The symptoms of this red blood cell deficiency are anemia, fatigue, sleepiness and poor concentration, none of which are unique to kidney disease. So we have troubles with these symptoms because they overlap. Anemia symptoms and kidney disease symptoms look alike. We can treat the anemia symptoms by replacing the hormone. Once we do that, many of the symptoms of kidney disease largely disappear until the illness is very far advanced.
Why is kidney failure so difficult to diagnose?
JAI RADHAKRISHNAN, MD: 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% of normal kidney function. 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.
What are some basic screening tests that a general practitioner might use to screen for kidney problems?
LEONARD STERN, MD: The general practitioner will typically do screening blood work. 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. The BUN is a widely used index. The serum potassium. The bicarbonate is an index of the acidity of blood.
