The Solution

First, kidney failure has to be identified, and then, measures to treat it must be undertaken. The United States is shockingly deficient in both areas.

Symptoms of kidney failure don't appear until most of kidney func tion has already been lost. However, people at risk for kidney disease can check their own urine using simple tests, and get their physicians to check their blood for problems early on. If more at-risk people found out earlier that they had kidney disease, they could markedly improve their future health by taking effective steps immediately.

This book lets people know about the available and effective treatments (many of which can be done in their own home) that can slow the progression of kidney disease. By these means, people can delay dialysis or transplantation for as long as possible or even totally avoid either procedure.

The treatment I describe alleviates symptoms markedly. Appropriate care for kidney failure includes a very-low-protein diet, with supplements, as well as blood pressure control and specific therapies to regulate the metabolism of sodium, potassium calcium, phosphorus, and acid, and to correct anemia, high blood cholesterol, and high blood uric acid (which causes gout). Certain drugs are helpful and others are contraindicated. Transplantation, which has become more successful but is limited by the number of donors, may become more widely available; this book discusses how.

Note: This book does not discuss children with chronic kidney disease. As children are treated at Johns Hopkins exclusively by pediatricians, I have no experience caring for them.

Ella Johnson, a 49-year-old schoolteacher came to Johns Hopkins in 1994 for treatment. She suffered from polycystic kidney disease, an inherited kidney disease that consists of cysts in the kidneys. Her mother had also had polycystic kidney disease and had been treated here for several years. Ella also had high blood pressure and recurrent urinary tract infections. Her left kidney could easily be felt during a physical exam, and was therefore considerably enlarged. She was placed on a low-protein diet supplemented by essential amino acids. She also started fish oil capsules and gets regular exercise. During seven years of follow-up, her kidney failure has progressed very slowly. The rate of loss of her kidney filtration capacity, also known as glomerular filtration rate, is only 1.8 ml per minute per year, compared with an average rate of about 7 ml per minute per year in patients with polycystic kidney disease. At this rate, she will be well into her 70s before she needs dialysis or a transplant.

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