Tampa Nephrologist at Kidney Walk

The Florida Kidney Physicians team wishes to thank all of those who participated in the Kidney Walk, for having spent such a nice day with us, celebrating the gift of life and each other. The positive energy of thousands of people at the Kidney Walk was invigorating, inspiring and amazing. We are proud to be one of the sponsors supporting this event that raises money for research, patient services, professional education, public health education, and community services.

At the Kidney Walk, Dr. Rajendra Baliga gave a talk about the importance in Early Detection of Kidney Disease.



We are very grateful to everyone that came to the Pig Jig event this past weekend 🐖. Florida Kidney Physicians was proud to be one of the sponsors supporting this event that raises money for Nephcure, a non-profit organization committed to supporting research, improving treatment and finding a cure for the debilitating kidney disease, FSGS.

We would like to thank you all for helping FKP support Tampa Pig Jig 2018. 🐽 ❤️

Tampa Nephrologists at Pig Gig


By Doctor Alberto Casaretto.

What do my Kidneys Do?

  1. Clean your blood of waste and toxins.
  2. Regulates the extracellular fluid volume, the kidneys work to ensure an adequate quantity of plasma to keep blood flowing to vital organs.
  3. Regulation of osmolality of blood.
  4. Production of Hormones. Erythropoietin – is made in the kidney and is an important hormone in the production of blood in your bones.
  5. Regulates the concentration of important electrolytes like Potassium, Sodium, and Calcium.

How do I Know if I have Kidney disease?

If you have been to your Primary care doctor recently and had blood work, you have probably had your kidney function checked. The two blood tests that check for Kidney disease is Blood Urea Nitrogen (BUN) and Creatinine. Blood Urea nitrogen is a waste product that your Liver makes when it breaks down protein and Creatinine is a waste product made in your Muscles. When your BUN and Creatinine are elevated, we say you have a kidney problem since the Kidney is the organ that removes these two waste products from your body. Another test that is used to evaluate your kidneys filtering ability is Estimated Glomerular Filtration rate (eGFR).

When do I need to see a Nephrologist (Kidney Doctor)?

Since Kidney disease is typically a silent disease- there are no symptoms until kidney disease is severe, the only way to know if you have kidney disease is to check your blood work- specifically BUN and creatinine. Also if you have blood or protein in your Urine- these are signs that you may have damage to some of your filters in the Kidney. You should also consider seeing a Kidney doctor if your eGFR is less than 60.

What can I do to protect my Kidneys?

  1. Stay Hydrated-One of the easiest ways to keep your kidney healthy is to drink enough water. It is recommended that you drink at least 1 1/2 liters of water per day.
  2. Eat Healthy- Avoid High Salt diets.
  3. Watch your Blood Pressure
  4. Exercise regularly
  5. Stop smoking

Are there medications that could be harmful for my Kidneys?

If you have Chronic Kidney disease you should be careful with Non- steroidal -Anti-inflammatory medications (such as Ibuprofen and Naproxen). Some Antibiotics can also damage the Kidney- especially if the duration of the antibiotics is extended.
Some of the contrast dyes that are used for radiologic test can also be toxic to the Kidney such as the contrast used for CAT scans and Cardiac catheterizations. If you have kidney disease – talk to your doctor before doing these tests.


Diabetes, like many chronic diseases, may co-exist with mental health conditions like depression. For some patients with diabetes that can lead to a third problem.

Researchers from the University of Toronto found that people with diabetes, who were also depressed, had an increased risk of developing chronic kidney disease (CKD).

Diabetes affects every cell in the body. When your blood sugar is too high–especially over a period of time–it can cause significant cellular damage.

The longer a patient has diabetes the more likely he or she is to develop complications like heart disease, eye damage, skin problems, nerve damage, kidney damage, and even kidney failure.

Marta Novak, MD, Ph.D., of the University of Toronto, led the study of more than 933,000 patients who also had diabetes. The patients were selected from a larger group of more than three million US veterans who had signs of kidney disease.

Researchers used the glomerular filtration rate (GFR) to determine kidney damage. The GFR is is an indication of how well the kidneys can filter urine. A normal GFR is 90 or above. Patients in the study had a GFR of 60 or above.

At the time they enrolled in the study 340,806 of the patients had been diagnosed with depression.

Dr. Novak and her colleagues found that patients who had diabetes and were depressed were younger, had a higher GFR and were more likely to have other problems–known as comorbidities.

180,343 of the patients developed chronic kidney disease (CKD). Patients who were depressed were more likely to develop CKD and having depression was also linked to all causes of death.

The research does not indicate depression causes CKD in people with diabetes, only that there is a link between the two.

The study was published in the June issue of Diabetes Care.

Information on study funding and conflict of interest was not available.


  • HealthDay, “Depression linked to CKD in patients with diabetes”
  • Diabetes Care, “Increased Risk of Incident Chronic Kidney Disease, Cardiovascular Disease, and Mortality in Diabetic Patients Wi
  • Mayo Clinic, “Diabetes”
  • National Kidney Foundation, “Glomerular Filtration Rate”
  • Image Courtesy of Tyler Olson |


A new tool for Chronic Kidney Disease (CKD) Patients

Frequently,CKD patients nearing the start of dialysis can face several health issues requiring a trip to the ER. If the ER Doctor is unfamiliar with your kidney health vitals, several common medications and tests, such as a CAT Scan,could have an adverse effect on a CKD patient’s kidney function. To help protect our CKD patients from the possibility of these adverse effects, FKP created the Kidney Passport allowing patients to effortlessly carry their personal kidney health vital labs with them and thereby inform any doctor anywhere in the world.

The Kidney Passport is a compact document that fits in your wallet, contains all the vital lab information of your kidneys for the last 6 months and it’s stamped with FKP Doctors’ contact information allowing any health care professional to call us anytime.

Our FKP Chronic Kidney Disease patients can rest assured knowing that if he or she is facing any health issue and presents in the ER, or other healthcare facility, their kidney health information is available and FKP doctors will be always there to ensure the best recovery with appropriate medication, studies and treatment plans.

Our main goal is prevention, education and advocacy. Finally, this simple tool gives our patients the means to remain informed of their kidney health and carry with them live-saving information that other healthcare professionals can rely on.

The FKP family remains committed to keeping kidneys healthy!


Uremic Symptoms – Chronic Kidney Disease Stage 5 – eGFR less than 15 ml/min

When a person reaches end-stage renal disease (ESRD), both kidneys have stopped or almost stopped doing their jobs. Patients start developing symptoms when their eGFR is Below 15 ml/min ( Stage 5 Chronic Kidney Disease) .

The body fills up with extra fluid and wastes that would normally be filtered out. This is called uremia. If you learn the signs and symptoms of uremia, you’ll be better able to watch for them and alert your doctor.

Signs Of Uremia:

Head – headaches, fatigue, and fuzzy thinking can be caused by uremia.
Mouth – food may taste bad or like metal, causing a loss of appetite.
Lungs – shortness of breath can be caused by a build-up of fluid in the lungs or by anemia.
Stomach – loss of appetite, nausea, and vomiting can occur if uremia is very severe.
Bladder – less (or no) urine may be produced. Some people still make urine, but it is mostly fluid – the wastes are not removed.
Nerves– Tremors, excessive sleeping
Hands – swelling can be caused by fluid build-up.
Feet – swelling can be caused by fluid build-up.
Skin – build-up of uremic wastes can cause severe itching.
Blood vessels – high blood pressure can occur because the failing kidneys no longer keep blood pressure at normal levels.


Why is Monitoring Phosphorus Important in Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and Dialysis?

10 Things ESRD CKD and Dialysis patients need to know about Phosphorus:

1.     Phosphorus is a very common and important mineral element in the body, symbol P.

2.     Phosphorus is found in meat, dairy products, dark cola (non translucent), beans, nuts, and in some food additives, especially in processed foods.

3.     Phosphorus is important in bone metabolism and in maintaining the proper pH (acidity) of the blood stream.

4.     When Phosphorus is combined with oxygen, it is called phosphate.

5.     Healthy kidneys maintain a proper level of blood Phosphorus by eliminating excessive Phosphorus in the urine.

6.     Patients with ESRD and CKD can retain too much phosphorus, called hyperphosphatemia.

7.     High levels of phosphorus combine (bind) with Calcium. Calcium can come out of the bones and lead to weak bones (renal osteodystrophy). The Phosphorus-Calcium complexes can also be deposited into organs and blood vessels, leading to hardening of these organs.

8.     CKD, ESRD, Dialysis, and Hemodialysis patients are counseled to follow a diet that limits the amount of phosphorous-containing foods they eat.

9.     CKD, ESRD, Dialysis and Hemodialysis patients are often prescribed phosphorus-binding medications. Phosphorus-binding medications are usually taken before meals to help prevent phosphorus from being absorbed from the intestines.
Dialysis patients have their blood level of phosphorus measured every month to keep the phosphorus level in the appropriate range.

If you are a CKD, ESRD, Dialysis, and Hemodialysis, talk to your FKP Physicians.



High blood pressure

The kidneys play a key role in keeping a person’s blood pressure in a healthy range, and blood pressure, in turn, can affect the health of the kidneys. High blood pressure, also called hypertension, can damage the kidneys and lead to chronic kidney disease (CKD).

What is high blood pressure?

Blood pressure measures the force of blood against the walls of the blood vessels. Extra fluid in the body increases the amount of fluid in blood vessels and makes blood pressure higher. Narrow, stiff, or clogged blood vessels also raise blood pressure.
Hypertension can result from too much fluid in normal blood vessels or from normal fluid in narrow, stiff, or clogged blood vessels.
People with high blood pressure should see their doctor regularly.

How does high blood pressure hurt the kidneys?

High blood pressure makes the heart work harder and, over time, can damage blood vessels throughout the body. If the blood vessels in the kidneys are damaged, they mfay stop removing wastes and extra fluid from the body. The extra fluid in the blood vessels may then raise blood pressure even more. It’s a dangerous cycle.
High blood pressure is one of the leading causes of kidney failure, also called end-stage renal disease (ESRD).

People with kidney failure must either receive a kidney transplant or have regular blood-cleansing treatments called dialysis. Every year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States-United States Renal Data System. USRDS 2007 Annual Data Report.Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.

What are the signs and symptoms of high blood pressure?

Most people with high blood pressure have no symptoms. The only way to know whether a person’s blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, called the systolic pressure, represents the pressure when the heart is beating. The bottom number, called the diastolic pressure, shows the pressure when the heart is resting between beats. A person’s blood pressure is considered normal if it stays at or below 120/80, which is commonly stated as “120 over 80.” People with a systolic blood pressure of 120 to 139 or a diastolic blood pressure of 80 to 89 are considered prehypertensive and should adopt lifestyle changes to lower their blood pressure and prevent heart and blood vessel diseases. A person whose systolic blood pressure is consistently 140 or higher or whose diastolic pressure is 90 or higher is considered to have high blood pressure and should talk with a doctor about the best ways to lower it.

What are the signs and symptoms of chronic kidney disease (CKD)?

Early kidney disease is a silent problem, like high blood pressure, and does not have any symptoms. People may have CKD but not know it because they do not feel sick. A person’s glomerular filtration rate (GFR) is a measure of how well the kidneys are filtering wastes from the blood. GFR is estimated from a routine measurement of creatinine in the blood. The result is called the estimated GFR (eGFR).
Creatinine is a waste product formed by the normal breakdown of muscle cells. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood.
An eGFR with a value below 60 milliliters per minute (mL/min) suggests some kidney damage has occurred. The score means that a person’s kidneys are not working at full strength.
Another sign of CKD is proteinuria or protein in the urine. Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of failing kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. CKD is present when more than 30 milligrams of albumin per gram of creatinine is excreted in urine, with or without decreased eGFR.

How can kidney damage from high blood pressure be prevented?
The National Heart, Lung, and Blood Institute (NHLBI), one of the National Institutes of Health (NIH), recommends that people with CKD use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.

How can blood pressure be controlled?

The NHLBI recommends five lifestyle changes that help control blood pressure. People with prehypertension or high blood pressure should
maintain their weight at a level close to normal.
eat fresh fruits and vegetables, grains, and low-fat dairy foods.
limit their daily salt, or sodium, intake to 2,000 milligrams. They should limit frozen foods and trips to fast food restaurants. They should read nutrition labels on packaged foods to learn how much sodium is in one serving. Keeping a sodium diary can help monitor sodium intake.
Get plenty of exercises at least 30 minutes of moderate activity, such as walking, cycling, or swimming, most days of the week.
avoid consuming too much alcohol. Men should have no more than two drinks-two 12-ounce servings of beer or two 5-ounce servings of wine or two 1.5-ounce servings of hard liquor a day. Women should have no more than a single serving a day because differences in the way foods are broken down in the body make women more sensitive to the effects of alcohol.

Can medicines help control blood pressure?

Many people need medicine to control high blood pressure. Several effective blood pressure medicines are available. The most common types of blood pressure medicines doctors prescribe are diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and calcium channel blockers. Two of these medicines, the ACE inhibitors, and ARBs have an added protective effect on the kidneys. Studies have shown that ACE inhibitors and ARBs reduce proteinuria and slow the progression of kidney damage. Diuretics, also known as “water pills,” help a person urinate and get rid of excess fluid in the body. A combination of two or more blood pressure medicines may be needed to keep blood pressure below 130/80.

Who is at risk for kidney failure related to high blood pressure?

Everyone has some risk of developing kidney failure from high blood pressure. African Americans, however, are more likely than Caucasians to have high blood pressure and its related kidney problems—even when their blood pressure is only mildly elevated. In fact, African Americans are six times more likely than Caucasians to develop hypertension-related kidney failure.2
People with diabetes also have a greater risk of developing kidney failure. Early management of high blood pressure is especially important for African Americans with diabetes.


FKP starts Monthly Chronic Kidney Disease classes for its Patients. The classes are given regularly and are held in Conference rooms at REHC offices. Patients are referred by their FKP doctor to attend the CKD classes. Most patients that attend the classes have Stage 4 Chronic Kidney Disease, some are in Stage 5 . These classes give patient an opportunity to get all their questions answered.

Kidney Disease

Patients are educated on the Different Dialysis Modalities that are available to them including :

  1. In Center Hemodialysis

  2.  Home Hemodialysis

  3. Nocturnal hemodialysis

  4. Continuous Ambulatory Peritoneal Dialysis (CAPD)

  5. Continuous Cycling Peritoneal Dialysis (CCPD)

Kidney Transplantation is also discussed at these classes. The patient is educated on how to prepare for eventual Dialysis and Kidney Transplantation.

Dr Casaretto and Lorianne English are the teachers for this class.



by Beth Greenstein, LCSW Social Worker extraordinaire North Star Center, Boca Raton, Fl 561-0500 ext. 40

Shawn Achor, the author of The Happiness Advantage notes we have three mental paths when we are faced with adversity:

1. We can keep circling around, have no change, and end up exactly the same as when we started out. 2. We can be worse off then we started. This results in us being more afraid of conflict and challenge or

3. We can pursue a path that results in us being stronger and more capable after the crisis.

Sounds great, but is it doable??? Absolutely.

Take Fred, not happy about being on dialysis. Who could be? He was only 60, retired due to a heart condition, widowed and because of his disability, living with his sister and his brother-in-law. Hard to tell which one of those two are the craziest!

So, he couldn’t help it. Told himself it was all unfair and boy, was he was pissed! Then to make matters worse, he now can’t have ice cream, couldn’t go on extended weekend trips whenever he wanted. Add to this the fun of being stuck by a needle. No, it gets better. He wakes up one morning, gets ready to come to that clinic and guess what, he has none of that vibration stuff going on in his arm. It happened not one month but the following month again! Now he gets to enjoy spending another few hours arranging to get the thing going again, rushing to one of those Access places and having to spend his usual day off doing back to dialysis!

How about Jose! He is only 26, should be going clubbing at night, maybe finished with college and ready to show the world his stuff. But, nooooo! He gets to spend nights tied up to that PD machine. Yea, he knows, at least he has his days free. Right! What about the never-ending doctor appointments, the constant work-up for transplant? Do those people ever answer their phone!!!

So, needless to say, its’ not easy! But doable, yes!! Because, there is a tool, mightier than the sword! Nope, not Superman. Not even the Green Lantern!

As Anchor goes on to say “Happiness is not about lying to ourselves or forgetting negative experience but adjusting our brain so that we see the ways to rise above the circumstances.”

So, there’s what is called the ABC approach, easy enough to remember! A-The adversity, we can’t change it B- The belief about it, whether we think the problem is solvable C- The consequence of our belief D- the disputation – telling ourselves our thought IS A BELIEF NOT A FACT!

For example, Fred tells himself, “I am helpless, I have to have dialysis if I want to live” Jose says,”It’s’ all my families fault, they gave me the genes and didn’t help me.” True? Not true? As your social worker extraordinaire, I can tell you one thing (and probably only one thing!) which is THOUGHTS ARE THINGS.

What do I mean? If you keep telling yourself negative, angry, stress thoughts, guess what! Will you win the lottery! Will you be happy! Will you find the hot date you want on Match

Chances are slim. Because many, many people, much smarter than I (hard to believe, I know) will tell you there is a strong link between our mind, our body, and our actions.

So, what now? (Isn’t this where we started from?) Remember:

WE ALL HAVE CHOICES IN OUR THINKING AND thoughts are things. (Gee, didn’t I see that somewhere recently) Here are some changes and choices you can make today:

1) Decide to say “Thank you” when you wake up in the morning. Yea, I know its corny, do it anyway! Tons and tons of research show that those who have an ATTITUDE OF GRATITUDE are healthier and happier. Isn’t this the goal?

2) Get a mentor! Ask that Social Worker in your unit. She needs a break from all that paperwork and sitting in her office anyway! I have a mentor, a nice man or woman in every one of my units who is happy to help someone else. Believe it or not, it helps them!

3) Get active. That’s right. Get off your duff! If your MD says Ok, spend a part of every day, moving that body!!!! Use it or lose it.

4) Find something you enjoy, people, sometimes, yes, even family, a hobby; go to the beach (we are in Florida!)

5) And of course, HELP SOMEONE ELSE,( you knew that was coming!) we all have this ability, even if its just to smile at someone, tell a joke or heaven forbid, tell someone if you can do it, they can too!

6) Contact this social worker extraordinaire, I take Medicare, Humana, and other insurances and am nice, good and helpful. Just ask Fred and Jose!

Copyright by Florida Kidney Physicians.