Q & A with nephrologist, Mark Mancini, MD
Mark Mancini, MD is the medical director of Shoreline Nephrology & Hypertension practice for the South County Medical Group. After graduating from the University of Connecticut School of Medicine where he received his medical degree and completed his residency, Dr. Mancini joined South County Health in 1999 where his patients benefit from the community health philosophy.
What led you to specialize in nephrology?
Nephrology is a specialty that encompasses disciplines from a multitude of other specialties, including cardiology, hematology, oncology, endocrinology, and therefore is an all-encompassing specialty. In short, all of the organs work together. It is this system interdependence that makes nephrology so interesting. It is one that deals with a wide variety of disorders, including kidney disease, dialysis, congestive heart failure management, edema management, hypertension management, and electrolyte imbalance. It requires discipline, and a “total patient perspective”, when interpreting renal disorders.
Are kidney disorders typically genetic or brought on by lifestyle?
Renal disease is commonly, as are so many cases in life, affected by lifestyle, with poorly defined genetic predisposition to developing renal disease. We know that renal disease can run in families, particularly in certain diseases such as polycystic kidney disease, but even hypertension, which is a very common cause of chronic kidney disease, is more prevalent in families. The same can be said for diabetes as well. Additionally, certain racial groups are more prone to renal disease, such as African-Americans and Native Americans. Therefore, I definitely think that genetics plays a role. However, it is our lifestyle, and how we treat our body, that may ultimately affect whether or not we develop kidney disease. We need to be smart about how we conduct our daily lives and how we treat our bodies.
What are the symptoms of kidney disorders?
The symptoms of kidney disease are very nonspecific. Very advanced kidney disease can cause symptoms such as sleep disorders, headaches, alteration in appetite, alteration in taste, fluid retention, generalized fatigue, and difficulty concentrating. However, there are a multitude of non-renal disorders that can cause all of the same symptoms. Therefore, there is no one specific symptom that is indicative of kidney disease. The best way to determine if a person has kidney disease is with a blood test to measure a person's level of creatinine.
How do primary care physicians detect issues that may alert them that a patient is suffering from a kidney disorder?
There are two tests that should be done periodically on patients, with some patient groups, such as diabetics, and those with essential hypertension, that should be screened on a more regular basis - a blood creatinine level, and a urinary albumin/creatinine ratio test.
What is the relationship between kidney disorders and hypertension?
There is tight interdependence of hypertension and chronic kidney disease. Hypertension is a primary cause of chronic kidney disease, accounting for approximately 40-42 percent of cases of end-stage renal disease in this country. Chronic kidney disease also leads to hypertension. It can be a vicious cycle. Interestingly, when an individual receives a kidney transplant for their kidney failure, blood pressure typically normalizes or improves dramatically, highlighting the central role that kidney function plays in regulating blood pressure.
What can people do to prevent kidney disorders?
Knowing that chronic kidney disease is more prevalent in individuals who are overweight, have uncontrolled high blood pressure, uncontrolled diabetes, and are smokers, this knowledge can empower an individual to take control of their health to improve their quality of life and longevity. Regular exercise, 3-4 times per week of aerobic activity, controlling one's weight, adhering to a low-salt diet, approximately 2.4 grams of sodium per day (equivalent to 1 teaspoon), seeking to control blood pressure to approximately 130/75, working with your physician to control diabetes, cholesterol management, and avoidance of tobacco products, may all help to avoid kidney problems, or delay progression of existing kidney disease. There is a myth that high fluid intake to “flush the toxins out of the body” will help to prevent kidney disease is widespread. While we certainly want to avoid dehydration, the average person needs no more than 48-64 ounces of fluid per day. Under conditions of increased fluid loss, such as diarrhea, vomiting, or excessive sweating because of exercise, increased fluid intake is justified. Otherwise, flooding oneself with several bottles per day of water really has no benefit.
Dr. Mancini can be reached by calling Shoreline Nephrology & Hypertension, a member of the South County Medical Group, at 401-782-0090 (MOB Wakefield) or 401-596-3313 (17 Wells St., Westerly).
South County Hospital’s Board Certified Nephrologists include, Dr. Mancini, Joseph M. Romanello, MD, and Peter C. Shorter, MD (board eligible).