Treating Kidney Disease with Kevin O'Kelly, M.D.

Being diagnosed with kidney disease is a challenge more and more Americans face. In South Carolina, one in eight people have kidney disease. But you can do some things to prevent and manage the disease. In this episode of Advance with MUSC Health, Kevin O’Kelly, M.D., a urologist at MUSC Health Marion Medical Center, talks about the importance of kidney health, who is at risk for kidney disease, and how to prevent kidney failure.

“Not every patient goes on to end stage renal disease and requires dialysis or transplantation. A majority of these patients are managed with diet and medications, so the outcome in general is very good.”
— Kevin O’Kelly, M.D.

Topics Covered in this show

• O’Kelly describes the main functions of the kidneys, to filter the blood and remove waste products, and emphasizes that healthy kidneys are vitally important to our daily activities.
• Kidney disease is a condition that damages the kidneys and can lead to kidney failure. There are many causes of kidney disease, including diabetes, high blood pressure, and obesity. O’Kelly explains that other conditions, like lupus and long-haul COVID, can affect the kidneys, too. He says many people with the disease “don’t see it coming.”
• He explains how urologists and nephrologists work together to treat kidney disease. Urologists typically handle surgical aspects but also can also provide screening and care.
• O’Kelly sees patients with kidney disease every day. The first symptom people with kidney disease will notice is weight gain, usually associated with accumulation of fluid inside the tissues of the body such as in the lower extremities, the hands, or the face. Puffiness or swelling around their eyes and feeling lethargic are also signs.
• Many people are unaware of the signs of kidney disease and O’Kelly hopes more can be done to educate patients on warning signs so health care workers can diagnose more readily and improve outcomes.
• Kidney disease can be diagnosed with a blood test and a urine test. While there is no cure for kidney disease, O’Kelly says it can be managed with medication and lifestyle changes. If kidney disease progresses to kidney failure, dialysis or a kidney transplant may be necessary.
• MUSC Health has a long history of an excellent transplant program, which is known throughout the United States, and has been very successful, O’Kelly says. The program is also expanding outside of Charleston so more people can receive transplants closer to home.
• Exercise and diet are important to preventing kidney disease and to keep if from progressing. Kelly explains that not every patient goes on to end stage renal disease and requires dialysis or transplantation and that most patients are managed with diet and medications, with very good outcomes.
• He encourages listeners to see their primary doctor every year to screen for signs of kidney disease and other health concerns.

Read the transcript below

[00:00:00] Erin Spain, M.S.: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Being diagnosed with a kidney disease is a challenge more and more Americans face. Here in South Carolina, one in eight people have kidney disease. But there are many things you can do to prevent kidney disease and manage it. Here with details as Dr. Kevin O'Kelly, a urologist at MUSC Health, Marian Medical Center. Welcome to the show, Dr. O'Kelly.

[00:00:42] Kevin O'Kelly, M.D.: Thank you, Erin. It's a pleasure to be here.

[00:00:43] Erin Spain, M.S.: The kidneys, they play such a vital role in keeping our bodies healthy and functioning. Tell us all of the ways that kidneys are important.

[00:00:53] Kevin O'Kelly, M.D.: Kidneys are important in cleansing the bloodstream from its metabolites. They receive up to 20% of the cardiac output or the outflow from the heart in order to cleanse the bloodstream. So, they're vitally important in our life and our daily activities.

[00:01:08] Erin Spain, M.S.: So, let's talk about kidney disease. What is that exactly? And people sometimes may hear renal disease as well. Is it the same thing? What's the difference?

[00:01:17] Kevin O'Kelly, M.D.: Kidney disease or renal disease are synonymous, basically they mean the same thing. It's referred to as a neuropathy in our particular specialty. And it's where you have damage to the kidney. Nephritis is an inflammation of the kidney and has several types according to the type and location of inflammation. Inflammation can be diagnosed by blood tests. Nephrosis is a non-inflammatory kidney disease that is associated with a nephrotic syndrome and these two disease entities where you have loss of kidney function to some degree and can result in kidney failure. Complete loss of kidney function is what we call end stage renal disease. However, this is not as prevalent, and if it is present, we can do dialysis or transplantation.

[00:02:01] Erin Spain, M.S.: You're a urologist. You diagnose and treat diseases of the kidney and the urinary system, but which kidney conditions do you treat, and which do you not? And which would go over to a nephrologist?

[00:02:13] Kevin O'Kelly, M.D.: In general, urologists deal with the surgical aspects of the genital urinary system. So, we look at tumors, we look at stone disease, we look at obstructive uropathy from the prostate or kidney stones. So, we more or less handle the surgical aspects and the medical aspects of kidney disease or renal diseases handled by a nephrologist.

[00:02:33] Erin Spain, M.S.: So how often in your practice with your patients are you dealing with kidney disease?

[00:02:39] Kevin O'Kelly, M.D.: Probably on a daily basis. What we do is when we see patients, we will draw blood and do what's called a basic metabolic profile to assess the function of the kidney. And there we look at the B.U.N and creatinine, which are measures of how well kidneys function, and assign a score to it. And basically, that will tell us whether the patient has abnormal function or normal function.

[00:03:01] Erin Spain, M.S.: Before people come to see you. There are often signs or symptoM.S. that the kidneys are not working properly. Tell me about some of those first signs or symptoM.S.. What are they?

[00:03:11] Kevin O'Kelly, M.D.: So, the first symptoM.S. people will see is weight gain, and that's usually associated with accumulation of fluid inside the tissues of the body. You can see it in the lower extremity, the hands, or the face, and sometimes people will see puffiness or swelling of their, around their eyes. Also, you'll see, where patients basically become lethargic or not as active in society and they'll basically, due to high blood pressure, they can have damage to their kidney, and they don't see it coming.

[00:03:40] Erin Spain, M.S.: You just mentioned many comorbidities that folks may be having that will make it difficult to detect that they have kidney disease, but more than 20 million Americans have chronic kidney disease, and that number has actually doubled each decade for the past two decades. What are some of the factors that are contributing to the rise in this disease? Is it all these other comorbidities you mentioned, like diabetes, et cetera?

[00:04:05] Kevin O'Kelly, M.D.: A lot of people unfortunately, have diabetes and that creates a nephropathy, which can cause this, and it quietly comes upon them. There is damage to the nephron, which is the functioning unit of the kidney, and they can develop a disease entity called Kimmelstiel-Wilson Disease, which causes abnormal deposition, in the basement membrane of the kidney or the nephron. And this leads to damage long term. So, this is an issue. High blood pressure can also be associated with it. Lupus, more recently, long haul covid disease has been associated with it. And you can have other entities that are congenital like polycystic kidney disease. Those are all some of the examples that can cause abnormalities.

[00:04:47] Erin Spain, M.S.: According to America's Health ranking in 2020, kidney disease accounted for more than 85 billion in Medicare costs. How tough are conversations with your patients about the financial hardships they may face trying to receive care?

[00:05:02] Kevin O'Kelly, M.D.: Any medical disease is expensive. Unfortunately, because of the prevalence of this particular disorder, it's in these large numbers. MUSC's been good about treating these patients. They don't turn patients away. and they're willing to treat patients.

[00:05:15] Erin Spain, M.S.: So, tell me about some of the treatments offered at MUSC Health. You said much of what you do is surgical in nature. So first go through the types of surgeries that you do on folks with kidney disease and what other options are available.

[00:05:28] Kevin O'Kelly, M.D.: We look at dialysis for patients who have end-stage renal disease in which they will go Monday, Wednesday and Fridays or Tuesdays and Thursday and Saturdays, basically three days a week to cleanse their bloodstream of metabolites. The other options are if there's an obstructive uropathy, for instance, a kidney stone and a large prostate that have lent itself to this or hydronephrosis, we can address that surgically. And then last but not least is transplantation. We can use cadavers or living donor, to take care of that issue and the higher success rates are seen with transplantation from living donor. So those are the aspects we look at in order to treat. Generally, MUSC has a transplant team in Charleston, which can assist with this, and I believe in the upstate in Lancaster now they're starting a new program for the upstate. And then also MUSC has a long history in Charleston of an excellent transplant program, which is known throughout the United States as being very successful.

[00:06:24] Erin Spain, M.S.: What are some things that we can all do to take better care of our kidney health? What are things we can start thinking about and doing every day?

[00:06:32] Kevin O'Kelly, M.D.: I think your diet is very important. High dietary intake of animal proteins, animal fats and cholesterol can increase your risk for renal disease. Exercise will also help and watching our diets in regards to our fatty intake. Control of your blood pressure and diabetes is so key to this disease entity.

[00:06:53] Erin Spain, M.S.: If someone is diagnosed with a kidney disease and they manage it very well, what are the outcomes like for them?

[00:07:01] Kevin O'Kelly, M.D.: Generally, very good. Not every patient goes on to end-stage renal disease and requires dialysis or transplantation. A majority of these patients are managed with diet and medications, so the outcome in general is very good.

[00:07:13] Erin Spain, M.S.: Tell me about MUSC Health and how it's grown in recent years and how that's a benefit to your patients.

[00:07:19] Kevin O'Kelly, M.D.: In the past, this community has lacked an academic medical center, and now that we're present in this area, we're able to provide care that was unable to be done in the past, and that's an exciting future. This area has potential for great growth and it, it is expanding. If you look at the satellite programs by MUSC, it's really developed a great program that can provide care to all the citizens of, of the state, and they continue to expand. So that's exciting.

[00:07:49] Erin Spain, M.S.: So, if there's anything you would like to leave our listeners with today when it comes to kidney health, what would you say?

[00:07:54] Kevin O'Kelly, M.D.: I would say annual checkups are so important because we can screen for diseases, including renal disease and other diseases that can be life-threatening. So, seeing your primary care physician at least once a year, you'll be able to monitor and it can potentially take care of issues that may cause problems with your health.

[00:08:12] Erin Spain, M.S.: What do you do to optimize your health and live well?

[00:08:16] Kevin O'Kelly, M.D.: I try to exercise, eat properly, and try and balance my professional and social life so that I can have longevity.

[00:08:25] Erin Spain, M.S.: Well, thank you so much, Dr. Kevin O' Kelly for joining us today and talking about this condition that affects so many people in this country and here in South Carolina. We appreciate your time.

[00:08:37] Kevin O'Kelly, M.D.: Thank you, Erin. I enjoyed speaking with you.

[00:08:39] Erin Spain, M.S.: For more information on this podcast, check out Advance.MUSCHealth.org.