To Your Good Health: What can be done after diagnosis of chronic kidney disease?
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I am a 76-year-old woman. I read your column daily, but I do not remember reading anything about chronic kidney disease. I have just been diagnosed with CKD and have been reading as much as I can get my hands on. This is very frustrating, since much of what I find is contradictory. However, my biggest concern is that the doctor sent me to a nephrologist, who told me that I have CKD, stage 3 — and then nothing!
In my reading, I have found that this is a common complaint of people who have CKD. One is diagnosed, after having several expensive tests run and money made for the medical institutions. Then nothing is done until one is at stage 5 and needs either a transplant or dialysis — again, moneymakers for the medical institutions. The sad thing is that stage 5 probably could be prevented through education and active care.
What can be done to raise awareness of CKD, and what can be done to provide better care for patients who have been diagnosed, before they reach stage 5? — L.M.
ANSWER: The definition of “chronic kidney disease” is based on the kidneys’ ability to filter out the toxins the body makes. One chemical, creatinine, has been a very good marker for overall kidney function. The lower the creatinine level, the better the kidney function and the higher the “creatinine clearance,” the number that defines the stage of chronic kidney disease. Stage 3 CKD is a creatinine clearance between 30 and 59 (yours is 44, according to the lab report you sent me).
However, as people get older, kidney function decreases. The rate is variable, but it averages around 7.5 per decade. Because of this, many people will get to the point of a diagnosis of CKD when they have normal kidneys that have aged as expected. I think this is the case in you.
Unfortunately, there are no treatments proven to slow, halt or reverse the loss in kidney function associated with normal aging. I don’t believe your doctors are looking to make money for the medical center, they are looking to see whether you might have any cause other than “normal aging” as a cause of kidney damage. The labs you sent show no such cause, which means there is no specific treatment.
What distresses me about your story is the poor communication you received. Knowing that your kidney results are most likely a function of normal aging, that there are no treatments necessary and that it is unlikely you will progress to stage 5 (end-stage, requiring dialysis or transplant) would likely have been very reassuring.
DEAR DR. ROACH: Your column from January about thymus cancer states that the thymus is located in the neck. Perhaps you meant the thyroid, which is in the neck. The thymus is under the sternum (at least that is where mine was removed from)! — R.H.
ANSWER: You are right about the thymus location. I did mean the thymus, but I was thinking of its starting place in human embryo development. It originates in the neck (just like the thyroid and parathyroid) then settles in the anterior superior mediastinum, the front upper part of the chest, at about the level of the heart and in front of the lungs. It often is removed in people with myasthenia gravis, where its removal may help long-term control of the disease, or with a tumor of the thymus. I can offer as excuse only that it’s really important in early development in the immune system and has very little role in adults.