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Our experienced physicians and advanced practice providers are specialists in kidneys and kidney related diseases. This includes Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD), Hypertension, Anemia, Kidney Transplantation, Dialysis and more. Below are more details on some of the common conditions managed by Snohomish Kidney Institute.


Chronic Kidney Disease, or CKD, is the gradual, yet progressive decline in kidney function over time. Just as the body ages and loses function, so do the kidneys. Most of the time there is no significant damage as it is a slow process. Those with CKD however, experience an accelerated decline in the function of their kidneys and may need to be under the care of a nephrologist, or kidney doctor. Patients who have conditions such as diabetes, hypertension, or other diseases that attack the internal structure of the kidneys are at greater risk for developing CKD. When CKD conditions worsen to an advanced state, waste products within the body accumulate and can trigger a multitude of other symptoms. Such symptoms can include: excessive weight gain or weight loss, a decrease in the output of urine, fatigue, body swelling, a lack of appetite, paleness, an increased tendency to bruise or bleed, confusion, and in severe cases, seizures or coma. Your nephrologist’s goal is to help preserve as much of the kidney function as possible and educate you on renal replacement therapy options, such as dialysis or kidney transplant, should symptoms worsen.

If you or your patient has any of the below conditions or symptoms, please consider calling our office:

  1. Elevated Creatinine (Creatinine > 1.5 mg/dL or GFR < 45 ml/min)
  2. Hypertensive Urgency
  3. Proteinuria or Hematuria
  4. Severe edema or volume overload
  5. Recurrent kidney stones


Unfortunately, many patients who suffer from Chronic Kidney Disease will lose kidney function at some point (either acutely or chronically) and need a modality to replace the functions of the human kidney. Dialysis is one method of renal replacement therapy. Dialysis can be performed in two ways:

  1. Hemodialysis – This method uses an external machine that acts as an artificial kidney. The patient’s blood will be taken from their body and moved to this machine. The machine will then perform the role of the kidney by removing excess fluid, correcting electrolytes, removing waste products and buffering acid production. Once these items have been performed, the blood will be returned to the patient’s body. 
  2. Peritoneal Dialysis – In this method, a fluid is added to the patient’s abdominal cavity. This fluid helps to perform the job of the kidney by removing water, correcting electrolytes, removing waste products and buffering acids. Once these activities have been completed, the fluid, along with the bodily waste products, are drained from the patient’s body.

Many patients will go to a dialysis facility multiple times a week to receive hemodialysis however, there are opportunities for both hemodialysis and peritoneal dialysis to be performed in the comfort of your own home. If you elect to pursue home dialysis, you will need to receive training on how to perform whichever mode of dialysis you select in a safe and knowledgeable manner. The greatest benefit to home dialysis for many patients is that they are able to perform dialysis independently and on their own schedule, from home. Please be sure to work directly with your nephrologist to determine the best option for you and your lifestyle should you be required to go on dialysis.


Hypertension is the medical term for high blood pressure. The average person’s blood pressure should be systolic or <120/80mmHg. Patients are considered pre-hypertensive if their blood pressure readings are >120/80mmHg. True hypertension is determined if the patient’s blood pressure is >140/90mmHg.

There are also several other terms related to hypertension that you may need to become familiar with.

Essential (primary) HTNthe cause of this is not truly understood. Medical professionals believe it is caused from a combination of genetic background, race, diet, weight gain and other environmental factors.

Secondary HTNthis form of high blood pressure has a different underlying cause than essential hypertension and requires additional screening, which your physician will request. Some of the causes of secondary hypertension include: CKD, sleep apnea, narrowing of the kidney arteries, disorders of the adrenal gland, NSAIDs (i.e. Ibuprofen, naproxen), or birth control pills.

Resistant HTNthis form of hypertension is defined as having a higher than normal blood pressure despite having been treated with 3 medications, one of which is a diuretic.


For patients whose kidney functions have declined enough that intervention is necessary, a kidney transplant may be the best option. This solution can provide a higher quality of life than those undergoing dialysis. Transplant recipients tend to have more energy, more freedom and a diet that is less strict. Please work with your nephrologist closely if you think you might be a candidate for a kidney transplant.


If there are not a sufficient number of red blood cells in your body, you may be diagnosed with anemia. This is a common condition for those who also have Chronic Kidney Disease. Anemia is  common in CKD patients because your kidneys send signals to your body to produce red blood cells from a hormone called erythropoietin (EPO). This hormone will be lacking in those with kidney disease, thus causing an insufficient amount of red blood cells to be produced.  Red blood cells are an important piece of your blood as they carry oxygen through the bloodstream which help bones, muscles and organs to perform properly. Your nephrologist can help determine if you have anemia and will work directly with your primary care team to determine the best care plan for you.