Let’s Talk About Kidneys

No day is ever the same for a nephrologist. Dallas Nephrology Associates’ Dr. Paul Skluzacek may see his kidney patients in the office, have hospital rounds, dialysis rounds and much more. In this episode of Let’s Talk About Kidneys, learn about Dr. Skluzacek’s busy days providing patient care and how his schedule changes from one day to another.

Nephrologists are kidney doctors. They have special training that includes completion of medical school followed by a residency in Internal Medicine and then additional specialty training in Nephrology.

They treat systemic conditions affecting kidneys, such as diabetes, an autoimmune disease, as well as hypertension (high blood pressure) and electrolyte disturbances.

Reasons to see a nephrologist may include:

• Protein or blood in the urine
• Uncontrolled high blood pressure
• Kidney stones
• Chronic kidney disease (CKD)
• Kidney failure
• Vascular access management
• Transplant care

For a nephrologist, each day is different. Hours may be spent seeing kidney patients in an office-based setting at the clinic, running tests as well as interpreting them. They also prescribe medicine and treatments, conduct hospital rounds and visit their patients at dialysis centers.

Nephrologists also spend time making notes on their patients’ physical conditions and advise them how to stay healthy.

“The clinic patients are the outpatients that we see in the office,” says Dr. Skluzacek. “The focus there is to preserve their kidney function, protect their kidneys and keep them out of the hospital.”

Patients who are admitted to the hospital are there because their kidney illness is more serious.

“They can be as sick as being on the ventilator in the ICU to patients that are there just for severe hypertension or high blood pressure control,” Dr. Skluzacek says.

With a schedule that includes practicing at four locations across the Dallas-Fort Worth Metroplex, Dr. Skluzacek says he spends a lot of time on the road. He also sees his dialysis patients once a week.

“The vast majority of things we can handle over the phone now because we have access to the electronic health records through the Internet,” he says, “but probably about half of the time, I have to go in and see a patient.”

Dr. Skluzacek believes that compassion is an important part of being a physician, especially if you are a nephrologist.

“Patients with kidney disease have complex illnesses, and it's hard to navigate the healthcare system,” says Dr. Skluzacek,” so we as providers need to be compassionate, not only with the patients, but with their families and their other situations.”

Your first visit to the doctor after being diagnosed with kidney disease can be a big deal. Tune into this episode where Dallas Nephrologist Dr. Michael R. Wiederkehr breaks down what to expect at your first visit with a nephrologist at Dallas Nephrology Associates.

Nephrologists – experts in kidney care – treat conditions that affect the kidneys.

Primary care physicians run routine blood or urine tests. When these results are abnormal, it could indicate that something is wrong with the kidneys. In this case, the primary care doctor will refer the patient to a nephrologist.

Other reasons to see a nephrologist include conditions that affect the kidneys. These include:

• Kidney stones
• Diabetes
• Hypertension (high blood pressure)
• Electrolyte disturbances

Dr. Wiederkehr says the first appointment is longer than most appointments.

“You can expect to be present for about an hour because I need to get to know you and discuss some things that I couldn't quite understand from your records,” Dr. Wiederkehr says.

During the visit, the nephrologist is working to create a comprehensive picture of your kidney health and look at how other conditions may be affecting your kidneys.

Blood and urine tests are typically run, and frequently, a kidney ultrasound is arranged at an outside facility. In some cases, a kidney biopsy might be needed, but Dr. Wiederkehr says this is not typical.

An exam is performed that focuses on the kidneys and the organs that are affected by them. The heart, lungs and legs are examined to look at circulation and find out if any swelling is present.

On your first visit to Dallas Nephrology Associates you will need to bring:

• Insurance card
• Drivers license or photo identification
• Completed health history
• All medications you currently take. Be sure to bring the medications rather than just a list of them.

After the first appointment, a follow-up visit will be scheduled to discuss the exam and test results. After the follow-up visit, the appointment frequency will be determined by your situation. Patients with conditions that need urgent attention will see their nephrologist sooner and more frequently.

“I think as a rule, if you're a new patient with us, I will see you back in two to three months if it's something that's not urgent,” Dr. Wiederkehr says.

Disclaimer

Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity or organization they represent. The views and opinions expressed by DNA employees, contractors or guests are their own and do not necessarily reflect the views of DNA or any of its representatives. Some of the resources identified in the podcast are links to other websites. These other websites may have differing privacy policies from those of DNA. Please be aware that the Internet sites available through these links and the material that you may find there are not under the control of DNA. DNA shall have no responsibility for the accuracy, legality or content of the external site or subsequent links. Contact the external site for answers to questions regarding its content. The resources included or referenced in the podcasts and on the website are provided simply as a service. DNA does not recommend, approve, or endorse any of the content at the linked site(s). The content provided on this website and in the podcasts is not medical advice and should not be used to evaluate, diagnose, treat, or correct any medical condition. The content is solely intended to educate users regarding chronic kidney disease, end-stage renal disease (“ESRD”), end-stage kidney disease (“ESKD”) and related conditions, and ESRD/ESKD treatment options. None of the information provided on this website or referenced in the podcasts is a substitute for contacting a healthcare professional.

When most people think of sodium, they think of salt. In this episode of Let’s Talk About Kidneys, Dallas Nephrology Associates’ Senior Clinical Dietitian Carolyn Cochran breaks down what sodium is, how to identify it in common foods and ways to make lifestyle adjustments for healthier kidneys.

Sodium is one of three important electrolytes found in the body. Electrolytes control the fluids going in and out of your body’s tissues and cells.

“Sodium is essential for life,” Carolyn says. “It's in animals, vegetables, minerals and is important for muscle function, nerve function, and for fluid balance.”

Many types of salt are used to season food. A survey conducted by the American Heart Association found that more than 60 percent of respondents thought that sea salt was healthier than table salt. But whether you’re using kosher salt, table salt or Himalayan black salt, Carolyn says all salts are equal.

“The bottom line is that they all contain sodium and the amount of sodium is comparable,” says Carolyn.

Sodium is an essential nutrient in your body. One of the jobs of the kidneys is to keep sodium in balance, Carolyn says. If sodium is out of balance, your body’s fluid balance is also affected. This can affect muscle and nerve function.

Many people have a sensitivity to salt, which can be exhibited in high blood pressure, also known as hypertension. High blood pressure is the number two cause of chronic kidney disease (CKD), second only to diabetes.

In the U.S., 2,300 milligrams is considered a healthy target. Carolyn says that the average U.S. citizen will consume 3,500 to more than 5,000 milligrams of sodium per day, especially when dining out. A low-sodium diet is about 1,500 to 2,000 milligrams.

Only a small percentage of the population who experience excessive sweat loss due to exercise–such as athletes–need more sodium. But Carolyn says most people could benefit from a low-sodium diet.

A teaspoon of salt has 2,000 milligrams of sodium, but sodium isn’t just found in a salt shaker. Many foods have “hidden” sodium.

“Sodium grows out of the ground. Sodium is in animals. It is just everywhere,” Carolyn says. “So you've got to give credit to those first 500, maybe even 600 milligrams of sodium, and then you can start counting (your sodium intake).”

Getting into the habit of reading labels is important for anyone who needs to track their sodium intake. At the top of the label, the serving size can be found. The size of the portions are determined by the manufacturer. The sodium content is found near the middle of the label and is measured in milligrams.

To the right of the sodium is a percentage of the recommended amount of sodium in a diet, but Carolyn says to remember that this number might not be the percentage that you are aiming for if you’re on a low-sodium diet.

If you need help managing your sodium intake, Carolyn suggests talking to your doctor about Medical Nutrition Therapy. Dallas Nephrology Associates has registered dietitian nutritionists who are experienced in helping patients who have renal disease.

“We realize that every person is complex and that many things need to be taken into account,” Carolyn says.

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. Then, Dr. Cindy Corpier and her patient and colleague, Tiffany, talk about the patient aspect of kidney disease and how to successfully manage diet, medication, and daily care when dealing with kidney disease and transplant.

What to Know About Kidney Transplant Surgery

The patient may go home on day four or five after surgery in routine transplant surgery. Then, the patient is put on a post-transplant schedule to monitor the transplant, especially when it comes to patient compliance with immune-suppressing drugs. Typically, each weekly visit takes about 90 minutes to dive into the patient’s health.

Best Practices for Visiting Your Nephrologist

Dr. Corpier has recommendations on best practices to be an involved participant in your healthcare when your nephrology visits. First, she recommends that the patient bring a family member or advocate to help them process the information and ask follow-up questions. In addition, taking notes in between your visits, along with questions for your doctor, are helpful to keep the patient informed and involved in their healthcare. Finally, a good doctor will address the issues you feel are most important, along with your doctor's concerns for your health.

Disclaimer

Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. READ FULL DISCLAIMER

Take a behind-the-scenes look into the world of DNA with real examples of our values in daily life. Dr. Cindy Corpier shares the basics of kidney care, early detection and preventative actions for a kidney transplant, and how to develop a care plan with a healthcare team.

What to Know About Kidney Failure

Kidney failure can often happen without any symptoms, which is why Dr. Corpier supports screening events, such as ones sponsored by the National Kidney Foundation. Usually, a patient is referred to a nephrologist late, and Corpier describes some of the frustration and grief that comes with not being able to help some 10, 15, or even just 5 years earlier.

Treatment varies depending on the cause of the failure. For some diseases, there isn't a specific treatment. Blood pressure medicine or other medications can often remove or delay the need for dialysis or transplant. Both dialysis and transplantation have specific criteria and processes for approval, which Dr. Corpier explains.

Misconceptions About Kidney Disease

A common misconception is that a transplant is a cure. This isn't true, even if a patient may not like to hear that. Transplantation and dialysis are reserved for people who have or will lose all kidney function. So the goal, Dr. Corpier explains, is to restore normal function or maintain the current state of function. But neither are cures in the sense that a patient's life will be the same after.

People also tend to believe that they won't suffer from kidney disease because they are young, healthy, or take care of themselves. But kidney disease is often a result of blood pressure, diabetes, or other unexpected diseases. Dr. Corpier tries to be as transparent as possible about the treatment process, including what to expect during evaluations and post-operation.

Life After Kidney Disease

For patients, Dr. Corpier recommends keeping their health information organized and accessible, especially if they're post-transplant. Keeping a list of all your medications is at the top of her list. She doesn't expect patients to remember every number--that's what physicians are for--but encourages knowing your own body's baselines, especially when traveling, visiting new specialists, or in case of an ER visit.

Everyone would like to go through life without worrying about their health. But because a transplant isn't a cure, Dr. Corpier and all physicians at DNA seek to find the middle ground between treatment and life. In Dr. Corpier's words, the purpose of your life is not to be a patient. It's to live your life.

DISCLAIMER

Dallas Nephrology Associates’ (DNA) podcast series, Let’s Talk About Kidneys, is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA.

READ FULL DISCLAIMER (https://www.dneph.com/podcast-disclaimer/)