What I'm Learning About Kidney Health

You probably don't think much about your kidneys, I know I don't.? But I've been learning more over the last several years as my mother's kidney disease advanced. Over a third of people will have some form of chronic kidney disease once they are 65 or older. Kidney disease is a particularly tricky one. It's often undetected or doesn't come up unless someone has diabetes or hypertension and yet when the kidneys go wrong, so much goes wrong. Odds are, if you are caring for an older loved one, you are going to need to learn about chronic kidney disease, in particular,? the diet and hydration recommended for each stage. I am not a doctor, this is not medical advice, I'm just learning this as many of us will have to.?

The tough thing about chronic kidney disease (CKD) is that first word, chronic. It's not curable and in older people, you are often playing a game of stabilization. The disease part basically means that the kidneys aren't working as well as they should and that leads to all sorts of other concerns. Kidney disease is particularly hard to understand for laypeople because you've got five different stages (technically six because stage three has an a and a b). It's not until stage 3b that things start getting gnarly in my opinion. My mother has Stage 3b and appears to be headed toward Stage 4. Stage 5 is full kidney failure and time for dialysis.

There are a variety of numbers associated with the kidneys. A basic renal function panel will include levels of key minerals in the body and if they fall in normal levels. Your key indicator for CKD is the eGFR, the estimated glomerular filtration rate. Glomeruli are little balls of capillaries that do the work of filtration in the kidneys. That little e on the front of the abbreviation is important. This is an estimate and it's done partly using creatinine. You may have heard of creatine in supplements before. As I understand it, creatinine is the waste product and so the more it's in the urine, the less the body is doing its job. A renal panel monitors that as well as BUN (blood urea nitrogen), calcium, phosphorus, glucose, and other metrics.?

Not all panels may measure the same things but the eGFR is the one to watch for changing issues. That and protein in the urine. My mother also has proteinuria, a concentration of albumin in the urine. This can also be associated with acute kidney injury which can sometimes happen after a surgery or sometimes happens randomly but generally means that something is happening with the kidneys that is more acute. In my mother's case, her uncontrolled hypertension is probably part of the equation.?

For those of us caring for people with CKD, it's a game of shifting priorities and frequent testing of both blood and urine. Depending on the stage of the disease, salt may be severely restricted and calcium, potassium, and protein may also have to be reduced. In the early stages, the DASH diet may be enough to help keep the disease from progressing. In later stages, it's best to meet with a registered dietician who can provide specific recommendations. My mother opted not to do that. She's got an interesting situation because she has multiple comorbidities and so multiple diet recommendations. Most of them overlap but a few of them conflict.?

In the end, my mother will eat what she wants, and there's little I can do about that (no luck on getting her to try tofu). What I can do is monitor her fluids and food intake, as well as keep an eye on things like leg swelling and changes in her bathroom habits. And I can learn something here. I can adjust my diet, my water intake, and my exercise habits now. I can better monitor my own kidneys because the stats are there. This could be my fight, and your fight, too.