Why are the kidneys so important?

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

• remove waste products from the body
• remove drugs from the body
• balance the body's fluids
• release hormones that regulate blood pressure
• produce an active form of vitamin D that promotes strong, healthy bones
• control the production of red blood cells

Below you will find more information about the kidneys and the vital role they play in keeping your body functioning.

• Where are the kidneys and how do they function?
• What are some of the causes of chronic kidney disease?
• How is chronic kidney disease detected?
• Can kidney disease be successfully treated?
• How is kidney failure treated?
• What are the warning signs of kidney disease?

Where are the kidneys and how do they function?

There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains up to a million functioning units called nephrons. A nephron consists of a filtering unit of tiny blood vessels called a glomerulus attached to a tubule. When blood enters the glomerulus, it is filtered and the remaining fluid then passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid according to the body's needs, the final product being the urine we excrete.

The kidneys perform their life-sustaining job of filtering and returning to the bloodstream about 200 quarts of fluid every 24 hours. About two quarts are removed from the body in the form of urine, and about 198 quarts are recovered. The urine we excrete has been stored in the bladder for anywhere from 1 to 8 hours.

What are some of the causes of chronic kidney disease?

Chronic kidney disease is defined as having some type of kidney abnormality, or "marker," such as protein in the urine and having decreased kidney function for three months or longer.

There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Some kidney conditions are inherited (run in families).

Others are congenital; that is, individuals may be born with an abnormality that can affect their kidneys. The following are some of the most common types and causes of kidney damage.

• Diabetes is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. This results in a high blood sugar level, which can cause problems in many parts of your body. Diabetes is the leading cause of kidney disease.
• High blood pressure (also known as hypertension) is another common cause of kidney disease and other complications such as heart attacks and strokes. High blood pressure occurs when the force of blood against your artery walls increases. When high blood pressure is controlled, the risk of complications such as chronic kidney disease is decreased.
• Glomerulonephritis is a disease that causes inflammation of the kidney's tiny filtering units called the glomeruli. Glomerulonephritis may happen suddenly, for example, after a strep throat, and the individual may get well again. However, the disease may develop slowly over several years and it may cause progressive loss of kidney function.
• Polycystic kidney disease is the most common inherited kidney disease. It is characterized by the formation of kidney cysts that enlarge over time and may cause serious kidney damage and even kidney failure. Other inherited diseases that affect the kidneys include Alport's Syndrome, primary hyperoxaluria and cystinuria.
• Kidney stones are very common, and when they pass, they may cause severe pain in your back and side. There are many possible causes of kidney stones, including an inherited disorder that causes too much calcium to be absorbed from foods and urinary tract infections or obstructions. Sometimes, medications and diet can help to prevent recurrent stone formation. In cases where stones are too large to pass, treatments may be done to remove the stones or break them down into small pieces that can pass out of the body.
• Urinary tract infections occur when germs enter the urinary tract and cause symptoms such as pain and/or burning during urination and more frequent need to urinate. These infections most often affect the bladder, but they sometimes spread to the kidneys, and they may cause fever and pain in your back.
• Congenital diseases may also affect the kidneys. These usually involve some problem that occurs in the urinary tract when a baby is developing in its mother's womb. One of the most common occurs when a valve-like mechanism between the bladder and ureter (urine tube) fails to work properly and allows urine to back up (reflux) to the kidneys, causing infections and possible kidney damage.
• Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and "street" drugs such as heroin and crack can also cause kidney damage.

How is chronic kidney disease detected?

Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

1. Blood pressure measurement
2. A test for protein in the urine. An excess amount of protein in your urine may mean your kidney's filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
3. A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have. To access the GFR calculator, click here.

It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:

• are older
• have diabetes
• have high blood pressure
• have a family member who has chronic kidney disease
• are an African American, Hispanic American, Asians and Pacific Islander or American Indian.

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.

Can kidney disease be successfully treated?

Many kidney diseases can be treated successfully. Careful control of diseases like diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Kidney stones and urinary tract infections can usually be treated successfully. Unfortunately, the exact causes of some kidney diseases are still unknown, and specific treatments are not yet available for them. Sometimes, chronic kidney disease may progress to kidney failure, requiring dialysis or kidney transplantation. Treating high blood pressure with special medications called angiotensin converting enzyme (ACE) inhibitors often helps to slow the progression of chronic kidney disease. A great deal of research is being done to find more effective treatment for all conditions that can cause chronic kidney disease.

How is kidney failure treated?

Kidney failure may be treated with hemodialysis, peritoneal dialysis or kidney transplantation.

• Treatment with hemodialysis (the artificial kidney) may be performed at a dialysis unit or at home. Hemodialysis treatments are usually performed three times a week.
• Peritoneal dialysis is generally done daily at home. Continuous Cycling Peritoneal Dialysis requires the use of a machine while Continuous Ambulatory Peritoneal Dialysis does not. A kidney specialist can explain the different approaches and help individual patients make the best treatment choices for themselves and their families.
• Kidney transplants have high success rates. The kidney may come from someone who died or from a living donor who may be a relative, friend or possibly a stranger, who donates a kidney to anyone in need of a transplant.

What are the warning signs of kidney disease?

Kidney disease usually affects both kidneys. If the kidneys' ability to filter the blood is seriously damaged by disease, wastes and excess fluid may build up in the body. Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

1. High blood pressure.
2. Blood and/or protein in the urine.
3. A creatinine and Blood Urea Nitrogen (BUN) blood test, outside the normal range. BUN and creatinine are waste that build up in your blood when your kidney function is reduced.
4. A glomerular filtration rate (GFR) less than 60. GFR is a measure of kidney function.
5. More frequent urination, particularly at night; difficult or painful urination.
6. Puffiness around eyes, swelling of hands and feet.

End-Stage Renal Disease Management

When you have end-stage renal disease, you want the best dialysis care delivered by experts in the field. Ochsner Kidney Care, a partnership between Ochsner Clinic Foundation and National Renal Care, now offers those living with end-stage renal disease more convenient, comprehensive care and dialysis services.

• In-center Hemodialysis
• Home Peritoneal Dialysis
• Home Hemodialysis
• Nutritional counseling
• Social services
• Anemia and bone management
• Traveling guest/visitor services
• Patient education

With its partner, National Nephrology Associates, Ochsner End Stage Renal Disease Services provides care to approximately 320 patients in six dialysis units in New Orleans, Houma, Thibodaux, Galliano (Cut Off), Baton Rouge and in-home dialysis. All the units are fully staffed including renal social workers, a specialized renal dietitian and attentive clerical staff. Hemodialysis schedules are flexible and the late shift accommodates patients with special needs. The renal rehabilitation process has been dubbed the "Quality of Life" program at Ochsner, where a special committee meets monthly to steer efforts. Dialysis caregivers, including the financial and nursing administrators, dialysis technician representatives, nurse representatives and patients form this committee. This group provides input to establish and promote quality of life initiatives. Just a few of Ochsner’s many successful programs are:

• Dialysis Patient Exercise Program Every dialysis pod has an exercise bicycle, which is offered to each and every patient to be utilized during the HD treatment. Prescription dialysis exercise programs are written for those patients interested in pursuing this process. Symptomatic improvement, weight loss and better well being are the goals. Bikes are also available in the Houma and Thibodaux Dialysis Units and in the waiting room of the Peritoneal Dialysis Unit. Each peritoneal dialysis patient has a tailored exercise program prescribed.
• A Holiday Health Fair This is held yearly during the Christmas season. Education booths are set up for patients and their relatives concerning end stage renal disease care, modalities of end stage renal disease and availability of local community resources. Music is provided. Attendance has been "standing room only" in recent years.

The Nephrology Fellowship at Ochsner Medical Center is a 2-year program established at a state-of-the-art quaternary care academic medical center and one of the top kidney and liver transplant centers in the country. The training program was approved by the ACGME in February 2012 and has rapidly become one of the most prestigious programs in the South Gulf region. Ochsner Health has a long tradition of excellence in patient care, innovative research and outstanding post-graduate medical education.

Program Goals

The goals of the program are to train the next generation of nephrologists for them to become leaders in academic and community-based nephrology and to provide them with proficiency, knowledge and skills that will enable them to practice in any professional setting after graduations.

Learn More About Our Program:

• Program Highlights
• Educational Experience
• Clinical Experience
• Research/Scholarly Activities
• Leadership & Faculty
• Our Fellows
• Teaching Facility
• Stipend & Benefits
• Contact Information
• Internal Medicine Residency Program

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Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. CKD is also known as chronic renal disease.

What is chronic kidney disease (CKD)?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

The Facts About Chronic Kidney Disease (CKD):

• 26 million American adults have CKD and millions of others are at increased risk
• Early detection can help prevent the progression of kidney disease to kidney failure
• Heart disease is the major cause of death for all people with CKD
• Glomerular filtration rate (GFR) is the best estimate of kidney function
• Hypertension causes CKD and CKD causes hypertension
• Persistent proteinuria (protein in the urine) means CKD is present
• High risk groups include those with diabetes, hypertension and family history of kidney disease
• African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors are at increased risk
• Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine

What causes chronic kidney disease (CKD)?

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other conditions that affect the kidneys are:

• Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units. These disorders are the third most common type of kidney disease.
• Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue
• Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
• Lupus and other diseases that affect the body's immune system
• Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men
• Repeated urinary infections

What are the symptoms of chronic kidney disease (CKD)?

Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:

• Feel more tired and have less energy
• Have trouble concentrating
• Have a poor appetite
• Have trouble sleeping
• Have muscle cramping at night
• Have swollen feet and ankles
• Have puffiness around your eyes, especially in the morning
• Have dry, itchy skin
• Need to urinate more often, especially at night

Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:

• Have diabetes
• Have high blood pressure
• Have a family history of chronic kidney disease
• Are older
• Belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders and American Indians

Learn more About Glomerular Filtration Rate (GFR)

GFR—glomerular filtration rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, race, gender and other factors.

The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.

What happens if my test results show I may have chronic kidney disease?

Your doctor will want to pinpoint your diagnosis and check your kidney function to help plan your treatment. The doctor may do the following:

• Calculate your Glomerular Filtration Rate (GFR), which is the best way to tell how much kidney function you have. You do not need to have another test to know your GFR. Your doctor can calculate it from your blood creatinine, your age, race, gender and other factors. Your GFR tells your doctor your stage of kidney disease and helps the doctor plan your treatment.
• Perform an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your doctor whether your kidneys are too large or too small, whether you have a problem like a kidney stone or tumor and whether there are any problems in the structure of your kidneys and urinary tract.
• Perform a kidney biopsy, which is done in some cases to check for a specific type of kidney disease, see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor removes small pieces of kidney tissue and looks at them under a microscope.

Your doctor may also ask you to see a kidney specialist who will consult on your case and help manage your care.

Dialysis is life-sustaining care for those whose kidneys are failing. When the kidneys fail, they cannot do their jobs of filtering the blood and ridding the body of toxins, waste products and excess fluids. Dialysis, along with medication and proper diet, can take the place of many functions of healthy kidneys.

Ochsner Nephrology experienced in providing different dialysis options for patients, which include:

• Acute dialysis (hospitalization inpatient)
• Chronic outpatient dialysis

Acute Dialysis

At Ochsner’s Acute Dialysis Department, their primary goal is to provide the best experience possible to patients needing vascular access procedures or hemodialysis therapy. This includes comfort, timeliness, safety and effectiveness.

Expectations

Patients can expect prompt service in dialysis and a safe and effective treatment. They can also look forward to:

• Comfortable treatment and privacy during transport and treatment
• An explanation of all procedures and any medicines you get
• A healthcare team that cares about you as a person and listens and responds to your concerns

Department Goals

• Meet or exceed all regulatory compliance guidelines
• Promote patient and visitor satisfaction and exceed expectations whenever possible
• Increase patient and visitor educational opportunities
• Achieve all clinical targets established by the quality assurance committee
• Promote excellence in nursing through education, certification and clinical ladder
• Maintain a work environment conducive to high employee morale and, thus, better patient care
• Utilize state-of-the-art technology and provide the most current evidence-based care to patients

Outcomes/Report Cards

The key quality initiatives for the Acute Dialysis Department are:

• Anticoagulation management: Reducing risk of clotting during dialysis and avoid post-dialysis bleeding
• Ochsner Health has passed the Anticoagulation Forum's assessment program, and can be considered an Anticoagulation Center of Excellence.
• Blood pressure management: Reducing blood pressure drops during dialysis
• Ultrafiltration management: Optimizing safe fluid removal to achieve treatment goal
• Patient education: Assuring every patient is given information needed and desired to understand plan of care during and after hospitalization

Chronic Outpatient Dialysis

There are a number of treatment options listed below for patients needing chronic dialysis support. It is important to contact your nephrologist to determine which treatment choice is best for you. There are many factors that go into your decision and your Ochsner nephrology team is here to support you on making the best choice for your care.

Treatment Options

• Outpatient Hemodialysis is a method of removing waste products and extra fluid that builds up when the kidneys are no longer able to remove them. To perform hemodialysis, it is necessary to filter your blood through an artificial kidney, which is attached to a machine. A very small amount of blood is removed and returned to one of your veins, which has surgically been adapted for this.
• Home Hemodialysis can be done at home by you and a partner. You and your partner would participate in an extensive training program to learn how to set up the machine, initiate the dialysis treatment, and discontinue the treatment. Home hemodialysis allows you to schedule your treatments to fit your routine. Patients still come to the dialysis facility for a monthly visit to see the nurse, social worker, dietitian, and nephrologist.

• Home Peritoneal Dialysis (PD) uses a thin membrane in your abdomen, called the peritoneum, to perform dialysis. During treatments, a cleansing fluid called dialysate is put into your abdomen through a small, flexible tube called a PD catheter. The dialysate pulls the waste and extra fluid from your blood into the peritoneal cavity.
• Continuous Ambulatory Peritoneal Dialysis (CAPD), there are typically four exchanges of the dialysate done daily, with each exchange taking approximately 45 minutes.
• Continuous Cycling Peritoneal Dialysis (CCPD), uses a machine to drain the dialysate in and out of the body. CCPD is usually performed for eight to ten hours daily, and you are able to do this treatment at night while sleeping.

• Kidney Transplant is a surgical procedure performed to give you a healthy, functional kidney that will perform all of the functions that a damaged one can no longer do. A transplanted kidney is either donated from a living donor such as a spouse, family member or friend or the kidney can come from a deceased (cadaveric) donor. Not all patients with kidney failure are acceptable candidates for transplant, but if you are interested, you should let your nephrologist and social worker know. A referral can be made to a transplant center of your choice, and the transplant center can then determine if you meet the initial criteria and assist you with further evaluation.

Patients with erythropoietin requirements due to pre-dialysis or end-stage renal disease receive weekly or biweekly injections of erythropoietin. Patients with diseases such as cancer or AIDS are also eligible. Close monitoring of the hemoglobin, hematocrit and blood pressure assures clinical evolution. Outpatient infusion of intravenous iron is also available for patients who have been documented to have iron deficiency anemia and who are unresponsive to oral therapies.

Referrals to the Nephrology Department can be made by calling 504-842-6044 in New Orleans or 225-336-3163 in Baton Rouge.

Interventional Nephrology Program

The Interventional Nephrology Program at Ochsner includes a percutaneous-access service directed by an interventional nephrologist and staffed by an additional nephrologist and a dedicated access nurse.

Our goal is to serve the needs of our patients through providing coordinated treatment.

Ochsner's Interventional Nephrology Program provides Hemodialysis Vascular Access (HDVA) care and performs the following procedures:

• Hemodialysis Tunnel catheter insertion, exchange, removal and repair
• Placement of temporary or permanent hemodialysis catheters
• Peritoneoscopic peritoneal dialysis catheter placement
• Bone biopsies
• Kidney biopsies
• Consultation for difficult access problems
• Angiogram of AV fistula and grafts
• Angioplasty of AV fistula and grafts
• Thrombectomy of AV fistula and grafts
• Endovascular stent placement of AV fistula and grafts

Results are followed closely by the Access Task Force, which has developed a computerized model to facilitate data acquisition.

Ochsner also performs routine, difficult and high-risk renal biopsy procedures under ultrasound, fluoroscopy or CT guidance. Transplant biopsies are routinely performed as well.

When it comes to laparoscopic peritoneal catheter placements, they’re scheduled as outpatient surgeries.

Outpatient bone biopsies, meanwhile, are offered for the evaluation of metabolic bone disease or renal osteodystrophy.

Procedures Performed:

Fistulagrams

Fistulagrams are performed by injecting contrast through vascular access and monitoring the function of the fistula or graft. If there is any evidence of stenosis, we perform angioplasty any stent placement based on KDOQI guidelines.

A fistulagram is usually indicated for the following reasons:

• Difficult needle placement
• Persistently swollen arm
• Increased machine pressures
• Difficulty achieving hemostasis at the end of treatment
• Decreased blood pump speeds
• Decreased Kt/V or URR (due to recirculation)
• Clotting the system two or more times per month

Thrombolysis/Thrombectomy

• Sometimes stenosis of the downstream leads to a cascade of events resulting in thrombosis of the AV access. We perform endovascular removal of the thrombus burden from the arterial inflow and venous outflow.

Hemodialysis Central Venous Access Placement for Temporary Renal Replacement and Tunnel Dialysis Catheter Placement

• We perform placement of tunnel dialysis catheter for acute renal failures and also advanced chronic kidney disease patients prior to their Hemodialysis Vascular Access, such as AV fistula and graft, being established