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
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
- 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
- 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.