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Johns Hopkins Bayview News - Knowledge is Power

Summer 2011

Knowledge is Power

By: Sara Baker
Date: July 1, 2011

Learning the causes, signs and treatment options of renal disease could save your life

patient and husband
Clementine Smith was back to traveling just three months after her kidney transplant.

Have you ever heard of chronic renal disease? You might not be familiar with this disease, which causes the kidneys to slowly lose function over time, but chances are you are very familiar with the two common conditions that usually cause it. High blood pressure and diabetes account for two-thirds of the cases of chronic renal disease, which affects an estimated
11 percent of adults over 20 years old. Anyone with these risk factors or a family history of kidney disease should understand the signs and symptoms of chronic renal disease, and take a proactive approach to the health of their kidneys.

Understanding Renal Disease

Clementine Smith didn't know what to think, but she knew she wasn't herself. "I was extremely tired," says the 62-year-old Baltimore resident. "Sometimes it was a struggle to get out of bed." She also felt bloated, and her ankles were swollen.

Smith visited her primary care doctor, who diagnosed her with chronic renal disease. She had both high blood pressure and diabetes, the disease's two most common causes. Smith was referred to Duvuru Geetha, M.D., a nephrologist (kidney specialist) at Johns Hopkins Bayview, to learn more about her diagnosis and treatment options.

Chronic renal disease affects the kidneys, the two bean-shaped, fist-sized organs located on either side of the spine that filter waste and excess water from the body. Over a matter of months or years, people with chronic renal disease lose kidney function until their bodies are no longer able to properly filter waste. Patients reach end-stage renal disease once their kidneys are functioning at less than 15 percent. At this point, dialysis or kidney transplant become necessary.

Knowing Is Half the Battle

When Dr. Geetha determined that Smith's kidneys were functioning at a level that required dialysis, she had a wealth of resources available. Johns Hopkins Bayview has a strong reputation in renal medicine; it was the first hospital in Baltimore
to offer dialysis and to perform a kidney transplant. Although dialysis is offered on campus, Smith elected to be trained for home dialysis. "I wanted my routine to be as normal as possible," she says. With the help of her husband Neddie, Smith set
up her dialysis each night before she went to bed. "Dialysis is an interruption to your lifestyle, but it keeps you going," says Dr. Geetha, noting that because of better treatment options, chronic renal disease no longer carries a death sentence. "I have patients who are still going strong 30 years after their transplants," she says.

Most patients do not experience  any symptoms of chronic renal disease, especially in its early stages, but that doesn't mean it can't be caught early on. In fact, early detection is  your best bet for a favorable outcome, says Dr. Geetha.

"We can do things to prolong the life of the kidneys," she says. "The worst thing you can do is wait." She recommends regular blood pressure screenings, urinary analyses and blood tests, especially if you have high blood pressure, diabetes
or a family history of kidney disease. If it's caught early on, Dr. Geetha can help counsel patients on ways to slow down their loss of kidney function through diet, exercise, quitting smoking, avoiding medications that are toxic to the kidneys, and controlling blood pressure, blood sugar and cholesterol levels.

Return to Normalcy

As Smith was working with Dr. Geetha to manage her chronic renal disease and performing her home dialysis, she also was working with the transplant team at The Johns Hopkins Hospital. The Johns Hopkins Kidney Transplant Program was one of the first in the nation, and performs about 320 kidney transplants each year. Although there is no cure for chronic renal
disease, "transplantation is as close as we can get to normal," says Dr. Geetha. In April 2007, Smith got the phone call she had been waiting for, that the transplant team had a kidney for her, and it was a match.

Just three months after her transplant, Smith returned to doing what she loves best, traveling with her husband. That celebratory vacation to Las Vegas has been followed by many more, including a recent trip to visit friends and family in Germany. Smith continues to have regular blood work done to make sure that her kidneys are functioning properly, and meets with Dr. Geetha regularly to discuss the results. She takes medicine to control her blood pressure and diabetes,
and exercises to maintain her fitness level. "Today, I feel so blessed," says Smith.

Support for Chronic Renal Disease

The DaVita Dialysis Center, located on the Johns Hopkins Bayview campus, offers an end-stage kidney disease education class that is free and open to the public. Topics covered include dialysis and transplant options and renal diet recommendations.

First Thursday of every month 1 p.m.
For more details, call 410-558-9004.

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