Dr. Allen Wolfert has seen it all when it comes to kidney health in his 40 years as a nephrologist.

But one major problem with kidney disease that really has not changed over four decades is that it normally is not detected until damage already has been done.

"When you're dealing with chronic kidney disease, there are often no symptoms until it is already advanced," Wolfert said. "The most common symptom is no symptom. I have patients who say to me, 'I feel fine; how can I have a kidney problem?' Well, the body is very good for compensating. It can fool you for quite a long time."

Wolfert practices with Teredesai, McCann and Associates, seeing patients in Baden, Chippewa and Hopewell townships, and Ohio Valley.

A graduate of Albert Einstein College of Medicine of Yeshiva University in New York, he has been practicing in the Beaver and Pittsburgh areas for 30 years.

"My interest in nephrology developed when I was in medical school," he said. "Albert Einstein College has a phenomenal training program in nephrology. Early on, it was an almost terminal disease, but so much has changed over the years.

"For years, many nephrologists spoke a different language when it came to kidney disease. The approach and treatment often varied from physician to physician."

Wolfert said much of that changed about 20 years ago, when the National Kidney Foundation released clinical practice guidelines that present evidence-based recommendations to aid clinicians in the treatment of particular diseases or groups of patients.

One of those guidelines concerns GFR (glomerular filtration rate), a test used to check how well the kidneys are working.

"It made things much easier to explain in terms of working with patients," Wolfert said. "When you talk to people now, you can tell them, their creatinine is 1 or their creatinine is 2 and it makes it much more understandable. Or you can say, an acceptable GFR is 100 and yours is 50. Often they know coming in what we're talking about."

Wolfert said the reason many people are armed with knowledge is that they've already done research on the internet. Wolfert said he has no problem with it and welcomes web searches.

"I am a big reader," Wolfert said. "I like to read up on changes and advancements, so as long as their source is a good one, I encourage people to read up on their condition."

Kidneys filter wastes and excess fluids from the blood, which are then excreted in the urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in the body.

But while kidney disease is a silent disease, it also is a silent killer.

"The best example to compare it to is heart disease," Wolfert said. "With some people, their first presentation that there is a problem is with a heart attack. Kidney disease is very similar. It can and will surprise you. And if you have hypertension and diabetes, you are a candidate."

So how does one avoid kidney disease, or at the very least, decrease the chances of developing it?

"Well, it's not a magic number of glasses of water that you need to drink every day," Wolfert said. "You don't want to get dehydrated, but drinking water will not solely prevent kidney disease. Drugs, especially, are sensitive to your kidneys. Many people don't realize the damage they're doing with taking drugs on their own.

"Some people take ibuprofen like candy," he added. "It's fine to take it every now and then. But if you go through a bottle regularly, check with your physician and see if that's OK."

Wolfert said triggers should not be ignored.

"Family history contributes to kidney disease," he said. "So if you are at risk, especially, keep your sugar and your blood pressure at good levels. If you show a lot of protein in your urine, you may be developing kidney problems, especially if your sugar has been out of control regularly.

"Diabetics should always watch for changes in their eyes, which is a sign of organ damage."

Wolfert said that while there have been advancements in dialysis, it can still be a rough road for patients. According to the National Kidney Foundation, the average life expectancy on dialysis is five to 10 years, although many patients have lived on dialysis for 20 or even 30 years. On the other hand, patients who receive a kidney transplant typically live longer than those who stay on dialysis. A living donor kidney functions, on average, from 12 to 20 years, and a deceased donor kidney from eight to 12 years.

"I wish I could say that life with dialysis is wonderful now, but it isn't," Wolfert said. "When most people hit the point that they need dialysis, they usually have something else wrong with them. Dialysis is much safer than it was 20 years ago, and transplant survival has gotten much better. The thing that I heard 20 years ago that I still hear today, though, is that the patients feel wiped out after dialysis. That is still an issue."

At one time, a patient's main choice, Wolfert said, was hemodialysis, which was done in a hospital or dialysis center.

A second option now is peritoneal dialysis, which is done at home. Both reduce wastes and excess water from the blood, but in different ways. In hemodialysis, blood is pumped out of the body to an artificial kidney machine and returned to the body by tubes that connect to the dialysis machine. In peritoneal dialysis, the inside lining of the patient's stomach acts as a natural filter.

"Other countries have used peritoneal dialysis for years, but it was limited here until about five years ago, when for some reason we had a push in this country to switch to it," Wolfert said. "Peritoneal dialysis is easier on the patient, and they can do it in the comfort of their home. Most seem to have different symptoms and people are able to live a much more normal lifestyle doing their dialysis at home.

"But many don't want to try it," he added. "They want to get it done by professionals in a hospital or dialysis setting. It's all what you're comfortable with."