Routine Checkups Can Detect Kidney Disease Before Problems Arise

By Andrew Wilson

The National Kidney Foundation says one in three people in the U.S. are at risk for kidney disease, but many will not realize it until kidney disease is quite advanced.

“Kidney disease can be silent until it is quite advanced,” said Matthew Pesacreta, M.D., Chief of Nephrology at St. Clair Health. “Most people who have kidney disease do not show visible symptoms. The way we detect kidney disease is through a blood test called ‘creatinine,’ which is a muscle breakdown product that is supposed to be cleared out of the body through the kidneys. So, when the kidneys are not functioning properly, the creatinine level accumulates. We are then able to utilize a formula that takes into consideration the blood level of creatinine, patient's age and gender to determine an estimated percent of kidney function, the glomerular filtration rate, or ‘GFR.’ Urine tests can also be helpful. The presence of blood or protein in the urine can sometimes indicate a kidney issue even if the GFR is normal, or above 90 ml/min.”

That doesn’t mean that there are never any visible symptoms though. In an advanced state, Dr. Pesacreta says that compromised kidney function can lead to accumulation of fluid in the body, which manifests as swelling in the legs or shortness of breath. In addition, the buildup of toxins the damaged kidneys are unable to eliminate can lead to poor appetite, weight loss and fatigue. These signs are usually not present until the kidney function is 15 percent or less.

The color or consistency of the urine is often less important, but there are certain conditions that present with abnormal urine. “If the urine is exceptionally foamy or very dark, or cola colored, that potentially indicates kidney disease,” he said.

Patients are usually referred to a nephrologist when kidney function is about 40 to 60 percent. Although kidney function declines as we age, that doesn’t mean that all older people have kidney disease.

“An average 70-year-old without kidney disease may only have 80 percent kidney function when measured by the estimation calculators. We all lose some kidney function as we age, approximately 1% per year as we reach our 5th decade,” he said. “The two most common causes of kidney disease are diabetes and high blood pressure.”

Dr. Pesacreta notes a sedentary lifestyle and cigarette smoking aren’t direct causes of kidney disease, but they complicate treatment of high blood pressure and type 2 diabetes, which do cause kidney disease.

“While I can’t say smoking is a direct cause of kidney disease, like it is for lung cancer, as a nephrologist, I can say smoking tends to accelerate every bad process in the human body,” he said. “Smoking accelerates heart disease and can make high blood pressure more difficult to control, which can then cause kidney disease.”

Dr. Pesacreta considers one oft-repeated piece of advice for keeping kidney disease away to be a myth, and that is the belief that increased fluid intake will reduce your risk of developing kidney disease. He says that there is no evidence to suggest that is true, instead he suggests practicing a healthy lifestyle.

“A healthy lifestyle helps reduce your chances of developing kidney disease,” he said. “Drink when your thirsty, maintain a reasonable weight, eat a healthy diet, get regular exercise, and follow-up regularly with your primary care physician. High fluid intake is sometimes recommended, but that is in preventing kidney stones and for people with earlier stages of Polycystic Kidney Disease - the most common type of inherited kidney disease - but not the general patient with chronic kidney disease.”

Kidney disease is rarely able to be reversed, but that doesn’t mean that there is no hope. The same advice about maintaining a healthy lifestyle applies for people who have already been diagnosed with kidney disease.

“If you’ve been diagnosed with kidney disease, let’s control what we can control; the underlying factors,” Dr. Pesacreta said. “Get your diabetes under control, get your blood pressure under control. While a healthy lifestyle and weight loss doesn’t directly improve kidney function, if you improve the underlying factors then you can slow the progression of kidney disease.”

He said there are first line blood pressure agents (Angiotensin converting enzyme inhibitors and Angiotensin receptor blockers) and medications that were initially developed for diabetes, SGL2 inhibitors, that are demonstrating very good results and extending kidney life far more than it was even five or 10 years ago.

For those with very advanced disease, dialysis may be the only option. The National Kidney Foundation reports that 557,000 people are currently on dialysis.

“Some people hear the word ‘dialysis’ and equate it to a death sentence,” Dr. Pesacreta said. “That isn’t the case. People are living with dialysis longer than ever before, and we are aggressive with getting our patients evaluated for transplant once their kidney function is less than 20 percent, so some patients never end up on dialysis, they are transplanted first.”

One group of over-the-counter medication to be aware of is non-steroidal anti-inflammatories (NSAID), better known as ibuprofen or by brand names like Motrin, Naproxen, Meloxicam, or Aleve.

“The vast majority of over-the-counter medications don’t cause kidney damage, and short-term usage of NSAIDs won’t cause problems either, but excessive or prolonged usage can cause kidney damage,” Dr. Pesacreta said.

Treatment options depend on a number of factors, including age of the patient, cause of the kidney disease, and especially how early they are referred to a nephrologist.

“If someone is referred late, there is less in our wheelhouse to intervene. For instance, the SGLT2 inhibitors are not recommended for a GFR less than 25 ml/min, and the use of ACE or ARB therapy to control high blood pressure may be more complicated in advanced kidney disease related to other electrolyte problems. Lastly, once patients see us it is a bit of a wakeup call that they need to be more aggressive with their overall health,” he said. “The best advice continues to be maintaining regular visits with your primary care physician, which can lead to early detection, and being cognizant of the elements of a healthy lifestyle.”

Dr. Matthew Pesacreta is Chief of Nephrology at St. Clair Health. He specializes in nephrology and is board-certified by the American Board of Nephrology and the American Board of Internal Medicine. Dr. Pesacreta earned his medical degree from the University of Pittsburgh. He completed internal medicine residency at UPMC, where he also completed fellowships in geriatrics and nephrology. Dr. Pesacreta is affiliated with Teredesai, McCann and Associates and was named a Top Doctor by Pittsburgh Magazine in 2024. He sees patients at 1597 Washington Pike, Suite A22, Bridgeville, PA, 15107. He can be reached at 412-489-6919.