By the way, this thought-provoking question comes to us from one of our Facebook followers.  Many thanks to him for suggesting it!

Q: Why isn’t there a permanent cure for Chronic Kidney Disease (CKD), since it is on a par with cancer and is very costly to treat.  What are the main obstacles to a cure?

A: What a great question!

There are both scientific and socioeconomic obstacles:

Scientific:
CKD is not a single disease, but a common disease process caused by many different underlying diseases, such as diabetes, hypertension, glomerulonephritis, etc.  By the time CKD ensues, the damage to the kidney is already done, and is very difficult to reverse.  The best that can be expected at that point is to slow down further deterioration of the kidney, for which there are, in fact, some quite effective treatments.

There is active research going on to find a cure for some of the underlying diseases, with some minor successes. For example, some patients with Type I diabetes have received pancreatic cell transplants that allow the pancreas to function normally, effectively “curing” their diabetes.  Some types of hypertension are curable and some types of glomerulonephritis can be cured with steroids and other immunosuppressant drugs.  Obviously though, there is a very long way to go!

Socioeconomic:
CKD is extremely common (more than 10% of the adult population suffers from it), but it does not have the visibility of cancer.  This is because few patients with CKD actually  die from it.  In fact, it is estimated that less than 10% ever reach end-stage kidney disease and need dialysis or a transplant.  The remaining 90+% die of cardiovascular diseases (heart attacks, heart failure, strokes).  CKD is the major risk factor in these deaths, but most people do not know to attribute them to kidney disease.  Thus, the general public is not fully aware of how common or how serious CKD is, and consequently, the amount of money available for kidney disease research is tiny compared to that devoted to cancer research.  Conclusion: we need to get the word out!

Michelle, is there any way to research how much money goes to cancer research vs kidney research in this country? I predict that the disparity will be shockingly large.

A quick search on the web turned up many articles with conflicting numbers for dollars spent on cancer research – estimates of $10 to 12 million yearly for the American Cancer Society and $5 to 6 million for the National Cancer Institute.  (This doesn’t even account for all the dollars raised by organizations devoted to specific types of cancer.) Yet, I found it very difficult to find any information on how much money is spent on kidney research.  This could have had something to do with the search terms I was using (I’ll be sure to refine them and try another web search soon), but it’s more likely evidence that Dr. Yu is right.  We really must get the word out about CKD and the need for more research!

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Q: So we decided to start with a really simple question.  Can you tell me why we have two kidneys?

A: Actually that is a great question!

Having two kidneys is not essential for adult life. Adults who donate one kidney for transplantation, or who undergo unilateral nephrectomy for some reason, live a normal lifespan and have no increased risk of complications. Thus, we assume that the reason we have two kidneys is so that there is some extra reserve of kidney mass in case we sustain some renal insult (e.g. toxic injury, or traumatic injury).

Having said that, about 1 in 1000 individuals are born with one kidney (unilateral renal agenesis). The limited data available suggest that these individuals have an increased risk of hypertension, proteinuria and focal segmental glomerulosclerosis in later life. Whether this is because of the reduced renal mass since birth, or because of some other factor is unclear.

Q: Why exactly is the kidney mass important?

A: The kidney is made up of nephrons, whose job is to filter, secrete and reabsorb solutes and water. More kidney mass = more nephrons.

So there you have it. If you have any questions or comments regarding this Q & A, please post them on our blog or on Facebook and we will get them answered. Special thanks to my friend Karen for suggesting this first question! And if you have a new question you’d like answered, just ask.  We can’t dispense medical advice, but we can certainly enlighten you on the workings of the kidney and kidney disease.

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