The sneakiest of conditions

Zoomer | December 1st, 2002

Of all the organs in the body, the kidneys are perhaps the most secretive. If you enjoy good health, you’re hardly even aware of them.

“But the kidneys are sneaky organs,” says Dr. David Churchill, professor of medicine (nephrology division) at McMaster University in Hamilton. “You never know there’s a problem until the situation is serious.”

“Kidney disease primarily affects people in their later years,” says Dr. Churchill, “and the number of older Canadians experiencing kidney failure has more than doubled in the past 10 years. In fact, 50 per cent of new patients diagnosed with kidney failure — an estimated 4,500 annually — are 65 or older.”

However, Dr. Churchill is quick to point out that recent studies indicate early identification and treatment can improve the disease’s outcome, perhaps even delaying the start of dialysis, a process used to clean the blood once the kidneys have failed to function.

Each the size of a clenched fist, the kidneys are situated on either side of the spine under the lower ribs. When working properly, they do an excellent job of cleaning the blood at a rate of a litre a minute (water and wasteroducts are separated from the blood; much of the water is reabsorbed, and the waste concentrated into urine). But it’s this very efficiency that can be their downfall.

“The signs and symptoms associated with kidney disease aren’t apparent until they’re functioning at 10 per cent of normal,” says Dr. Churchill. “It’s why people over 60 should undergo regular testing, especially urine analysis. “A failure to participate in regular screening practices often results in kidney disease not being detected until a patient has been diagnosed with another condition, in particular, diabetes, high blood pressure or urinary tract obstructions.

Fighting anemia
For David Seyler of St. Albert, Alta., the anemia that accompanied his kidney disease was draining. “I hardly wanted to get out of bed in the morning.” After two years of weekly self-injections of a hormone to raise hemoglobin levels — a treatment Seyler dreaded — his doctors switched his medication to Aranesp. His hemoglobin levels are now being maintained in the target range, and the number of injections has been reduced to one every three weeks.

“I have so much energy now. I garden, I walk an hour a day,” says Seyler. “This drug has made a heck of a difference in my life.”

Next page: Signs and symptoms of kidney disease

Signs and symptoms of kidney disease

  • High blood pressure.
  • Puffiness of eyes, hands and feet.
  • Passage of bloody, cloudy or tea-coloured urine.
  • Protein in the urine.
  • Excessive foaming of the urine.
  • Frequent passing of urine during the night.
  • Less urine or difficulty passing urine.
  • Fatigue.

    The Stages of Kidney Disease
    Chronic renal failure (CRF) is an irreversible condition characterized by progress-ively impaired kidney function. The early stage of CRF (when kidneys no longer function properly but don’t yet require dialysis) is known as chronic renal insufficiency (CRI). Over time, CRF progresses from CRI to end-stage renal disease (ESRD), when patients no longer have adequate kidney function to sustain life. Without dialysis or a kidney transplant, ESRD is fatal.

    • Patients with CRF often suffer from anemia, a complication that occurs when the kidneys no longer produce sufficient erythro-poietin, a hormone that stimulates the production of oxygen-carrying red blood cells (RBCs). When RBC levels drop, the body adapts by drawing blood away from those organs capable of functioning with less oxygen (the kidneys), ensuring a continued supply to the two most important organs — the brain and the heart.

    “If someone has anemia due to kidney failure, it can be corrected by supplying a manufactured version of the natural hormone erythropoietin. The first available form of erythro-poietin is injected anywhere from one to three times a week,” says Dr. Churchill. “While it works extremely well, advances have been made that now allow for less frequent dosing with a new form of erythropoietin.”

    Called Aranesp (known generically as darbepoetin alfa), this new treatment maintains its levels in the blood three times longer, allowing it to treat anemia with less frequent injections. Aranesp was approved for use in Canada in August 2002, and its use in Canada has been increasing steadily since then. Its effectiveness at raising hemoglobin levels with the added benefit of fewer injections is improving the lives of CRF patients.

    “Aranesp’s main advantage,” says Dr. Churchill, “is that it requires considerably less frequent injections than other therapies, making it easier and more convenient for patients as well as the medical profession, caregivers and health-care facilities.”

    This Special Sponsored Feature was produced by the editors of CARPNews 50Plus with an educational grant from Amgen Canada Inc.