A chronic hepatitis C diagnosis often spurs us to educate ourselves about the liver. Few of us think about our kidneys, but we should. People living with hepatitis C have a higher risk of developing kidney failure compared to those without hep C (52.6% vs. 38.4%). (Hepatitis C Virus Infection Increases Risk of Developing End-Stage Renal Disease Using Competing Risk Analysis PLoS One June 27, 2014)
So, let’s talk about our kidneys. The kidneys are two organs located on each side of the spine in the middle of the back, below the ribs. They are shaped like kidney beans and are about the size of your fists. The kidneys are essential. You can’t live without them, although you can live with only one kidney. Like the liver, you can live with substantial kidney damage.
The kidneys do much more than make urine. They:
- Filter the blood – The kidneys remove wastes and drugs from the body; maintain the body’s proper fluid balance; regulate electrolytes; keep the acid/base concentration in the blood constant.
- Regulate blood pressure.
- Stimulate red blood cell manufacture.
- Maintain calcium levels in the body.
More than 26 million Americans have kidney disease, which is roughly one in nine adults. Millions more are at increased risk for getting it. Kidney disease that is detected and treated early, may prevent more serious kidney disease and other complications.
Kidney disease usually affects both kidneys. If the kidneys’ ability to filter the blood is impaired, then wastes and excess fluid can build up in the body. Like liver disease, kidney disease may be silent or have vague symptoms in its early stages. There are six warning signs of kidney disease:
- High blood pressure.
- Blood and/or protein in the urine.
- Abnormal creatinine and blood urea nitrogen (BUN) blood test. Increased BUN and creatinine results indicate that waste is building up in the blood because of reduced kidney function.
- A glomerular filtration rate (GFR) less than 60. GFR is a blood test that measures kidney function.
- More frequent urination, particularly at night; difficult or painful urination.
- Puffiness around the eyes, swelling of hands and feet.
Kidney Diseases Associated with Hepatitis C
The incidence of chronic kidney disease in the U.S. is rising. Diet and sedentary lifestyle contribute to this risk, and so does having hepatitis C. In addition to CKD, other kidney diseases associated with hep C include:
- Membranoproliferative glomerulonephritis
- Membranous nephropathy
- Polyarteritis nodosa
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) recently updated Recommendations for Testing, Managing, and Treating Hepatitis C, and assigned the highest treatment priority to hep C patients with the hepatitis C-related kidney diseases.
Cirrhosis and Kidney Failure
Liver failure may lead to kidney failure, causing a complication known as hepatorenal syndrome. This occurs when someone with severe cirrhosis has a loss of kidney function. Less urine is removed from the body, and there is a build-up of nitrogen-containing waste products in the blood. Up to 10% of those with liver failure will experience hepatorenal syndrome.
Kidney (and Heart and Liver) Health
What is good for the kidneys is good for the heart, liver, and the rest of the body. You can probably guess what the recommendations are for taking care of your kidneys, because they are the same ones that show up when we talk about health.
- Control your weight.
- Exercise regularly.
- Quit smoking.
- Keep your blood pressure in the target range.
- If you have diabetes, control your blood glucose level.
- Keep cholesterol levels in normal ranges.
- Take medicine as directed. Don’t overuse over-the-counter painkillers or NSAIDs, such as ibuprofen or naprosyn.
- Eat a healthy, balanced diet. Choose foods that are healthy for your heart: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat proteins.
- Reduce salt. Aim for less than 2,300 milligrams of sodium each day; 1500 milligrams or recommended amounts if you already have kidney disease.
- Limit alcohol consumption, and avoid it altogether if you have liver disease.
- Stay hydrated.
- Avoid cola drinks. Drinking two or more cola drinks (either diet or regular) daily may increase kidney disease risk. Non-colas do not seem to increase the risk. If you already have kidney disease, skip colas altogether.
- Get regular medical check-ups.
- Know your family medical history – tell your medical provider if kidney disease runs in your family.
Nearly three million Americans have chronic hepatitis C, compared to 26 million who have kidney disease. If you already have hep C, minimize your risk of kidney disease by taking your health in to your hands, or in this case, your kidneys.