Lehigh County Health & Medicine Spring 2021 - 7

L C M E D S O C .O R G

a low sodium/salt diet are all important
ways to improve blood pressure. Adequate
sleep, exercise, weight loss and smoking
cessation can all slow down worsening of
kidney function. Nephrologists can help
look for secondary causes of elevated blood
pressure as well as manage hypertension with
various medications. Patients should check
their blood pressure at home with a home
blood pressure device to achieve control
through medications and reducing sodium/
salt intake. Patients can also work with their
primary care physicians or endocrinologists
to help lower elevated blood sugars. Those
with either type 1 or type 2 diabetes mellitus
are at risk of kidney disease. As kidney
function declines, nephrologists can help
manage complications medically. The earliest
sign of kidney disease due to diabetes is
increased protein in the urine in the form
of albumin. The presence of albumin often
appears earlier than bloodwork abnormalities
so annual monitoring for albumin in the
urine is important. Blood pressure lowering
medications called angiotensin converting
enzyme inhibitors (ACEis) and Angiotensin
II receptor blockers (ARBs) have been shown
to slow the loss of kidney function. ACEis
and ARBs end in -pril or -sartan and help
lower protein in the urine. Working closely
with endocrinology, as well as a kidney doctor,
will help keep a patient's kidneys working
as long as possible.  
 Common signs of kidney disease include
weight gain and ankle swelling from the
inability to remove extra water from the
body. For example, increased swelling or
shortness of breath from fluid overload can
be managed with water pills called diuretics.
Some examples of diuretics are furosemide,
torsemide or bumetanide. Kidneys are
responsible for potassium excretion. As kidneys fail, particularly in later stages of CKD,
potassium levels in the blood can rise. High
potassium levels, also called hyperkalemia,
can lead to cardiac conduction abnormalities,
potentially leading to arrhythmia, low blood
pressure and even death. Nephrologists and
patients can work together to help control
elevations in potassium levels with diet and
medications. As kidneys are responsible
for acid/base balance, some primary care

providers or nephrologists will provide
sodium bicarbonate tablets to raise low serum
bicarbonate levels to normal range. Low
serum bicarbonate levels can put patients
at risk of bone loss and fractures. Patients
can develop anemia in late stage CKD as
well. IV iron, oral iron and/or medications
that stimulate the bone marrow to produce
more blood are utilized to manage anemia.
Nephrologists or hematologists generally
order these medications. 
Patients often do not know they have
kidney issues as labs can be abnormal without
patients having symptoms. Because chronic
kidney disease occurs slowly over time,
patients can get accustomed to these slow
deleterious changes. Symptoms related to
kidney disease are more often felt by patients
when there is a sudden change in kidney
function or when patients are experiencing
late stage chronic kidney disease (stage 4
or 5). Later signs of kidney disease include
nausea, vomiting, loss of appetite, weakness,
fatigue, itching, muscle cramps and anemia.
If volume status, electrolytes, acid/base status
and/or symptoms of toxin buildup cannot

be managed medically, dialysis is pursued
according to the patient's goals of care.
Monitoring bloodwork, urine testing and
ensuring close follow up with a primary care
provider and/or nephrologist will allow for
better management of chronic kidney disease
to determine its cause and slow progression to
preserve renal function whenever possible.

RESOURCE
https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html

SPRING 2021 | Lehigh County Health & Medicine 7
http://www.LCMEDSOC.ORG https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html
Lehigh County Health & Medicine Spring 2021

Table of Contents for the Digital Edition of Lehigh County Health & Medicine Spring 2021
