In this interview, Kerry Reynolds, MD chats with Meghan Sise, MD, director of onconephrology at Mass General Hospital, to learn more about how immune checkpoint inhibitor (ICI) therapy affects kidney function.
Center for Renal Education
Explore This Treatment Program
About the Program
The Mass General Center for Renal Education provides a support service for patients and their families where information concerning renal replacement options including hemodialysis, peritoneal dialysis, and transplantation is offered.
In collaboration with MGH nephrologists, experienced renal nurses, a dietician, and social worker, the Center provides education about Chronic Kidney Disease and its management with individualized plans of care that include nutritional counseling, blood pressure management, medication review, and supportive services. The team is dedicated to help patients with renal disease live a full and happy life.
The Center for Renal Education has also received the 2000 Mass General Brigham in Excellence Award for its leadership, innovation, quality treatment, and outstanding commitment to patient service.
Questions & Answers
What do kidneys do?
The kidneys are two of the body's most important organs. They are responsible for filtering the blood and eliminating waste products and excess water in the form of urine. Kidneys also help regulate blood pressure, make new red blood cells and maintain healthy bones. The kidneys are located below the rib cage and next to both sides of the spine (backbone). They are shaped like kidney beans. Some people are born with one kidney, which may be larger than average. The body can still function with one healthy kidney.
What are the reasons for kidney disease?
- Diabetes: Kidney Disease can be a complication of diabetes. Poorly controlled blood sugar damages the blood vessels in the kidneys; diabetes is one of the leading causes of kidney disease
- Hypertension (High Blood Pressure): Poorly controlled hypertension can damage the small vessels within the kidneys. The kidneys then become diseased and will no longer function normally
- Glomerulonephritis: This causes inflammation of blood vessels in the kidneys; this process can damage healthy kidney tissue
- Polycystic Kidney Disease (PKD): Fluid filled sacs (i.e. cysts) are formed inside of the kidneys. Normal tissue is replaced by these cysts
- Medications/Toxins: Unusually heavy use of pain medication such as ibuprofen may cause kidney damage. Toxins, heavy metals, and/or X-Ray dyes may also harm the kidneys
- Kidney Stones: A collective mass commonly called stones can damage kidney tissue or block drainage from the kidneys creating permanent damage
- Lupus: A connective tissue disease that affects all organs of the body including the kidneys
There are several words associated with kidney disease that are helpful to understand:
- Renal - The Latin term for kidney is "ren." Renal disease refers to diseases related to the kidney
- Nephrologist - The Greek term for kidney is "nephro." A nephrologist is a physician who specializes in the medical treatment of kidney disorders
- Acute Renal Failure - This term refers to sudden loss of kidney function. This can be either temporary or permanent
- Chronic Renal Disease - Refers to long-term damage of the kidney
- Renal Insufficiency - Applied to when kidney function has decreased, but the kidneys are still partially working
- End Stage Renal Disease - This is the stage where the kidneys have stopped working. Dialysis or transplantation (renal replacement therapy) are needed at this stage to maintain life
How do you know if you have kidney disease?
Symptoms can include:
- Unusual fatigue, nausea, vomiting
- Change in the appearance of urine (red, dark brown, and/or foamy)
- Unusual change in your daily urination pattern (increased/decreased amounts, constant frequency, burning sensation, and/or the need to urinate constantly during night)
- Swelling of ankles, hand, and/or face
- High blood pressure
- Unusual shortness of breath, difficulty breathing
- Changes in taste and/or bad breath
What can be done?
- See your primary care physician as soon as possible
- A nephrologist may be consulted to help in your care
- Certain blood tests, imaging tests (X-Rays, scans, etc.), and/or a kidney biopsy may be ordered to confirm kidney disease
- Medical care and constant follow-up is very important to successful management of the disease
Can kidney disease be cured?
Most types of kidney disease become progressive or worsen over time. However, it is possible to slow the progression of some types of kidney disease with good healthcare management. Close and continuous follow-up with your primary care physician and nephrologist is very important.
How can kidney disease be controlled?
- If you have diabetes, careful control of your blood sugar is very important. Evidence consistently shows that careful control of your blood sugar in insulin-dependent diabetes can slow the progression of kidney disease.
- Your physician and dietician can help you control your blood sugar through diet, exercise, and medication.
- Hypertension is often a silent disease without noticeable symptoms. Controlling high blood pressure with diet, exercise and medications can help to slow the progress of kidney disease. Careful follow-up with your healthcare team to control high blood pressure is very important. A blood pressure of 120/80 mmHg or less is best.
Reducing dietary protein
Low protein diets may be helpful in slowing the progression of kidney disease. Your physician and dietician can determine if you are a candidate for a low protein diet. Do not start a low protein diet without the guidance of your primary care physician and dietician.
Normal kidneys maintain healthy bones by balancing calcium and phosphorus. This can still be achieved as kidneys begin to fail with medications and a low phosphorous diet. Careful and continuous follow-up of blood values are necessary.
Normal kidneys always make a substance called erythroprotein, which helps the body make red blood cells. When kidney function decreases, less erythroprotein is made. Thus, anemia (a deficiency of red blood cells) can develop, causing further complications. Fortunately, anemia can be corrected through medications prescribed by your doctor. For example, Epoetin Alpha is a medication that replaces erythroprotein. Careful and continuous follow-up of blood values and blood pressure are necessary.
What if my kidney disease becomes worse?
When your kidneys fail or stop working, dialysis is needed to maintain life. Dialysis is a form of kidney replacement therapy to remove waste products from the blood and regulate fluids. There are two kinds of dialysis:
Hemodialysis: Involves cleaning or filtering the blood through an artificial kidney machine. This procedure is performed by nurses and technicians in a dialysis center several times a week.
Peritoneal Dialysis: Involves a solution flowing from a bad through a special tube into the abdominal cavity. Waste products and extra fluid from the blood are removed through this tube. The home peritoneal dialysis self-dialysis patient is trained, supported, and continuously followed by peritoneal dialysis nursing staff members.
Am I a candidate for a kidney transplant?
Some patients may be candidates for a kidney transplant procedure. The kidney may be donated by a family member, an unrelated donor, or a cadaver donor.
Who can help me with my kidney disease?
You are the most important member of the healthcare team. You can help us by actively participating in your care. Other members of your healthcare team include:
- Your primary care physician
- Other doctors involved in your care
- Renal nurse, dietician, and social worker
Who can I talk to?
Being diagnosed with kidney disease can be stressful for you and your family. Now that you have been diagnosed with kidney disease, you may be asked to make some changes in your life. Your healthcare team understand how hard this is for you and wants you to know we are available to help you throughout the process.
You may be asked to change your eating habits and/or begin taking medications to help treat your kidney disease. Changes are often difficult to deal with when you are adjusting to a new diagnosis, going to medical appointments, and learning new ways to take care of your health.
You may feel overwhelmed and/or nervous. These feelings are perfectly normal and if you feel this way, you may find it helpful to discuss your concerns and fears. Although some people are not comfortable expressing their feelings, doing so can help to reduce anxiety.
Your family and friends can also be a source of support. The renal social worker and entire healthcare team are available to help you through this process as well.
The most important thing to remember is that you are not alone. Your healthcare team will work together with you and your family to get through this difficult time and successfully make the needed changes in your life.
- Apr | 7 | 2021
In this presentation from April 7, 2021, Winfred Williams, MD, and Jamil Sulemana, RN, BSN, discuss kidney disease in the black community, the differences between dialysis and kidney transplant, and when one should consider kidney transplantation.
- Patient Story
- Feb | 10 | 2021
When Ann Foti learned that she could become a living donor for her husband, Gino, she was determined to donate her kidney to him; however, because of complications with Gino’s condition and the onset of the COVID-19 pandemic, their journey toward transplantation surgery was far from simple.
- Staff Story
- Nov | 17 | 2020
Winfred W. Williams, MD, has been named a deputy editor of The New England Journal of Medicine. Williams, who is associate chief of the Division of Nephrology, becomes the first African American to serve in that role.
- Press Release
- Sep | 2 | 2020
Mass General study demonstrates that kidneys infected with hepatitis C can be safely transplanted into healthy recipients
Mass General study demonstrates that kidneys infected with hepatitis C can be safely transplanted into healthy recipients.
- Aug | 18 | 2020
As scientists learn more about COVID-19, it has become clear that the virus especially impacts those with existing medical conditions, such as kidney disease.