Protecting Your Kidneys: Vital Tips from a Nephrologist

March is National Kidney Month. Kidneys are two bean-shaped organs that filter wastes and extra water out of our blood and make urine. Damage to your kidneys means they can’t filter blood the way it should, which could lead to kidney disease. Our guest for this episode is Leo Yamaguchi, M.D., associate program director and vice chief of clinical services for the TTUHSC School of Medicine's Internal Medicine Division of Nephrology. Dr. Yamaguchi explains how our kidneys work, some of the causes of kidney disease, how we can keep our kidneys safe and why we might want to consider becoming an organ donor. 

Transcript

Melissa Whitfield  0:09 
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, healthcare providers and researchers. March is National Kidney month. Kidneys are those two bean shaped organs that filter extra water and wastes out of our blood and make urine. Damage to your kidneys means they can't filter blood the way it should, which could lead to kidney disease. Our guest for this episode is Dr Leo Yamaguchi, a nephrologist with Texas Tech physicians. Dr Yamaguchi explains how our kidneys work, goes over some of the causes of kidney disease, what we can do to help keep our kidneys safe, and why we might want to consider becoming an organ donor.

Melissa Whitfield  1:02 
Dr Yamaguchi, welcome to our podcast.

Dr. Leo Yamaguchi  1:11 
Thank you. It's very good to be here.

Melissa Whitfield  1:13 
How are you today?

Dr. Leo Yamaguchi  1:14 
I'm very good and yourself.

Melissa Whitfield  1:15 
I'm very well. Thank you. Thank you. Can you tell us a little bit about yourself, your expertise and what you do here at the Health Sciences Center?

Dr. Leo Yamaguchi  1:25 
Yes, my name is Leo Yamaguchi, originally from Portland, Oregon, and then did my med school out in Nebraska, with my clinical years in Phoenix, and then residency in Las Vegas, and then my nephrology fellowship in San Diego. I just started working here in October, and I'm very excited working on a lot of projects already, so it's been a lot of fun.

Melissa Whitfield  1:43 
Well, welcome to Texas and Welcome to Texas Tech University Health Sciences Center.

Dr. Leo Yamaguchi  1:47 
Yes, thank you.

Melissa Whitfield  1:47 
So as you mentioned, nephrology, you're here to talk to us about kidneys. And can you just explain to us what do our kidneys do? What's their function?

Dr. Leo Yamaguchi  1:57 
To keep this as simple as possible, you know, your kidneys help keep your body in a balance. You know, they clean your blood, they remove waste and toxins. They reabsorb nutrients, regulate volume, regulate bone health, acid base, blood pressure. So very simply, those are the main roles of the kidney. There's a lot of the lot they do. And you know, we talk a lot about all these little things with our patients, and it's been fun being a teacher. You know? It's one of the things I think a nephrologist is as a teacher and teaching patients to advocate for themselves and understand these complex medical problems and making them as simple and understandable as possible.

Melissa Whitfield  2:36 
What is kidney disease and what causes it and what are some of the symptoms?

Dr. Leo Yamaguchi  2:43 
Kidney disease is kind of a blanket term, but essentially, it's a progressive damage and loss of function in the kidney and its ability to do kind of things I just mentioned about regulating and cleaning the blood and regulating volume and blood pressure and toxins. So when your kidney gets weaker, its ability to do those things can can be hindered a bit. So the causes of kidney disease, there's many different causes, but I think the main ones, you know your kidneys like a filter, so just with age, your filter is going to degrade over time, just like the rest of your body, right? So age is a factor, but other variables could be high blood pressure, diabetes, obesity, those are all common things that can contribute to the weakening of the kidney or kidney disease.

Melissa Whitfield  3:31 
We all have two kidneys. Do they work in tandem? Or does one work and while the other one takes some time off or?

Dr. Leo Yamaguchi  3:38 
Yeah, so we have two kidneys. They work together to do the daily job of the kidneys, if you will. You know, some people have certain diseases or predispositions where one kidney may be working a little bit harder than the other. You know, some people get damaged to one kidney in particular. So again, usually all things being normal, kidneys work together, but there are instances where one kidney can take over a little bit more function than the other.

Melissa Whitfield  4:06 
So kidney disease, I know you mentioned, it's kind of a blanket phrase, but is there a cure, and what kind of treatment is there?

Dr. Leo Yamaguchi  4:14 
So there's no cure for kidney disease, unfortunately, and when I tell a lot of my patients is, you know, when your kidney gets damaged, it scars and we lose that function forever. So really, the focus of the treatment is mitigating that injury. So for you know, for age, unfortunately, there's nothing we can do to slow down time. But for diabetes, high blood pressure, or obesity, those are all things that we talk to patients a lot about how to control and how do we optimize these things to minimize further injury to the kidneys.

Melissa Whitfield  4:46 
What does it mean when someone's kidneys fail? And is that the same as renal failure?

Dr. Leo Yamaguchi  4:51 
Yeah, so it's kind of like tomato, tomato, a little bit. You know, we talk about kidney failure. It's kind of a spectrum, right? We classify these by stages. But typically when we use kidney failure and we talk about someone's kidneys who really can't do the day to day demands the body needs, to the point where these toxins, the volume, the blood pressure, get out of control, and we really need something to help, and that something is is usually in the form of dialysis. And we have many different types of dialysis, but in general, I don't, I don't want to get too into details of all that. But, you know, in general, dialysis is a form of treatment when your kidneys fail. The other thing we talk a lot about is kidney transplant as a form of treatment for kidney failure. You know, I know here, that's something we're trying to get going here in Lubbock kidney transplant program. But yeah, those are kind of the main things we talk about when we talk about kidney failure.

Melissa Whitfield  5:44 
So kidneys failing and renal failure are the same?

Dr. Leo Yamaguchi  5:47 
Yes, you know, I don't use those specific words because I think they're not as specific when I talk to my patients and again, teaching them, you know, part of that teaching is understanding the stages and talking about, you know, what is CKD five or chronic kidney disease stage five mean, what percent kidney function do you have? And when do we start talking about dialysis? So I don't use those exact terms. I like to be a little bit more specific. But yes, some people use that general term as well.

Melissa Whitfield  6:17 
It's what people Google.

Dr. Leo Yamaguchi  6:18 
Yes, yes.

Melissa Whitfield  6:19 
So you just mentioned that kidneys, once they start failing, they can't heal themselves. Does drinking a lot of water help or is there anything else that people can do to help?

Dr. Leo Yamaguchi  6:30 
So I get asked that a lot in clinic, a lot of patients think drinking more water is going to help their kidneys recover. And although that statements not, it's not wrong, but I think really, it goes back to understanding what causes, what caused their kidney disease in the first place. So, for example, when I, you know, tell patients if I'm really sick, I'm vomiting, I'm having diarrhea, you know, I'm not eating and drinking. If that happens for a long enough time, I can't sustain some injury to the kidney, and that scenario, drinking fluids to keep up with your losses makes sense, right? You know, a lot of times I tell patients, you're you're like this cup of water, and when you're really sick and you're not eating, drinking your water gets really low and you need to replenish that. So that's when water can help protect the kidneys. Now, in chronic kidney disease from diabetes or high blood pressure, this damage has occurred over a long period of time, and water is really not going to change that variable too much so, and especially when your kidneys get quite weak, its ability to regulate volume whatever you put in can go awry. And if you drink too much water, it can actually cause a problem. So again, educating patients a lot about drinking to thirst and what the appropriate amount of water is, is something you do a lot in clinic.

Melissa Whitfield  7:48 
How can we protect our kidneys? And as we mentioned before, you mentioned transplants. So some people will have only one kidney. How are they extra careful? And also, I think some people have been on medications for a long times, and there's always, you know, the ad to say, this might harm your kidney. How worried should we be?

Dr. Leo Yamaguchi  8:06 
Yes, that's a good question. How do we protect our kidneys? I think that really goes back to understanding what we think the cause of the injury is in the first place, and optimizing those things. Again, diabetes, blood pressure, weight control, are the big ones that I usually deal with in clinic, there are medications from our end. You know, as a doctor, there are medications that can help prolong kidney health that are proven in evidence in the data. So we talk a lot about who is an appropriate candidate for those particular medications, and how do we start these medications and monitor for side effects? We talk about that a lot. So really, it comes down to identifying the cause. From a patient perspective, you know, they can optimize those things, and from a physician perspective, how to protect the kidneys, providing certain medications that can decrease the stress, if you will, that's put on the kidneys. Some people do only have one kidney. Can be congenital, can be lost from trauma. Some people have kidney cancers, and you know, they have to get a kidney removed. Those patients initially will lose about half their function. It makes sense. You you have two kidneys. You lose one. You're 50% of what you were. But the kidney does have a remarkable ability to to grow and compensate to a degree. So initially, you know, as soon as that kidney gets removed, you'll lose 50% but over some period of time, you may regain some function back. And it's hard to tell you exactly how much that is, but it's again, something that we can watch closely and counsel patients. You know now that you have one kidney, your reserve is a little bit less than what you used to have, so your ability to handle injury is less as well. So you may be more prone to more significant injury when you compare someone that has two kidneys versus one

Melissa Whitfield  9:50 
For those around us with kidney transplants or donors, kidney donors, is there anything we can do to help support them?

Dr. Leo Yamaguchi  9:57 
Yes, you know, I think the biggest thing. Thing that someone can do is, if they want, is to become an organ donor. I'm one myself. You know, giving an organ to someone who needs it to survive. I think it's an incredible gift, and I've opted to participate in that. Again, it's not meant for everyone, but it's an option that you can do. You know, the demands really high and the supply is really low. And just to give you some perspective on numbers, 12 people die every day while waiting on the kidney transplant list. And there's about 90, when I looked, there's about 90,000 people in the US that are waiting for a kidney right now. And in 2022 about 25,000 kidney transplants happened. So the demand is way bigger than the supply. So you know, one thing we can do as a population is, if you're interested donating your organs, you know, unfortunately, if you pass, that's an option. Another option too is, is living donation. So for example, if you know someone that that's affected by kidney disease and their kidneys are weak enough where the kidney doctor is starting to talk to them about kidney transplant as an option, family or loved ones or friends can offer to donate a kidney to that loved one. Now the matching process is a little bit complicated, but to keep it simple as I can, you know you can be a match, where you can actually donate your kidney to your the person who needs it, your loved one. That's one scenario. The other scenario is where you aren't a match. So where does your kidney go? Well, it can actually go to someone else, and the kidney that they were going to get from their loved one could actually go back to you. So it can be kind of, we call it a chain. I mean, it can be a chain event where you may not get your loved ones kidney, but you'll get someone else's living kidney through the matching process, organ donation process, so that's another way we can advocate for kidney transplant. And then, in general, just being supportive of the decision. It's a big surgery, it's a lot of follow up. And you know, one of the criteria for for getting a transplant just not medical, but it's a social support. Do you have someone that can take care of you? And getting involved in those discussions is really important, and a criteria to even get at kidney.

Melissa Whitfield  12:06 
Is there anything else that you would like to add?

Dr. Leo Yamaguchi  12:09 
You know, I'm really excited to be here in Lubbock. You know, we have a lot of expansion goals as a division. I think one of our things is growth. So we're trying to open up a clinic in La Mesa to reach patients a little bit more south of here, there's a high need for. We're also trying to partner with oncology, the cancer center, to open up a kidney cancer specific clinic. A lot of the new therapies out there for cancer, you know, unfortunately, can affect the kidneys, and having someone to watch that closely is important. So that's kind of a sub specialty within the division we're trying to grow. And, you know, we're working closely with UT Southwestern for kidney transplants, advocating for that as well. And, you know, making sure we let all our patients know that this potentially is an option for you, and how to how we go about, you know, seeing if you're a candidate. So there's a lot of projects within our division that we're excited about to really hopefully will help the community here.

Melissa Whitfield  13:06 
That's amazing. I hope this happens too.

Dr. Leo Yamaguchi  13:10 
Yes.

Melissa Whitfield  13:11 
Well again, thank you so much for coming to our podcast. We hope to have you again sometime soon to talk about all these projects.

Dr. Leo Yamaguchi  13:17 
Yes, of course. Thank you very much.

Melissa Whitfield  13:18 
Thank you.

Melissa Whitfield  13:21 
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be substitute for professional medical advice. Always seek immediate medical advice from your physician or your healthcare provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.