Be kind to your kidneys

As Oroville Hospital’s lead nephrologist, Dr. Subil Go is used to people having absolutely no idea what he does. Even if one explains that nephrology is the branch of internal medicine that deals exclusively with the functioning of the kidneys, that doesn’t necessarily help too much.

“I think a vast majority of patients don’t even know what a kidney is—there’s a huge vacuum of not knowing—versus a brain or a heart,” said Go. “When it gets to parts of the body such as the liver, the spleen, the kidneys, it’s much more nebulous.”

So, let’s start with a brief rundown of what the kidneys—that pair of bean-shaped, toxin-filtering organs located in the abdominal cavity on either side of the spine—actually do.

“The kidney is basically a filtration organ. It cleans out waste products from the body and helps with the elimination of toxins,” Go said. “It makes urine as the vehicle for eliminating toxins.”

The kidney also plays other important roles in the proper functioning of the human body, such as “hormone function—it aids in controlling vitamin D levels, and makes hormones to maintain blood health and bone health. One of the side effects of severe kidney disease is not enough blood.”

The kidneys, he explained, “communicate with the bone marrow to create blood”—no small job. “The kidney basically senses the need for new blood,” said Go. “Once the kidney receptor feels like there is insufficient blood, it sends a message to the bone marrow by way of hormones to make more blood. In kidney disease, the kidney is unable to message the bone marrow.”

Additionally, the kidneys work to maintain the balance of calcium, sodium and potassium in the body, as well as balance the pH—“the acidity”—of the human body. “The kidney is the organ most responsible for pH balance,” said Go, “and it is one of the most important jobs of the kidney.”

As a doctor who specializes in treating diseases of the kidneys, Go mainly sees patients who already have some form of kidney disease. By the time a person walks through Go’s office door, he or she often has already been diagnosed by a primary-care doctor—hence the talk of the necessity of dialysis, a regularly performed, mechanized process for filtering and removing liquid wastes from the body. In almost all cases, dialysis “is usually permanent therapy until a patient can get a transplant.”

Go also does extended aftercare for individuals who have received kidney transplants.

“A lot of times the people who come my way already have advanced problems,” said the personable 37-year-old who is originally from the Philippines. “I’m extinguishing the fire, not preventing the fire. Some patients are sent to me when very little can be done to reverse their disease. It’s heartbreaking to have to discuss right off the bat how to deal with their poor health.”

Advanced kidney disease, said Go, is generally defined as the kidneys having less than 20 percent of their function.

Maintaining kidney health is extremely important for quality of life, and to maintain life in general. While there are individuals who, due to donating a kidney or losing one for some other reason (such as a car accident), maintain a normal, active lifestyle with only one kidney, ideally one should have a well-functioning pair so as not to tax the body unnecessarily.

How then to prevent kidney disease and maintain optimal health for these all-important organs?

“We need to raise awareness of the causes of kidney disease,” offered Go. Uncontrolled high blood pressure—or hypertension—and diabetes are “big factors predisposing one to kidney disease. If I had to name two diseases that increase the risk of kidney disease the most, it would be these two.” The combination of the two, he said, is “potentially lethal.”

Advanced kidney disease “doesn’t happen overnight,” added Go. “That’s one of the good things. It tends to present itself over months, years. You don’t get diabetes one day and overnight get kidney disease.”

Go recommends that people who have been diagnosed as having diabetes or hypertension ask their primary-care doctor a point-blank question: “Are my kidneys all right?” The doctor will perform the necessary blood work to determine the state of kidney health.

“Be proactive,” Go recommends. Anyone wishing to detect possible kidney problems should get an annual physical examination from his or her primary-care doctor. Too often, “my conversation with patients who come to me almost always begins with a surprise—they didn’t know they had weak or diseased kidneys.

“Most of the time, kidney disease is sent my way because it was picked up by a diligent primary-care doctor with a blood test,” he said.

The last thing that Go wants to see—which, unfortunately, he sees all too often—is the patient who has already detected blood in his or her urine, or is painfully passing kidney stones.

“Two complaints that bring them right to the door are if they pee blood, or if they’re passing kidney stones,” Go said. “Unfortunately, those are the two dramatic things that get them through the door—blood or stones.”

While the majority of kidney-disease sufferers will experience no symptoms, Go reiterated, the appearance of blood in the urine can indicate bladder cancer, a kidney infection or the passing of a kidney stone.

As for the seriousness of kidney stones, Go said it “depends on the size—and whether or not both kidneys are affected.” In the case of the massive, antler-shaped “staghorn”—or “struvite”—kidney stone, “it can appear in both kidneys, and block all urine output,” as well as be extremely painful and, in some cases, require surgical removal.

Go, however, does not offer pat answers regarding the treatment of kidney disease, being calmly adamant that “as for treatment, it’s going to be individualized.”