We were lucky enough to catch an interview with the wonderful Dr. Priya Deshpande, MD, at Mount Sinai Doctors Brooklyn Heights. She has been kind enough to answer some really important questions that parents have about nephrology, hypertension, and secondary hypertension. We hope you enjoy!
~Rebecca Conroy, Editor of A Child Grows in Brooklyn
Tell us about your specialty…
As an adult nephrologist, I mainly see adults whose kidney function is impaired (called chronic kidney disease). Usually, these patients have a history of hypertension and diabetes mellitus, but there are other conditions that can affect the kidney as well (inflammatory conditions, genetic conditions, etc.). I also help prepare patients with very severe kidney failure for dialysis and refer them for kidney transplant evaluation. Aside from managing chronic kidney disease and hypertension, I also help manage patients who have had kidney stones. I see patients over 18 years old Monday- Friday various hours between 8:30 am and 7 pm at Mount Sinai Doctors Brooklyn Heights.
Why did you, personally, choose to specialize in nephrology?
Aside from the thrill I get from tackling complex electrolyte disturbance cases, I think that chronic kidney disease patients are a special population, and I enjoy helping patients as well as their primary care providers and family members better understand the disease and prognosis. My patients and I have very important discussions about their wishes and goals, particularly in those who are contemplating dialysis or renal transplant. Caring for chronic kidney disease patients allows me to integrate all that I learned during my training, from nephrology to nutrition to helping people emotionally cope with renal disease.
What exactly is hypertension, and how does it relate to the kidneys?
Hypertension (also known as high blood pressure) is a disease process where your systemic blood pressure is higher than 140/90. Most adults who have high blood pressure have “essential hypertension,” which means that its cause is not well understood. However, we do know that sustained elevated blood pressure causes inflammation and accelerates atherosclerosis (hardening of the arteries) and that this, over time, affects blood vessels all over the body. When the blood vessels to vital organs — such as your kidneys, heart, and brain — are affected, organ damage can occur.
The kidneys play an integral part in controlling systemic blood pressure. They regulate the amount of fluid and electrolytes in your body. They also are the targets for various hormones secreted by your adrenal glands that are responsible for blood pressure. Any disturbance in kidney function, hormonal regulation, and fluid/electrolyte balance can contribute to hypertension.
For children, what should we worry about in terms of hypertension? Is this type of situation genetic most of the time?
Children and adolescents can develop hypertension, but the etiologies are likely different than in adults. Again the reason for most hypertension in adults is not well understood, but in children we look for what’s called secondary hypertension. Secondary hypertension can be caused by hormonal disturbances (e.g., pheochromocytoma), including problems with the adrenal gland (e.g., congenital adrenal hyperplasia), and renal disease (e.g., glomerulonephritides, polycytic kidney disease). Also, some medications have been known to raise the blood pressure in children such as glucocorticoids, contraceptives, and anabolic steroids.
What should parents keep an eye out for?
Unfortunately there may some scary symptoms associated with severely high blood pressure. If a child is experiencing severe headaches, chest pain, changes in mental status, focal neurologist symptoms (unable to move a part of body), or shortness of breath, the child needs emergency medical care.
If a child starts having blood in the urine, lower extremity swelling (edema), or swelling below their eyes (periorbital edema), I would recommend taking them to their pediatrician to rule out any kidney issue. This can be done with a simple blood and urine test. We have five wonderful pediatricians right here at Mount Sinai Doctors Brooklyn Heights.
If the child starts experiencing palpitations, flushing, or fast heart rate along with high blood pressures, we should consider adrenal gland problems or medications (certain decongestants, illicit drugs, amphetamines, etc.) as potential causes.
Are there any dietary rules that all parents should be aware of for kidney health?
I recommend that all of us try to restrict the amount of sodium that we ingest. Unfortunately, there is a lot of sodium in the foods we eat (especially in pre-prepared, packaged foods) and there is some data that this high sodium diet contributes to the onset and progression of hypertension, chronic kidney disease, heart disease, and cerebrovascular disease.
Adults and children with hypertension, kidney disease, or diabetes have to be particularly strict about decreasing their sodium consumption (the recommendation is less than one teaspoon a day). Also patients with kidney disease may have to restrict potassium, phosphorus, and protein intake, depending on what their doctor recommends. As a nephrologist, I recommend a well-balanced diet with fruits, vegetables, lean proteins, and dairy, without too much added sodium or sugars.
Is high blood pressure always a fast-lane toward kidney issues?
Not necessarily. For reasons we don’t quite understand yet, not everyone with hypertension develops kidney disease. In a good number of cases, proper treatment of hypertension, particularly with medications called ACE-inhibitors or ARBs, can help slow the progression. However, in some cases chronic kidney disease could still progress despite treatment of hypertension. A better understanding of the effects of hypertension on the kidney is definitely needed through continued research.
Are certain sports dangerous for kids to do who are suffering with kidney issues?
Kids who are born with only one kidney (which is rare, but does happen and is diagnosed by prenatal ultrasounds) should probably avoid contact sports.
Adolescents and adults with uncontrolled blood pressure who want to exercise could probably do light/low impact exercises as long as they have their doctor’s okay. They can discuss with their doctor about intensifying their activity especially if their blood pressure improves. Also patients with uncontrolled blood pressure should avoid weight lifting until pressure improves.
Can yoga and meditation help?
Although there are some studies supporting the use of yoga and meditation, I think more intensive investigation is needed using randomized control trials. Also you may want to check with your yoga instructor or physician to see if there are any poses that patients with hypertension, heart disease, or cerebrovascular disease should avoid. I also think the yoga, meditation, and exercise help with your overall health and sense of well-being, but shouldn’t replace prescribed medication.
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Priya Deshpande, MD, is a board certified nephrologist at Mount Sinai Doctors Brooklyn Heights, seeing patients Monday-Friday various hours between 8:30 am and 7 pm. She is certified by the American Board of Internal Medicine. She was awarded her medical degree from SUNY Downstate Medical Center, and she completed her residency in internal medicine at Montefiore Medical Center/Albert Einstein College of Medicine and her fellowship in nephrology at The Mount Sinai Hospital. Dr. Deshpande sees patients over age 18 for various conditions such as chronic kidney disease, acute renal failure, polycystic kidney disease, kidney stones, hypertension, and post-kidney transplant management. She is the proud mother of a one year old child.
Mount Sinai Doctors Brooklyn Heights is a two-floor multispecialty group practice with an urgent care center and more than 36 specialties, including adolescent medicine, allergy, cardiology, dermatology, endocrinology, gastroenterology, internal medicine, maternal and fetal medicine, neurology, OBGYN, orthopedics, pediatrics, podiatry, primary care, pulmonology, radiology, urology, vascular surgery, and walk-in urgent care. The practice is located at 300 Cadman Plaza West, on the 17th and 18th floors. You can make appointments online at mountsinai.org/bh or zocdoc.com.