The Kidney Warning Signs You’re Missing— And Why Waiting is Dangerous

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To celebrate the 10 year anniversary, Health Lab hosted its the first Health Lab Live Show, which brought two Health Lab articles to life by interviewing experts live on stage in front of a live audience while deep diving into trending health and wellness topics. Julie Wright, M.D., a nephrologist, talks about the silent symptoms you’d never suspect, why most people don’t catch issues until it’s too late, and what you can do today to get ahead of any issues. She even says you might be able to prevent it if you spot concerning bloodwork early. Read the article here.

Transcript

Johanna Younghans-Baker: 

Good afternoon and welcome everyone to the Health Lab live show. My name is Johanna Younghans-Baker, and I'm the editor-in-chief of Health Lab. 

And welcome back if you joined us just for the perimenopause and menopause show that we had right before this. If you weren't here for the first show and you don't know what Health Lab is, Health Lab is Michigan Medicine's online news publication that features health, wellness, and research news with interviews with our experts from across the campus on a variety of different topics. 

To give you a little taste of how much reach we have, we just hit over 70 million page views, and have over 5,000 published articles to date. We have a podcast. We're featured all over Michigan Medicine socials. And we have two weekly newsletters, one called Health and Wellness, and another called Research and Innovation. And shameless plug, please subscribe if you're not already. There's 35,000 subscribers already. So a lot of people are interested, and we've been having it go for a long time. 

The reason we're hosting today's events are because we're celebrating Health Lab hitting 10 years. And we thought, what better way to celebrate it than actually bringing one of our articles to life? And so we're doing a little bit of a play on podcast live shows. You might have seen those if you follow podcasts. They take their shows on the road and they interview their guest or their expert live.

So you're in for a real treat today with our guest. Joined with us again to lead the conversation is Mary Masson, our Senior Director of Media Relations here at Michigan Medicine, interviewing top nephrologist Julie Wright-Nunes, a member of our robust nationally and internationally recognized nephrology division, who's an expert on chronic kidney disease and its prevention. 

Today, Dr. Wright-Nunes will talk about red flags your kidneys might be signaling to you that you should not ignore, okay? It's a very important topic that needs more awareness, and luckily we dive into that today. So without further ado, please enjoy the show, and Mary, take it away. 

Mary Masson:

Thank you, Johanna, and thank you, Dr. Wright-Nunitz, for joining us today. I think it's a lot of fun to take one of our articles and bring it to life. We know a lot of people read us online, but we wanted to try something new for our 10-year anniversary.

I'm excited to talk about uh the kidneys and um we can yeah we can kick things off just by um, maybe you can start by telling us about kidneys and why they're so important to our health?

Dr. Julie Wright-Nunes:

Absolutely. Thank you. So, I'm excited to be here too, and thank you so much for the invitation and happy to be a part of this new initiative. 

So regarding kidneys, usually normally people would have two of them, and each individual kidney is about the size of your own fist, and they're located in kind of the back or flank area and I think they're remarkable. I'm a little bit biased towards the kidneys being a kidney doctor, but um, I think of them as our humble heroes. So first, I think people are aware that they clean the blood, or at least maybe people might be familiar with that. 

So that's one of their primary functions. They kind of clear the toxins out of our system, and then when they excrete the waste, that comes out through the urine. But some people aren't aware of the many other things that the kidneys do, so they help keep our blood counts up, stop us from being anemic. They make a hormone that helps red blood cell production. They stop us from being anemic. They also are involved in bone health believe it or not. They work with vitamin d and hormones - other things; calcium and phosphorus to keep your bones healthy. They have a really important role in blood pressure control, so if kidneys are hurt, then the blood pressure can become very high. Likewise, high blood pressure and reverse can cause damage to the kidneys over time and hurt the kidneys, so it's kind of a two-sided thing with blood pressure. 

The other thing is that as people get kidney damage, if they were and that develops into something called chronic kidney disease, we're learning that there's associations between heart health and kidney health, and we're still exploring a lot of that but there's important roles in that as well.

So again, I kind of think the kidneys are our humble heroes, and go kidneys.

Mary Masson: 

I like that. I think we'll use that as the cheer for the day. Go kidneys. Okay, so how do we know if our kidneys are working okay? Are there tests that doctors can do, and are there things that we should look for as warning signs?

Dr. Julie Wright-Nunes:

Great question. I think just starting with tests that doctors can do. There are tests that doctors can do, providers. Some of them might be done in a specialty; nephrology. That's my specialty as a kidney doctor; fancy word for that. And then also in primary care. 

One of the tests we get is a blood test. And the blood test actually shows us two things. One is called creatinine. So creatinine is a breakdown product of... protein that we eat, muscle breakdown, just normally day to day. And when that number goes up, it means your kidney function; your kidneys are filtering less of it - kind of a more important indicator in the blood work is another blood test called EGFR. 

So that stands for estimated glomerular filtration rate. It's a really kind of fancy word. It's hard for me to even pronounce. And if you just know what the abbreviation is, EGFR, it stands for filtration. And you can kind of think of that like you want a car engine to run at 100%. You want that EGFR filtration to say about 100 when you look at lab tests. And when it's lower than that, that can indicate that you have kidney damage or reduced kidney filtration. So the EGFR is a really important test. 

And then a second test that's easy and not even as invasive as a blood draw would be the urine albumin test. So that just requires that we give a urine sample in a cup. And albumin is a type of protein. We keep that protein in our blood vessels. We want it to stay there. And when the albumin leaks out into our urine, it can indicate kidney damage. So those two tests, the EGFR and the urine albumin to creatinine ratio, are two tests that are really pretty easy and they can tell us a lot of information. 

Mary Masson:

Do you regularly get those tests? Like if I go in for my annual physical, would those tests be a part of something that you do with blood work usually? 

Dr. Julie Wright-Nunes:

That's a great question. Typically they are. I think for most health maintenance exams that individuals might get, most people would be getting these tests done once a year. There is a little bit of debate about who should be getting these tests. You know, whether or not the tests are always appropriate, especially in people who don't have risk factors for kidney damage or chronic kidney disease. And we can talk about that if you want to a little bit later as far as risk factors. But so definitely for people who have risk factors, these tests are recommended. And sometimes if you've developed kidney damage over time, it's even recommended to do these tests more than once a year; so with more frequency. And that kind of comes into play if somebody has developed something called chronic kidney disease. And as it gets more advanced, then you're doing more testing along the way for monitoring and if you're putting people on therapy. So great question. And typically it'd be part of health maintenance, but not always.

Mary Masson: 

So sometimes we hear about chronic kidney disease or kidney failure. Of course, those can be intimidating to hear those things, right? Can you tell me a little bit more about what those terms mean and what people should know if that is mentioned? What are the things that you like to tell your patients? 

Dr. Julie Wright-Nunes:

I love that question. Thank you.

So first of all, I think there's a lot of medical jargon, right? And one of the reasons we're all here and even talking today is to try to maybe break that down and make it more simplified.

Patients are more and more engaged. They're smart. But there's even medical terms that are difficult for us in medicine, and we use some of them, right? So when we talk about kidney disease and chronic kidney disease, I think of those as synonymous. And kind of the more unified term is chronic kidney disease. And in nephrology, I don't know if it's like all the other specialties, but we love our abbreviations. So we abbreviate it CKD. So we have, so far we have urine albumin, that has an abbreviation. We have EGFR, right? I just talked about that. 

Now we have chronic kidney disease, which is CKD. There's five stages of that, with one being very mild, and five being more severe or the most severe. And that's the stage at which we're putting people on dialysis or trying to get them a transplant. And actually, even at stage four, we're trying to prepare for that ahead of time. 

So those terms are really intimidating. And I will have you know that I, as a fellow, learned a lot about...how I needed to improve my communication around the terms, chronic kidney disease and kidney disease, because it's kind of a catch-all term, and it doesn't really tell you why you have kidney damage, but it's really shocking for people to hear the words chronic and disease, and that occurred to me once during fellowship when I'd been seeing one of my patients for a couple of years, and I mentioned their chronic kidney disease stage three, and they started crying in front of me. And I said, well, why are you crying? And they said, I have chronic kidney disease.

And I felt horrible because I'd been seeing them for two years. I'd been putting it in their notes. And for whatever reason, maybe hadn't said the words or maybe said them differently. And I realized at that moment, first of all, it's important to say the words and also to put it in context for individuals. 

Because after I explained, well, you know what? You have this, but it just means that your EGFR, your filtration is reduced. We're watching it. That's why you're seeing me. And you're actually the same person you were two years ago. 

So it really gets into health literacy. It gets into how we optimize communication. And that's so important. And I think that we, as people in medicine, have an obligation to try to think about ways to make the experience of hearing this information as comfortable as possible for our patients. And that starts with me as being one of those individuals. So that's why I focus my research in that area. 

Mary Masson:

Yeah, that's really interesting. It makes me think a couple summers ago, I got Lyme disease because I got bit by a tick. And I remember the doctor saying to me, I got Lyme disease, and I flipped out, you know, because to you, you know, you're saying the words all the time, right? But to me, that was scary to hear it. And of course... tell everybody here, you don't have to be really scared if you have Lyme disease. Very few people who have Lyme disease really have long-lasting issues. 

Okay, sorry, back on topic here. So are the warning signs and symptoms of chronic kidney disease…what are the warning signs? And why would you call this kind of kidney damage or chronic kidney disease silent? 

Dr. Julie Wright-Nunes:

Right, another great question. Thank you. So, there are warning signs of chronic kidney disease. The kind of final stage, and you had mentioned kidney failure. I'm sorry, I don't think I addressed it earlier - So kidney failure would be the final stage of kidney disease where the kidneys aren't working enough. They're not filtering enough to clean your blood on their own. And so people, again, will need dialysis or a kidney transplant to do that function.

When people hit that final stage, there are often symptoms. There can be swelling in the legs because if you recall I said that one of the things that the kidneys help do is control blood pressure. They also control fluid in the body. So if they're reduced in what they can do, fluid builds up and we get puffy. Our legs swell. We can get short of breath. That can be coughing that we feel, maybe chest pressure or discomfort. Also can get itching because the toxins are building up in our body and our blood pressure as I said might go up we might feel fatigued, get nauseous vomit, even have a metallic taste in our mouth, and at very advanced stages, even feel a little foggy or get confused.

So, I've listed a whole host of things right but the thing is that a lot of these are nonspecific. So somebody might think, well, I'm feeling a few of these things, but maybe I just have the flu. You know, maybe I'm not just feeling well because there's somebody sick at home. And so it can be a little bit confusing for people. 

And then what's further confusing, and what comes into the silent part, is that at the earlier stages of chronic kidney disease and even into the more advanced stages, so stage four, Even into five, there are some people who present to us in an emergency room situation, maybe did not get those blood tests or urine tests in the past, and they are in florid renal failure, and they have no symptoms. Or the symptoms developed over time. And I was talking to a colleague of mine, a patient advocate, who also has a podcast, and we were talking on it a little bit. And he was saying, you know, as a patient, I think I did have symptoms, but they kind of whispered in, they crept in. And so sometimes I think we have a lot of symptoms, but we don't ignore them, but we get used to them. And we tolerate them. And it's not until we're getting a lab test to show how bad things are that we actually acknowledge what's going on. 

So the silent part is that you can have no symptoms at all until things are pretty advanced. And that's the tricky part. 

Mary Masson: 

Yeah, so you talked a little bit about this, but what happens if you do ignore those signs and symptoms? 

Dr. Julie Wright-Nunes:

Exactly. So if people ignore the signs and symptoms, then they're putting themselves really kind of at risk and maybe without knowing it. But certainly if they start having things like the swelling and the chest pressure, you can develop heart arrhythmias. Certainly the kidney disease can progress further with filtration that's even less. And then people might do something, as we call it, crash into dialysis. 

So, they're basically learning about their dialysis once they first hear that they had kidney disease. So that's really the biggest risk. And I think earlier on, it's not so much maybe ignoring symptoms because, as I said, people might not have them all the time. But if, let's say, for example, a person did get their EGFR done, or they had an abnormal urine test, you know, of course, part of the main part of the onus is on us as providers. If we're ordering this stuff, then we need to be communicating what it means with our patients - and I do feel like and I'm one of them we have a ways to go to optimize that and again that's why I'm working on this in research - but also if you see something, especially now with portals not everybody can access them, but if people can I think it's a really great opportunity to kind of raise the hand saying, this doesn't look quite right. You know, this lab looks red. What does that mean? So I think those are some of the best things you can do, because if you can catch kidney disease or some of those abnormal tests early, then maybe you don't even develop it to begin with.

Mary Masson:

So who's at the highest risk of kidney disease? 

Dr. Julie Wright-Nunes:

Right. So we know that from research, the highest proportion of people who reach end-stage kidney disease who might require dialysis or need transplants either have diabetes mellitus or hypertension. 

And unfortunately, sometimes things travel in pairs. So there's a lot of the patients that we see particularly impacted that have both of those. So having those conditions are definitely risk factors. It doesn't mean for sure that you're going to develop chronic kidney disease, but they're definitely risk factors, and would be the indication to get that testing, that blood work, that urine testing that we talked about in line with your provider, and advocating for that if it's not being done. 

Other risk factors can be family history. There's genetic components to some of the chronic kidney disease types. One example would be polycystic kidney disease, where the kidneys fill with cysts, they get real big. There's also some genetic predisposition related to African American ancestry, predisposing people to end-stage kidney disease and hypertension. There's also rare kidney diseases - so rare kidney diseases are defined as... well, any rare disease is defined as less than 200,000 people that it's impacting. And even though it might not affect that many people in the U.S. per se, the impact to people can be quite profound, because a lot of these rare diseases, we're just learning how to better treat them and can really be impactful to people who get them. 

Older age is also - as I get older, that doesn't seem so old anymore - so greater than 65, but that's kind of a cutoff generally that's used. Morbid obesity, people who maybe need to just get a little more active or not even that, just trying to optimize the health with relationship to weight is not an easy thing, but also can be a risk factor as well. And then sometimes if people are exposed to toxins or even herbal supplements or medications that might seem like they're safe and they are in usual doses, if you take a lot of them over time, they might hurt the kidneys. In particular, there's a group called non-steroidal anti-inflammatories, and I don't want to make anybody mad who happens to make those. And so I won't mention any brands, but this class of agents - I take them myself - they help me with inflammation and pain. But over time, taking large, large doses over years can also be a risk factor to develop some kidney damage because of them as well.

Mary Masson:

So I suppose it's... a good idea to talk to your doctor about those supplements that you are taking, right? 

Dr. Julie Wright-Nunes:

Yeah that's a great a great point so absolutely um talk with your provider your doctor whether you happen to be seeing a kidney doctor for kidney issues or your primary care doctor, and I will tell you another learning for me kind of over the years is, um, making sure that I'm not giving cues to individuals that might make them not want to tell me things. 

So that can be a whole host of things, right? It can be all kinds of history that people may or may not want to reveal, and it can also be things that they're taking or supplements. And curiously, I found some hesitation from some of my patients that - they don't necessarily always want to tell me if they're on an herbal medication or vitamins, not so much, but things where they're really trying to be proactive, and they've heard about something that's great and that it's advocated to help your kidney health. And, you know, we kind of all want to take that active part and help ourselves, right? And so I never want to discourage that. And I do try to tell them, you know, please share that with me, because there are some things that downright can hurt your kidneys. but it's more of a trust thing. And certainly I'll keep seeing and supporting them in any way that I can, and I try to emphasize that, but just make sure that we're sharing that because, too, sometimes there might be unintended consequences, and that might be medication interactions. It can be also some of the supplements aren't held to purity standards. You know, the FDA might look at the supplement and say, hey, it has this in it, but all of the other fillers that can contain things that hurt the kidneys are the things that we're most concerned with. 

And so what I tell my patients is to look for something with a USP symbol, United States Pharmacopeia. It doesn't exactly say it's entirely pure, but they're held to a little bit different purity standards. And again, just try to be open and make sure that we have that engaged dialogue. 

Mary Masson:

Yeah. So we talked a little bit about this before. Maybe you can offer some more detail. If someone suspects an issue with their kidneys, what are the tests that you should ask your doctor to order? 

Dr. Julie Wright-Nunes:

Right. So there's a whole battery of tests that can help us figure out maybe if we're concerned about our kidneys, what's going on with them. We can order imaging tests. We can order all different kinds of blood tests. But I'd say that the two tests that I would advocate for as a patient is, again, the blood test, that's EGFR, tells us about our filtration, and the urine albumin to creatinine test, which is the urine albumin test I was talking about earlier. It's noninvasive. Again, just pee in a cup. 

You can test the amount of this protein albumin in there, and depending on how much is in there, we can see if that's abnormal and there might be a risk to your kidneys. And I'm going to say that, you know, I've been a patient, right? Maybe we all have; we've seen our doctor for health maintenance. But over the past year, I've become more of a patient in a more serious way - I had to start seeing surgeons and stuff like that. And thank goodness for them, and everything's, you know, okay right now. 

What I learned through that process, here I am in the medical profession, right? And I've been a kidney doctor for 15 years. My specialty of research is in patient-provider communication. And even I was sometimes hesitant to push on my surgeons, or ask questions, and I think it took me probably a few months of kind of some back and forth, and then just realizing, you know what, maybe like me, they want to engage with what I'm thinking and they want some pushback. And of course, it's a give and take. But I just say that we should all try to feel empowered when we're seeing our doctors. And if maybe we feel kind of not empowered, or we need some moral support to ask questions, bring somebody with you. And I think that's a great way to just lend moral support or somebody who can be your advocate. 

Mary Masson: 

Yeah, that's fantastic to hear that, and that you're looking into that. and also just advocating for it because I do think people, you know, it's such an intimidating place to be, right, when you're concerned about your health. And, you know, it's just refreshing to hear you advocate for that.

So thank you. 

So this sort of leads into my next question - is, what's the best way to approach kidney concerns with your doctor, especially if you're unsure about whether you have kidney disease or if you have the risk factors for it? 

Dr. Julie Wright-Nunes:

Yeah, that's great. A great point. So I'd say, first of all, arm yourself with information if you can.

There's a lot of information that's out there. And by out there, I mean news, internet, all kinds of media, and hopefully forums like this ensure that it's you know as optimized as possible but it's not always perfect information it's not always good information. So knowing your risk factors by coming to things like this, or looking online at vetted resources there's a couple of sites the national kidney foundation and american kidney fund again there's other sites I'm not advocating just for those two, but the reason that I like these not-for-profit organizations is they have online sites where you can pull down information as a patient and they'll talk and review risk factors they'll talk about kidney disease and developing kidney disease so arming yourself with information I think is a great first step. 

And then I think the other thing that I've used myself and that really helps me when patients come to see me is listing your questions.

Whether it's up here in your mind or on your phone or you're writing it, jotting it down - listing your questions that you have for your doctor ahead of time. Because I don't know about you, but when I get in front of my doctor, it all goes out the window. And then as soon as they're out of the room, like the questions come back in my mind. And I'm like, wait a minute, wait a minute.

Right? Chasing them down the hall, or through the portal. And that's all fine. But it's so much

better when it's face to face. Right. 

So what I try to do is first as the provider side of things, I'll ask folks, do you have questions? at the beginning. I didn't used to do that, but I do that now. And as a patient, I do try to write them down. And for me, I keep them in my phone.

The other thing I think that's important to understand, and I think we do if we're in healthcare, and maybe even if we're just patients experiencing healthcare, but there's only a limited amount of time that doctors are given with patients, right? It's a set amount of time set by the health systems. So I've got to make the most of that time in that short period. And so I am actually coming in, if I'm doing my job, I'm probably coming in reviewing everything about the patient beforehand, or most of it, and coming in with a plan right I have an agenda as a doctor so I want to boom boom boom get through that in my time frame, but the patients have an agenda too, right and so we need to do a better job or I need to do a better job of recognizing that. And one of the ways that I can recognize what the agenda is that the patient has is when they bring in their questions now sometimes you know so I'm an engineer first and then I went into medicine. 

So I know all about the patients who come in with their charts and their graphs and their questions. And, you know, they pull out the list on paper and it rolls down to the floor because there's 100 things on it. And so, I think as patients, we have to recognize that maybe you can't get all of those things reviewed or answered during that time. But if we prioritize the top two to three and then say, well, I have some other ones. What's the best way to come back and review this? I think that's a great start.

So I would say being armed with information, knowing if you do have risk factors, because those risk factors are our cues to doing testing, and then also advocating for yourself. And if you have to bring somebody, then bring them on in. 

Mary Masson:

So you don't mind if all your patients have an advocate with them? 

Dr. Julie Wright-Nunes:

I don't, and I would say that maybe a little bit of a secret that we don't like to admit sometimes, is that if people are super engaged and advocates, gee, that's going to impact our window that we have with them, right? And so sometimes people honestly might not always appreciate the questions. I think in the heart we do, but it might seem like we don't if we're busy and so forth, I guess is what I mean to say. But absolutely.

And sometimes I feel like with the... advocates or the second person who might be in the room.

Either they're taking notes or they're asking other things that I think would have been the question that this other individual would have had, the actual patient. But again, so much is going on in their mind that that person is actually asking for them. So not only do I not mind that, I actually like it. 

Mary Masson:

That's great. That's great to hear. So can you talk about any lifestyle habits that can prevent kidney disease or anything surprising that can make a big impact?

Dr. Julie Wright-Nunes:

Yeah, so I'll start with the surprising part. I think the surprising part is that there's nothing that's over the top and unusual, and that small changes can make a difference.

So I'm going to use myself as a personal example again as a patient. So I was told to cut down on some of the sodium that I... eight as part of kind of my medical stuff over the past year. And so I logged on a little app, what my sodium intake was. And it was embarrassingly like three times what I'd recommend to patients. Okay, I'm just saying it. Don't follow me, what I'm doing,

I'm not the person that you should, but I'm just being honest. Okay. 

So then I started tracking my sodium on this little app. And as I tracked the sodium, I began to feel so guilty that I wanted to lie to the app. So yes, because the app would turn green on a good day and red on a bad day. So I would lie it down so I could get a green day. And then I asked myself, who's a doctor, a kidney doctor who talks about sodium all the time, self, what am I thinking? So what I said is how about you try to be honest, but make more green days than red days in the month. 

And I will tell you, I had such success with that. I reached my goals, and yes, it did take time.

And yes it was a little unsatisfying to see some red days mixed in there, but I tried to stop mine to myself. And I've used that scenario, believe it or not, when I'm talking to my patients about dietary sodium. 

So that's a big thing with blood pressure, with a lot of other conditions, certainly chronic kidney disease. There's maybe different tweaks to the amount that a person should be eating, definitely less than 2,300 milligrams, which means you have to read the sodium on a container and figure out the serving size and then add it up during the day. But it's hard, right?

And the biggest part that's hard about that is because most of the dietary sodium that we eat isn't from table salt. It's from processed foods. And I am probably one of the biggest offenders.

I'm busy. I justify going out because, you know, we've worked hard all day. My son has too. We're going to treat ourselves or have, you know, dinner out. And it's really the processed foods that we eat.

So breads, sandwiches, stuff like that. And really just trying to make small strides and cutting out half of that can go such a long way. It can go such a long way with people's symptoms, with their blood pressure, with their swelling, and just general health. kind of more, like I said, common sense. So if people have diabetes mellitus, then keeping that under good control.

And activity, that's another one. A lot of my patients and even myself seem to feel like, golly, if it doesn't hurt, it's not activity. It's not doing anything good. But that's really not true.

Walking, you know, I might break a sweat when I am walking, especially if it's over a few minutes. But doing that every day, 30 to 45 minutes most days of the week. 

Again, getting that routine isn't an easy thing. But that really can go a long way. And again, helping blood pressure, overall health. And then, you know, making sure if you are taking medications, like we said, share what they are with your provider, that they're in the right dosage range, nothing super therapeutic. And you might not know that, but sometimes people, you know, if they're taking these herbal supplements, like they've heard, oh, take a ton of vitamin C or take a ton of this. So that's the kind of thing I wouldn't recommend. And make sure that your doctor knows about it. Yeah.

Mary Masson:

Well, this has really been very insightful. 

Dr. Julie Wright-Nunes:

Thank you. 

Mary Masson:

Thank you so much. But before we end, is there any key takeaways that you would love for our audience to take away from this talk?

Dr. Julie Wright-Nunes:

Sure. So first of all, thank you all for being here and being engaged to hear and listen about kidneys. I think that's the first step - is just, one, to know about the kidneys. You know, we did a research survey of youth and found that 3% and so youth was defined as 14 to 24 and we asked have you heard about the kidneys through school or through your learning, so 3% had learned about the kidneys through school or learning and most of them 87% wanted to learn more about it. And so I think you know now coming forth and trying to just learn about the kidneys that they exist what they do I think is a great first step. Knowing that if let's say you are diagnosed with kidney disease, that it isn't an end, it's a beginning of being more informed.

And as was mentioned, there's 30 million people who have chronic kidney disease. And we don't want people to get to end-stage kidney disease, but the people who do are a very low percentage of that. So you're not alone. And even if you do progress and need dialysis or transplant, you're also not alone, and as was um stated earlier with Johanna, you know, with this 30 million - it's actually less than 20 percent are aware they have chronic kidney disease so that means 80 don't know they have it so definitely trying to find um your empowerment or getting help for doing that with your doctors just to make sure that if you have any of the risk factors that you're screened, that the test, EGFR, urine albumin, very easy.

Again, as I said, just being here a part of it, sharing things through this is a great opportunity.

So I really have to thank you and Johanna and your whole team for doing this because it's such a great opportunity to hear and see about kidneys. For the first time, I was talking to one of my nephrology bosses, and it was during the Super Bowl. And I don't really understand what goes on with the Super Bowl, but I was watching it with my 14-year-old. And there was a commercial for a medication called an SGLT2 inhibitor. And they mentioned the kidneys. And I was like, Yes! It's on national TV during a Super Bowl! So, you know, every little bit we do can just increase awareness. And I really appreciate it. So thank you.

Host:

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