Let's Talk About Kidneys – Details, episodes & analysis

Chronic Kidney Disease (CKD) is a condition that affects how the kidneys work over time. For women with CKD who are planning to have a family, there are important factors to consider to ensure the best possible outcomes. Can I have a baby if I have CKD?

In this episode of Let's Talk About Kidneys, Dr. Lauren McDonald, a nephrologist with Dallas Nephrology Associates, discusses the diagnosis, staging, and common tests for patients with chronic kidney disease (CKD).  Dr. McDonald explains how kidney disease is diagnosed, common symptoms, and some of the key tests, including BUN, creatinine, GFR, hemoglobin A1C, kidney biopsies, and more.  She also discusses the importance of being your own healthcare advocate, family histories, how to maintain health records, and the importance of monitoring your diabetes, and hypertension.  

When most people think of sodium, they think of salt. In this episode of Let's Talk About Kidneys, Dallas Nephrology Associates' Senior Clinical Dietitian Carolyn Cochran breaks down what sodium is, how to identify it in common foods and ways to make lifestyle adjustments for healthier kidneys. 

Sodium is one of three important electrolytes found in the body.  Electrolytes control the fluids going in and out of your body's tissues and cells. 

"Sodium is essential for life," Carolyn says. "It's in animals, vegetables, minerals and is important for muscle function, nerve function, and for fluid balance." 

Many types of salt are used to season food. A survey conducted by the American Heart Association found that more than 60 percent of respondents thought that sea salt was healthier than table salt. But whether you're using kosher salt, table salt or Himalayan black salt, Carolyn says all salts are equal. 

"The bottom line is that they all contain sodium and the amount of sodium is comparable," says Carolyn. 

Sodium is an essential nutrient in your body. One of the jobs of the kidneys is to keep sodium in balance, Carolyn says. If sodium is out of balance, your body's fluid balance is also affected. This can affect muscle and nerve function. 

Many people have a sensitivity to salt, which can be exhibited in high blood pressure, also known as hypertension. High blood pressure is the number two cause of chronic kidney disease (CKD), second only to diabetes.

In the U.S., 2,300 milligrams is considered a healthy target. Carolyn says that the average U.S. citizen will consume 3,500 to more than 5,000 milligrams of sodium per day, especially when dining out. A low-sodium diet is about 1,500 to 2,000 milligrams. 

Only a small percentage of the population who experience excessive sweat loss due to exercise–such as athletes–need more sodium. But Carolyn says most people could benefit from a low-sodium diet. 

A teaspoon of salt has 2,000 milligrams of sodium, but sodium isn't just found in a salt shaker. Many foods have "hidden" sodium. 

"Sodium grows out of the ground. Sodium is in animals. It is just everywhere," Carolyn says. "So you've got to give credit to those first 500, maybe even 600 milligrams of sodium, and then you can start counting (your sodium intake)."

Getting into the habit of reading labels is important for anyone who needs to track their sodium intake. At the top of the label, the serving size can be found. The size of the portions are determined by the manufacturer. The sodium content is found near the middle of the label and is measured in milligrams. 

To the right of the sodium is a percentage of the recommended amount of sodium in a diet, but Carolyn says to remember that this number might not be the percentage that you are aiming for if you're on a low-sodium diet.

If you need help managing your sodium intake, Carolyn suggests talking to your doctor about Medical Nutrition Therapy. Dallas Nephrology Associates has registered dietitian nutritionists who are experienced in helping patients who have renal disease.

"We realize that every person is complex and that many things need to be taken into account," Carolyn says.

Your first visit to the doctor after being diagnosed with kidney disease can be a big deal. Tune into this episode where Dallas Nephrologist Dr. Michael R. Wiederkehr breaks down what to expect at your first visit with a nephrologist at Dallas Nephrology Associates. 

Nephrologists – experts in kidney care – treat conditions that affect the kidneys. 

Primary care physicians run routine blood or urine tests. When these results are abnormal, it could indicate that something is wrong with the kidneys. In this case, the primary care doctor will refer the patient to a nephrologist. 

Other reasons to see a nephrologist include conditions that affect the kidneys. These include:

• Kidney stones

• Diabetes

• Hypertension (high blood pressure)

• Electrolyte disturbances

Dr. Wiederkehr says the first appointment is longer than most appointments. 

"You can expect to be present for about an hour because I need to get to know you and discuss some things that I couldn't quite understand from your records," Dr. Wiederkehr says.

During the visit, the nephrologist is working to create a comprehensive picture of your kidney health and look at how other conditions may be affecting your kidneys. 

Blood and urine tests are typically run, and frequently, a kidney ultrasound is arranged at an outside facility. In some cases, a kidney biopsy might be needed, but Dr. Wiederkehr says this is not typical. 

An exam is performed that focuses on the kidneys and the organs that are affected by them. The heart, lungs and legs are examined to look at circulation and find out if any swelling is present. 

On your first visit to Dallas Nephrology Associates you will need to bring:

• Insurance card

• Drivers license or photo identification

• Completed health history 

• All medications you currently take. Be sure to bring the medications rather than just a list of them.

After the first appointment, a follow-up visit will be scheduled to discuss the exam and test results. After the follow-up visit, the appointment frequency will be determined by your situation. Patients with conditions that need urgent attention will see their nephrologist sooner and more frequently.

"I think as a rule, if you're a new patient with us, I will see you back in two to three months if it's something that's not urgent," Dr. Wiederkehr says. 

Disclaimer

Dallas Nephrology Associates' (DNA) podcast series, Let's Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity or organization they represent. The views and opinions expressed by DNA employees, contractors or guests are their own and do not necessarily reflect the views of DNA or any of its representatives. Some of the resources identified in the podcast are links to other websites. These other websites may have differing privacy policies from those of DNA.  Please be aware that the Internet sites available through these links and the material that you may find there are not under the control of DNA. DNA shall have no responsibility for the accuracy, legality or content of the external site or subsequent links. Contact the external site for answers to questions regarding its content. The resources included or referenced in the podcasts and on the website are provided simply as a service.  DNA does not recommend, approve, or endorse any of the content at the linked site(s).  The content provided on this website and in the podcasts is not medical advice and should not be used to evaluate, diagnose, treat, or correct any medical condition. The content is solely intended to educate users regarding chronic kidney disease, end-stage renal disease ("ESRD"), end-stage kidney disease ("ESKD") and related conditions, and ESRD/ESKD treatment options.  None of the information provided on this website or referenced in the podcasts is a substitute for contacting a healthcare professional.  

Tune into this episode where Dallas Nephrologist Dr. Michael R. Wiederkehr explains when you might need to see a Nephrologist. Dr. Weiderkehr breaks down what a nephrologist does and which tests might indicate it's time to see a kidney doctor. 

Nephrologists treat systemic conditions affecting kidneys, such as diabetes and autoimmune disease, as well as hypertension (high blood pressure) and electrolyte disturbances. They are experts in kidney care. 

Urologists and Nephrologists are sometimes confused with each other. Dr. Wiederkehr explains that this is because both doctors deal with the urogenital tract. 

Nephrologists aren't surgeons, but rather Internal Medicine sub specialists, Dr. Wiederkehr says. They are focused on kidney function.  

Urologists see patients with kidney tumors, or kidney stones, as well as treat other male issues, such as prostate or erectile dysfunction. They may also help male or female patients who have bladder issues. 

Primary care physicians run routine blood or urine tests. When these results return an abnormal number, it might mean that something is wrong with the kidneys. If this is the case, the primary care doctor refers the patient to a nephrologist. 

Dr. Wiederkehr says sometimes there's a reluctance by patients to see another doctor. 

"But there's always a reason why the primary care physician feels that something needs to be seen by a specialist," he says. 

A nephrologist referral does not always mean a kidney disease diagnosis is in your future, Dr. Wiederkehr says. 

"Our main purpose is really to find out," Dr. Wiederkehr says. "And if so, is it something that is more serious, or something that we can just manage periodically with some less close observation?"

Blood pressure, which is closely associated with the kidneys, may need to be regulated. You may also see a nephrologist if you have kidney stones. If this is the case, Dr. Wiederkehr says his goal is to prevent future kidney stone development. 

"You may not have kidney disease, it may just be in relation to the kidneys," Dr. Wiederkehr says. 

Tune into this episode where Dallas Nephrologist Dr. Daniel Richey talks about how some medications can keep your kidneys from working the way they should. Dr. Richey covers the most common over-the-counter (OTC) medications that are approved and not approved for patients diagnosed with kidney disease. Learn how to choose the right medications, and which ones to avoid.

Dr. Richey explains that the most important class of medications that patients with kidney disease should know about are non-steroidal anti-inflammatory drugs (NSAIDs). These include brand names like Ibuprofen, Aleve, Motrin and Naproxen. 

NSAIDs can be very dangerous for patients who have kidney disease to use on a daily basis. Dr. Richey tells his patients that it's OK to use these kinds of over-the-counter medications if they have an acute injury or need to reduce a fever. 

While NSAIDs can sometimes be used sparingly, taking them on an ongoing basis can cause severe damage to the kidneys.

Dr. Richey emphasizes that he's seen many patients experience significant kidney function decline as a result of improper NSAID use. He recommends talking to your doctor if you're not sure if you're taking an NSAID.

NSAIDs can cause fluid retention, electrolyte disturbances in blood work and can raise your blood pressure.  

Other supplements, medications and herbs that can cause high blood pressure include:

• Pseudoephedrine, which is commonly used for colds to relieve sinus stuffiness

• Popular over-the-counter weight loss supplements

• Licorice extract and licorice

• Some preparations of Chinese herbs 

Additionally, for many kidney disease patients, Vitamin C can be safe, Dr. Richey says. But patients with a history of kidney stones need to be careful with Vitamin C.

When it comes to selecting over-the-counter drugs for joint pain and fever, Dr. Richey says your choices are pretty straightforward - Tylenol (or acetaminophen). He says that these medications are completely safe for your kidneys.

Kidney patients often see several different doctors who prescribe them medications, so their lists change on a regular basis. Dr. Richey recommends that patients keep a list of their medications so they can bring it to their doctor appointments. When your kidney doctors know exactly what medications you're taking, they can provide you with the best overall care.

Listen in to hear Dr. Mehta fill us in on how DNA is involved in chronic kidney disease research, including the types of kidney disease that are under investigation within DNA medication clinical trials, the team roles in clinical trials, and what to consider if you are interested in applying to a clinical trial as a patient with kidney disease.

What is a Clinical Trial?

A clinical trial is a process in which a drug or medical procedure is tested on an adult patient with a specific illness or condition. In this case, DNA has participated and conducted research with different clinical trials ranging in study time from several weeks to several years. DNA conducts clinical trials on different types and stages of kidney disease. DNA currently has over twenty clinical studies in progress. 

Team Roles in a Clinical Trial

The principal investigator is responsible for the conduct of the trial. Components of a clinical trial include patient safety, wellbeing, the eligibility of the patient, and events that may happen to a patient during the trial. Team members will communicate several times daily about patients in a current clinical trial. 

Clinical Trial Phases

There are four clinical trial phases, phases one through four. The first phase is testing on humans, and the fourth involves after-market trials. Some drugs in trials can be directed towards specific types of kidney disease, such as diabetic or high blood pressure kidney disease. In addition, there are rare genetic kidney diseases that have medications in our clinical trials. 

Should You Consider Enrolling in a Clinical Trial?

As a patient, if you enroll in a trial with DNA, you will receive the standard of care treatment that includes monitoring the disease and treatment with medications. Then, if you are assigned to the treatment phase, you'll be able to receive treatment inside the clinical trial.

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. In this episode, Sandra M. Lauriat, MD, Nephrologist, and Director of CKD Education, talks about the importance of educating patients to make better choices and DNA's groundbreaking kidney patient education program. 

What is Healthcare Literacy? 

DNA believes in encouraging patients to understand and find reliable information regarding their own health. We also believe in providing education that's easy to understand and applicable to patients to improve the efficacy of health care plans and overall health. 

If a patient doesn't understand a healthcare provider, a patient needs to gather, look and understand information because of the difficulty of our medical situation here in America. So DNA likes to help patients understand and find what's reliable and suitable for them and their medical situation.

What Does

When a provider and patient come together to decide on treatment and nutritional options, an informed patient participates in putting together their comprehensive plan. Therefore, DNA prioritizes patient education because those involved in their healthcare are healthier, happier, and follow care plans more than those who aren't invested in their health. 

How Does DNA Improve Healthcare Literacy? 

Providing a robust education program outside the treatment room on disease information, how to keep kidneys healthy, and what to do as their disease advances are all part of how DNA improves the education of our patients.

Internal Links and Resources 

Dallas Nephrology Associates website: http://dneph.com/
National Kidney Foundation website: https://www.kidney.org/ 

National Institute of Health website: https://www.nih.gov/ 

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. In this episode, Mary Beth Callahan, Supportive Care Team Program Manager and Senior Social Worker, walks through creating an Advance Directive in the case that a patient is unable to communicate their medical treatment wishes to their healthcare team. 

What Is An Advance Directive? 

An Advance Directive ensures that a patient's medical treatment is carried out to their wishes. 10 or 15 years ago, an Advance Directive was just one document. Now, DNA and other medical leaders have decided that there needs to be a more extensive plan to detail what matters most to a patient. 

One resource for this form is prepareforyourcare.com, which is state-specific and accessible. You can walk through this form alongside the podcast, which will be a deep dive into the documentation of an Advance Directive, which includes preparing for end-of-life treatment and naming a decision-maker for your medical treatment. 

What Is Included in an Advance Directive?

The form will dictate who is permitted to make medical decisions on your behalf, as well as the level of flexibility of those decisions and what the patient's values regarding care are. It's important to choose a trusted adult as a decision-maker. In the event that a patient hasn't elected someone, many states will appoint a next of kin, spouse, or will take the decision to a court. 

An Advance Directive is also crucial in determining a patient's values and wishes. The patient can decide how much flexibility they want their decision-maker to have when it comes to certain situations. A patient may also want to specify what matters most to them. This may be prioritizing quality of life over longevity, religious or spiritual practices, and how much they would like to know about their illness. 

What To Do With An Advance Care Directive

Once you've filled out your Advance Directive to your satisfaction, you have to sign it in front of two witnesses or a notary. From there, copies can be made for you, anyone you named in the form, and your care providers. 

Callahan recommends filling the form out early and often, and revising every two years, at least. Oftentimes, patients wait too late to fill out an Advance Directive, and family members are left guessing as to their wishes. To Callahan, providing an Advance Directive is a gift to those in your life.

Disclaimer

Dallas Nephrology Associates' (DNA) podcast series, Let's Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER

Have you ever wondered how a primary care physician and nephrologist work together to help manage kidney disease? In today's episode, we will talk about the role of each doctor and how they partner together to coordinate a patient's care and take a look at the relationship between the Primary Care Physician (PCP) and the Nephrologist. Find out how they coordinate their care to help ensure a healthier patient. 

How a Patient Can Be Prepared for their First Nephrology Visit

Make sure to write down questions you want to ask your nephrologist. Many times, patients are questioning why they've been referred to a kidney doctor, so asking questions about your lab work and why you're there is a good place to start with your first visit. Your physician can break down your lab results, explain what they mean, and give you a clear understanding of why you're visiting a nephrologist.

What is a Nephrologist?

A nephrologist is a medical doctor that does not perform surgery, and manages low kidney function for a variety of kidney diseases and issues. Many patients end up seeing a nephrologist when their kidneys aren't filtering their blood effectively. Whether you have an acute or chronic issue, a kidney doctor can work with the patient to monitor, treat, and help alleviate symptoms of someone experiencing kidney problems. 

The job of a kidney doctor is to explain the medical testing, and terms, and to manage and hopefully stop the progression of kidney issues, including kidney disease. In addition, many patients are afraid they need dialysis when visiting a kidney doctor, which is not always the case.

Disclaimer

Dallas Nephrology Associates' (DNA) podcast series, Let's Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER