Kidney Disease Causes and Risk Factors

Dr. Rex Mahnensmith stands out as the former clinical director of nephrology and medical director of dialysis for Yale Medical Group, which he served for more than 20 years. Now an internal medicine physician at the StayWell Health Center in Connecticut, Dr. Rex Mahnensmith brings an in-depth knowledge of kidney disease and its risks.

Approximately 33 percent of adults in the United States have an elevated risk of kidney disease. Patients with this condition experience a gradual decrease in the kidney's ability to filter excess fluid and waste products from the blood. As kidney function becomes severely impaired, the level of waste, fluid, and electrolytes can build up in the body to dangerous levels.

This condition typically develops in response to other conditions. Diabetes and high blood pressure are the most common root causes, but recurring kidney infections can also cause the kidneys to fail. Other causes include extended obstruction of the urinary tract, inflammation of the kidney's internal structures, and the presence of polycystic kidney disease.

Patients who have a family history of kidney disease are at higher risk of developing kidney disease. The condition is also more common in individuals of Hispanic, African-American, Asian, and Native American heritage.

Stages of Chronic Kidney Disease

As a physician and chief medical officer at the StayWell Health Center in Waterbury, Connecticut, Dr. Rex Mahnensmith draws on more than 40 years of clinical practice experience. Dr. Rex Mahnensmith served for 20 years as medical director of dialysis and clinical director of nephrology at the Yale Medical Group, through which he treated numerous patients with kidney disease.

The course of chronic kidney disease involves five stages, which differ based on the kidneys' level of function and the amount of protein in the urine. Clinicians determine the former by testing the glomerular filtration rate, or GFR, which is defined by the amount of blood that the nephrons of the kidney can filter per minute.

A person with mild symptoms of kidney disease but normal or better GFR (90 percent or greater kidney function) receives a classification of Stage 1, which suggests potential kidney damage but normal levels of kidney function. Stage 2 correlates with a reduced GFR and 89 to 60 percent kidney function.

As GFR drops and kidney function decreases, the patient progresses through Stages 3a, 3b, and 4. A patient with Stage 5 chronic kidney disease, also known as end-stage kidney disease, has complete or near-complete loss of function, to the degree that there is a dangerous accumulation of water and waste in the blood. This causes a variety of symptoms including headache, cognitive disturbances, digestive distress, and changes in skin color.

Patients who reach Stage 5 chronic kidney disease typically need intensive treatment in order to survive. This may take the form of dialysis or a kidney transplant.

Challenges to Post-Acute Care

Dr. Rex Mahnensmith is an internal medicine physician at StayWell Health Center in Waterbury, Connecticut. Over the course of his long career, Dr. Rex Mahnensmith has also served in emergency, outpatient, nephrology, and geriatric settings. While employed in skilled nursing facilities, Dr. Mahnensmith participated in post-acute rehab care. Skilled nursing facilities face several challenges in providing post-acute care to patients recently released from a hospital setting.

Many patients, upon release from the hospital, need post-acute care in a skilled nursing facility before they are able to return home. In these types of situations, additional care and rehab services are necessary. While an important part of a patient’s healing process, skilled nursing facilities face several challenges that revolve around coordination of care and conflicting orders and documentation.

In facing these difficulties, medical professionals are seeking greater coordination between general practitioners, hospitals, specialists, and other involved parties. Utilizing electronic health records can help with essential communication. In addition, emerging technologies such as tracking devices that can detect decline and medication adherence can help. 

By embracing solutions to the challenges of care coordination, the medical community at large will be able to reduce preventable readmissions, strengthen partnerships, and increase the quality of care that post-acute patients receive.

What Is Glucose Intolerance?

Internal medicine physician Dr. Rex Mahnensmith has specialized in primary care for more than three decades. Since 2015, Dr. Rex Mahnensmith has been providing full-time primary care at StayWell Health Center in Waterbury, Connecticut.

Glucose intolerance is a condition where the level of glucose in a person’s bloodstream rises above 140 mg or remains above 100 mg more than two hours after the ingestion of glucose. Normally, after eating, the blood glucose concentration rises from below 100 mg to about 110 or 120 mg. The glucose is then transferred into cells and tissues by insulin in approximately 60 to 90 minutes. It is then utilized by our organs as energy or stored as glycogen. 

In a case of glucose intolerance, however, the body does not handle the glucose intake in the normal time frame. Thus, the ingested glucose is not fully used up by the cells and tissues for energy. This condition occurs as a result of insufficient secretion of insulin or resistance to its action. While not diabetes mellitus, glucose intolerance can be regarded as a prediabetic condition and requires swift action and remedy.

Maintaining Hemostability during Renal Therapy

Yale-educated internal physician Dr. Rex Mahnensmith is an award-winning doctor at the StayWell Health Center in Waterbury, Connecticut. Dr. Rex Mahnensmith earned an ABIM Subspeciality Certification in Nephrology and has written several peer-reviewed papers on renal diseases and treatments. 

When determining the best course of treatment for kidney failure, nephrologists must balance between the duration of treatment and the level of hemostability maintained during treatment. To reduce hospitalization time for patients with chronic kidney disease, faster versions of intermittent rental therapy may be preferred. 

However, acute kidney injuries in critically ill patients often are treated with continuous renal replacement therapies (CRRT). CRRT filters blood at a slower rate than other rental therapies, making it ideal for patients who are more sensitive to large fluctuations in fluids. 

This type of hemodialysis is considered safer for patients with high risks of hypotension. CRRT was first pioneered in the 1990s and uses a series of tubes and membranes to pass blood through a hemofilter, removing excess water and waste. To meet the needs of hospitals and dialysis patients, smaller and more economical versions of CRRT are currently in development.

Causes of Chronic Kidney Disease

A summa cum laude graduate of Denison University with a BS in biology, Dr. Rex Mahnensmith received his MD from the Yale School of Medicine (YSM) before fulfilling his internship and residency in internal medicine. An internist at StayWell Health Center in Waterbury, Connecticut, Dr. Rex Mahnensmith completed a fellowship in nephrology at YSM and has since focused on diagnosing and treating individuals with chronic kidney disease (CKD).

Also known as chronic kidney failure, CKD describes the gradual inability of the kidneys to filter excess fluid and waste from the body. While indicators of CKD might be limited in its nascent stages, they include the buildup of electrolytes, fluid, and waste to dangerous levels at an advanced stage, culminating in complications such as anemia, hypertension, nerve damage, and compromised nutrition and skeletal integrity.

A potential complication of CKD, hypertension is also one of the leading causes of the disease; indeed, along with diabetes, it accounts for approximately 65 percent of all cases. The third leading cause of CKD, glomerulonephritis refers to a constellation of disorders that inflame and damage the kidney’s filtering units. Similarly, chronic inflammation of the organ’s tubules and neighboring structures known as interstitial nephritis can also result in CKD.

Other causes of CKD include autoimmune and inherited diseases such as lupus and polycystic kidney disease, respectively. Pyelonephritis and various conditions resulting in protracted obstruction of the urinary tract have also been implicated in the etiology of CKD.

National Kidney Foundation Sponsors Golf Classic in Massachusetts

A graduate of the Yale School of Medicine, Dr. Rex Mahnensmith serves as an internal medicine physician at StayWell Health Center in Waterbury, Connecticut. A recipient of several awards and designations, Dr. Rex Mahnensmith earned a Research Fellowship Award from the National Kidney Foundation (NKF).

Founded in 1950, the NKF supports kidney patients and their families while raising awareness about the dangers associated with kidney disease. The organization’s efforts helped create the Kidney Early Evaluation Program, which allowed doctors to study and analyze ways to better treat kidney disease. The organization is now the largest and most comprehensive one dedicated to kidney disease.

The NKF sponsors several fundraising events throughout the year, including golf classics. The NKF Konica Minolta Golf Classic takes place on June 12, 2018, at the Boston Golf Club in Hingham, Massachusetts. Now in its seventh year at the Boston location, the tournament has raised more than $600,000 to support, prevent, raise awareness for, and treat kidney disease. Golfers have a chance to qualify for the national finals at Pebble Beach as well as compete for prizes provided by local and national sponsors.