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Kidney Disease in Older Patients

Woman swimming
January 28, 2015 (Updated: August 16, 2018)
Lily Moran

I’m seeing a worrisome trend in my older patients.  More and more of them are coming to me with back pain—that isn’t about their back.

Yes, their back IS where the pain is.

But no, it’s not always a back problem. It may be much more serious—kidney disease.

Our kidneys separate and eliminate the waste matter and toxins that are circulating through our bodies 24 hours per day, 365 days per year. But when they’re damaged, toxins and waste can accumulate, with dire consequences, especially in older people.

One part of the problem is that your kidneys lack the specialized cells that create pain signals when they’re under threat.  So they use your back as a “messenger,” sending a “your kidneys are in danger” signal to your back, which then sends a “your back hurts” message to your brain.

The lack of signals specific to symptoms of kidney disease is one reason why it can go undetected for many years. It’s what we call an asymptomatic disease, and once it begins, there is no cure—you can only slow its progress or replace the failed kidney’s function with dialysis or a transplant.

These are both painful outcomes. Dialysis is expensive, uncomfortable, and time consuming. And a transplant? The waiting list is often years long, and you’ll likely get sicker while you wait.

But what you really want to know is if you are at risk for kidney disease?

Pick your poison.  High blood pressure? Heavy drinking? Diabetes? Bad luck in the gene pool?  Heart disease? Obesity? Smoking? Some types of hepatitis and some cancers? Adverse drug interactions?

Even absent those identifiable clinical risk factors, a regular diet of environmental and food toxins can threaten your kidney health. You may not even know if you’ve been exposed.

Bottom line, we’re all at risk.

Some very worrisome data show how serious, and how common, undiagnosed kidney disease can be. The U.S. Renal Data System, which tracks end-stage kidney disease, “…suggests that 42 percent of patients newly diagnosed with end-stage renal disease had not seen a kidney specialist…prior to beginning dialysis” (italics mine).

Given the lack of symptoms or a cure, early detection is an urgent priority. The longer kidney disease goes untreated, the longer it takes for the few known treatments to kick in.

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Chronic Inflammation Decoded

The diagnostics for kidney disease are well understood, and the test is part of your routine screenings during an annual physical. As your own best caretaker, you should be as well informed about your medical situation as possible.  That’s why I’m going to familiarize you with the “basics” of the test, so you can act in your own best interest.

Blood tests give your doctor a detailed breakdown of any disease markers, the nutrients and waste products in your blood as well as how various organs (e.g., kidneys and liver) are functioning.  The report shows whether your levels of these substances are within the known healthy range, or higher or lower. This will tell your doctor what needs treating (sometimes nothing!) and how.

Three quick examples of what the routine test called a Chemistry or Metabolic Panel looks for, with my explanation of what’s measured and why:

BUN/Creatinine Ratio
Healthy ratio of BUN to creatinine
: 10:1 to 20:1 (men and older individuals may be a bit higher)
This test shows if kidneys are eliminating waste properly. High levels of creatinine, a byproduct of muscle contractions, are excreted through the kidneys and suggest reduced kidney function.

Healthy range:
9.0 to 10.5 mg/dL (the elderly typically score a bit lower)
Too much calcium in the bloodstream could indicate kidney problems; overly active thyroid or parathyroid glands; certain types of cancer, including lymphoma; problems with the pancreas; or a deficiency of vitamin D.

Estimated Glomerular Filtration Rate (eGFR)
Healthy range:
100+ mL/min
This test estimates the amount of blood passing through special filters (glomeruli) in your kidneys that filter waste from blood.

Blood tests are remarkable tools that help us pinpoint any of countless possible problems with amazing speed and accuracy.  Give them a round of applause—and go get yours done.

Protecting Yourself

Of course, it’s also helpful to avoid any habits that could make you more susceptible to kidney disease.  So, if any of this applies to you, I highly recommend that you:

  • Quit smoking
  • Keep your blood pressure under control, per your doctor’s instructions and by eating plenty of fresh fruits, vegetables and whole grains
  • Exercise regularly to control diabetes and cardiovascular conditions that increase the risk of kidney disease
  • Avoid aspirin unless your doctor recommends it

Steps that everyone should take include:

  • Drinking enough water: one-half ounce for every pound you weigh, so a 200 pound man would drink 100 ounces of water daily
  • Taking daily probiotics: the good bacteria help your kidneys process waste material
  • Drinking green juice: it can be as easy as juicing a bunch of parsley with water, lemon, and a touch of raw honey
  • Detox bathing: weekly Epsom salt baths are a basic measure to help your body remove waste and toxins

If Your Results Reveal Issues

If the routine tests show something possibly troublesome, the next step is a daily blood test.  Guided by test results, these will look for more detail on whatever trouble spots have emerged, and will advise interventions specific to your condition. This significantly reduces the likelihood of an intervention affecting healthy tissue.

A daily blood test, if that’s advised, might be a bit inconvenient, but it sure beats letting a treatable condition morph into a disaster.

Please get tested.  Please.

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