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Medical Conditions Doctors Miss

So you're sleepy a lot and maybe a little blue, and your blood pressure is on the high side. It could be stress, or these and other common symptoms could be signs of serious medical conditions that doctors sometimes overlook.

Chronic Kidney Disease (CKD) continued...

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 10 to 20 million Americans have chronic kidney disease. Of those people, 7.4 million have less than half the filtering capacity of a healthy young adult.

Researchers asked the latter group if they had ever been told they had weak or failing kidneys, and only 20% of the men and 5% of the women said their doctors informed them of their condition. The rest, a majority of people with CKD, didn't know they had the illness.

So many people don't know they have the disorder, because both doctors and patients are not aware of the risk for developing CKD, says Thomas H. Hostetter, MD, director of the National Kidney Disease Education Program.

The biggest risk factors for CKD are high blood pressure, diabetes, and family history of the disease. "People who have those conditions, and often their doctors, aren't aware that they're at risk for kidney disease so they don't get tested," says Hostetter. "But even if they have the test -- the most common (test) is the serum creatinine -- doctors don't often interpret it correctly."

Creatinine is a substance that is normally filtered from the body. If the kidneys are filtering wastes properly, there is a low level of creatinine in the blood. When filtering capacity of the kidney drops, there is a rise in blood creatinine levels.

One problem with this test is that creatinine levels don't rise that dramatically until kidney function is almost completely diminished, says Hostetter. Another problem with the test is that the amount of creatinine in the blood and urine is not only determined by filtering capacity, but by muscle mass as well. The greater the body's muscle mass, the more creatinine produced. This factor makes it more difficult to determine kidney disease in women.

"Women have lower muscle mass on average, and so it takes more kidney disease to drive their creatinine up because they start at lower levels," says Hostetter, noting that the same phenomenon of lower muscle mass and lower creatinine levels happens with the elderly and smaller people. He recommends that doctors take into account the patient's age, sex, and race in estimating kidney filtering capacity.

Patients can educate themselves on the risk factors of CKD and ask their doctors to test them if they think they're at risk. Risk factors include:

  • Age. The kidney usually begins to shrink at about age 35.
  • Race. Complications of kidney failure appear to be more common in certain ethnic groups, namely blacks, Native Americans, and, to a certain extent, Hispanics.
  • Sex. Men have a higher risk of developing CKD than women.
  • Family history of high blood pressure, diabetes, polycystic kidney disease, and chronic kidney disease. Both diabetes and hypertension are major causes of chronic kidney disease. Polycystic cystic kidney disease is one of several inherited illnesses that can cause kidney failure.
  • Hypertension
  • Diabetes
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