>> Hi, I'm Persaud Deborah.
I'm one of the nephrologists of Johns Hopkins
and welcome to ABCs of kidney disease.
In this segment, we're going to discuss
the diagnosis and staging of chronic kidney disease.
Chronic kidney disease is
a lot more prominent than people realize.
About 37 million adults in the US
are estimated to have chronic kidney disease.
That works out to about 1 in 7 adults.
Now the challenge is about 90 percent of these individuals may
not be aware that they have kidney issues.
Why is the diagnosis challenging?
You have to lose about 85 percent of
your kidney function before you may become symptomatic.
We don't want to wait till symptoms,
so we're relying on blood tests and urine test to be able to
pick up that diagnosis early and help us intervene early.
Who's at risk for kidney disease or who
should be screened for kidney issues?
Individuals who have a history of
diabetes have a history of high blood pressure,
have family history of high blood pressure,
diabetes, or kidney disease,
individuals who are over the age of 65,
people who have had history of an acute kidney injury,
even if they recover back to their usual level of kidney function,
they're at risk of developing
chronic kidney disease later on in life,
and those individuals who struggle with
obesity are also needing
to be screened for chronic kidney disease.
Luckily, diagnosing kidney disease
is easy with two different tests.
There's the urine test,
which is an albumin-to-creatinine ratio.
It screens for the amount of albumin,
which is a type of protein in the urine.
That can be a marker that there has been damage to
the kidneys or that the kidneys are
working much harder than they should be.
The other test is a blood test called for creatnine.
Now creatinine is a waste product from our muscles.
We have no other use for it.
It's a good way of measuring how
well are the kidneys filtering or cleaning the blood.
Now everyone has a different amount of muscle mass.
We can put these creatinine levels
into formulas that adjust for how old we are,
whether we're men or women,
and nutritional status and it gives us a calculated or
an estimated glomerular filtration rate or GFR.
The glomerular filtration rate or GFR,
it's a measurement of how well are
your kidneys cleaning or filtering the blood.
Creatinine is a waste product,
you don't have any use for it.
The higher your creatinine is,
that can be a reflection that your kidneys are
not effectively working to clean the blood.
It indicates how much kidney function you have.
It's considered normal as long as the GFR is greater than 90.
It will normally decrease with age
and it will decrease as your kidney disease gets worse.
It's used to help determine what
are the five stages of chronic kidney disease you're in.
We have five stages of
chronic kidney disease based on the level of GFR.
Stage 1 is a GFR greater than 90,
so you have normal cleaning of the blood,
but maybe you have protein in the urine or you
have a structural change in the kidneys.
Stage 5 is when somebody is
preparing for dialysis or transplantation.
Stage 2, 3,
and 4 are when we look for complications of
kidney disease and we're focusing on
the risk factors to slow down the progression of kidney issues.
As your kidney disease progresses,
creatinine will go up and the GFR will go down.
The staging helps us know when you need to have lab work,
how often you might need to follow up in the clinic,
and when we need to be looking for
complications of kidney disease.
Now there are many causes of chronic kidney disease,
but the two most common causes are
diabetes number 1 and high blood pressure number 2,
and when you think about how many people
have both diabetes or high blood pressure,
then it makes sense why there are so many people
that are potentially affected by kidney disease.
There are other categories of causes of kidney disease.
One is glomerulonephritis.
It's a group of diseases that
cause damage to the filtering units in
the kidney and it can either be secondary to
an infection or an auto-immune process.
Other types of kidney disease are inherited once,
such as polycystic kidney disease,
urinary tract obstruction,
if someone has constant issues where they're
not able to pass their urine,
they have that urine backing
up on the kidneys and causing damage,
individuals who have repeated kidney infections
can develop problems with scarring in the kidneys,
and then sometimes different medications
can cause some kidney disease.
Thank you for listening to our presentation.
This has been a part of the
Johns Hopkins Nephrology Patient Education Program
with a goal of improving the lives of those with kidney disease.
If you want to learn more about any of the topics we discussed,
here are a couple of different websites with
good education resources. Thank you.