by Kelly Brooks
March is National Kidney Month. According to the National Kidney Foundation all Americans should have their kidneys screened for kidney disease. There are more than 26 million Americans who already have kidney disease, and most don’t know it because there are often no symptoms until the disease has progressed.
“When you have this particular FSGS, you also have high blood pressure. They’re always together.” Smith says.
High blood pressure can damage blood vessels in the kidneys reducing their ability to work properly and is the second leading cause of kidney failure in the United States after diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
The need for regular screenings and early detection are more pronounced in the Black community.
According to the U.S. Department of Health and Human Services, African Americans are the largest group of minorities in need of an organ transplant. African Americans have higher rates of diabetes and high blood pressure than Caucasians, increasing the risk of organ failure. While African Americans make up 13 percent of the population, they comprise 34 percent of those waiting for a kidney, and 25 percent of those waiting for a heart.
For Smith, it was the battery of tests his physician administered that led to his diagnosis. One of the tests revealed he had albumin in his urine. Albumin, a protein found in blood, is usually filtered from urine by the kidneys. Thus having it present in your urine is a sign of kidney malfunction. Doctors use the albumin to creatinine ratio to monitor kidney damage.
“For about eight years my creatinine level stayed about the same,” Smith says. “It was around 200, it went up exponentially. The company [he worked for] was failing, my dad was dying from Alzheimer’s, and it was very challenging trying to maintain the balance of everything because I was commuting back and forth from out of town. Even at that point I was still functioning. When my kidney function got to about 20 percent, I really felt bad. I was just tired all the time. For a lot of people, that’s the thing that’s important to stress, you don’t know you have it until you’re at that point. You’re at 20 percent. You’re feeling bad, and there is such an overwhelming fatigue. You feel like you’re walking through quicksand. You can’t stay awake. You want to sleep. Your energy is drained and your urine starts to change. You find you have to go to the bathroom more often.”
Throughout this process Smith’s nephrologist, a doctor that specializes in the study of normal kidney function, told him he needed to slow down his busy lifestyle. But at only 42 years old, he was not ready for that.
“I’m in my prime. I’m finally at a point where I’m starting to roll. I’m making money. I see the future. It was hard to stop,” he says. But in 2001, he finally did and it was not an easy adjustment.
“It was so foreign to not be working 60 hours, 70 hours a week. I’ll never forget I was in a trial. We were selecting a jury. In the middle of [my colleague] questioning the jurors, I nodded off.
Literally. In court. I’m like wow!”
With his kidney function deteriorating, Smith received a transplant in 2004 from his sister-in-law Allison Sutton. The transplant was successful but after six years it began to fail and he needed another transplant.
The exact reason for the failure of his first kidney transplant is unknown.
“I never drank excessively. I was a social drinker. I worked out all the time. I was running probably six miles a week. I worked out two or three times a week,” he says.
The need for a second transplant came with a new set of problems. Antibodies known as anti-HLA antibodies, can attack the new organ. These antibodies are measured before transplantation and if they are found reactive to the donor organ the risk for rejection is higher and that makes it hard to match a donor for transplant.
“I got pretty sick from some of the treatments that tried to address [the failing of the first transplanted kidney] and it caused me to get two or three blood transfusions,” he says. “I went on dialysis because that kidney ultimately failed. Dialysis was bad. You go from scheduling your life to dialysis dictating your life. When you finish dialysis you are beat and most people need to rest the rest of the day.”
At some point, Smith began explore options.
“I did not realize at the time I was exploring this option that I was such a pioneer in the process,” he says. “All I knew was that I had been on dialysis for almost two years and I would do whatever was necessary to try and get off it.”
The process he refers to is called plasmapheresis. It is a new process experts are calling revolutionary that provides a way for an organ that was previously incompatible because of the presence of antibodies to become compatible by removing the plasma portion of the blood where the antibodies are located.
Dr. Robert Montgomery of Johns Hopkins Comprehensive Transplant Center recently published a study that says patients that underwent plasmapheresis who were previously very hard to match are now not only receiving transplants at a much higher rate, 98 percent as opposed to 6 percent without treatment, but they are twice as likely to be alive after eight years compared to similar patients who are not offered this therapy.
After plasmapheresis, Smith was able to receive a second kidney transplant in 2012. He is an active member of the Legacy Donor Foundation and a board member of National Kidney Foundation LA Affiliate.
The National Kidney Foundation offers free screenings to those most at risk for kidney disease – anyone with diabetes, high blood pressure, or a family history. Visit their calendar on their website www.kidney.org for locations and information.
April is National Organ Donation Awareness Month
Last year alone, organ donors made more than 28,000 transplants possible. Another one million people received cornea and other tissue transplants that helped them recover from trauma, bone damage, spinal injuries, burns, hearing impairment and vision loss. A single person may save up to eight lives through organ donation and enhance many others through tissue donation. People of all ages, races, and ethnicities can save and enhance lives by donating their organs, eyes and tissues. Organ and tissue transplants are needed by people from every area of our nation.
People of most races and ethnicities in the U.S. donate in proportion to their representation in the population. The need for transplant in some groups, however, is disproportionately high, frequently due to a high incidence of conditions such as high blood pressure or diabetes, both of which can lead to the need for a kidney transplant.
For example, African Americans, Asians and Pacific Islanders, and Hispanics/Latinos are three times more likely than Caucasians to suffer from end-stage renal (kidney) disease, often as the result of high blood pressure and other conditions that can damage the kidneys. About 30 percent of those currently waiting for organ donation are African American; and almost 34 percent of the more than 101,000 people on the national waiting list for a kidney transplant are African American. Also in 2014, 20 percent of all transplant recipients were African American; 73 percent of
African American transplant recipients received kidneys; and 16 percent of all deceased donors were African American.
Although organs are not matched according to race/ethnicity, and people of different races frequently match one another, all individuals waiting for an organ transplant will have a better chance of receiving one if there are large numbers of donors from their racial/ethnic background. This is because compatible blood types and tissue markers—critical qualities for donor/recipient matching—are more likely to be found among members of the same ethnicity. A greater diversity of donors may potentially increase access to transplantation for everyone.