After being diagnosed with kidney disease of any kind, many people will be faced with a lifetime of doctor visits, specialists, lab tests, dietary and fluid restrictions, and changes and the looming possibility of dialysis or the need for a kidney transplant if the disease continues to progress.
Medications and diet will be important to keep this from happening, which makes it even more important for the patient to pay careful attention to what is said by the nutritionist during each stage of kidney disease. While some will be lucky enough to slow or stop the progression of the various forms of kidney disease, it is very important to note that even if you do everything the way that you are supposed to, the disease may still move forward and become more serious.
One of the things that you will have to deal with is the constant need for many lab tests, which starts with a blood draw or a urine sample. In those who have serious kidney disease, a port may be placed so that the doctor can have constant access without having to puncture a vein each time. The port can also be used to give medications and can be more convenient, but can also be problematic because it needs specific care either by the patient, the patient’s family or, in some cases, a visiting nurse or care provider.
Some of the lab tests that you will need to have during treatment for kidney disease include:
Serum creatinine: muscle activity in the body creates creatinine, a waste product that is normally removed by the action of the kidneys. This tends to be one of the first waste products that start backing up in the blood vessels, which marks the start of kidney trouble.
Glomerular Filtration Rate (GFR): this rate determines how well the kidneys are functioning. A GFR that is below 30 indicates a problem and will warrant the need for a nephrologist (a kidney specialist). Any GFR below 15 indicates that the problem is serious and there will be the need for dialysis, and it may indicate the impending need for a kidney transplant.
Blood Urea Nitrogen (BUN): when the body breaks down proteins, not only from the foods that you eat but from normal metabolism as well, urea nitrogen is formed. This normal waste product is usually filtered from the blood by the kidneys and can rise if the kidneys are failing or if the patient is eating more protein than the body can effectively handle. The BUN can drop if the patient is eating too little protein as well.
Urine Protein: protein is a vital macronutrient, used by the body for a very wide range of systems and functions. Your body also creates some protein from other forms to be used for other reasons. The kidneys filter protein and protein byproducts from the bloodstream when they are working correctly; however, when they are not, protein will accumulate in the urine. Although there are other instances when protein can be detected in the urine, persistent, detectable protein levels in the urine is an early sign of impending kidney disease or damage.
Microalbuminuria: in those who are at higher risk for kidney disease, including those who have other conditions like high blood pressure or a very serious family history of kidney disease, this test will be used to detect even very small amounts of protein in the urine before the amount gets high enough to be detected by less sensitive tests.
Ratio of Protein to Creatinine: for some patients, the doctor will ask for a 24 hour sample of collected urine, which will show him how much protein is found in the urine each day. This test can be complicated because it relies on the patient collecting all urine for a full 24 hours, storing the container in their refrigerator and then bringing it to the lab the following day for testing. Instead, the doctor may choose to use the protein to creatinine ratio, which will estimate the amount of protein that is excreted in the urine instead.
Serum albumin: the body uses protein that it gets from food to create other types of protein, amino acids, hormones and enzymes. Albumin is one of these body proteins. Low levels of this in the blood can be caused by not receiving the adequate amount of protein in the diet or enough calories. It is also important to note that the body cannot store protein and needs new sources of it every day. Even a small amount of blood albumin can cause serious health problems, including the inability to fight off infections.
Normalized protein nitrogen appearance or nPna: this test is often used by the doctor to tell if you are eating enough protein or, in some cases, too much. The testing is done by collecting urine and blood samples, and you may be asked to keep a food diary as well.
Subjective Global Assessment (SGA): this testing may be asked for by the nutritionist rather than the kidney specialist and is used to check for symptoms of nutritional problems. The testing is done by asking questions about the daily diet, completing a weight check and a check of the fat and muscle amounts in the face, arms, hands, shoulders and legs.
Hemoglobin: the blood is made of several parts, including the hemoglobin, which is the part of the red blood cells that work to carry oxygen from the lungs to the rest of the body. A low level of hemoglobin indicates anemia. Treatment for anemia includes iron and a specific hormone.
Hematocrit: this is the measure of how many red blood cells your body is actually making. A low value for this test also indicates anemia.
TSAT and Serum Ferritin: these tests both measure iron in the body.
PTH or Parathyroid Hormone: an imbalance of calcium and phosphorous in the body can result in high levels of PTH and can cause bone disease.
Calcium: because calcium is vital to healthy bones and may be leached out during some forms of kidney disease, the level will be checked.
Phosphorous: a high level of this mineral can lead to weak bones. The doctor and nutritionist may put you on a phosphorous-restricting diet and may also give you a medication that will bind the remaining phosphorous in foods.
Potassium: this mineral is needed by the body so that the heart and other muscles work properly. The level of potassium has to be balanced or it will weaken muscles and can lead to heart irregularities.
(Source: National Kidney Foundation)
Blood and Urine Tests, Good Nutrition and Protein Supplements: A Case Study
Dave has kidney disease. At this point, he does not need to have dialysis; however, he does come to the lab very frequently to have blood work and to give a urine sample. He has had to do the 24 hour urine collection a time or two and is glad that the doctor has switched to using the protein to creatinine ratio instead. His overall diet was fairly healthy, but the nutritionist suggested that he change his fat intake to healthier Omega-3 fatty acids over the other, less healthy fats that he was eating and to increase the amount of protein and calcium in his diet. He will include a protein supplement because he’s had a lower appetite lately.
After trying protein shakes, Dave started using a new supplement, Profect, from Protica. Because it is so small, Profect can be consumed in a few seconds. While it only has 100 calories per serving, it gives Dave a high amount of digestible protein. He aims for two servings of Profect each day and then tries to increase his dietary protein from healthy plant sources for the rest of the day. On days when he simply cannot eat healthfully, he ups his intake of Profect to maintain his levels.