Good afternoon everyone and welcome to another edition of bdo’s kidney talks my name is sunna Hy and I am a program manager at the GW liver and pancreas Institute for Quality um today’s kidney talk is sponsored by the GW Ron and joy Paul Kidney Center molp the minority tissue
And Transplant education program the Pennsylvania Avenue Baptist Church and of course blackdoctor.org today’s presentation should be very interesting we’ll be discussing kidney terms that every patient should know our amazing presenter is going to be Dr Keith malanson the chief of transplantation at the George Washington University Hospital on our panel for
Today is Dr Clive cender who is a professor of surgery and also the founder of the minority tissue and Transplant education program so please get your questions ready sit back and enjoy the webinar Dr milans son take it away thank you sunna it is uh always a
Pleasure to be here uh of course it’s always great to be with the great uh Dr Calender and um and I’m glad that you’re here as well sunna and we and hopefully this will be an engaging talk that will get the public to ask us a lot of
Questions uh about kidney disease and what leads to kidney disease and what ways you should know you might be developing kidney disease I just got a little grab bag of some of the more common terms because these are the things that uh the sort of things that
People always ask me out in in the public so I figured it would be a good opportunity to discuss these specific terms and then you know like I said open it up to questions and see what the audience might have to ask so um with that let’s have the presentation we’ll
Go to the first slide It’s always important to stay hydrated um this is espresso I I do drink espresso but water is the most important fluid um all right so here you go kidney terms everyone should know next slide all right we’re going to start
With GFR this is the popular one this is what everybody wants to understand what is GFR okay here you go it stands for glamar filtration rate and what you need to understand about your kidneys is that interspersed throughout that entire organ and remember your kidney’s about I
Have a a little model right here right this is your kidney it’s about the size of your fist so this kidney well actually this a liver I just realized but it’s a liver but anyway the kidney is about the size of your fist okay and
Um so if you put your fist up that’s the normal size of your kidney interspersed all throughout that kidney are these tiny little engines called Glarus and in when we’re in medical school we learn to look under a microscope and see what a glus looks like and it looks like a
Little ball of spaghetti and the spaghetti are the little vessels and that’s how blood goes into into the kidney and then urine is pulled out of the blood liquid is pulled out of the blood and then out as urine okay so the GFR stands for how well those little engines inside your kidney
Are working now um you have thousands upon thousands upon tens of thousands of these little factories that work nonstop inside your kidney and as long as they are healthy and working well there’s you’re not going to have any problems with with kidney disease but when people start to develop kidney disease usually what’s
Happening is the glome are diseased in some way and when you look under the microscope you can see the disease the gleri start to die so what you’re measuring by a blood test you can actually measure how well the glami are working because the better your your um
Kidneys are filtering the junk the uh pollutions in your blood it gives us an estimate of how well the glami are actually working it would be like um every day driving down your street and determining how well the the garbage workers are doing their job just by
Looking at the amount of trash cans that have not been emptied that’s how we in Medicine by looking at the blood can tell how well the G how well the the the kidneys are working because you should have very little de debris left in your blood blood as your kidneys chug through
Your um your blood through the out um the blood through the kidney and then urine out um through your bladder so a bigger person is naturally gonna have a little bit more debris than uh a smaller person you know muscle mass matters because muscle is one of the main
Instruments of producing lots of toxins muscles are good but they also produce more more toxins and therefore you need better kidney function the more muscular that you are so here I basically said that it’s a blood test and it measures how well your kidneys are functioning
And a normal GFR will vary by your age because we all will lose some gamilla function over time sex men tend to have bigger kidneys they also tend to have more muscle and and like I said everything de lines with age so the magic number if there’s a magic number
The magic number is n zero okay now that’s interesting anyone that’s ever looked at their lab reports might might have recognized the fact that a lot of lab reports will report your GFR as normal if it’s greater than 60 and that’s not really ACC accurate
Because you know a GFR of 60s is is okay I mean it’s pretty good but it’s not normal for most uh people if you’re you know middle AG or younger right so um you want your GFR to be 90 to be tot or or above you
Know 100 you to be totally normal and um and so that would be a question to ask your provider is if you could be tested to determine exactly how high is your GFR and the reason why I I stress that is because there are five stages of
Kidney disease and the first two stages of kidney disease your GFR can still be pretty high so you want to know if there’s a change in your GFR right because a change from from uh year to year could connote something starting to go wrong but you wouldn’t know that if
You’re just looking at um um a test that maxes out at 60 in other words if you go from a GFR in in TW say say in 2020 your GFR was 85 okay it’s 85 but if you you got a test that maxes out at 60 it’ll say greater than 60
And then in 2022 your GFR dropped from 85 to 65 again your test is maxing out at 60 you wouldn’t even realize there’s a 20 point drop in your GFR and that’s important to know and you know when you have early changes in kidney in your kidney function that’s when it’s most easily
Treated un unfortunately Dr caler will tell you that most patients that’s not when they get diagnosed with kidney problems they get diagnosed later and the and the later you get diagnosed later meaning the the more your kidney function has declined and the more your kidney failure or or chronic kidney
Disease has progressed the more of a problem it is so you want to catch this sort of stuff early preventative medicine is the best medicine prophylactic medicine is the best medicine in in other words you want to make sure you’re doing the right things before anybody tells you there’s a problem next
Slide all right so what is CKD CKD is chronic kidney disease I’ve had numerous patients that have come to me and remember I’m a transplant surgeon so is Dr calender so when we are seeing patients they’re usually already diagnosed they’re usually at the end of the road that’s why they’re seeing a
Transplant surgery we’re not primary care position now of course Dr calender has made his career in as is in trying to make us be better at primary care right so so so although we are tertiary quantin care he with his organization motep what he has done is to try to get
People to understand very early in the process if they are at risk of things like kidney disease and that’s why in The Ron and joy Paul Kidney Center we brought in motep in order to help us do what he has done so effectively as his entire career so the reason why I say
That here is I’ve had numerous patients that you know I I can go back and look in their chart and I’m and I’m seeing in the diagnosis CKD and the patient coming to me and saying I just found out I had kidney disease I just found out oh I was so
Surprised I I went to the emergency room and um and they told me I need to start dialysis and I go back in the last five years somebody’s been putting CKD in their chart so why is it that the doctors or the healthare providers have diagnosed this
Person with a problem that the person doesn’t know they have you know and I put the blame on both parties uh but the issue is knowing what is in your chart now given the way things are today there’s no excuse I mean everybody uh well I shouldn’t say everybody but most
Of us who uh go to the doctor you have the ability to go into my chart and it’s different at different hospitals but you can go in and see your own test results you can go in and see the notes from the doctors you can go in and see the
Diagnosis that they’ve put into your charts and you should be doing that you should know everything about what the doctors are putting in your chart because to be quite Frank sometimes erroneous stuff is put into people’s charts and you want to find it right um I can give you some hilarious and onic
And um uh examples but I’m not I’m not going to give them all right now but you know I can tell you later but the point is CKD stands for chronic kidney disease and it’s a problem okay let me say that again chronic kidney disease is a
Problem no one should ever tell you oh you got yeah you it’s okay or you’re fine or it’s not a big deal it’s a big deal okay if somebody’s put CKD in your chart it’s a problem because most CKD progresses all right I just said that there were five stages of kidney
Disease the first two stages most people miss so you’re usually getting diagnosed at stage three and stage three is a precarious situation because you’re right on the fence you’re right on the border of no return because once you get to stage four that’s it that’s once you get to
Stage four you are going going to progress to inst stage renal disease which we’ll talk about but and and and and um instage renal disease means you need to be on dialysis usually and that’s what everybody hates they hate the concept of being on dialysis but what should be happening is you should
Get diagnosed a lot earlier so CKD means you have some kidney dysfunction so remember I told you a normal GFR is is 90 once you get below that then you’ve got CKD right I mean unless you’re 80 years old your GFR should not be below 90
Right so if as your c as your GFR drops then you get branded with this CKD uh moner now what can happen is no one may have discussed this with you your physician or provider may not have they the computer May generate this as a diagnosis um in the chart you know
Computers do this kind of thing and with artificial intelligence it’s only going to get worse right um I just hope computers can’t start operating anytime soon I I got to keep my job for at least another 20 years to pay for these kids but anyway let’s not get into my
Problems see Dr Calendar’s good I mean Dr Calendar’s kids are all grown up and he they vited through college and law school and whatever but I still have some uh some college tuition uh but Ai and these computers these fancy computers they’ll just automatically generate this put it into the bill and
Um and there you go so you can have this diagnosis and no one may have in in detail have discussed this with you right but CKD is a problem you need to be asking a lot of questions and really what you should do if I was you this is
What I would do if they if somebody put CKD on my chart then I want to see a CKD specialist I’m done having conversations with primary care doctors I need somebody that can talk to me about CKD and that would be a kidney doctor a nephr
Right you need to see a specialist all right and one of the you know we see these Divergent paths that people with good insurance and and higher income travel and people that don’t have good insurance and private in I mean yeah good insurance and and high income and
One of the early Divergence uh Divergent points is how quickly you see a specialist all right and Specialist Care when you need it you know because we’re really good about this in America to be honest this is one of the things in our medical system that we’re probably
Better than the rest of the world and that’s in super duper subspecialized medicine right so for for your heart surgeries for your brain surgeries for your transplant surgeries this is the place to be right where we don’t do a good job is in the primary care catching
Things Early you know um women having babies um Pediatrics these sorts of I look before some pediatrician calls in angry I’m not saying we don’t have good pediatricians I’m just saying that when you compare America to the world the world um the Civilized World outside of America does a better job with primary
Care than we do so since our Specialists are so good we should utilize them and and that means if you get branded as having CKD you need to see a kidney doctor all right and chronic kidney disease means you got a disease you got a problem and and and you need to be
Taking up certain strategies to preserve your kidney function right and and usually that means if you have diabetes you need to not have diabetes you need to be trying to treat your diabetes if you have high blood pressure you need to make it normal right it’s not rocket
Science right that’s why I love medicine it’s not complicated it’s very linear but you know when you got a problem you got to fix it okay and we’ll get to some of the causes later next slide all right in stage renal disease all right now this is the point of no return
Right remember I told you once you get to to ckd4 you’re headed to ESRD and that’s ckd5 and ckd5 which is in stage renal disease means your kidneys are are are not being able to keep up anymore you you you now have so much kidney disease that you
Need help and um and without that help you would die so that help is either going to be dialysis and there are a few types of ways you could get dialysis hemodialysis either at home or in a center most people go to a center or parital dialysis which is usually at
Home with a machine that clears your your um your blood overnight so um that is the point of no return and it’s very unfortunate and um in the United States we’ve got over a million people that have that have CKD you know that they’re million actually it’s millions of people with chronic
Kidney disease unfortunately if you take all the all the different um stages and uh within stage renal disease you got over a half a million people so six 700,000 people in this country are on dialysis there are millions of people that have um CKD you know about 10
Million people so there’s a lot of people with CKD and we only do about 25,000 kidney transplants per year so it is it is a huge problem once you get to inst stage renal disease because your life is so very much shortened when you don’t have kidneys that function well
Which is why you want to do everything in your power to avoid it and you can avoid it even when you get diagnosed with CKD and I hope that’s the take-home message today if is that if you have early kidney disease it’s not not the
End of the world but dude you need to be waking up you know it’s like the end of that Spike Lee movie for all you Le fans um not uh you see what was it called um um not do the right thing what was the one with all the
Fraternities soona did you see it you know um school days that’s right school days so at the end of school days the L the lar the Larry fish Fishburn um character says wake up remember he screams it out wake up well that’s what you need to do if you’ve been diagnosed
With chronic kidney disease you need to wake up and by the way Suna got that right because she is a member of the divine nine um I think she’s a Zeta yeah yeah she’s a Zeta yeah I’m just joking I’m just joking Suna I know you’re not a
Zeta um she is an AKA but all right moving on let’s go to uh the next slide Dr cender is a member of the Divine n as well um he didn’t make it into cap alpas size so I think he’s another one of those other fraternities but anyway next
Slide creatinin I get this question all the time and I’m sure you get it as well Dr CER what is creatin again remember earlier in the talk I I was talking about how the more muscle you have the more um waste products that are are produced and creatinine is one of those
Waste products and this comes from you know eating protein and it also comes down from comes from your own breakdown of creatinine and it’s a great way to look at the function of of your kidneys because it’s easily measured in your blood and your creatinine should stay at
A normal rate no matter how much meat you eat no matter how um rigorous of an exercise that you will complete like you can imagine if you go out and run a marathon you’re going to get a lot of creatinine generated in your blood just from all of
The muscle breakdown but someone with a normal kidney they’re just gonna flush it out but it’s one of the reasons why when you’re doing very rigorous exercises particularly when you’re getting dehydrated your urine starts to darken well that’s because of the creatinine that’s being generated okay
So it’s normal to have creatinine in the blood and um and you’re always going to have some but the better your kidneys work the lower the creatinine is going to be so what is a normal creatinine well normal creatinine is gonna vary based on how big you are right so a big
Muscular person you know someone who 6 foot6 and 250 pounds uh a creatinine of 1.4 would be perfectly normal but that’s a huge male and then if you have a woman who is you know 5 foot two and 90 pounds well for her to have a creatin of 1.4 is
Gonna be a problem right so that’s why I say don’t focus on the number because that number is is it it it’s variable number one and then number two it it it’s all subjective you know based on on how large you are so um you you look at
The creatinine but then you also have to look at the GFR and they both need to coincide so you would want to have a nice low creatin a number like 1.0 or or 0.9 and a GFR which takes into account your size a GFR greater than 90 so if you got a low
Creatinine and a and a and a high GFR then you have normal kidney function but here’s the the rub and I I I mentioned this earlier you still need to be uh monitoring what your numbers are doing because I guarant gue you the doctors will often miss this in other
Words if you’ve got a creatinine that’s still in the normal Zone however it’s increased that’s that’s something to take note of same thing with GFR so like I said last year your your GFR was 95 and this year it’s 85 last year your your your um creatinine was 0.8 this year it’s 1.2
But all those numbers are in the normal range but the but you’re moving in the wrong direction and when you’re moving in the wrong direction it could be a benign reason but you never assume it’s a benign reason you need to you need to get confirmation and the only
Confirmation would be to have tests repeated to hydrate maybe change some things and and sometimes what you need to change is some of the things that could be harmful to your kidneys you know um I I’ve said on this show before I have four um boys and you know they
All are athletes and they all work out and they all like to take supplements you know I’ve been through this all with every single one of them and um and and and protein and protein shakes and powders can be safe but they can be unsafe too so you always need to be
Mindful of how much of that stuff you’re taking um creatin which sounds and looks kind of like creatinine creatin is a a supplement that a lot of young uh bodybuilders like to take or people young athletes like to take and uh and again it can be safe in small amounts
With a lot of water but it can be a problem as well so you got to be mindful of all that people have this misconception if they get something from the health food store or from The Vitamin Store it’s somehow healthy I mean you know I remember um a
A gentleman telling me once that um marijuana is good for you because it comes it’s a weed it God created it it comes out of the earth and I explained to him I was like you realize like any medicine you can think of comes out of
There it comes from a plant usually so that that’s erroneous to believe that all these herbs and vitamins are somehow healthy just because they’re vitamins or herbs are natural no don’t don’t believe that because U oh oh now I’m gonna quote something else soon um Public Enemy uh
Don’t believe the hype don’t before your time soona but that was a great song so you know you got to understand um that you what is healthy is what’s healthy for you right so for you taking a certain supplement may not be working well it may interact with some of your
Other medications and that’s the other thing happened to my own I’ve said this on the show before happened to my own mother taking herbal medicine in place of doctor medicine right somebody somebody thinks oh well the the doctor wants me to take this stuff you know
That comes from industry and the man or whatever but I’m gonna not take that and take what I have now um gone and bought in the health food store my mom a registered nurse a brilliant woman um she is my mom uh but decided she was
Going to do that with her blood pressure medicine and it was not it was not good that that that that did not end well for her her blood pressure was not well treated with herbal medicine um so she’s fine today but she did have a heart
Attack before she learned so um I I hope that this message gets out there because I know there’s a lot of that in the community but um and I and look I’m not saying I’m I’m not a big supporter of the pharmaceutical industry but I’m telling you if a doctor is telling you
You need a medicine for a certain reason then here’s the experiment you could do if you want and that’s what I tell my patients well if what you think works for your blood pressure works better than the medicine that the doctor check um gave you well then do a simple
Experiment check your blood pressure on your herbal medicine and if it’s working then fine then I’m wrong but if it’s not then you’re wrong right so you got to do the that’s what my mom didn’t do she didn’t do the experiment she just started taking the herbal medicine
Thinking she was gonna be fine she wasn’t but anyway that’s creatin U and like I said we could talk about more about it in a second all right next slide bu this is another one that people see in in in in Wonder and this is blood
Ura nitrogen and this is part of the interface between the kidney and the liver because you know you have this this this Nexus this network in your body you got the heart the kidney and the liver the heart and the kidney are two pumps and the liver in the kidney
Are the two filters uh the liver has an additional additional function that it’s the master um uh assembler of the body the liver is taking all this stuff and putting it together in certain ways for metabolism anab ISM all this stuff your liver is not working well you you you
Are really in having a big big problem but your liver is taking fats from the blood and and and organizing them into like my cells and into cholesterol and and lipids and all that kind of stuff and it’s taking proteins and un undoing them from one one type of protein
Turning them into another but your liver is doing all this fancy stuff and then it excretes toxins into the blood that goes into the kidney and then the kidney urinates it out and they they work together and bu is one of the things that you will see it’s kind of like what
We were talking about with creatinine about the garbage men coming and you can tell that they’re cleaning the street every day well if if your bu should stay at a pretty low number a normal bu would be like 10 12 something like that and if
Your bu is starting to go up then that means something is aai um it could be kidneys but it also could be liver okay or you could have some other GI problem but your bu should be in the normal range and one of the fastest way
For your bu to go up out of the normal range is to be dehydrated so a high bu with a normal creatinine tells us that you’re probably just dehydrated but it’s another number that you can look at to determine normal kidney and liver function next slide hypertension okay again I always
Like to bring this up whenever I give a talk but what is high blood pressure I recently was in Louisiana um for a funeral and um once again you know have to talk to everybody at the funeral and hear all of their medical problems uh but I was surprised at the fact that
Most people still don’t get what don’t get it you know um I’m talking to many of my cousins I have a huge family in down in Louisiana good people all of them uh Louisiana is God’s country and you gotta love gota love all the people down there um they they they don’t eat
The healthiest though to be honest it’s good food I mean it’s the best in the world but it’s not it’s not that healthy so I’m talking to all my cousins friends and everybody and and and invariably half of them have high blood pressure so I’m talking to to them about high blood
Pressure and I’m like okay um are you so you’re you’re getting your blood pressure treated okay all right well how’s it running what’s your blood pressure what how’s it running oh it’s fine yeah no it’s good my doctor my doctor say everything’s fine yeah yeah yeah I understand but what’s the number
What’s the number just I I need the number oh oh you know oh it’s like um this morning it was like 150 50 over 95 oh 150 over 95 oh yeah yeah guess what that’s high that’s high yeah that’s a problem that’s a problem yeah you you
You need something else oh I know you’re taking your medicine yeah I understand I understand but you need more you know I mean people don’t get it so I I tell everybody what’s a normal blood pressure that top number shouldn’t be above 140 the bottom number should not be above 90
And and Dr CER will tell you this is being liberal because you know most doctors think that your numbers should be a good bit lower than this they should not be really they would say 130 as the high for systolic and and 80 should be the high for for diastolic
Right so if you’re above 149 you’re really you I mean this is treatable range which is why I put it on here this is you need treatment you know you can do funny things you know funny things meaning weight loss exercise um when you’re right at the borderline but what
When you’re when you’re this High you need treatment and I I I will tell my patients and my family look I get that you’re going to change your diet I get that you’re going to exercise and that you can get your blood pressure lower
And you may have done it in the past I get that but there’s no reason to take the risk while you get there in other words take get the medicine take the medicine get your blood pressure down but start the diet change decrease the salt in your diet um exercise decrease
The fat in your diet and then your blood pressure will continue to go down and then you won’t need the blood BL pressure medicine anymore and then you you can stop taking it but there’s no reason to play Russian Roulette because stroke heart attack these sort of things
That can happen to people can can occur while your blood pressure is high and it doesn’t have to be people think oh the stroke range is really yeah that’s true that a very high blood pressure increases your risk even more but a just over the the cut off blood BL pressure
Is increasing your risk as well so walking around with a 150 blood pressure thinking I’m just over the cut off is exactly the wrong way to think about it okay so um so yeah high blood pressure continues to be the number one biggest problem health problem in this country
And I just read an article the other day it’s the number one biggest health problem in the world right we need to get people to understand this and and and like I said said I just came back from Louisiana and I was I was frankly appalled that people still just don’t
Get it high blood pressure is a problem next slide and this is the other one diabetes right the twin terrce diabetes and high blood pressure diabetes is a is a big problem and again I and I I have actually gotten on Physicians about this telling patients
Oh yeah oh looks like you got a little bit of an issue there with your your sugar control you may be becoming maybe pre-diabetic or whatever so what does the patient hear when you tell them something like that okay I’m good yeah I might have a little you know they’re not
Hearing that they are becoming diabetic they’re not hearing what goes along with what that doctor just told them you know metabolic syndrome pre-diabetes this means you got a problem you have a problem you you have a diagnosis you need to make changes affirmatively one of my cousins this was a few years ago
And and he did a great job was diagnosed with pre-diabetes and this guy got it he immediately called me in a panic he couldn’t believe it because he thought he was really healthy and um and and told me his numbers and I was like yeah absolutely this is the problem and this
Is what you need to do and he immediately changed his diet immediately started exercising and and within a couple of months his numbers had totally nor normalized his blood sugars were normal his hemoglobin A1c dropped from 6.3 down to 4.9 okay so it’s possible to do it but
You’ve got to make changes right the hardest thing to change in your life is your diet to be honest it’s it’s the hardest because you have to eat every day you know if you like to smoke crack you can stop smoking crack you don’t need it every day right
Your body’s gonna crave it for a while is gonna crave it for a while but then you not you know you don’t need crack anymore you got to eat every day right so since you have to eat every day then this is a daily struggle we all struggle
With it right so diabetes is a is a big big problem there’s an epidemic in this country and um your blood sugar should never ever ever be above 120 if you’re normal your blood press your BL I don’t care if you just sat down and ate a
Whole chocolate cake your blood sugar is not going to go higher than 120 because you’re normal because your insulin is working you know you you just you know you can finish the cake and then take a blood take a a test your blood sugar should be normal and if
It’s jumping up really high even if it comes down then it’s your your um your axis your insulin to Sugar axis is off and that’s the beginning of type two diabetes that’s what type two diabetes is it just means that your insulin is not being released it’s not
As sensitive to the sugar the amount of sugar you’re taking in the body’s great you know our bodies are phenomenal instruments right they they they they they can take a a huge amount of um toxins and and and insult over time and still function well but you know what
You’re are seeing from these chronic diseases is that over time over and over and over these insults will eventually take their told which is why you want to get ahead of things you know you you you you used to be a smoker okay all right that was bad stop stop and then start
Living a different St of life you used to be overweight okay stop you lose the weight you live a healthy kind of you know you want you want to get into healthy habits and then years later you are you are different you know I’m be perfectly honest with you you
Know as a person of color I see patients that are older often times in my my clinic 60s 70 60s don’t seem that old anymore as I get as I get a little bit older to be honest but um but 60s 70s 80s and people I mean Dr calender would
Be the exception to the rule in the sense that he is of color but very very healthy and and I by this I don’t mean you know people talk about chocolate don’t crack I’m not talking about that I’m like this man has led a life that’s
Brought him Health in his 80s right and that’s what you want so what what I was going to say as a person of color it I I see lots of patients that are in their seventh and eighth even nth decade of life and they’re all they they they can
Be very healthy like surpr I just saw a lady in clinic um Asian lady you know who’s in her 70s and looked like she could be in her um 50s right so what I’m saying is unfortunately for us those people that are exceedingly healthy late in life tend not to be
People of color unfortunately why because all of these things I’m telling you about o being overweight having diabetes early in life having high blood pressure and not getting it adequately treated it takes a toll on your body over time right even though they can be asymptomatic over time it takes its toll
On your body and people that and and again some of this is is um can be Tethered to socioeconomics because good preventative care a good insurance seeing the sort of doctors that are are getting ahead of things that’s going to be easier done at um at the higher income ranges however
You know what else is done differently at the higher income ranges people less likely are trying to kill themselves and H and how do you try to kill yourself drug abuse smoking cigarettes being way overweight you know again I don’t want to insult anyone all I’m saying is the
The prescription to a healthy life is what you know Dr cender always says love yourself take care of yourself all that stuff he’s absolutely right you you’ve got to decide early in life um I want to be healthy I want to be healthy not only
Today I want to be healthy 30 years from now but anyway all right next slide obesity we got a big problem in America you know that’s it’s kind of ironic big problem but obesity is a big big issue right people are overweight one of the first things that strikes you when you
Travel is that Americans are fat you know I mean when you go to Europe I mean you’re I you know I go to Italy you walk the streets of Italy and you realize wow people are really thin and then you see somebody that’s a little big you’re like
Oh oh oh well there you go that’s that’s a bigger person and then you realize that’s an American right I mean you know I mean we are overweight and I’m Tak I’m putting myself in the category I mean meaning that I struggle with this as
Well I mean you know so I’m not saying just y’all we we need to do better we need to be smaller we need to do the things that people in other countries do they do a lot more walking than than than we do they do a lot more bike
Riding than than we do they eat small meals right I mean if you’ve ever been to Italy and gotten a plate of spaghetti and compare that to to what a plate of spaghetti looks like from a restaurant in the United States you realize real quick that we have a different way of
Eating you know and whereas they they they will stay and and eat a meal for hours and they’re eating like little things you know oh let me get a little bit of pasta oh let me have this little piece of meat oh let me have this little
Little salad you know I saw a presentation the other day and it was just on the calories in a typical American salad salad right and and it was all about the dressings that Americans put on this they might as well eat a Big Mac I mean the the the way
That they put salad dressing I I I’ve watched this in the cafeteria people taking um you know thousand island dressing and ranch I mean you might as I’m like you know don’t why why kill that lettuce with all that just just get a Big Mac I mean it
Would be less calories honestly so obesity is a problem I’m making light of it but it it is a it is a big issue um now I don’t know because I I have seen some miraculous things happen with these new medications you know and and from what I understand Medicare medic at
Least Medicare is is thinking about um covering these medicines and and I know it’s making a big change in a lot of people’s lives so um so we have to see but we’ve got to do a better job um Americans need to lose weight so what is
Body mass index and we’ll talk about that I think in the next slide but if you have a BMI over 30 you are obes all right that’s it now I know people will say Dr Milan on hasn’t it been proven that depending on your ethnic your ethnic group if you’re
African-American Or Hispanic that um these BMI um calculations are not quite accurate and and I would say yes but I’d also say and and and I got Dr cender here as my witness isn’t it ironic that the same group of people that wanted GFR to be changed because we didn’t we
Thought that it was wrong to say we had more muscle than than white people when we start talking about BMI we want to say well we got more muscle therefore our BMI I mean I just think it’s kind of ironic right you you want it both ways but my point my point is
You know BMI over 30 is obese plain and simple and yes if you are benching 350 pounds every day then yes all that muscle is is heavier so you got a good argument but if you’re not you’re obese and you need to be making a change anyway moving on moving on I’m hoping
I’m I’m I’m generating some controversy because I want a lot of good questions right right soona so um soon soon is gonna be policing the um all the questions all right next slide BMI this is what I was talking about so how do you get BMI BMI is your
Weight in kilograms or um by your height in the meter squared right and this is where we get these measurements and again I they can be a little subjective but the point is I think it is a it’s good to have an objective measure of how
Much fat you have now you know there there better ways of doing this U usually it’s more expensive you can do ple plethysmography and and um you know where you can send these waves through the body and determine exactly um what is your percentage of body fat I have one of those
Those scans in my office so you can you can see how much muscle you have and how much Fat’s in your body um and and things you can do the calipers so there there’s all sorts of way to measure and and you know in professional sports they
Do this stuff all the time because you want to see how much of fat the the athlete has but BMI is a kind of a rough way of doing it and and you do height and weight and like I said 25 to to 30 is overweight and obese is over 30 plain
And simple next slide all right now one of the things you need to understand with kidney disease is there are certain medicines that are that put you at higher risk and non-steroidals do put you at higher risk of kidney disease and and again it’s always surprising to me that some people
Are really abusing these medicines and um and their abuse of these medicines can lead to kidney disease so if you’re taking IBU Pro four or five times a day every day for for week and week and week and month and month and month this is very very high
Risk you know a lot of our people are taking these goodie powders and they’re abusing them they’re taking them every day they have headaches or whatever and you know I would say if you got a headache every day then you need to you need some kind of workout you know it’s
Not normal to have a headache every day or more than once a week right so you need to get that worked up rather than treating yourself because the treat treatment um is is a problem that’s not that’s not that you know you know sometimes people say the treatment is
Worse than the Cure yeah you need to figure out why you have these chronic pains and headaches and not take medicine that can that can hurt your your kidneys or even your GI tract a lot of GI bleeding is because of the same these same medicines metformin which is
A medicine used to treat diabetes can also be a problem for the kidneys and other there other oral anti-glycemic or medications that that are also problematic and you need to know that and these are the sort of questions you need to ask a lot of antibiotics can be
A problem for the kidneys right so every every medication you get from your doctor first of all you should understand why you’re taking it I mean and it I know that seems so simple right I have had numerous patients I will sit there with and I have their medicine
List and I’ll say oh um why are you on this medication I don’t know you you don’t have my chart there doc yeah I have the chart but you don’t know why you’re taking this medicine right how can you be on a medicine that you’re taking that and you don’t know
Why you’re taking it that to me that’s just that’s just crazy right so you should number one know why you’re taking it and then number two you should know what are the possible side effects of the medication what are the interactions of this medication right these are simple things and people people know
More about um the television shows that they watch they they now I’m I’m a I don’t think my wife is watching so I’m gonna talk about her a little bit so my wife thinks some of the people she sees on television she knows I mean she’s
She’ll argue with me she’s like no no no no he’s not like that no no no no no that’s not true I know that’s not true because I know what you don’t know these people this is an actor in a movie right you don’t know that person but they know
More about these people they’re watching on television than they know about the medication that they’re taking you know I’m sorry I I had to get on my soap box there for for a moment but um you know hopefully my wife is not watching I don’t I don’t want to have to sleep on
The sofa tonight but uh yeah you need to know about your medicines that you’re that you’re taking next slide oh okay all right if we get a Lisa milons on from Baltimore then we don’t take that question Suna I think that’s the first question we have I don’t know
About you Dr milons that is the first question but thank you so much Dr Manon for a great presentation and I hope our audience truly truly got as much as I did just sitting here um for this amount of time um and Dr calender please if there’s anything that you would like to
To harp on but so many good takeaway points Dr milans son um um from this talk and a few things that just stood out to me number one know your medication I don’t know if you saw me in the Square over here just going crazy
But you know we do a lot of Outreach for the Ron and joy paaw Kidney Center and even individuals who are on high blood pressure medication who cannot say this is what my normal blood pressure reading is or this is what is not normal for me and I’m on high blood pressure
Medication you have to know why you’re taking it and what those side effects are we talked about BMI anything over 30 audience is obese and it’s coming directly from a surgeon and that hinders in other areas not just because it’s a number but because of health concerns
And um un your higher risk in many areas including surgery so that number means a great deal um so let’s let’s go to um our platforms and see what questions we have we have a question here from Kimberly Dr Monon it says I have been diagnosed with stage three CKD
And taken metformin for type 2 diabetes what alternatives can I ask my doctor about that that’s a that’s a great question and we we see people that are exactly in that situation uh Kimberly and the good news is you know within the last few years there have been a lot of good
Alternatives um the problem is and this is this is what you need to know these great alternatives are expensive and so your the type of insurance you have matters all right but there’s a there’s a whole group of medications that are oral that can be taken instead of um
Metformin uh but even if and this is what patients don’t and I’m not saying this is gonna happen to you but even if the alternative is insulin it’s better uh when not now that you have stage three CKD it’s better that you do anything to preserve the kidney function
Than you that you have rather than taking any medicine that could hurt your kidneys but but yeah um the main thing is going to be to um to ask the doctor what are the Alternatives and then find out if your insurance company is turning turning down the medicines the doctors
May may want to prescribe and oftentimes there are even alternatives to some of these these these medicines um you know now of course everybody’s heard about OIC you know because people are taking it for um for reasons Beyond diabetes uh so sometimes there’s a shortage for people like you that actually might need
It uh but it’s very expensive and um and so the the insurance companies usually what I have found is they’re willing to work with the the patients but you may have to write a letter or make a call yourself you know and I and I guarantee
You I I’ve seen this happen where when the patient calls and complains um it it can carry a lot of weight with the with the company so but again it’s about you taking charge of your healthare but yeah you definitely in my the way I look at
It you definitely need to come off from metform what do you think Dr calendar yeah I agree with you completely that uh to get on a medication that is not nephrotoxic is it’s very important great um Dr malanson during your presentation you talked about if you have CKD before it becomes endstage
Renal disease that you can reverse it um I want to bring this question to you Dr calender what can individuals do to prevent themselves if they’ve been given that CKD diagnosis from ending up in a endstage renal disease um you know category well it’s important to
Recognize that uh as Dr Milson said it is reversible yeah and so we need to find out what is the disease entity that’s gotten you into the problem with kidney disease so if you have high blood pressure properly treat the hypertension you got diabetes properly treat the diabetes if you’re overweight lose
Weight exercise and and also change your nutrition less salt less sugar so those are the things that are easily done to help you stay at AG three or above and and actually go from three to two to one uh so that’s my answer to that question
I would also add to the questions that you raise the fact that in people who are overweight sometimes they can have of gfrs of gular filtration rates that are higher than 100 and sometimes being too too high is as bad as being too low and so you need to understand that if you’re
Obese uh you may have a uh GFR that’s higher than 100 but that high that alra filtration could hurt the kidneys as much as the uh under filtration okay thank you Dr Calender and as we’re winding down here um any final final message or words Dr manalansan to our um listeners if you
Guys continue to share questions we will address them and we will comment and make sure you get that answer but um any final takeaways that you have that you really want to make sure they they hear the message for today yeah well you know I think Dr calender just picked my my
Interest in this because he I think he made an excellent point about about hyperfiltration and therefore produa you know because a lot of these hyper filtrating patients will have protein in their urine so one of the tests you should always be asking about when you go to your physician on a yearly basis
Is do I have protein in my ear right and that’s a very easy test cheap test and it’s the earliest sign of kidney disease so Dr cender is right when you’re overweight you can hyper filtrate and that’s a problem the other thing you know the liver made me think about this
When you you mentioned obesity and again the number one for many years the number one cause of liver disease I mean people needing liver transplants yeah is obesity oh fatty liver right so it’s not and it’s not even just the bmis over 30 it’s the diet that you eat eating a
High-fat diet so I think those are the two you know take-home messages I I want to impart to to the uh people out there in listening land wonderful yes that I would make is that Dr lson has emphasized time after time uh is that the it’s the change in the uh bu the
Change in the creatinine the change in the glal filtration rate that is important it’s not so much the the the number it’s the change in the number and I think that’s something that he’s emphasized that needs to be reemphasized that when you go to your doctor ask him
What it was last year what is it now and I think that he’s he he’s emphasized it but I I I think reemphasizing is not uh uh going to be hurtful great point and thank you both so much Dr Keith malanson and Dr Clive calender pillars in our
Community and in the field of medicine thank you for taking time to talk about kidney terms that everyone should know um I want to say thank you to blackdoctor.org to the Ron and joy Paul Kidney Center to molp the minority tissue and Transplant education program and the Pennsylvania
Avenue Baptist Church this was kidney talks with boo you will see us again on November 10th 2023 please take this information and share it with someone in your community have a great day
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