Other Medical Issues When You Have CKD

It occurs to me that I’ve never included a sketch of the kidneys’ location.  This one is courtesy of  National Institute of Diabetes and  Digestive and Kidney Diseases, National Institutes of Health.  This institute is wonderful in allowing others to use their images and information as long as they are accredited.

Your kidneys, located in your body where the sketch demonstrates, are compromised.  That has a bearing on every infection, cold, surgery, disorder or anything else medical that may happen during your life. You need to be careful about any prescription drugs you may take. You need to read the accompanying literature very carefully to look for interactions. You have to read this material every time you obtain a refill since there may be new information about the drug since the last time you filled a script.

The idea is to be vigilant about prescribed drugs that may create some kind of side effect which may further damage your kidneys.  It’s a good idea to make certain your pharmacist knows you have CKD.  Naturally, you need to inform your nephrologist of any medications you intend to start or stop taking.

A case in point is erythropoietin [EPO]. This may be prescribed for anemia. The kidneys produce this protein which promotes the creation of red blood cells. A low red blood cell count may indicate anemia. Your liver also produces a small amount of EPO. All right, let’s say you’re not producing enough EPO and develop anemia.  Your nephrologist prescribes EPO injections.

However, EPO can worsen your HBP – which can both cause and be caused by CKD. Most nephrologists agree it’s better to take the EPO injections and increase your HBP medication to control your hypertension. Incidentally, low blood pressure is less serious than high blood pressure, but it still must be treated.

I’ll use my own situation as an example of how carefully CKD patients need to monitor their own health. I had a bladder infection, but didn’t know it.  I knew I wasn’t feeling well at all, so I called my primary care physician for an appointment.  Her medical assistant  [M.A.] told me my doctor was out of town for a week and to go to the urgent care center near my home since, as a CKD patient, I should not wait.  When I told the receptionist at the urgent care center that I had CKD, she sent me to the emergency room at the local hospital in case I needed blood tests or scans for which the urgent care center was unequipped.  The hospital did run a scan and blood tests.  This way, they were able to see if I had an infection, blockage or some imbalance that might not only make me feel sick but worsen the CKD.

I already knew I had a higher than usual white blood cell count from my previous fasting blood test for the nephrologist about a month before the emergency room visit.  He’d felt it was not significantly high enough to indicate an infection but was, rather, a function of a woman’s anatomy.  Women have shorter internal access to the bladder, as opposed to those of men.  Looked like my nephrologist might have misjudged.

However, he quickly picked up that the medication prescribed by the emergency room physicians, despite my having reiterated several times that I have CKD, was a sulfur based drug.  He quickly made a substitution, saving possible further damage to my kidneys.  The hospital insisted I only had Stage 2, so this was a safe drug for me.  I was nervous about this as soon as they became defensive about prescribing this medication.  You need to stick to your guns about being taken seriously when it comes to CKD.

I have had non-nephrology doctors tell me ridiculous things such as there’s nothing wrong with an Advil here or there or that I needed more then five ounces of protein a day.  I used to argue with them until I realized that I am the one responsible for slowing down the deterioration of my kidneys.  I have the help of my nephrologist and nutritionist, but it is ultimately up to me not to blindly listen to a doctor’s orders.  I need it explained, I need to understand if this is safe for me, and most importantly, I need to speak up if I feel it is not.  You, too, need to be your own advocate.  Take a friend with you to your appointments if you need moral support, but do not let anyone – doctor or not – dictate to you.

Of course, you already know about not taking non-steroidal anti-inflammatory drugs [NSAIDS] like Advil, Aleve and Ibuprofen, much less aspirin which can have an effect on your blood’s clotting ability possibly causing bleeding and harming the kidneys.  But did you know that certain other over the counter remedies can also be harmful to your health as a CKD patient?

They may contain elements you should not be taking if you have CKD.  For example, Alka Seltzer or baking soda is high sodium, and you are already trying to control your sodium intake.  Then there are antacids which may contain milk of magnesia, which can build up in your body and cause neurological difficulties.   Food supplements or vitamins may contain potassium or magnesium. Even diuretics can damage your kidneys by causing excess sodium excretion.  Read the labels and, if you’re not sure, ask your nephrologist. As I discovered, it’s better to be a pain in that doctor’s neck than risk taking a perfectly ordinary substance that had become a threat to you since your kidneys are not working as they should.  It’s a good idea to avoid enemas and laxatives since they may dramatically and quickly change your electrolyte balance.

I’ll continue with this topic on Tuesday, but right now I’d like to wish those who celebrate Christmas, a very merry one tomorrow.  For those, like me, who celebrate Hannukah or those who celebrate Kwaanza, I hope it was a good holiday for you.  On a personal note, since everyone else in my family celebrates Christmas and I’m the matriarch, I get to fill stockings for them all, cook a ham for my son-in-law, rib roast for my sweetheart and turkey for me.  I hear one of the kids is bringing home made egg nog (can I have that?  I’ll look it up right away!) and another is making Grandma’s recipe cheesecake.  Oh yes, there will be some fruits and veggies, too.  So, it’s true, some holiday celebrations do revolve around food!

Until Tuesday, keep loving your life.

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