Download Nephrology, P

NEPHROLOGY, P.A.
Juan Jose Olivero, M.D., F.A.C.P., F.A.S.N.
Juan Jorge Olivero M.D., F.A.S.N.
Peter Tuan Nguyen M.D., F.A.S.N.
Anna Kagan, M.D., Ph.D.
Chronic Kidney Disease (CKD)
Stages of CKD
CKD Stage
Description
GFR(mL/min/1.73m2)
1
> 90
60 – 89
3
Kidney dysfunction
With normal GFR
Kidney dysfunction
With mild  GFR
Moderate  GFR
4
Severe  GFR
15 – 29
5
Kidney Failure
< 15
6
Dialysis
2
30 – 59
K/DOQI Clinical Practice Guidelines, AmJ Kidney Dis 39 (Suppl 1):46-75, 2002
You have been diagnosed with chronic kidney disease stage
GFR
.
This is a guide to help reinforce what we spoke to you about during your visit with us today
regarding useful information about chronic kidney disease, diet, medications, and treatment goals
to help protect and preserve your kidney function.
You are not alone, 26 million Americans have CKD and millions more are at increased risk for
this condition which include people with diabetes, hypertension, smoking, cardiovascular disease
and those with a family history of kidney disease.
Kidney disease is identified by laboratory abnormalities including urine and blood tests, which
are used to calculate the Glomerular filtration rate (GFR) which is the best estimate of kidney
function.
Early detection and treatment can slow down the progression of chronic kidney disease for which
it is important to be followed by your physician closely.
6560 Fannin, Suite 2206
Houston, TX 77030
Phone (713) 790-4615
Fax (713) 790-5878
The following are specific goals that will be important in protecting your kidneys.
1. If you have diabetes, maintain a HbA1c of less than 6.5%, to achieve this:
a. Diet 50% of the effort
b. Exercise 25% of the effort
c. Medications 25% of the effort
2. Control your cholesterol with the following goals:
a. Total cholesterol less than 180mg/dl
b. Triglycerides less than 150mg/dl
c. HDL (good cholesterol) greater than 40mg/dl
d. LDL (bad cholesterol) less than 100mg/dl
3. Target blood pressure close to 130/80.
This may require several medications with different mechanisms of action.
Diet is essential to maintain healthy kidneys so follow this advice.
1. Restrict sodium intake “salt” to less than 2000 milligrams per day. Sea salt is not any
better than regular salt. Unless instructed differently, avoid salt substitutes.
As a general rule, canned foods, or processed foods such as sausages or deli meats, and
condiments such as ketchup have large amounts of sodium.
2. Restrict protein intake to less than 0.8 grams per kilogram of your body weight. This
refers to animal protein. Protein from vegetables and soy is unrestricted. You should not
restrict protein intake if you are age 75 or older.
One ounce of meat, fish or poultry has 7 grams of animal protein; ½ a cup of milk has 4
grams of animal protein.
3. Contrary to popular belief, there is no need to drink excessive amounts of fluid to
maintain “healthy” kidneys. In fact, this leads to complications such as leg swelling,
difficult to control hypertension, worsening congestive heart failure and in the worst case
seizures (particularly while taking diuretics or “fluid pills”).
It is important to alert your physicians about your GFR to correctly dose medications and avoid
medicine that is harmful to the kidney. In particular, these medications should be avoided:
Anti-inflammatory Agents
Over the counter
Prescription
Ibuprofen
Naproxen
Advil
Naprosyn
Alleve
Diclofenac
Motrin
Indomethacin
Toradol
Tylenol is safe to take as long as it does not exceed four 500mg tablets per day.
Aspirin is also safe to take, provided it is not contraindicated for other reasons.
6560 Fannin, Suite 2206
Houston, TX 77030
Phone (713) 790-4615
Fax (713) 790-5878
You should never receive IV contrast for MRI (called gadolinium)
If IV contrast is needed for a CT scan or cardiac catheterization, there is need to prepare you to
prevent contrast induced kidney injury. Discuss this with the ordering physician and we can
provide further instructions as some medications will need to be held prior to the procedure.
Complications of Chronic Kidney Disease:
You will be evaluated for specific complications related to chronic kidney disease and this will
likely require specialized medications.
Secondary Hyperparathyroidism(SHP)- There are four parathyroid glands that are located
close to the thyroid gland which produce excessive amounts of parathyroid hormone as kidney
function decreases. This hormone can lead to bone problems, muscle problems and more
importantly can lead to calcification of the arteries. For this reason, some patients will need to
be started on a prescription vitamin D analogue to help suppress production of this hormone.
Elevated Phosphorus- occurs when the kidney is unable to excrete this substance (usually in
CKD stage 4) and higher phosphorus levels, greater than 5mg% have been associated with
increased cardiovascular disease so that it is important to correct this by means of diet restriction
and phosphate binder medications.
Anemia- usually occurs in chronic kidney disease stage 3 and progressively worsens in stage 4
and 5. Anemia has adverse effects in heart function, brain function, and may accelerate
progressive loss of kidney function. Iron replacement when indicated in conjunction with
injection of either erythropoietin (Procrit®) or darboepoietin (Aranesp®) need to be given at
regular intervals (weekly-monthly).
Patients with Chronic Kidney Disease Stage 4 and 5
Symptoms of worsening kidney function include:
Fatigue
Lack of Appetite
Leg swelling
Metallic taste
Itching
Difficulty sleeping
Early morning nausea
It is important to prepare for either dialysis or kidney transplant at these stages.
The different alternatives of treatment will vary according to physicians recommendations and
patient’s preference.
It is of utmost importance to preserve the veins in your non-dominant arm for future need for a
dialysis vascular access placement. So no IV’s or blood draws should be done on this arm from
this point forward.
6560 Fannin, Suite 2206
Houston, TX 77030
Phone (713) 790-4615
Fax (713) 790-5878