JAI RADHAKRISHNAN, MD: That's absolutely correct, Lisa. There are two issues here. The first is that you have a tremendous amount of reserve in the kidneys before any symptoms manifest, and typically we don't see patients come in with any problems until they're down to about 25 or 30% below normal. The second issue is that the symptoms that accrue from kidney damage are so vague that you might easily ascribe it to something like depression or fatigue from working too hard, and in reality there's a lot of damage being done in the kidney that could lead to a lot of problems like high blood pressure and anemia. Again, it's basically difficult to detect.
LISA CLARK: Now, you are specialists. It would behoove a general practitioner to really acquaint themselves with the symptoms and warning signs of various kidney diseases, and as you say, that's a very difficult thing to do, but let's talk about some of the things that your doctor might look for that you might look for, say, in acute situations.
LEONARD STERN, MD: You might look at it from a slightly different perspective. The general practitioner that sees a patient will typically do screening blood work, and the majority of the time, the patients that we would see would be people whose blood work is abnormal, where some measure of kidney function -- we use a marker called the serum creatinine, which is a general gauge of kidney function. When that number is elevated, then the general practitioner might suspect that there is something awry with the kidneys.
Another screening test the general practitioner could use would be urinalysis, where they look for the presence of protein or inflammatory cells. Sometimes the blood work, in addition to the creatinine, might give the practitioner a clue that there's a problem. The serum protein level, the albumin, might be reduced, or the lipid levels or cholesterol might be elevated. All could be features of subtle kidney disease.
