Are You Taking Care of Your Kidneys? with Jorge Gutierrez-Aceves, MD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Odds are you don't think about your kidneys all too often, and that's pretty understandable. They're not exactly an attention-seeking organ. But your kidneys are essential for your survival. And for many folks, they're not doing so hot. It's estimated that 1 in 7 people have chronic kidney disease, meaning their kidneys are beginning to lose function.

Today, we're going to talk with urologist Jorge Gutierrez about ways to keep your kidneys healthy. He's one of the many experts at Cleveland Clinic who visit our weekly podcast to broaden our understanding of our bodies. So with that in mind, let's find out why our kidneys deserve a little TLC.

Welcome back to the podcast, Dr. Gutierrez. It's always nice to see a familiar face.

Dr. Jorge Gutierrez:

Thank you so much. Very happy to be here again with you, John, and very happy to share with the audience some recommendations.

John Horton:

You have great advice. And you're here to talk about kidneys. That's your specialty here. But when it comes to kidneys, it seems that many of us don't really know what we've got inside of us. I found one survey showing that 80% of people didn't know the primary function of the kidneys or where they're located. And I love this one: 25% of people thought they could live without their kidneys. So I'm assuming, in your job, you have to do a lot of explaining to folks about what's going on with the kidney.

Dr. Jorge Gutierrez:

Yeah, totally right. So the first thing is, seems like a silly thing, but it's important, kidneys are in the back part of the body. They are located in a cavity that we call retroperitoneum, that is really the posterior part of the front abdomen where all the bowels live. And the reason why it's important to say this is because main issues common from the kidney in the back part of your body. Example, a standard block of the drainage of urine, pain is going to start in the back part of your body.

But let me explain to you the renal function. What is the kidney? What does the kidney do? The kidney's a filter. The kidney is going to filter everything that we have in the blood that we don't need. And the filter, it works so perfectly that it will ... in the internal structure of the kidney, it will separate the good things from the bad things in blood.

So those bad things that we can call waste product, that can be some salts and minerals and some other waste things and the excessive liquid that we don't need inside the body, it's going to be filtered by the kidneys, and it's going to be secreted. Now, this liquid, going to call urine, and urine is full with all these waste products. So a good renal function will keep whatever we need inside in the blood and will excrete whatever we don't need inside the blood.

John Horton:

It's kind of like the cleaning mechanism for your whole body. It's kind of scrubbing everything down.

Dr. Jorge Gutierrez:

That is a filter. Exactly this. This is exactly this. And this is why when somebody has renal dysfunction, renal failure, so the kidneys are not working well, this is the reason why these waste products are not eliminated from the body, and that's when they start getting toxic inside the body. And this is the main concern, of course, of the renal dysfunction. The filters that we were saying, this cleaning mechanisms that we have that are the kidneys, it's not working well. So a lot of the bad things in the blood will remain inside the body.

John Horton:

Well, you can see, just by hearing that, you can see why it's so important to maintain kidney health. I mean, it reminds me if a garbage picker or the people who collect garbage go on strike, it's a mess. You know what I mean? If nobody's picking it up, you got all this stuff accumulating. If your kidneys don't work, you're going to have that same thing. And just within your body, all this waste is going to build up and that's just never going to be good.

Dr. Jorge Gutierrez:

That is exactly the best analogy that you can say. Yeah. Imagine that in your house, you just keep the waste for one week to the next week to the next week, and at some point it's going to be [inaudible 00:04:30]. So this is exactly what happens, but unfortunately, worse that it gets renal function, it's going to be more difficult to clean all this garbage or this waste product that have been accumulated there in the blood.

John Horton:

Yeah. And it's amazing just how much your kidney does. I wrote down the one stat, and I just want to make sure I look at it. I saw that the kidneys process 200 quarts of fluid every day, which is enough to fill a large bathtub. That's a lot of work.

Dr. Jorge Gutierrez:

Yeah. That's the amount of the filtration, if you will, of the kidney. Yeah.

John Horton:

Wow.

Dr. Jorge Gutierrez:

Just to follow with this, what's happened when the kidneys start failing, when the kidneys stop working? It's going to start coming to a point where symptoms begin, because at the beginning, there are no symptoms. The kidneys start having issues working and we don't notice that or we don't know that unless we do some sort of blood test and find out that the kidney is not working or start working unproperly. But the bottom, or important thing, is to let people know that whenever the renal dysfunction has progressed to a point that the kidneys cannot clean anymore the blood, there's no other way than to do an artificial cleaning of the blood, which is called dialysis, or transplant, receive another kidney. So it is important because this is, I mean, unless there's an acute issue that mostly ever the acute issues resolve, a chronic heart kidney disease is going to progress to the point that there's not going to be any chance to help the kidney anymore, but doing an artificial cleaning of the blood with the dialysis.

John Horton:

Are there any early signs that somebody might be able to pick up on that their kidneys are starting to have a little trouble?

Dr. Jorge Gutierrez:

Again, symptoms at the beginning are very infrequent. I will say that the initial symptoms that maybe already when you have what we call intermediate kidney failure, maybe dizziness, maybe headache, maybe a lack of appetite, so people don't want to eat, maybe problems with sleeping and some of the things like hypertension and yeah, basically these are the most frequent symptoms. And also, people may start noticing that they are not producing the same amount of urine. So they are voiding less liquid, less urine than in the past. And those are symptoms, again, that, unfortunately, don't happen early when the conditions start. But there are things that people can anticipate in order to prevent this.

John Horton:

We're going to get into the tips here. All right. I like that because it sounds like you really want to make sure you keep those kidneys humming along and working their best. So lay out what we can do to make sure everything's working properly.

Dr. Jorge Gutierrez:

Exactly. There are risk factors that will favor their renal dysfunction, and the main two are hypertension or diabetes. So everybody who has hypertension or diabetes, they need to be sure that they have a good control. You may have hypertension and you think that you're taking the correct medication. But if you're not checking the pressure frequently, that means that the kidney is going to be suffering without notice. Diabetes is the same, probably even worse, because people may be taking a medication, but whenever they do the blood test and maybe not very frequent at the beginning of the diabetes, for example, then the kidney have suffered consequences of that.

John Horton:

Yeah, I was going to say, so those two control your blood pressure and keep your blood sugar in check would be two key things.

Dr. Jorge Gutierrez:

Correct. Especially for … sorry, for those people who already know that they have this condition, hypertension and diabetes. So bottom line is they need to do a close follow-up on these two conditions; otherwise, they will increase the risk of renal dysfunction. Some of the things that I think are very important people to understand is we find now a lot of things at the counter that people can take for pain control or some other things. Medications are a high-risk factor for renal damage or for renal dysfunction, especially pain medication and the long-term, anti-inflammatory medication in the long-term and some other medications.

But I think people should not be receiving a lot of [out of] prescriptions and better to look for medical care, in case that they have some chronic condition. For example, somebody has chronic pain. And for some people, it's easy just to go to the counter and buy something that relieves the pain. Not a good idea. I think it's better to understand where the pain is coming from and how the pain can be treated.

John Horton:

Yeah. You always hear that. And that's one of those things I don't think a lot of us realize, I guess, the potency of some of those pain medications that you take. And if you take them regularly over and over and over again, it sounds like you can do some damage to your kidney over time.

Dr. Jorge Gutierrez:

Yeah, sure, sure. You do. Some other two frequent conditions that people don't realize that their risk factor for renal dysfunction are smoking and drinking alcohol. So smoking and drinking alcohol, again, in the long term, will have a risk for renal dysfunction. But now, the most important thing to understand is a sum of all these factors. Somebody who smokes is going to be somebody who drinks alcohol. And in addition to that, has hypertension and start having diabetes and so on and so on. So all these factors together are going to increase the risk of renal dysfunction, for sure.

John Horton:

And then, I think you had mentioned earlier, too, that we had talked about hydration. It's something that sounds like your kidneys really need. You got to have fluid going through and make sure you're getting enough water in.

Dr. Jorge Gutierrez:

Correct. We were discussing that if you get hydrated, what it's going to do, you're going to help with washing out or eliminating all the salts and minerals that the kidney's excreting. And these salts and minerals, I mean, we discussed that they may be the basis of the formation of a stone, but also, they may collect or get stuck in a part of the internal tissue of the kidney that will affect, in the long term, the renal function. So yes, hydration is always recommended. If somebody has already renal dysfunction, maybe that the hydration or the amount of liquids need to be adjusted, but in order to prevent renal dysfunction, yes, it's always good to get hydrated, to get physical activity and physical activity with good hydration after the “bad” physical activity.

I have a healthy diet, a healthy diet. If you eat a lot of meat, a lot of animal protein, and you eat some things that are, at the end, risk for damage to the renal function. Again, I think the most important thing is to consider that there are different factors, but at the end, it's a summary of all these factors. It's not only a single factor in anybody.

John Horton:

Yeah. It sounds like a lot of it goes to overall healthy living and just everything that you brought up — hydration, healthy diet, keeping your blood sugar in check, your blood pressure in check, maintaining a healthy weight, exercising, and then limiting alcohol and smoking — I mean, those are just good overall health tips.

Dr. Jorge Gutierrez:

That's right. That is right, yeah.

John Horton:

It is amazing. We talked about how kidney function is so important and how so many people don't even realize that they have issues. And I know I was really shocked to read that chronic kidney disease causes more deaths each year than breast cancer or prostate cancer. And that was from the National Kidney Foundation. I don't think a lot of people realize that. It seems like this is kind of an under-recognized public health crisis.

Dr. Jorge Gutierrez:

That is totally right. And if you see also the data coming from all the different institutions in this country, you're going to see that there's an increase in the number of kidney transplant all over the place. And the reason the kidney transplant is … that we have, unfortunately, more and more people with some renal dysfunction. And I was saying earlier that before the kidney transplant, people need to have assistance of this artificial machine that washed the kidneys or that made the function that the kidney cannot do and wash the blood, which is called dialysis, but the dialysis in the long term is not going to be possible for everyone or has a limited lifetime maybe well. So the amount of kidney transplant need for transport for new kidneys is increasing all over the place. And the reason why is because, unfortunately, there are more and more people with renal dysfunction.

John Horton:

So you laid out this guidance, this advice on things we can do to help our kidneys stay healthy. If you do that, I mean, how likely are you to prevent kidney issues? I mean, do we really have that much control over what happens?

Dr. Jorge Gutierrez:

I think that's a very important question because there may be some other genetic factors or some other factors that can still increase the risk of renal dysfunction. But again, as I was saying before, as this is assumatory of factors, if you can decrease the risk factors that are on your hand, like diet and smoking and alcohol and all these things that you can prevent, at least you can decrease the overall risk of having renal dysfunction at some point.

There may be some other factors that probably don't even understand very clear, like genetic factors or some other conditions that at the end they're going to try to renal dysfunction, but what is in the hints or in the capacity of the people to prevent the things that we are discussing, but then there's always a good recommendation to start there.

John Horton:

Yeah, you can just improve your odds, it sounds like-

Dr. Jorge Gutierrez:

…that's it.

John Horton:

...if you make these sorts of healthy changes.

Well, Dr. Gutierrez, I got to say, we talked at the start about how people knew very little about their kidneys. If they've listened to this whole podcast, I hope they're part of that future survey because the scores are going to look a little better given all the information that you've shared.

Dr. Jorge Gutierrez:

But I think it's a great way you're doing because there's no other way than just promote more information to the patient. Say there are simple things that they can do in order to improve their general health. Risk factors, as we were saying, diabetes, hypertension, obesity. Of course, obesity is a big risk factor. So people need to understand that the consequences of these conditions of these diseases sooner or later is going to be renal dysfunction. So they need to be aware of all these things and, hopefully, they can help the health of their kidneys.

John Horton:

I can't think of a better way to end than with that statement. So once again, I appreciate your time and you coming in to share so much information with us, and I look forward to having you back on.

Dr. Jorge Gutierrez:

Very happy to do it. Thank you so much.

John Horton:

You need your kidneys to live, and your kidneys need your help to be at their best. Take care of them by drinking enough water, eating a healthy diet, controlling your blood pressure, blood sugar and weight. They'll thank you for it.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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