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Dr. Wiederkehr, Tiffany Archibald
Tiffany Archibald 00:01
Let’s talk about kidneys takes a deep dive into the chronic kidney disease patient journey. We’re here to inspire meaningful conversations and to help people living with CKD gain a full understanding of their disease. If your test results indicate any abnormalities or a decrease in kidney function, your doctor may refer you to a nephrologist. Learn more about the symptoms. Hello, Dr. Wiederkehr, how are you today? Thank you so much for taking the time coming here being our guest on our podcast today.
Dr. Wiederkehr 00:36
You’re welcome. Glad to be here.
Tiffany Archibald 00:37
And I think that this topic that we’re going to discuss with you is, I think one of the most important topics on the podcast because especially for patient because it’s introducing them to the world of nephrology, and we’re getting down to the basics. So I have a couple questions. Are you ready to answer them and go on? All right, let’s jump in.
Tiffany Archibald 01:00
So the topic is when should you see a nephrologist? So my first question is, why am I even being referred to a nephrologist?
Dr. Wiederkehr 01:09
A great question. I have a lot of patients asked me that question when I walk in. There’s a lot of confusion, or even the word nephrologist is a little complicated. It’s Greek nephron means kidneys. So the patients typically know it’s about the kidneys, but you don’t really know exactly what’s wrong with my kidneys, do I have a disease? Or is it just something else. So very often, your primary care physician runs routine blood tests or urine tests and finds an abnormal number. And that indicates there’s something that’s affecting the kidneys. And that’s the reason you’re seeing me. But not always, I can also see you because there’s something that’s associated or in relation with the kidneys, for example, blood pressure. We know the kidneys are very important for regulating your blood pressure. So if your blood pressure is hard to control, or fluctuates or drops too much or goes up too high, then we typically get involved into primary care physician wants volunteer to see see us. Sometimes it’s a kidney stone, you know, it’s not really a kidney, but it’s a stone that’s in the kidney. And so we’re seeing, you know, really our goal is to prevent more stones have to make sure you don’t get more stones in the future. And sometimes it’s even an abnormal number such as what we call an electrolyte, which is like a sodium level or a potassium level or a calcium level. So it’s very often it is about the kidney function, but quite often it is in relation to the kidneys, but not really your kidney function. And you may not have kidney disease, you know, it may just be in relation to the kidneys.
Tiffany Archibald 02:50
Okay, so if a patient comes to see you, does that automatically mean they have chronic kidney disease?
Dr. Wiederkehr 02:59
No. And in fact, one reason we’re seeing you is to help find out, is it really a, quote, disease? Or is it just an abnormal number that looks like it’s abnormal, but our tests show that this is actually a benign condition? It’s not a disease, and something you don’t need to worry about. So it’s not necessarily a disease, which always sounds a little bit dreadful. But I think our main purpose is really to find out, is it something that we call a disease? And if so, is it something that is more serious, or something that we can just manage periodically with some less close observation?
Tiffany Archibald 03:38
Okay, and what is the difference between a urologist and a nephrologist?
Dr. Wiederkehr 03:43
There’s a lot of confusion about that. So we both deal with the urogenital tract. But the neurologists first of all, they’re surgeons, and we’re Internal Medicine sub specialists. So the neurologist very often deals with kidney tumors, or kidney stones that are stuck in the kidneys to remove the kidney stone. But also typically they deal with male issues such as prostate or even sexual dysfunction, erectile dysfunction, so they focus more on the male, like a gynecologist for women where neurology is more for the male men for sexual part, or bladder part. Neurologists also deal with bladder issues that affect both men and women. So they may see women to help with bladder leakage. We’re typically we’re really focused more on the kidney function. And as I mentioned, we’re not surgeons, we’re really Internal Medicine sub specialists.
Tiffany Archibald 04:44
Once I get the referral to a nephrologist, and my PCP see something abnormal on my test, how soon should I be seeing you and getting in for that first appointment?
Dr. Wiederkehr 04:56
We like to see you within about two weeks. That’s really our goal. It doesn’t always work out that way. But that’s really our goal. Always if there’s something more serious, we see fast – next day, next two days. But we don’t want you to wait too long, because there’s a lot of questions and sometimes some anxiety. You know, what’s going on? Or what’s fine. So we try to see you quite soon. And our goal is really within two weeks.
Tiffany Archibald 05:24
Okay. And just a side note, I think that if you know, patients are listening, and they haven’t seen a specialist before, and you want to see them in those two weeks, I think making sure that they check their insurance so that there’s not a lagging in that, would you agree with that?
Dr. Wiederkehr 05:39
Yes. So very often, the holdup is logistics or what we call insurance issues. We have to verify the insurance. We sometimes don’t get a call back or the verification. And so it’s sometimes just paperwork that holds it up. But assuming that’s pretty smooth and straightforward, we’d like to see you fairly quickly.
Tiffany Archibald 06:02
Okay. And then what sort of abnormal blood or urine tests that are kind of the indicators that a nephrologist needs to be seen?
Dr. Wiederkehr 06:12
So the typical blood test is a test called creatinine, which is a funny name, but it basically it’s a waste product that’s coming mainly from muscles. And when your kidney is not able to eliminate the waste, it builds up in the blood. So when the blood level goes up, the creatine goes up in your blood, that shows that we have less kidney function to eliminate that waste product. Another tests is BUN. There’s some other fancier tests that we typically don’t use. Now in the urine, which is very important, you may have completely normal blood tests, but something shows up in the urine. And you’ll hear your nephrologist talk about I find protein in the urine, which is because the kidneys are like a filter, multiple filters, and they try to keep all the good stuff in your body, such as protein. So when the protein shows up in your urine, that shows there’s a leakage of protein, and there’s maybe some damage to the filters in your kidneys. Or it can be blood. You may see the blood. You may notice one day that you have blood in the urine. But very often you don’t see the blood at all. It’s what we call microscopic. So it’s just when we look at it under a microscope, and we find some red blood cells. And the PCP and the tests they find is on the test, but she may not see that. So the urine tests are often protein that shows the leakage or blood. And in the in the blood test, it’s typically the Creatinine or a BUN.
Tiffany Archibald 07:51
Okay, that was a good summary of that. And if I come to you, I’m seeing a nephrologist. Does that affect my overall health? Can you explain the difference in that?
Dr. Wiederkehr 08:04
Yeah, so the kidneys are really an essential part of your whole body because they eliminate all the waste products but they also control a lot of hormones. For example, people are surprised to learn that my blood pressure is controlled by the kidneys, my blood level red blood cells or anemia is controlled by the kidneys. You wonder why would that be that’s how it is and also own disease. So your bone health is also affected by the kidneys that regulate how much calcium and phosphorus and some other electrolytes are being eliminated or kept in the body. So in the bigger picture the heart and the kidney, they’re lacking a crosstalk – they talk to each other. A sick heart affects the kidneys. You may have an abnormal kidney function because your heart is sick. And the opposite is true also. You may have a bad heart number because your kidneys are sick. So the two really talk to each other and kind of work together. So the heart specialist, the cardiologists and then a nephrologist. Very often we have the same patient we work together we have the same issues. And interestingly enough, some very often that we have the same medications or similar medications because they affect the health both the kidneys and the heart. So yes, having good kidney function and having that work properly affects your entire body. Not just the heart, but that’s one that I would think is very important.
Tiffany Archibald 09:39
And then once I see you for that first appointment, how often would a patient come in to see a nephrologist?
Dr. Wiederkehr 09:47
It really depends what we find. And what our tests show. I would say after an initial visit, I typically see you back fairly quickly, because I want to discuss the results of the lab tests. And by the way, I always send everything I do to your primary care physician. So he or she gets everything we do. There is always communication. And it’s much better these days with electronic health records. Everything we do, they can see and vice versa. So there’s great communication. But I want to see you back fairly soon, because O will discuss the results so you don’t wonder what’s going on? What did they find?
Tiffany Archibald 10:25
Can you define fairly soon? Just so that if a patient is listening they can kind of understand if they have to rearrange their schedule or something.
Dr. Wiederkehr 10:33
Okay, and so you just mentioned seeing the PCP. So does a nephrologist replace a PCP? Do you guys work together?
Dr. Wiederkehr 10:33
Yeah, so typically, soon means two to four weeks, okay? Now, if it’s something that is really, it’s been there for a long time, it’s not really worrisome, but just needs to be checked periodically. I may see you back in a year. If I see you you back in the year, I will give you a phone call and explain to you, by the way, your test, it’s pretty benign. You don’t have to worry. Go back to your PCP at least once a year just to kind of stay in the loop and make sure everything is okay.
Dr. Wiederkehr 11:06
We work together. So never, the answer will be never. And I think it’s very important for the patient to understand. We really work together with a primary care physician, but we don’t replace each other. There’s many things that we don’t do that the primary care physician must do. An example is cancer screening, but of course, female health, male health, osteoporosis. There’s there’s many other tests that the primary care physician will test and they’ll work with you. But we don’t replace. We work together.
Tiffany Archibald 11:44
So when should I see my PCP versus a nephrologist. You just kind of broke that down, but if you can give me two main, general health issues that the PCP would cover.
Dr. Wiederkehr 11:59
Cancer screening, always. And typically, diabetes, blood sugar management. We probably do more blood pressure management, because it’s kind of in our area, because the kidneys affect the blood pressure. Vaccinations is also very important. You have to be up to date on your vaccinations. And he or she, the primary care physician knows exactly when you do for your next job. We don’t we don’t do that we really focus more on your kidneys than you know.
Tiffany Archibald 12:28
Okay. And so we are at the end of our general questions, but just to kind of wrap up for those that are listening. Can you give me two to three main points that we discussed in this podcast that you think patients should really be attentive to?
Dr. Wiederkehr 12:45
Okay, well, I think the first point would be make sure you see us.
Tiffany Archibald 12:50
get the referral, we get the referral process, make sure you see him okay.
Dr. Wiederkehr 12:53
And I know there’s a reluctance. Why do I need to see another doctor? And I understand that’s completely normal. But there’s always a reason why the primary care physician feels that something needs to be seen by a specialist. So make sure you see us for an evaluation to see what’s going on. The second point is if we make a medication change, or give you a new medication, make sure you understand what is the medication for, why am I taking it out, how long do I need to take it. And also, you may find out the medication is not covered by your insurance. That happens very often. And it’s very difficult for us to know your exact plan. And if it’s part of the formulary, or if it’s not it’s part of the formulary. So make sure you give us feedback. If you go to a pharmacy and they want to charge you $500 for a new medication, you say no and let us know. And I can very often find an alternative that’s just as good or very similar. And the third point I want to make is that if there’s any change in your clinic. Let’s say you have a side effect, you take a new medication and you have a side effect. You have a cough, or you feel like you have leg swelling, or you have you’ve got shorter breath when you take it, or you can’t sleep at night when you take it. So if the if you feel like the medication has an effect on you, you should not take it because it’s a side effect that you don’t tolerate. Make sure you let us know. Don’t wait for your next appointment. Give the clinic a call or send us a message on the portal, which is very convenient. And so we can make the change quickly.
Tiffany Archibald 14:27
Okay, and you mentioned the portal and I think I’ll summarize this podcast with that. If you are a DNA patient, there is an app and it’s called Follow My Health and that is the portal that you’re referring to. And that’s where you have that constant communication. You can upload prescription bottles. You can get lab results. So if you are a DNA patient, Follow My Health is a great app to make sure that you are registered for and getting that information from your nephrologist. This has been super informative. It took us down to the basics and let us know why a patient was seeing an nephrologist and just all the things that go into that first appointment. So I really appreciate you taking the time and visiting with us today.
Tiffany Archibald 16:41
My pleasure. Thank you.
Tiffany Archibald 16:42
Thanks for tuning in today learn more about Dallas Nephrology Associates at www.dneph.com. And if you found the information valuable, be sure to share with those who are impacted by chronic kidney disease.