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 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.

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.

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.

You have been diagnosed with chronic kidney disease (CKD). You are not alone, more than 26 million people in the United States have this disorder. Diabetes and hypertension are the most common causes. Even though there is no cure for CKD, we want to make you aware of ten things that may help your kidneys last longer – sometimes even for years:

• Control high blood pressure. Controlling high blood pressure is proven to be the most important treatment for slowing kidney damage. Your blood pressure should be less than 120/80 if you have excess protein in your urine, otherwise it should be less than 130/80.
• Discuss with your doctor medications that block the renin-angiotensin system. These medicines not only control blood pressure, but they also benefit your kidneys by lowering the protein in your urine. They are a proven treatment for slowing kidney damage.
• Lower your cholesterol. Kidney damage can increase the amount of “bad” cholesterol called LDL, and this is associated with a faster progression to kidney failure. Lowering cholesterol will almost certainly slow kidney damage.
• Stop smoking. A very good study revealed that smoking cessation slows kidney damage by 30%.
• Follow a weight-loss diet, if you are overweight, and a protein-restricted diet. Obesity may cause increased protein in the urine and promote damage to the kidneys. Weight loss is proven to be effective in slowing kidney damage. Even if you are not overweight, we may suggest a modest protein-restricted diet that is proven to slow kidney damage.
• Avoid pain pills such as Advil®, Aleve and Motrin®. These medicines are known as nonsteroidal anti-inflammatory pills, and they are proven to potentially harm the kidneys.
• Neutralize excess acid. Damaged kidneys cannot get rid of the body’s acid normally. It is not yet proven in humans that neutralizing your acid will slow kidney damage, but it is proven to prevent bone damage and muscle wasting
• Take vitamin D. Damaged kidneys do not produce enough active vitamin D. It is not yet proven that vitamin D supplements will slow kidney damage, but we think that it might. Vitamin D also plays an important role in supporting healthy bones and fighting infections.
• Control phosphorus levels. Phosphorus plays an important role in supporting healthy bones, but when you have kidney damage the phosphorus levels become too high. It is not yet proven that decreasing phosphorus levels slows kidney damage, but it will certainly help prevent bone damage. A diet and/or medication may be prescribed.
• Treat anemia. Damaged kidneys do not produce enough of a specific hormone, erythropoietin (EPO), which normally instructs your body to build blood. It is not yet proven that giving this hormone will slow kidney damage, but it will improve your energy, your heart and probably your lifespan!

There are several reasons why a primary physisican refers to a kidney specialist. Some of them are

• If the Kidney function indicators(Creatinine, BUN, eGFR) are not in normal range
• If Kidney function indicators are worsening
• Sudden change in renal function.
• Low or high sodium
• Low or high potassium
• Kidney stones workup and treatment
• Kidney cysts workup and follow up
• Renal diet advice
• Uncontrolled/Resistant hypertension

• Your appointment will be confirmed by our office 1-2 days prior to it.
• Please fill the registration form online or fill out a printed form before the appointment which can reduce wait times.
• Print out, Fill in and sign the Notice of Privacy practices, Access to private health information form Acknowledgement of Review of Notice of private practices forms available on the website(under the New Patient appointment tab).
• Also bring all the medications and blood tests (for the last few years if available) on the date of appointment
• You can also print out the Medication log, BP log prior to appointment which may be helpful during the appointment
• The appointment typically lasts for 30-45 minutes. You may be asked to give an urine sample
• Printed format of lab slips for blood tests and urine tests will be given if needed
• As appropriate, date for subsequent appointment will be given by the office staff at the end of the appointment