around the world.

Up to 10.5 million people need dialysis or a kidney transplant, but many don’t receive these lifesaving treatments due to cost or lack of resources.

In addition, more than 13 million people suffer acute kidney injury. Some will go on to develop chronic kidney disease or kidney failure.

Levin says, “Using all these sources of data, and existing estimates of acute and chronic kidney diseases, we estimate approximately 850 million kidney patients — a number which surely signifies an ‘epidemic’ worldwide.”

Kidneys remove waste products and help balance the volume of fluids and minerals in the body. They also produce a hormone that tells the body to make red blood cells, the researchers explained.

“Even if many patients with damaged kidney function don’t feel ill, they’re at high risk for other health problems,” says Carmine Zoccali, president of the European Renal Association — European Dialysis and Transplant Association.

Heart disease deaths due to chronic kidney disease are high — 1.2 million cardiovascular deaths were attributed to kidney disease in 2013.

“The number of people with kidney diseases is alarmingly high, but the public is not aware of this reality. These patients have outcomes and kidney diseases impose a heavy financial burden on health care budgets,” says Mark Okusa, president of the American Society of Nephrology.

The annual per-patient cost of dialysis is $88,195 in the United States.

Even though you can have no symptoms, here are 10 to look out for, according to the National Kidney Foundation.

While the only way to know for sure if you have kidney disease is to get tested, Dr. Vassalotti shares 10 possible signs you may have kidney disease.

If you’re at risk for kidney disease due to high blood pressure, diabetes, a family history of kidney failure or if you’re older than age 60, it’s important to get tested annually for kidney disease.

Be sure to mention any symptoms you’re experiencing to your healthcare practitioner.

  1. You’re more tired, have less energy or are having trouble concentrating. A severe decrease in kidney function can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired, weak and can make it hard to concentrate. Another complication of kidney disease is anemia, which can cause weakness and fatigue.sleeping
  2. You’re having trouble sleeping. When the kidneys aren’t filtering properly, toxins stay in the blood rather than leaving the body through the urine. This can make it difficult to sleep. There is also a link between obesity and chronic kidney disease, and sleep apnea is more common in those with chronic kidney disease, compared with the general population.sluggish2
  3. You have dry and itchy skin. Healthy kidneys do many important jobs. They remove wastes and extra fluid from your body, help make red blood cells, help keep bones strong and work to maintain the right amount of minerals in your blood. Dry and itchy skin can be a sign of the mineral and bone disease that often accompanies advanced kidney disease, when the kidneys are no longer able to keep the right balance of minerals and nutrients in your blood.
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  4. You feel the need to urinate more often. If you feel the need to urinate more often, especially at night, this can be a sign of kidney disease. When the kidneys filters are damaged, it can cause an increase in the urge to urinate. Sometimes this can also be a sign of a urinary infection or enlarged prostate in men.lawyersleaving
  5. You see blood in your urine. Healthy kidneys typically keep the blood cells in the body when filtering wastes from the blood to create urine, but when the kidney’s filters have been damaged, these blood cells can start to “leak” out into the urine. In addition to signaling kidney disease, blood in the urine can be indicative of tumors, kidney stones or an infection.openyoureyes
    6. Your urine is foamy. Excessive bubbles in the urine – especially those that require you to flush several times before they go away—indicate protein in the urine. This foam may look like the foam you see when scrambling eggs, as the common protein found in urine, albumin, is the same protein that is found in eggs.

 

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7. You’re experiencing persistent puffiness around your eyes. Protein in the urine is an early sign that the kidneys’ filters have been damaged, allowing protein to leak into the urine. This puffiness around your eyes can be due to the fact that your kidneys are leaking a large amount of protein in the urine, rather than keeping it in the body.

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8. Your ankles and feet are swollen. Decreased kidney function can lead to sodium retention, causing swelling in your feet and ankles. Swelling in the lower extremities can also be a sign of heart disease, liver disease and chronic leg vein problems.

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9. You have a poor appetite. This is a very general symptom, but a buildup of toxins resulting from reduced kidney function can be one of the causes.

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10. Your muscles are cramping. Electrolyte imbalances can result from impaired kidney function. For example, low calcium levels and poorly controlled phosphorus may contribute to muscle cramping.

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HOW IS KIDNEY DISEASE DETECTED?

Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

  1. A test for protein in the urine. Albumin to Creatinine Ratio (ACR), estimates the amount of a albumin that is in your urine. An excess amount of protein in your urine may mean your kidney’s filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
  2. A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have.

It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:

  • are older
  • have diabetes
  • have high blood pressure
  • have a family member who has chronic kidney disease
  • are an African American, Hispanic American, Asians and Pacific Islander or American Indian.

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.

 maria.dorfner@yahoo.com