1. Kidney Notes

2. Where Are the Kidneys? There are two kidneys, one in each side of your back…around the area where your waist is. Each kidney is about the size of your fist Each kidney contains a million little machines called nephrons. Q. If you have 2 kidneys how many nephrons do you have? A: 2 Million!!

3. What is a Nephron? It is a filtering machine that has two main parts –The Glomerulus is a ball of tiny blood vessels that receives blood from the body and takes out (filters) some of its fluid –The Tubule is a little tube that collects fluid and does even more filtering.

4. What Happens in the Tubules? In the tubules, chemicals and water are either put into the fluid or taken away. At the end of the tubule, the fluid becomes urine. Eww!

5. How Much Fluid do the Kidneys Handle? About 189 liters of fluid every 24 hours.About 189 liters of fluid every 24 hours. Less than 2 liters are removed from the body every day in the form of urine,Less than 2 liters are removed from the body every day in the form of urine, So about 187 quarts are returned to your blood stream from the kidneys.So about 187 quarts are returned to your blood stream from the kidneys.

6. The kidneys are SOOO SMART! They are powerful chemical factories that: Remove waste from our body Remove drugs form our body Balance the body's fluids Control the amount of salt, potassium and acid in the body Make hormones that control blood pressure Make active vitamin D that promotes strong, healthy bones Control when red blood cells are made

7. The Kidneys and Chemical Balance Kidneys control when salt, potassium and acid can leave your body. When you eat, you produce acid that the kidneys get rid of in your urine. Did you know that if you are a vegetarian you make less acid than if you eat meat? Some patients have to take bicarbonate (baking soda) to neutralize the acid!!

8. The Kidneys and Acid When your kidneys fail, they can’t get rid of the acid, so more and more stays in your body. Your cells don’t like all that acid, and your body cannot grow well. If you have this problem, a daily shot of growth hormone can help you grow.

9. The hormones What is a hormone? A chemical signal Made by one part of the body Travels through the blood Starts or stops activity in another part of the body.

10. The Kidney-Bone Connection Parathyroid gland: located in your neck that makes hormones that control growth of your bones Acidosis If your kidneys fail, they can’t get rid of acid. In time, you may have too much (acidosis) Acidosis sends the wrong message to the parathyroid The parathyroid makes hormones that tell your bones not to grow. Your bones may get thin, become weak, even break.

11. The Kidneys and Phosphorus If your kidneys fail, they cannot get rid of the phosphorus that you eat. High phosphorus causes bone pain or weak bones that may break The phosphorus can stick together and clog up your blood vessels. When your kidneys fail you will need to Change what you eat (less phosphorus) Take medicines that stick to the phosphorus in your intestines, before it gets into your blood!

12. The Kidneys-Heart Connection The heart pumps your blood When the heart squeezes the blood into your blood vessels (arteries), the moving blood pushes against the sides of the arteries. That pushing force is your blood pressure. Two numbers are checked for your blood pressure Systolic pressure (bigger number) = how much pressure when your heart is squeezing the most Diastolic pressure (smaller number) = pressure when your heart rests between beats. Example: 120/80

13. The Kidneys-Heart Connection When your kidneys fail, your blood pressure may go up High blood pressure can lead to health problems, like heart attacks and strokes that damage your brain

14. The Kidneys-Bone Marrow Connection Kidneys make a hormone called erythopoietin (EPO) EPO tell your bone marrow to make new red blood cells When kidneys fail they stop making EPO Then your bone marrow cannot make enough red blood cells (anemia) Shots of EPO 1-3 times each week can get your red blood cells back to normal

15. The Kidneys-Brain Connection When your kidneys fail, you may not be able to learn as well as other classmates, because Toxins (poisonous substances) that are normally filtered out of blood by the kidneys slow down your brain Anemia keeps your brain from getting oxygen and also slows it down High blood pressure can cause a stroke (bleeding inside your brain)

16. Chronic Kidney Disease A problem with the kidneys that gets worse and worse. It can’t be cured, but it can be controlled.

17. Did you know that CKD is what is called “silent”? This means that you do not feel different, because your body has no major problems. Doctors can tell how sick your kidneys are with blood tests By the time you feel sick, your kidneys may already be very, very sick

18. What You Should Learn Causes of CKD Stages of CKD and Treatment Long-term outcome with CKD

19. What Causes CKD? You were born with it (birth defect): your kidneys or urinary tract had problems growing before you were born You were born with it (familial disease): kidney disease runs in your family, but problems may not happen for several years. You got it after you were born (acquired): your kidneys got sick for some other reason (even your doctor may not know exactly why)

20. Stages of CKD There are 5 stages, based on how well your kidney is working (we measure this by testing the creatinine level in your blood). Stages 1 and 2: kidneys still working well. Normally you will not need medications Stage 3: kidneys not working as well. You will need some medications

21. Stages of CKD Stage 4: kidneys not working well at all. You will need more medicines, including shots in some cases Stage 5: kidneys are not working (full renal failure). You will need something else to work for them: –Kidney machine: dialysis –New kidney: transplant –You stay in Stage 5 and go back and forth between kidney transplant and dialysis

22. Dialysis There are 2 kinds for chronic kidney failure Hemodialysis – blood leaves your body, gets filtered and returns Peritoneal dialysis – fluid goes in your belly and leaves with toxins, acid, etc.

23. Transplant The most common way to help people sick with Stage 5 Kidney Disease Many people “waiting in line” on the transplant list to get a new kidney You can get a kidney from a family member or a friend (shortest wait) or from someone who died (longer wait). New kidney lasts for several years –will last longer if you take your medicines correctly.

24. Loss of a Kidney Transplant “Loss” means your new kidney stops working. You’re back at Stage 5. Why does that happen (to teenagers)? –The #1 reason you lose your new kidney is NOT taking your medicines What happens then? –You wait (years) for another kidney transplant. –In the meantime, you go back on dialysis. TAKE YOUR MEDICINES!!

25. Why do teenagers not take their medicines? There are several reasons you might not: You don’t understand your medical condition You believe that nothing bad will happen You want to be “normal,” like everyone else You “don’t feel sick” to begin with, so not taking the medicines doesn’t feel any different.

26. More reasons teens don’t take their medicines? You don’t see any “real problems” or direct consequences if you miss your medicines. –“It’s no big deal.” You don’t think that the health team can tell when you’re not taking medications.

27. Guess What? When teens don’t take medications health providers notice changes. There are several: You’re not growing as you should Tests of your blood show –Medication levels that are too low or too high –Kidneys that aren’t working. Problems are found during physical examination at the doctor’s office

28. So can health providers really tell when teens don’t take their medicines? YES, without a doubt. But….health providers can also help you remember to take your medicines…ask them for suggestions!

29. What can you do to remember your medicines? Put all your medicines in a container that has little cubbies for each day of the week. Take your medicines at the same time every day Pick something you already have to do every day and always take medicines at the same time –Getting dressed –Eating your breakfast –Brushing your teeth

30. Do you have suggestions to other teenagers about how to remember to take your medicines?

31. Long-term outcome of CKD Most people who have CKD before age 18 live to become adults! New medicines and treatments only work on people who are alive. You’ll be on your own sooner than you think You need to learn how to manage your disease without the help of your parents.

32. Your medicines: what you need to know Why do you take each of your medicines? What problems (side effects) can happen with your medications Which other medicines “don’t mix” with yours and can cause problems if you take them together. Read the label on the container: –When do you need to take them? –How much should you take? –Are there special instructions (like taking with food)? Call for refills 2 weeks before you run out!

33. Your Medical Appointments Come to the appointments with at least 3 questions for your nurse or doctor Before you leave each appointment, make sure the next appointment is already set up and you can make it Don’t miss your medical appointments

34. Your Diet Restrictions WHAT: Learn about the food you can eat WHY: Understand the reasons you have to avoid certain kinds of food DON’T: You should avoid pre- packaged and pre-made food. Fresh food will help keep your kidneys healthy.

35. Exercise! The more active you are, the healthier your kidneys and heart will be. Check with your medical team before starting physically demanding or contact sports

36. Do not smoke! Smoking can speed up damage to your kidneys, even if you’re doing everything else perfectly!

37. Do not drink or use illegal drugs Alcohol can make your blood pressure go up and can cause your kidneys not to work as well. Drug use may interfere with taking needed medications. Some drugs “don’t mix” with your medications and make them not work or cause serious side effects. Other drugs may be “kidney poisons” (nephrotoxic). Protect your kidneys. Do not take risks.