1. Kidney Notes™ Angie Johnson, MD, Mary Hunter Benton, Maria Ferris, MD, MPH, PhD, and the STARx team at the UNC Chapel Hill

2. Introducing the Kidneys Module 1

3. Where Are the Kidneys? There are two kidneys, one on each side of your back…near your rib cage. Each kidney is about the size of your fist Each kidney contains a million little machines called nephrons.

5. How Much Fluid do the Kidneys Handle? About 189 liters of fluid every 24 hours. This is about 50 gallons of fluid!About 189 liters of fluid every 24 hours. This is about 50 gallons of fluid! –One gallon is the size of a big jug of milk

6. Fluid the Kidneys Handle Every Day The kidneys work so fast!!

7. What do the kidneys do? K eep up vitamin D levels that helps you have strong, healthy bones I nstruct your body to make red blood cells D ispose of drugs from your body N eutralize the body’s fluids E liminate waste from your body Y ield hormones that control blood pressure S upervise the amount of salt, potassium and acid in the body You will learn more about this in the next module. Time for your quiz!

8. Quiz 1

9. Why Your Kidneys Are So Important! Module 2

10. What We Know From Module 1 Most people have 2 kidneys. The kidneys are located around the area of your waist and are the size of your fist. Kidneys filter 50 gallons of fluid a day. Kidneys act as laboratories for your body, eliminating wastes, cleaning blood, and producing hormones and cells that your body needs to stay healthy.

11. That was a lot of information! Let’s break it down, and learn more!

12. The Kidneys and Chemical Balance Your kidneys control salt, potassium and acid in your body. EVERYTHING you eat has these ingredients

13. The Kidneys and Chemical Balance One of your kidney’s jobs is to get rid of the acid in your body –If your kidneys are sick, they can’t do their job. You may have to take bicarbonate (baking soda) to neutralize the acid!!

14. Why Do I need to Get Rid of Acid? If your kidneys fail, they can’t get rid of acid. In time, you may have too much acid. This condition is called acidosis.

15. Why is Acidosis bad? Acidosis sends the wrong message to your body-- it tells your bones NOT to grow! Your bones may get thin, become weak, and even break!

16. The Kidneys and Acid When your kidneys fail, they can’t get rid of acid Your cells don’t like all that acid, and your body cannot grow well. If you have this problem, a daily shot of growth hormone can help you grow.

17. Kidneys and Phosphorus If your kidneys fail, they cannot get rid of the phosphorus that you eat. High phosphorus causes bone pain or weak bones that may break

18. The Kidneys and Phosphorus When your kidneys fail, you will need to: Change what you eat (less phosphorus) Take medicines that stick to the phosphorus in your stomach and intestines, before it gets into your blood!

19. The Kidneys-Heart Connection The heart pumps your blood Blood pressure is how strong your heart beats Your kidneys help control your blood pressure

20. What Do Those Numbers Mean? Your doctors will tell you what your blood pressure numbers are and what your blood pressure numbers should be You need good blood pressure numbers to protect your heart and brain!

21. Why Are Your Kidneys Important to your Heart? When your kidneys fail, your blood pressure may go up High blood pressure can lead to health problems, like heart attacks and strokes that can damage your brain

22. The Kidneys-Bone Marrow Connection Kidneys make a hormone called erythropoietin. It is also called EPO for short…( sounds like a hipo!) EPO tells your bone marrow to make new red blood cells

23. Why Do I Need EPO? When kidneys fail, they stop making EPO. Without EPO, your bone marrow cannot make enough red blood cells. This is called anemia. Shots of EPO help make red blood cells go back up!

24. The Kidneys-Brain Connection When your kidneys fail, learning in school may be hard because: Your kidneys cannot get rid of waste in your body which may slow down your brain Anemia (low red blood cells) keeps your brain from doing the best job it can High blood pressure can cause bleeding inside your brain

25. Quiz 2

26. What is Chronic Kidney Disease? A problem with the kidneys that gets worse and worse. It can’t be cured, but it can be controlled. Module 3

27. Did you know that Chronic Kidney Disease (CKD) is what is called “silent?” This means that you do not feel different because your body problems that you do not notice. Doctors can tell how sick your kidneys are with blood and urine tests By the time you feel sick, your kidneys may already be very sick

28. What should I learn about CKD? What makes CKD happen? Why did I get CKD? What are the stages of CKD? How can we fix CKD?

29. What Makes CKD Happen? There are two possible answers: (1) You were born with kidney problems OR (2) Your kidneys became sick when you got older There are ways to treat both types of CKD!

30. Why did I get CKD? It is something that just happens, like having blonde hair or brown eyes. It did not happen because you did something wrong.

31. What are the Stages of CKD? There are 5 stages of CKD. Stages 1 & 2: Your kidneys work mostly OK. Stage 3: You need some medicines. Stage 4: You need more medicines & maybe shots. Stage 5: You need extra help to clean your blood (called dialysis) or you need a kidney transplant.

32. How Do The Kidneys Get Extra Help in Stage 5? Two ways to help the kidneys 1. A kidney machine: Dialysis 2. A new kidney: Transplant

33. What Kinds of Dialysis Are There? There are 2 kinds of dialysis for chronic kidney failure: Hemodialysis – blood leaves your body, gets filtered by a machine and returns Peritoneal dialysis – fluid goes in your belly and leaves with toxins, acid, etc.

34. Hemodialysis

35. Peritoneal Dialysis

36. What is a Transplant? A transplant is the most common way to help people sick with Stage 5 Kidney Disease. A transplant is where you get a new kidney from someone else Sounds weird right? It’s ok!

37. How Can You Get a Transplant? Many people are “waiting in line” to get a new kidney. This is really through a waiting list. You can get a kidney transplant from A family member A friend From someone who died.

38. How Long Can You Keep Your Kidney Transplant? You can keep a kidney transplant for many, many years. –It will last longer if you take your medicines!

39. Loss of a Kidney Transplant “Loss” means your new kidney stops working. Why does this happen to teenagers? –The #1 reason you lose your new kidney is NOT taking your medicines

40. What happens if you “lose a transplant?” What happens then? –You wait (years) for another kidney transplant. –In the meantime, you may go back on dialysis. –SO, IF YOU HAVE A TRANSPLANT, TAKE CARE OF IT AND TAKE YOUR MEDICINES!!

41. Quiz 3

42. Why Patients Don’t Take Their Medicines (and why they should!) Module Four

43. Why do patients not take their medicines? There are several reasons you might not: You don’t understand your medical condition You believe that nothing bad will happen You want to be “normal,” like everyone else You “don’t feel sick” to begin with, so not taking the medicines doesn’t feel any different.

44. More reasons patients don’t take their medicines? You don’t see any “real problems” or direct consequences if you miss your medicines. –“It’s no big deal.” You don’t think that the health team can tell when you’re not taking medications.

45. Guess What? When patients don’t take medications doctors notice changes.

46. What are some of these changes? There are several: Patients don’t grow as they should Blood tests show your kidneys aren’t working Problems are found during your visits at the doctor’s office

47. So can health providers really tell when patients don’t take their medicines? YES, without a doubt. But….doctors, nurses, and pharmacists can also help you remember to take your medicines…ask them for suggestions!

48. What can you do to remember your medicines? Put all your medicines in a container that has little cubbies for each day of the week.

49. What can you do to remember your medicines? Pick something you do every day and take medicines at the same time. You can take your medicines every day when you are: –Getting dressed –Eating your breakfast –Brushing your teeth

50. Do you have suggestions to other patients about how to remember to take your medicines?

51. Quiz Four!

52. Module Five What YOU Need to Know as you Grow Up With CKD

53. You will be on your own! You need to learn how to manage your disease without the help of your parent(s). –You will need to keep track of your medications and be responsible for taking them. –You will need to know how to get in touch with your health care team and keep track of medical appointments. – You will need to understand how your health insurance works.

54. What do you need to know about your medicines? Why do you take them What they do When and how to take them –Read the label on the pill bottle Which other medicines “don’t mix” with yours

55. What about Medicine Refills? Call for refills 2 weeks before you run out. Ask your doctor how to refill your medicines.

56. Your Medical Appointments Don’t miss your medical appointments! Come to the appointments with at least 3 questions for your doctor Before you leave each appointment, make sure the next appointment is already set up and you can make it

57. Are You on a Special Diet? YOU SHOULD KNOW: WHAT TO EAT: Learn about the food you can eat WHY: Understand the reasons you have to avoid certain kinds of food WHAT NOT TO EAT: You should avoid pre-packaged and pre-made food. Fresh food will help keep your kidneys healthy.

58. Learn How to Read Food Labels! Ask your doctor what foods and ingredients are good and which ones are bad!

59. Exercise! The more active you are, the healthier your kidneys and heart will be. Make sure to check with your doctors before playing physically demanding or contact sports.

60. Do not smoke! Smoking can damage your kidneys, even if you’re doing everything else perfectly!

61. Do Not Drink Alcohol Alcohol can make your blood pressure go up and can cause your kidneys not to work as well.

62. Do Not Use Illegal Drugs Drug use may get in the way with your needed medications. –They may make them not work or cause side effects Other drugs may be “kidney poisons” Protect your kidneys. Do not take risks.

63. Quiz 5!

64. PROTECT YOUR KIDNEYS: TAKE YOUR MEDICINES AND DO NOT TAKE RISKS! Thank you for your attention, The UNC STARx Team