We’re Just Not Compatible

How many times have you heard this as a young single person? Not too many, I hope. I can clearly remember feeling terrible upon hearing this, “It’s not you; it’s me.” Worse yet when I was the one saying it. It did seem necessary all that long ago. Read on and you’ll find out what this has to do with National Donor Month.

As far as incompatible, in this case, I don’t mean you and me. [Although that could be true.] I mean a kidney transplant between two people who are not a match. Unsurprisingly, this is called an incompatible kidney transplant and you just might call it old fashioned since paired kidney donations have appeared. Let’s see what we can find out about incompatible donation anyway.

Photo by Nathan Cowley on Pexels.com

My old friend, The Mayo Clinic, offers the following:

“In the past, if your blood contained antibodies that reacted to your donor’s blood type, the antibody reaction would immediately cause you to reject your transplant. This would prevent a successful transplant. Back then, the only option was to identify recipient-donor transplant pairs with compatible ABO blood types.

Over the years, advances in medicine made ABO incompatible kidney transplant possible between some recipients and living donors. The option of having a living donor with a different blood type reduced the time on a waiting list for some people.

With an ABO incompatible kidney transplant, you receive medical treatment before and after your kidney transplant to lower antibody levels in your blood and reduce the risk of antibodies rejecting the donor kidney. This treatment includes:

• Removing antibodies from your blood (plasmapheresis)
• Injecting antibodies into your body that protect you from infections (intravenous immunoglobulin)
• Providing other medications that protect your new kidney from antibodies) [stet.]”

I don’t know that I’d want to go through all this in addition to the bodily trauma of having a new organ in my body. Then again, knowing me, I’d probably have jumped at the chance if that was the only way for me to stay alive. [Hence, my eagerness to endure chemotherapy, surgery, and radiation to eradicate that nasty pancreatic cancer from my body.]

I do know that I needed more information on plasmapheresis since it was a new concept for me. The National Kidney Foundation did not disappoint:

“Plasmapheresis is a process that filters the blood and removes harmful antibodies.  It is a procedure done similarly to dialysis; however, it specifically removes antibodies from the plasma portion of the blood.  Antibodies are part of the body’s natural defense system which help destroy things that are not a natural part of our own bodies, like germs or bacteria.  Antibodies against blood proteins can lead to rejection after a blood-type incompatible transplant.  In severe cases, this could cause the kidney transplant to fail.  Plasmapheresis before transplant removes antibodies against the donor blood-type from the recipient, so they can’t attack and damage the donated kidney. 

Depending on the antibody levels and the transplant center protocols, a medicine to keep more antibodies from forming may also be administered intravenously. In rare cases, the patient’s spleen is removed using minimally invasive surgical technique to keep antibody levels low.

 After the transplant, the patient may require additional plasmapheresis treatments before discharge from the hospital. He or she will then take the similar immunosuppression medications as patients receiving a blood type compatible kidney.  At some centers, a biopsy may be done soon after transplant to ensure antibodies are not causing rejection of the transplanted kidney.”

I was having a pretty hard time figuring out when and how incompatible transplants started being used until I hit upon the World Journal of Transplantation:

“Principally after 1998, there was a worldwide increase in the rate of kidney transplantations from living donors that involved ABOi. This fact may be principally ascribed to four factors. (1) Since 1998, our knowledge of the diagnosis and treatment of ABMR has substantially improved. (2) By the beginning of 2000, Japanese authors published excellent results in renal transplantations involving ABOi … although the main limitation of the Japanese strategy was the splenectomy associated with their pretransplantation protocol. (3) Later, Johns Hopkins University and the Mayo Clinic in the United States documented the possibility of performing such transplantation without splenectomy with the administration of an anti-CD20 monoclonal antibody (rituximab [RTX].  (4) Finally, Swedish authors developed a new technique that demonstrated outcomes in renal transplantation involving ABOi that were similar to the outcomes of standard renal transplantation….”

Wait a minute. What is this splenectomy of which they speak? Oh, right, I had one during my cancer surgery. Welcome back to my long absent favorite dictionary, the Merriam-Webster, for the definition: surgical removal. Now, what’s a spleen? Thank you to Medical News Today for answering my question:

“The spleen’s main roles are:

• filtering old or unwanted cells from the blood
• storing red blood cells and platelets
• metabolizing and recycling iron
• preventing infection

The spleen filters the blood, removing old or unwanted cells and platelets. As blood flows into the spleen, it detects any red blood cells that are old or damaged. Blood flows through a maze of passages in the spleen. Healthy cells flow straight through, but those considered unhealthy are broken down by large white blood cells called macrophages.

After breaking down the red blood cells, the spleen stores useful leftover products, such as iron. Eventually, it returns them to the bone marrow to make hemoglobin, the iron-containing part of blood,

The spleen also stores blood cells that the body can use in an emergency, such as severe blood loss. The spleen holds around 25-30% of the body’s red blood cells and about 25% of its platelets.

The spleen’s immune function involves detecting pathogens, such as bacteria, and producing white blood cells and antibodies in response to threats.”

No wonder I’m so tired all the time. Especially if we add my chronic kidney disease stage 3B and sleep apnea. Yuck!

Oh, one last note. Remember, incompatible transplant is not used as much these days since paired donations and transplant chains have come into use.

Until next week,

Keep living your life!

Yes, Living Donation Help is Available

Let’s say you’ve read the past two  or three blogs and understand that more kidney donations are needed. Let’s say deceased donation is just not hitting you right. Let’s say you want to make a living donation since you have two kidneys and only need one to stay alive. First of all, congratulations on making that big decision. Next, do you know there are organizations that will help you… and it won’t cost you a penny. I’ll let the organizations speak for themselves.

You do need to apply for this first one. Not all applications are guaranteed entry to the program.

The National Living Donor Assistance Center
“Many people would like to donate an organ to a family member or friend, but would have trouble paying for related expenses—like transportation, lodging, food, and dependent care—that are not covered by insurance, especially if they lose wages during their recovery from donation surgery. The costs of the process can be a burden for donors and recipients; for some, these costs might make living organ donation impossible.

The National Living Donor Assistance Center exists to provide access to transplantation for those who want to donate, but face financial barriers to doing so.

This program is administered by the Division of Transplantation (DoT), Healthcare Systems Bureau (HSB), Health Resources and Services Administration (HRSA), United States Health and Human Services (HHS) through a cooperative agreement with the University of Kansas (KU) and the American Society of Transplant Surgeons (ASTS). For details about the legislation that authorizes this program and its history, please click here.”

UNOS (United Network for Organ Sharing) offers information that clarifies some of the questions you may have, in addition to assistance in donating.

“With living donation, a living person donates an organ or part of an organ for transplantation. Most living donors donate one of their kidneys or a part of their liver. Much more rarely, living donors may donate other organs. Living organ donors make thousands of transplants possible every year.

Relatives, loved ones, friends and even individuals who wish to remain anonymous often serve as living donors to spare a patient a long and uncertain wait. In 2023, more than 6,900 transplants were made possible by living donors.

If you are considering living donation, it is critical to gather as much information as you can from various sources.

View downloadable brochures for more detailed information

Who can be a living donor?

Living donors should be:

• in good overall physical and mental health and
• older than 18 years of age.

Medical conditions such as uncontrolled high blood pressure, diabetes, cancer, certain infections, or an uncontrolled psychiatric condition, could prevent you from being a living donor.

Since some donor health conditions could harm a transplant recipient, it is important that you share all information about your physical and mental health. You must be fully informed of the known risks involved with donating and complete a full medical and psychosocial evaluation. Your decision to donate should be completely voluntary and free of pressure or guilt.

Visit the UNOS patient website, Transplant Living, to learn more about living donation.”

The National Kidney Registry outlines the approximate time necessary to donate a kidney.

“Donating a kidney is a life-changing gift but also a major commitment that involves extensive testing, major surgery and weeks of recovery time. If you decide to donate a kidney, here’s the process you’ll go through.

Screening & Testing

1. 45 mins Complete a confidential screening / medical history
2. ~3 days Center will contact you
3. ~3 days Complete standard workup
4. 1 – 4 months Get cleared for donation

Surgery & Recovery

• 1 day Complete pre-op
• 1 – 5 hours Complete surgery
• 1 – 4 days Recover in hospital
• 1 week Refrain from flying
• 1 – 4 weeks Recover at home*

*Most people can return to normal activities after 2 – 4 weeks. Donors with physically demanding jobs may need 4 – 6 weeks of recovery before returning to work. High-performance athletes will need 6 months to a year before they are back to pre-donation performance levels.”

How could I not check the American Kidney Fund for more information?

“If you are interested in living kidney donation:

• Contact the transplant center where a transplant candidate is registered.
• You will need to have an evaluation at the transplant center to make sure that you are a good match for the person you want to donate to and that you are healthy enough to donate.
• If you are a match, healthy and willing to donate, you and the recipient can schedule the transplant at a time that works for both of you.
• If you are not a match for the intended recipient, but still want to donate your kidney so that the recipient you know can receive a kidney that is a match, paired kidney exchange may be an option for you.

Another way to donate a kidney while you are alive is to give a kidney to someone you do not necessarily know. This is called living non-directed donation. If you are interested in donating a kidney to someone you do not know, the transplant center might ask you to donate a kidney when you are a match for someone who is waiting for a kidney in your area, or as part of kidney paired donation. You will never be forced to donate.”

Hey, how do you find the transplant centers anyway? The National Kidney Foundation offers easy to follow directions.

“To find a transplant center in your area visit the Organ Procurement and Transplantation Network (OPTN) website. Then follow these steps:

1. Select ‘Transplant Centers by Organ’ under Member Type
2. Select ‘Kidney’ for Organ Type
3. Select your state or region”

I tried it… just to check, of course. I entered my state rather than region and found four kidney transplant centers in Arizona. Well, that was easy.

Today’s blog was only a sampling of the places that can help you with your living kidney donation. I hope it was enough to peak your interest.

Until next week,

Keep living your life!

National Donate Life Month Redux

It’s the second week of National Donor Month already. I did want to say congratulations again to all those who post on social medica that they’ve received their kidney… and not just this month.

I’d like to show you some of the activities for this month. You may want to join some of these observances. Thank you to Donate Life America for the following list:

• “National Donate Life Blue & Green Day– April 12, 2024
  On National Donate Life Blue & Green Day, the public is encouraged to wear blue and green and to engage in sharing the Donate Life message and promoting the importance of registering as an organ, eye and tissue donor.
• Blue & Green Spirit Week– April  6–12, 2024
  Each day of the week leading up to National Donate Life Blue & Green Day is dedicated to a special theme, and will include: recognizing donors, volunteers and healthcare heroes; giving hope to those waiting; and engaging the public in fun at-home activities.
• National Pediatric Transplant Week– April 21–27, 2024
  National Pediatric Transplant Week focuses on the powerful message of ending the pediatric transplant waiting list. Throughout the week, clinical partners share their innovative work and patient stories (candidates and recipients), donor families whose children have saved and healed lives through organ, eye, and tissue donation are honored, and recipient families share their thanks and celebrate milestones. Donate Life America (DLA) would like to thank the United Network for Organ Sharing (UNOS), the American Society of Transplantation (AST),  American Society of Transplant Surgeons (ASTS) and Transplant Families for their partnership in developing and promoting National Pediatric Transplant Week.”

By the way, this is all new to me. So new that I missed Donate Life Living Donor Day on April 3. For those of you who are living donors, I sincerely hope both you and the person or chain members you donated to are doing well and enjoyed the observances that day.

Donate Life America’s web page has an explanation of who they are for folks who haven’t heard of them before or folks that have but didn’t quite know what they did [like me]:

“Donate Life America is a 501(c)3 nonprofit organization leading its national partners and Donate Life State Teams to increase the number of donated organs, eyes and tissues available to save and heal lives through transplantation while developing a culture where donation is embraced as a fundamental human responsibility. 

DLA owns, manages and promotes Donate Life℠, the national logo and brand for the cause of donation; motivates the public to register as organ, eye and tissue donors; provides education about living donation; manages the National Donate Life Registry at RegisterMe.org; and develops and executes effective multi-media campaigns to promote donation.” 

I am stage 3B chronic kidney disease. I know little about donation or transplants. So, I need to know why there are all these celebrations and observances. Perhaps you too are curious. The Kidney Foundation answered my question:

“Many people who need transplants of organs and tissues cannot get them because of a shortage of donations. Of the 123,000 Americans currently on the waiting list for a lifesaving organ transplant, more than 101,000 need a kidney, but only 17,000 people receive one each year. Every day 12 people die waiting for a kidney. Organ and tissue donation helps others by giving them a second chance at life.”

Whoa! How can that be? Maybe religious beliefs forbid donation? As a Jew, I was taught that I need to be buried as I was born – whole. My Jewish Learning, my go-to site for clarifying anything I don’t understand about my religion offers the following:

“… there is widespread support for organ donation across the spectrum of Jewish observance, from Reform to haredi Orthodox. Some authorities, citing the injunction in Leviticus 19 not to stand idly by the blood of one’s neighbor, go further in suggesting that Jewish tradition mandates organ donation in certain circumstances. The Conservative movement endorsed that position in 1995, when it established that post-mortem organ donation is not merely permissible, but required. Some Orthodox figures also consider organ donation obligatory.”

Christianity, Islam, Muslim, Hinduism, and Buddhism are also in favor of organ donation. Rather than blanket approval of organ donation, many religions differentiate between the two types of donations: living and deceased. Remember, there may be different sects within the same religion and these sects may differ in their opinions regarding organ donation. 

I think I mentioned in an earlier blog that I am donating my disease-ridden body to science instead. While my religion does not endorse this, there is so much wrong with my body that I feel it can offer many teaching lessons to researchers and scientists.

Life Source reminds us why donations – not only kidney donations – are so important:

• “In the United States, more than 100,000 men, women and children are on the national organ transplant waiting list ….
• Every 8 minutes, a new name is added to the ever-growing transplant wait list. Unfortunately, an average of 16 people die each day waiting for their second chance at a healthy life to arrive.
• ONE person – one registered organ donor – can save up to 8 lives through organ donation, and improve over 75 lives through tissue and cornea donation.” 

I’ve mentioned the two types of kidney donation above. I had no idea there were two until I started writing the blog. Just in case this is new to you, too, here is the information about them from UC Davis Health. Notice that living donation is further divided into different categories:

“Donor kidneys come from two sources: deceased organ donors or living donors. Deceased donors are people who have suffered brain death after a head trauma or medical problem in the brain such as bleeding.  The families of these patients make the generous decision to donate their organs. Patients who are on the transplant wait list are waiting for organs from deceased donors. It is not uncommon for patients to wait many years for a deceased donor kidney.

Kidneys can also come from living donors. There are three types of living donors:

• Living related donors (LRD) are donors who are blood relatives of the recipient. Usually these are parents, children or siblings.
• Living unrelated donors (LURD) are not blood related and are usually spouses or friends of the recipient.
• A third type of living donor is called an altruistic donor or non-directed donor. These donors volunteer to donate a kidney to any person in need without knowledge of the recipient. In these cases, the transplant wait list or donor paired exchange can be used to select a recipient.”

There will be more on donation in next week’s blog.

Until next week,

Keep living your life!

This is no Joke

Today is April Fool’s Day! [Oh, happy anniversary to cousins Gail and Bob Halpern.] But today’s topic is no joke. Last week, the lovely Leesa Thompson eased us into National Donate Life Month. We’ll learn more about this today.

Let’s start at the beginning. This is a relatively new celebration, started in 2003, only 21 years ago. The American Society of Transplantation explains:

“National Donate Life Month (NDLM) was instituted by Donate Life America and its partnering organizations in 2003. Celebrated in April each year, NDLM features an entire month of local, regional and national activities to help encourage Americans to register as organ, eye and tissue donors and to celebrate those that have saved lives through the gift of donation.”

The American Society of Transplantation describes itself as:

“The American Society of Transplantation is a diverse organization dedicated to advancing the field of transplantation and improving patient care by promoting research, education, advocacy, organ donation, and service to the community through a lens of equity and inclusion.

The history of the AST starts in 1981, when its charter members met and decided a separate society should be organized for transplant physicians. The American Society of Transplant Physicians (ASTP) was founded on May 10, 1982, and open to all physicians and health professionals interested in transplant medicine and biology. In 1998, the ASTP name was changed to the American Society of Transplantation (AST). Today, we are a growing and diverse organization of more than 4,200 members representing all areas of the field of organ transplantation and donation. In 2018, the Society grew, incorporating patient voice into its efforts through the evolution of its public facing Power2Save campaign. As we look to the future, our vision is bold and aspirational. While our 5 pillars remain the same, it is important that we plan a deliberate roadmap for the future.”

Donate Life America was a fount of information. One type of donation is deceased donation. I wrote about that in last year’s Christmas blog. I unwittingly called it a cadaver donation and am still apologizing for that mistake. However, I digress, so back to Donate Life America which offers more information about deceased donation:

“Deceased organ donation is the process of giving an organ or a part of an organ, at the time of the donor’s death, for the purpose of transplantation to another person. Only after all efforts to save the patient’s life have been exhausted, tests have been performed to confirm the absence of brain or brainstem activity, and brain death has been declared, is donation a possibility. 

The state donor registry and National Donate Life Registry are searched securely online to determine if the patient has authorized donation. If the potential donor is not found in a registry, their next of kin or legally authorized representative is offered the opportunity to authorize the donation. Donation and transplantation professionals follow national policy to determine which organs can be transplanted and to which patients on the national transplant waiting list the organs are to be allocated.”

I’ve written about living donation, too. Rather than list the multiple blog dates, you can use the Topic dropdown on the right side of the blog and scroll down to donation. In the meantime, I’m going to hop over to the American Kidney Fund to find out about the different kinds of living donation:

“ If you need a new kidney, consider a living donor kidney transplant. A kidney transplant from a living donor will last longer than a transplant from a donor who has died (a deceased donor). And your transplant can happen as soon as you and your living donor are ready!

A living donor kidney transplant is a surgery to give you a healthy kidney from someone who is still alive. On average, living kidney donor transplants last 15 to 20 years. Deceased donor transplants last 10 to 15 years on average. Each year, about 4 out of every 10 donations (40%) are from living donors. 

What are the types of living donor transplants?

Directed & nondirected donation

Directed donation is when a living donor gives a kidney to a person they have chosen, such as a family member or friend. This is the most common type of living donor transplant.

Nondirected donation is when a living donor gives a kidney to a stranger. This is sometimes called altruistic or good Samaritan donation and is the least common type of donation.

Kidney paired donation (KPD) and donation chains

Kidney paired donation (KPD) and donation chains can happen when a donor and recipient pair are not a good match, so they swap with other pairs to get better matches. These swaps make transplants possible for more people and have become more common in recent years:

• With kidney paired donation (also called paired exchange), two donor and recipient pairs swap donors to get better kidney matches.
• With donation chains, many pairs or nondirected donors swap donors to get better kidney matches.

Incompatible kidney transplant

Some transplant centers now offer incompatible kidney transplants when a donor and recipient are not a good match. Transplant doctors use special methods to make the recipient’s body less sensitive to the donor’s incompatible kidney. Talk to your doctor about if this could be an option for you.”

Because I’m 77, I wondered if my age would be a problem should I need a transplant. The National Kidney Foundation answered my question:

“In many cases, people who are older or have other health conditions like diabetes can still have successful kidney transplants. Careful evaluation at a transplant center is needed to understand and deal with any special risks. You may be asked to do some things that can lessen certain risks and improve the chances of a successful transplant. For example, you may be asked to lose weight or quit smoking. Only a transplant center can decide if you are healthy enough to receive a kidney transplant.

If you have diabetes, you may also be able to have a pancreas transplant. Ask your healthcare professional about getting a pancreas transplant along with a kidney transplant.”

After 14 years of writing about anything kidney related, I realize this is a pretty superficial blog about donation. Hang on, we have the rest of the month for more information.

Until next week,

Keep living your life!

A Matter of Life: National Kidney Month, Donor Month, and the Donor’s Dilemma

Our old friend, Leesa Thompson …. Wait a minute! I don’t mean you’re old, Leesa. I mean we’ve had a couple of guest blogs from you before. Please forgive me. Anyway, Leesa has brought another guest blog to me. This one is perfect for National Kidney Month and a lovely way to end this celebratory month. Take it away, Leesa…

National Kidney Month is observed annually in March to raise awareness about kidney health, kidney disease prevention, and the importance of early detection and treatment. During this month-long observance, various organizations, including the National Kidney Foundation (NKF) and the American Kidney Fund (AKF), as well as healthcare providers and advocates, work to educate the public about kidney health and the risk factors associated with kidney disease. The primary goals of National Kidney Month are to:

1. Raise Awareness: National Kidney Month aims to increase awareness about the importance of kidney health and the prevalence of kidney disease, which affects millions of people worldwide. By educating the public about the risk factors, symptoms, and complications of kidney disease, advocates hope to encourage individuals to take proactive steps to protect their kidney health.

2. Promote Prevention: Kidney disease is often preventable or manageable when detected early. National Kidney Month provides an opportunity to promote healthy lifestyle habits, such as maintaining a balanced diet, staying hydrated, exercising regularly, managing blood pressure and blood sugar levels, and avoiding tobacco use, which can help reduce the risk of developing kidney disease.

3. Support Patients: National Kidney Month also serves as a platform to show support for individuals living with kidney disease and those who have undergone kidney transplantation. It highlights the importance of access to quality healthcare, treatment options, and support services for kidney disease patients and their families. Throughout National Kidney Month, activities may include educational events, screenings, fundraisers, advocacy campaigns, and social media initiatives aimed at raising awareness and promoting kidney health. By participating in these activities and spreading the word about kidney health, individuals can help reduce the burden of kidney disease and improve outcomes for those affected by this condition.

Donate Life Month is an observance held annually in April [Gail here: more on that next month] to raise awareness about organ donation and encourage individuals to register as organ, eye, and tissue donors. During Donate Life Month, various events, campaigns, and educational initiatives are organized by organizations such as Donate Life America, transplant centers, and other healthcare organizations to promote the importance of organ donation and transplantation. The primary goal of Donate Life Month is to inspire people to make the decision to become organ donors and to discuss their wishes with their families. By increasing awareness about the critical need for organ donors and dispelling myths and misconceptions surrounding donation, advocates hope to save more lives and improve the quality of life for individuals awaiting life-saving transplants. Throughout the month of April, activities may include community outreach events, educational workshops, social media campaigns, donor registration drives, and storytelling initiatives featuring transplant recipients, donor families, and healthcare professionals. These efforts aim to highlight the profound impact of organ donation on individuals and communities and to encourage meaningful conversations about donation and transplantation. Participation in Donate Life Month provides an opportunity for individuals to learn more about the donation process, the importance of registering as a donor, and the incredible gift of life that organ donation represents. By engaging with the Donate Life community and supporting initiatives to raise awareness, individuals can help to increase the number of registered donors and ultimately save more lives through organ transplantation.

Becoming a living kidney donor is a decision that carries significant weight, both for the donor and the recipient. Understanding the full spectrum of advantages and disadvantages associated with this altruistic act is essential for individuals contemplating such a profound gesture, particularly in light of the critical shortage of available kidneys for transplantation.

On the positive side, the primary benefit of being a living kidney donor lies in the opportunity to save a life. With approximately 100,000 individuals approved for kidney transplants in the United States alone, the demand for organ donors far exceeds the available supply. By offering one of their kidneys to someone suffering from kidney failure, donors directly impact the recipient’s health and lifespan. This act of selflessness not only saves a life but also brings immeasurable satisfaction and a deep sense of fulfillment to the donor, knowing they’ve made a tangible and potentially life-saving difference in another person’s life. Moreover, the impact of a kidney donation extends beyond the individual recipient to their family, friends, and community. It fosters a culture of compassion and generosity, inspiring others to consider organ donation as a means of giving back and making a positive impact on society. Additionally, undergoing the rigorous medical evaluation process before donation can lead to early detection and treatment of previously undiagnosed health issues in the donor, ensuring the best possible outcome for both parties involved. Furthermore, living kidney donors typically experience minimal long-term health effects, with studies indicating that they generally enjoy good health and life expectancy post-donation. This reassurance can alleviate concerns about the potential impact on the donor’s own health and well-being. Additionally, the experience of being a living kidney donor can lead to personal growth and a deeper appreciation for one’s own health. Donors often report feeling a renewed sense of purpose and gratitude for their own well-being, inspiring them to prioritize self-care and adopt healthier lifestyle habits.

However, despite the numerous benefits associated with being a living kidney donor, there are also potential drawbacks and considerations to be mindful of. Donating a kidney involves undergoing surgery, which carries inherent risks such as bleeding, infection, and adverse reactions to anesthesia. While serious complications are rare, donors must be prepared for the physical discomfort and recovery period following surgery, which may necessitate several weeks of rest and limited activity. Furthermore, the emotional and psychological impact of being a living kidney donor should not be underestimated. Donors may experience a range of emotions, including anxiety, guilt, and worry about the recipient’s well-being, as well as concerns about their own health and future. It is essential for donors to have access to adequate support and counseling throughout the donation process to address any emotional challenges and ensure their well-being. Additionally, there may be practical and logistical considerations to contend with, such as arranging time off from work for surgery and recovery, coordinating travel and accommodations if the donor and recipient are not in the same location, and navigating financial expenses related to the donation process. Donors should carefully plan and prepare for these logistical challenges to minimize stress and ensure a smooth donation experience.

In summary, while being a living kidney donor offers the opportunity to save a life and make a profound difference in someone’s life, it is essential for individuals to carefully weigh the potential risks and benefits before making this decision. By thoroughly considering all aspects of the donation process and seeking support from medical professionals and support networks, potential donors can make an informed decision that aligns with their values and priorities, ultimately contributing to the greater good and leaving a lasting legacy of compassion and generosity.

Thank you for closing out National Kidney Month and easing us into National Donate Life Month, Leesa.

Until next week,

Keep living your life!

World Kidney Day

Last Thursday was World Kidney Day… and I’m late celebrating it. There are loads of medical issues in the family right now, but I’m trying to make up for this lapse. This past Saturday, I offered the digital versions of these books for free on Amazon:

What Is That and How Did I Get It? Early Stage Chronic Kidney

SlowItDownCKD 2011

SlowItDownCKD 2012

SlowItDownCKD 2013

SlowItDownCKD 2014

SlowItDownCKD 2015

SlowItDownCKD 2016

SlowItDownCKD 2018

SlowItDownCKD 2019

SlowItDownCKD 2020

Why? Because 90% of people with chronic kidney disease don’t know they have it. I wanted them to know enough to realize that it’s worth a blood test and a urine test to be diagnosed. I also posted three reels publicizing this offer on social media. It’s that important to me that you find out for yourself whether or not you have CKD.

Then I thought we’d do something a little different this year and let World Kidney Day speak for itself:

“World Kidney Day is a global campaign aimed at raising awareness of the importance of our kidneys.

World Kidney Day comes back every year. All across the globe many hundred events take place from public screenings in Argentina to Zumba marathons in Malaysia. We do it all to create awareness. Awareness about preventive behaviors, awareness about risk factors, and awareness about how to live with a kidney disease. We do this because we want kidney health for all.

World Kidney Day is a joint initiative of the International Society of Nephrology  (ISN) and the International Federation of Kidney Foundations – World Kidney Alliance (IFKF-WKA)

…..

Advancing equitable access to care and optimal medication practice

Chronic kidney disease (CKD) is estimated to affect more than 850 million people worldwide and resulted in over 3.1 million deaths in 2019.[1] Presently, kidney disease ranks as the 8^th leading cause of death[2], and if left unaddressed, it is projected to be the 5^th leading cause of years of life lost by 2040.[3]

Over the last three decades, CKD treatment efforts have centered on preparing for and delivering kidney replacement therapies. However, recent therapeutic breakthroughs [4] offer unprecedented opportunities to prevent or delay disease and mitigate complications such as cardiovascular disease and kidney failure, ultimately prolonging the quality and quantity of life for people living with CKD.

While these new therapies should be universally accessible to all patients, in every country and environment, barriers such as lack of CKD awareness, insufficient knowledge or confidence with newer therapeutic strategies, shortages of kidney specialists, and treatment costs contribute to profound disparities in accessing treatments, particularly in low-and-middle-income countries, but also in some high-income settings. These inequities emphasize the need to shift focus towards CKD awareness and capacity building of the healthcare workforce.

Achieving optimal kidney care requires overcoming barriers at multiple levels while considering contextual differences across world regions. These include gaps in early diagnosis, lack of universal healthcare or insurance coverage, low awareness among healthcare workers, and challenges to medication cost and accessibility. A multi-pronged strategy is required to save kidneys, hearts, and lives:

• Health policies – Primary and secondary prevention of CKD require targeted health policies that holistically integrate kidney care into existing health programs, secure funding for kidney care, and disseminate kidney health knowledge to the public and the healthcare workforce. Equitable access to kidney disease screening, tools for early diagnosis, and sustainable access to quality treatment should be implemented to prevent CKD or its progression.
• Healthcare delivery – Suboptimal kidney care results from limited policy focus, inadequate patient and provider education, lack of resources for high-quality care, and limited access to affordable medication. To enact strategies successfully, it is essential to adopt a comprehensive, patient-centered, and locally oriented approaches to identify and remedy barriers to high-quality kidney care.
• Healthcare professionals – Addressing the shortage of primary care professionals and kidney specialists requires enhancing training, minimizing loss of healthcare providers, and building capacity among healthcare workers, including primary care physicians, nurses, and community health workers. Education on appropriate CKD screening and adherence to clinical practice guideline recommendations are key to successful implementation of effective and safe treatment strategies. Embracing scientific innovation and utilizing pharmacologic and non-pharmacologic tools for CKD treatment, as well as fostering effective communication and empathy among professionals would greatly impact patient well-being.
• Empowering patients and communities – Globally, patients struggle to access care and medication due to high costs and misinformation, which impact their health behaviors and adherence. Raising awareness about CKD risk factors such as diabetes, hypertension, and obesity, enhancing health literacy about healthy lifestyle choices, self-care, and promoting long-term adherence to treatment strategies can bring large benefits especially when initiated early and consistently maintained. Involving patients in advocacy organizations and local communities will empower them to make informed decisions and improve their health outcomes.

[1] https://vizhub.healthdata.org/gbd-results/
[2] https://www.healthdata.org/news-events/newsroom/news-releases/lancet-latest-global-disease-estimates-reveal-perfect-storm
[3] https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)31694-5.pdf
[4] Renin-angiotensin inhibitors, SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and GLP-1 receptor agonists, have shown benefits in delaying kidney function decline together with reducing risks of cardiovascular events and death.”

Re-reading this, I’m wondering if there’s a method to offer all the titles offered for free this past Saturday permanently free. That just might be a teeny bit of help in raising awareness about CKD risk factors.

Remember the kidney awareness work I do is my way of giving back for all the good in my life. What good? There’s surviving pancreatic cancer, meeting Bear, maintaining a close relationship with my children, having two grandsons, awaiting a new hip, keeping my CKD and diabetes under control, and – well – I could go on and on. Sure, there was bad in my life, too, but why waste energy dwelling on that?

Talking about good, here’s hoping you had a good, fun Saint Patrick’s Day. My children and grandsons called me to wish me a Happy Saint Patrick’s Day which automatically made it a Happy Saint Patrick’s Day.

World Kidney Day may have passed, but it’s still National Kidney Month here in the United States. Honoring that, in addition to the blog and books, I’ve agreed to a podcast interview in April and to attend a pharmaceutical conference in May.

Until next week,

Keep living your life!

Women in Nephrology

You know, in addition to being National Kidney Month, March is also National Woman’s Month. Once again, I decided to combine the two and write about women in nephrology. Nefrologia [English edition] started us off with names you may or may not recognize:

“ Internationally, in an attempt to highlight the work of women in the scientific field, the International Society of Nephrology (ISN) wanted to pay tribute to women who had collaborated closely in the development of the specialty…

Dr Josephine Briggs, responsible for research at the US National Institutes of Health in the 1990s on the renin-angiotensin system, diabetic nephropathy, blood pressure and the effect of antioxidants in kidney disease.

Dr Renée Habib (France), a pioneer of nephropathology in Europe. She worked with the founders of the ISN to establish nephrology as a speciality.

Dr Vidya N Acharya, the first female nephrologist in India inspiring the study of kidney diseases, dedicating her research to urinary infections and heading a Nephrology department in Mumbai.

Dr Hai Yan Wang, head of department and professor of Nephrology at the Peking University First Hospital since 1983, president of the Chinese Society of Nephrology and editor of Chinese and international nephrology journals.

Dr Mona Al-Rukhaimi, co-president of the ISN and leader of the working group on the KDIGO guidelines in the Middle East, as well as a participant in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.

Dr Saraladevi Naicker, who created the first training programme for nephrologists in Africa and the Kidney Transplant Unit at Addington Hospital.

Dr Batya Kristal, the first woman to lead a Nephrology department in Israel and founder of Israel’s National Kidney Foundation. She conducts her current research in the field of oxidative stress and inflammation.

Dr Priscilla Kincaid-Smith, head of Nephrology at Melbourne Hospital, where she promoted the relationship between hypertension and the kidney and analgesic nephropathy. The first and only female president of the ISN, she empowered many other women, including the nephrologist Judy Whitworth, chair of the World Health Organization committee.”

I turned to BMC Nephrology to learn a bit about another woman in nephrology, Dr. Natalia Tomilina. This is from an interview with Dr. Tomilina:

“For me specializing in nephrology happened by chance. After graduating from university, I worked as a general practitioner, and very soon realized that I needed something more than just routine clinical practice; I needed to grow professionally. In 1962–1963 the hospital where I worked introduced a nephrology program. It was not yet a nephrology unit, just 20 beds on the internal medicine floor for patients with kidney diseases. At the time, nephrology as a specialty was only starting to be recognized both in the Soviet Union and in other countries. I was lucky to have met Professor Maria Ratner, who invited me to work with her. I could have moved to the hospital’s research institute, but it seemed to be less interesting, so I chose nephrology and Professor Ratner became my mentor. I found it fascinating, and I have continued to be fascinated by nephrology all my life….”

More recently, as I wrote in March 29’s 2021 blog:

“Dr. Vanessa Grubb first approached me when she was considering writing a blog herself. I believe she’s an important woman nephrologist since she has a special interest in the experiences of Black kidney patients. Here is what University of California’s Department of Medicine’s Center for Vulnerable Populations lists for her: 

‘Dr. Vanessa Grubbs is an Associate Professor in the Division of Nephrology at UCSF and has maintained a clinical practice and research program at Zuckerberg San Francisco General Hospital since 2009. Her research focuses on palliative care for patients with end-stage kidney disease. She is among the 2017 cohort for the Cambia Health Foundation Sojourns Scholar Leadership Program, an initiative designed to identify, cultivate and advance the next generation of palliative care leaders; and the 2018 California Health Care Foundation’s Health Care Leadership Program. 
 
Her clinical and research work fuel her passion for creative writing. Her first book, HUNDREDS OF INTERLACED FINGERS: A Kidney Doctor’s Search for the Perfect Match, was released June 2017 from Harper Collins Publishers, Amistad division and is now in paperback.’ [Gail here: Dr. Grubbs writes the blog, The Nephrologist; has the YouTube channel, Real Kidney Talk with The People’s Nephrologist; and is an advocate with her Black Doc Village.]

I think Dr. Li-li Hsiao should also be included in today’s blog since she has a special interest in the Asian community and their experiences with kidney disease. The following is from the Boston Taiwanese Biotechnological Association:  

‘…. She is the Director of Asian Renal Clinic at BWH; the co-program director and Co-PI of Harvard Summer Research Program in Kidney Medicine. She is recently appointed as the Director of Global Kidney Health Innovation Center. Dr Hsiao’s areas of research include cardiovascular complications in patients with chronic kidney disease; one of her work published in Circulation in 2012 has been ranked at the top 1% most cited article in the Clinical Medicine since 2013. Dr. Hsiao has received numerous awards for her outstanding clinical work, teaching and mentoring of students including Starfish Award recognizing her effective clinical care, and the prestigious Clifford Barger Mentor Award at HMS. Dr. Hsiao is the founder of Kidney Disease Screening and Awareness Program (KDSAP) at Harvard College where she has served as the official advisor. KDSAP has expanded beyond Harvard campus. Dr. Hsiao served in the admission committee of HMS; a committee member of Post Graduate Education and the board of advisor of American Society of Nephrology (ASN). She was Co-Chair for the ‘Professional Development Seminar’ course during the ASN week, and currently, she is the past-president of WIN (Women In Neprology [sic])’”

Just in case you wondered, Zippia [billed as the job experts] showed 47.37% of nephrologists were female as of 2021. And, yes, they did earn less than their male counterparts: 88 cents to the male’s dollar. From all the different sites I looked at, there is still a pay gap between the two genders. All I have to say about that is, “Huh? This IS 2024, isn’t it?”

Until next week,

Keep living your life!

It’s National Kidney Month

Hello, hello, and a belated welcome to National Kidney Month. This year, for a change, I decided to go to a non-medical site for a clear explanation of what this month is. The entire blog [except my introduction, of course.] is from National Today, a site committed to which celebrations are on which day[s]:

“March is dedicated to National Kidney Month. The kidneys, two bean-shaped organs located in the back of the abdomen, perform crucial functions to filter out toxins, produce red blood cells, and regulate pH. They filter about half a cup of blood every hour, creating urine from harmful and unnecessary waste.

When kidneys fail to function properly, waste builds up in the blood and leads to a weakened system and a host of problems like anemia, nerve damage, and high blood pressure. Chronic kidney disease(CKD) affects more than 1 in 7 American adults and is the 9th leading cause of death in the U.S.

HISTORY OF NATIONAL KIDNEY MONTH

National Kidney Month, observed every March, brings awareness to kidney health and encourages people to support kidney disease research and take steps to keep their own kidneys safe and healthy. 

Kidneys filter blood, make urine, and produce the red blood cells that carry oxygen through your body. These vital organs also control blood pressure and produce vitamin D to keep bones strong.

Malfunctioning kidneys can lead to painful kidney stones and infections that, left untreated, require a transplant. Some pre-existing conditions, like high blood pressure and diabetes, put you at increased risk for kidney disease. 

Chronic Kidney Disease(CKD) affects almost 40 million American adults. In 2016, three-quarters of a million people in the U.S. required dialysis or a kidney transplant. Dialysis and kidney transplants, the only treatment options for severe kidney failure, are difficult, expensive, and not always available. Patients seeking new organs may not always get them in time to survive; in the U.S., twelve people die each day waiting for a kidney.

To prevent kidney disease, the National Kidney Foundation recommends taking proactive steps to keep your kidneys healthy and prevent the onset of CKD. You can protect your kidneys by managing high blood pressure, making healthy food and drink choices, and reducing stress. 

The National Kidney Foundation grew out of a mother’s determination to further research into treatment for kidney conditions. When her infant son was diagnosed with nephrosis, Ada DeBold started the Committee for Nephrosis Research to organize efforts to find treatments and connect patients and doctors. DeBold continued crusading for the organization, which eventually became the National Kidney Foundation. The Foundation conducts fundraising to support important research into the treatment and prevention of kidney disease.

NATIONAL KIDNEY MONTH TIMELINE

1984

National Organ Transplant Act Passes

The NOTA establishes the National Organ Procurement and Transplantation Network, which maintains an organ matching registry to address organ shortages and streamline the donation process.

1954

First Successful Kidney Transplant

The first successful kidney transplant is performed between two identical twins in Boston.

1943

Dialysis Invented

Dutch doctor Willem Kolff invents the ‘artificial kidney’ to clean the blood of kidney failure patients.

1902

Animal Experiments

The first successful kidney transplants in animals are performed at the Vienna Medical School.

NATIONAL KIDNEY MONTH FAQS

What month is National Kidney Month?

National Kidney Month is observed annually during the month of March.

Is there a ribbon for kidney disease?

Kidney Disease Awareness is symbolized by the color green. Purchase green ribbons, green wristbands, or green magnets directly from a Kidney Disease Awareness non profit in order to help raise funds for treatments.

What are the symptoms of chronic kidney disease?

Symptoms include difficulty urinating or less urine, sweeping in the extremities, shortness of breath, nausea, and feeling cold and tired. If you experience chronic symptoms that you suspect are related to kidney function, consult your physician.

HOW TO OBSERVE NATIONAL KIDNEY MONTH

1. Join the organ donor registry

Most organ donations come from deceased people. Register to be an organ donor when you die and your healthy organs and tissue can save dozens of lives.

2. Donate to a kidney non-profit

Non-profit organizations do the important work of raising awareness about kidney disease, providing resources and assistance to patients, and connecting patients, doctors, and donors.

3. Be good to your kidneys

Are you keeping your kidneys healthy? Aim for a lower intake of sodium and sugars, more whole grains and low-fat dairy, and regular exercise to reduce your risk of kidney disease, high blood pressure, diabetes, and other diseases.

5 FASCINATING FACTS ABOUT KIDNEYS

1. You only need one kidney to live

Although you’re born with two kidneys, each of which have about 1.5 million blood-filtering units(nephrons), you only need about 300,000 nephrons to filter your blood properly.

2. Your kidneys are lopsided

The right kidney is slightly smaller and sits lower than the left to make room for another important organ, the liver.

3. You can drink too much water

This can cause a condition called hyponatremia, which, though not common, can damage the kidneys.

4. Sausage casing and orange juice cans

Willem Kolff, who invented the first artificial kidney that led to today’s dialysis technology, used sausage casings, orange juice cans, and a washing machine to create a rudimentary blood cleaning mechanism.

5. Climate change may increase kidney disease

As parts of the world get warmer, the dehydration that leads to kidney disease is likely to rise among manual laborers.

WHY NATIONAL KIDNEY MONTH IS IMPORTANT

1. It reminds us to be good to our bodies

Make sure you take care of your body and your vital internal organs so they can continue taking care of you.

2. It’s a chance to express gratitude for our health

If you have fully functional kidneys, be grateful! Take a minute to feel gratitude for all the internal organs that do the invisible, daily work of keeping us alive.

3. It shows that science is awesome

Just a few decades ago, kidney disease could mean a death sentence. Today, although it’s still a serious and frightening illness, we can often fight off kidney failure with dialysis and organ transplants.”

Many thanks to National Today  for their simple, straight forward explanation of National Kidney Month.

Until next week,

Keep living your life!

And the Nose…

Since I wrote about the ears and kidney disease last week, I got curious about the nose and kidney disease. Makes sense to me. If CKD can affect your hearing, why not your sense of smell? I was delighted to find out I wasn’t the only one interested in this.

Photo by Anastasia Shuraeva on Pexels.com

I started my inquiry with the Sage Journal which calls itself “Your gateway to world-class research.”  There I found a study originally published in Ear, Nose and Throat Journal that came to the following conclusion:

“The study has demonstrated that patients with CKD have prevalence of olfactory dysfunction, and it appears that the affectation was more at the central olfactory pathway. The severity of olfactory dysfunction increases with worsening severity of kidney disease. This finding will serve as basis to ensure olfactory function assessment is included as parts of routine evaluation of patients with CKD, with the aim of improving their overall well-being and quality of life.”

How very interesting. Therefore, if your kidneys become worse, so does your sense of smell. But why? Wait a minute. I never received an evaluation of my sense of smell at my nephrologist’s. Have you?

Let’s go back to seeing if we can figure out why our sense of smell is somehow attached to our kidney function. This is PubMed’s contribution to our search:

“Olfactory receptors (ORs) are chemosensors that are responsible for one’s sense of smell. In addition to this specialized role in the nose, recent evidence suggests that ORs are also found in a variety of additional tissues including the kidney. As this list of renal ORs continues to expand, it is becoming clear that they play important roles in renal and whole-body physiology, including a novel role in blood pressure regulation.”

As usual [Ah, you know me so well.] I needed more:

Science Digest included this information that may help:

Nefrologia (English Edition) points out the key points about loss of smell in kidney disease;

“Alterations in the olfactory function of patients with CKD in pre-dialysis, PD and HD are common, although little recognised.

• •

The tests most widely used for assessing olfactory function are odour threshold, discrimination and identification tests.

• •

One of the most important consequences of olfactory deficits is their association with the patient’s nutritional status.

• •

The effect of HD on smell is still not fully understood, as not all studies have shown correction of the deficit with treatment.

• •

Renal transplantation corrects dysosmia….” [Gail here. This is an altered perception of smell.]

While I find this fascinating, I wondered why it was important. The National Kidney Foundation had the answer:

“’Impairments in smell and taste have been linked with decreased appetite and food intake and can decrease the quality of life for affected patients,’ said Katherine Lynch, MD, a junior faculty member at Beth Israel Deaconess Medical Center. ‘The ability to smell and taste declines with age, but patients with chronic kidney disease tend to have earlier and greater decline in these senses than patients without kidney disease.’”

Dr. Lynch is studying the effects of smell and taste loss in order to identify ways to combat malnutrition and improve the lifestyle of patients with kidney disease. Her research is being supported by a Young Investigator’s Grant from the National Kidney Foundation.”

Umm, who said anything about taste. Let’s take a look at that, too. Kidneywise blew me away with their informative chart:

“Changes in CKD	Effects of change
Reduced saliva flow	Some studies have found that people with end-stage kidney disease have a reduced flow of saliva which may be caused by changes in fluid status. This can cause dry mouth which affects the taste buds.
Changes in saliva pH	Normal saliva is slightly acidic but some studies have shown that the saliva of people with end-stage kidney disease is more alkaline which can affect taste.
High levels of urea in saliva	People with end-stage kidney disease have higher levels of urea in their saliva than those with normal kidney function. This affects the perception of bitter taste, causing either an increase or a decrease in perception of bitter taste. It can also cause a metallic taste.
High levels of sodium in saliva	This can increase the salt taste threshold and can therefore cause a salty taste.
High levels of bicarbonate in saliva	This can cause a reduction in the intensity of savoury (umami) taste and may be one of the reasons for lack of interest in meat in many people with CKD.
High levels of  potassium in saliva	This can cause a metallic taste.
Lower levels of zinc in blood	Zinc deficiency can be as high as 40% in those receiving haemodialysis treatment. Zinc deficiency can lead to a reduction in overall taste.”

I started wondering if they had the same kind of chart for loss of smell. No such luck. On to how to treat loss of taste due to kidney disease. I crossed the pond [so to speak] and found what I was looking for on the National Health Service’s website:

“Food tastes
If your food tastes.	Tips
Bitter	Avoid foods sweetened with saccharin – this can leave a bitter aftertaste
Metallic	Gargle lemon juice before eating   Use plastic cutlery
Sweet	Add lemon juice to your water   Dilute drinks with soda or mineral water   Use spices such as ginger, nutmeg, and cinnamon to sugary foods/puddings to offset the sweetness
Salty	Avoid salty and processed foods   Add a pinch of sugar to food before serving
Aversion to meat/protein foods	Serve cold meats with pickle or chutney   Serve fish, chicken, and egg dishes with strong flavoured sauces i.e., curry, sweet and sour   Marinate meat in fruit juice or wine

More ideas to help you manage taste changes:

• Rinse your mouth or clean your teeth before meals.
• Suck on mints or chew gum.
• Use herbs and spices to add flavour e.g., pepper, cumin, and rosemary.
• Allow hot foods to cool down.
• If you are prescribed nutritional supplements, your dietitian may be able to recommend a sharper tasting variety, such as a juice or yoghurt style supplement.”

Well, that’s enough to absorb in one sitting. Let me know if you have specific questions and I’ll do my very best to answer them.

Until next week,

Keep living your life!

I Hear Ya

I am lucky enough to personally know several nurses. At one point or another, each has mentioned the connection between the kidneys and the ears. I disregarded that until I realized how often I’d heard it. But I didn’t understand it. One is on your head and the other above your bladder. Hmmm. Time to find out how they’re connected.

The National Library of Medicine helped in starting my research:

“Chronic kidney disease is a major public health challenge, globally. Inadequate excretion of metabolic waste products by the kidneys results in circulation of these toxic materials in the body. This can cause damage to tissues and organ systems including the auditory system which can lead to hearing loss.”

Okay, I can accept that providing we define metabolic waste products. Study.com to the rescue:

“Metabolic waste in the body refers to substances created during the metabolism of food that is unusable by the body. Metabolic waste is transported from cells by the bloodstream to be excreted by organs in the body.”

Oh, and just in case you forgot what metabolism is [from Study.com again]:

“Metabolism is a chemical process that converts energy stored in food to energy an organism uses for bodily functions and maintenance. The energy in food is converted during digestion. Metabolism controls the structure and function of the body. It’s a multi-step process.

Metabolism = Food is Consumed => Catabolism & Anabolism => Energy & Metabolic Wastes

• Catabolism: Breakdown of food into specific nutrients such as carbohydrates, proteins, and fats individual cells can use for energy
• Anabolism: at the cellular level, individual nutrients are transformed into substances the body needs for building and maintaining bodily tissues”

As usual, I wanted more information so I went to a site connected with hearing, Hearing Unlimited:

“If you asked a medical professional about the kidneys and the ears, they would tell you that ‘the kidneys share physiologic, ultrastructural and antigenic similarities with the stria vascularis of the cochlea.’ Or, in plain English: a specific part of our ears shares functional and structural characteristics with our kidneys.

It almost sounds unreal – how could the ears share similarities with the kidneys? But research has confirmed that physiological mechanisms of fluid and electrolyte balance are present in both organs. This matters because it means that when a health issue affects the functionality of one (i.e. the kidneys or the ears), it’s likely to affect the other. So while hearing loss doesn’t cause CKD – or vice versa – patients with certain types of hearing loss are likely to experience problems with their kidneys (and vice-versa).”

This sounds like something out of science fiction. But it also makes sense. I wanted to be certain I understood what I was reading. Spectrum Hearing made it abundantly clear:

“A child who has one developmental problem may have other problems that arose at the same time:  Kidney problems and hearing problems, for example, are often found together because both kidneys and the inner ears develop at the same time.” Dr. C. George Boeree

In utero is one example of a possible connection between ears and kidneys. Individuals with Chronic Kidney Disease (CKD) also presents [sic] with a higher likelihood of hearing loss.

Tissues of the kidney and the inner ear are similar and share a common metabolic function, therefore problems that affect kidney function can also damage the inner ear.  High blood pressure, diabetes and a family history of CKD can increase your risk of developing kidney problems and hearing problems.  High blood pressure can cause CKD and CKD can cause high blood pressure.  Diabetes can cause damage to many organs in your body including the kidneys, heart, blood vessels and the inner ear.”

I get it now, but wondered if I could find more information about hearing problems causing chronic kidney disease. Let’s go back to Hearing Unlimited for a moment:

“So while hearing loss doesn’t cause CKD – or vice versa – patients with certain types of hearing loss are likely to experience problems with their kidneys (and vice versa).”

MedlinePlus gives us an example one of the diseases involved:

“Alport syndrome is a genetic condition characterized by kidney disease, hearing loss, and eye abnormalities.

People with Alport syndrome experience progressive loss of kidney function. Almost all affected individuals have blood in their urine (hematuria), which indicates abnormal functioning of the kidneys. Many people with Alport syndrome also develop high levels of protein in their urine (proteinuria). The kidneys gradually lose their ability to efficiently remove waste products from the body, resulting in end-stage kidney disease (ESKD).

In late childhood or early adolescence, many people with Alport syndrome develop sensorineural hearing loss, which is caused by abnormalities of the inner ear. Affected individuals may also have misshapen lenses in their eyes (anterior lenticonus) and abnormal coloration of the retina, which is the light-sensitive tissue at the back of the eye. These eye abnormalities seldom lead to vision loss.”

Sensorineural? What’s that mean? The Mayo Clinic explains:

“There are three types of hearing loss:

• Conductive, which involves the outer or middle ear.
• Sensorineural, which involves the inner ear.
• Mixed, which is a mix of the two.”

Let’s check Hearing Tracker to see what they have to say about hearing loss and kidney disease:

“People with CKD may also be at risk of developing other health complications, including hearing loss. A growing body of research points to a connection between CKD and hearing loss, highlighting the possible harmful effects of CKD on the hearing system. In fact, the National Kidney Foundation estimates that that 54% of people with moderate kidney disease have some kind of hearing loss.”

I never knew. Did you? So, how about getting your hearing checked?

Until next week,

Keep living your life!

That’s Low

Just when I wonder if I’m going to run out of topics to write about, I receive a reader’s request. This week, I was saved by a request to write about low anion gap. I know, I know, it sounds like we’re pioneers trekking our way across the mountains when you see that phrase out of context. So, let’s put it into context.

If you looked, you’d find the phrase included in the following blood tests according to the Cleveland Clinic:  

“The anion gap measurement is based on the results of individual electrolyte blood tests, which are commonly included in the following routine bloodwork panels:

• Comprehensive metabolic panel (CMP).
• Basic metabolic panel (BMP).
• Electrolyte panel.”

Let’s do our usual backtracking a bit. My first stop was at Quest Health to find out what the CMP covers:

“This test is a useful tool containing routine screening tests that may help healthcare providers identify signs of certain medical conditions, such as kidney or liver disease, diabetes, hypertension, and other health conditions.

Glucose

Calcium

Total protein

Alanine aminotransferase

Aspartate aminotransferase

Alkaline phosphatase

Bilirubin

Blood urea nitrogen

Creatinine

Albumin

Carbon dioxide

Chloride

Potassium and sodium”

Hmm, no mention of the anion gap here.

Let’s try a different site, MedlinePlus, to see what the BMP tests for:

“A basic metabolic panel (BMP) is a test that measures eight different substances in your blood. It provides important information about your body’s chemical balance and metabolism. Metabolism is the process of how the body uses food and energy. A BMP includes tests for the following:

• Glucose, a type of sugar and your body’s main source of energy.
• Calcium, one of the body’s most important minerals. Calcium is essential for proper functioning of your nerves, muscles, and heart.
• Sodium, potassium, carbon dioxide, and chloride. These are electrolytes, electrically charged minerals that help control the amount of fluids and the balance of acids and bases in your body.
• BUN (blood urea nitrogen) and creatinine, waste products removed from your blood by your kidneys.”

Again, no mention of the anion gap. Surely, the electrolyte panel will evaluate the anion gap. This time I turned to GoodRxHealth:

“An electrolyte panel (also referred to as a ‘metabolic panel’) measures electrolytes and other substances in the blood that play important roles in your overall health. These include:

• Sodium (Na): plays a key role in fluid balance and brain function
• Potassium (K): regulates the heartbeat as well as nerve and muscle activity
• Chloride (Cl): contributes to fluid balance and acid-base levels in the blood
• Carbon dioxide (CO2): indicates how well your body is maintaining the right acid-base balance
• Blood urea nitrogen (BUN) and creatinine (Cr): two waste products that provide a measure of kidney function
• Glucose: also known as ‘blood sugar’”

What! Again, no mention of anion gap. Although, you may have noticed lots of duplication for items measured among the tests. That is sort of helpful. But that’s it! I’m turning to my favorite dictionary of all time, the Merriam-Webster to see if I can find a definition for this elusive phrase. Uh-oh, nothing there. [Oh well, you can’t find everything there just because it’s my favorite.]

The University of Rochester Medical Center was much more to the point:

“Your blood contains sodium, chloride, and bicarbonate. All of these are charged particles. The value for the anion gap tells your healthcare provider something about which other charged particles must be in your blood to make it neutral.

This test gives clues about different types of acidosis, when your blood is too acidic. It also tells your provider about alkalosis, when your blood is not acidic enough. Acidosis and alkalosis can be life-threatening. It’s important to find the causes and treat them as soon as possible.”

Finally. Now we get to the good part. What does a low anion gap mean? WebMD to the rescue:

“If you really do have a low anion gap, it could mean your blood doesn’t have enough of a protein called albumin. Albumin helps important vitamins, hormones, and enzymes move throughout the body. Low albumin can be a sign of:

• Kidney problems. Healthy kidneys block albumin from entering urine. When albumin is leaked into the urine, it may be a sign of kidney disease.
• Heart disease. Heart disease, when treated with diuretics, may lead to alkalosis and low albumin.
• Certain types of cancer . Cancer may cause potassium levels in the blood to drop, causing alkalosis. Chemotherapy cancer treatments may also lead to lower potassium levels.
• Liver disease. The acid—base balance in liver disease is complex. Your doctor may check look for respiratory alkalosis, metabolic acidosis, low albumin, and changes in your potassium levels.”

Wonderful, just wonderful. What are you supposed to do with that? Before you get upset, I ran across this very important warning on MedicalNewsToday:

“A low anion gap reading is very rare, and it often results from a laboratory error. As a result, a doctor who finds a low reading typically orders a second test.”

Add this information from Health Matters and I think we can start to make the connection between the kidneys and the anion gap:

“Our body chemistry consists of a never-ending cascade of molecules reacting with one another to make more complex molecules. A few are commonly familiar: sodium, potassium, and chloride. These can be further classified by their electrical charge. Sodium and potassium are positively charged and are referred to as cations; chloride is negatively charged and is referred to as an anion. An anion gap refers to the measured difference between cations and anions in serum, plasma, or urine….”

It seems low anion gap is very rare and could be due to lab error. If it’s confirmed, your doctor will have to test more to determine what is causing this condition before they can treat it. Notice kidney disease can cause low anion gap as well as some medications can. This was all new to me. I certainly hope it was helpful to the reader requested the information.

I very much appreciate reader comments telling me how interesting they find the blogs. Just remember that I’m not a doctor. I’m learning right along with you.

Until week,

Keep living your life!

Black History Month

It’s Black History Month. Ah, but what is that? “As Andrea Wurtzburger wrote in People Magazine (I knew there was a reason I grabbed this first each time I waited in one medical office or another [prior to the pandemic].) in the February 13, 2020… 

‘Black History Month is an entire month devoted to putting a spotlight on African Americans who have made contributions to our country. Originally, it was seen as a way of teaching students and young people about the contributions of Black and African Americans in school, as they had (and still have) been often forgotten or left out of the narrative of the growth of America. Now, it is seen as a celebration of those who’ve impacted not just the country, but the world with their activism and achievements.’”

To me, Black History Month means it’s time to remind you of some of the Blacks who have contributed to our health as chronic kidney disease patients. Ready? Let’s start. Oh, first, a reminder: nephrology is a young science so some of these people may still be practicing. I took the liberty of italicizing what I considered their most important contributions.

My first stop was Black Health Matters which listed the most prominent Black nephrologists:

“Kirk Campbell, M.D.

An associate professor in the Division of Nephrology and the Vice Chair of Diversity and Inclusion, as well as the director of the Nephrology Fellowship Program and an ombudsperson for medical students at the Icahn School of Medicine at Mount Sinai in New York. Kirk Campbell, M.D., treats patients with renal disease and leads an NIH-funded research program focused on understanding the mechanism of podocyte injury in the progression of proteinuric kidney diseases. 

Olayiwola Ayodeji, M.D. 

Nephrologist Olayiwola Ayodeji, M.D., has led the development of the Clinical Trials Program at Peninsula Kidney Associates and served as a principal investigator on many research trials. He currently serves as the Medical Director of Davita Newmarket Dialysis Center and the Davita Home Training Center. He is board certified in nephrology and internal medicine…. 

Crystal Gadegbeku, M.D.

A graduate of the University of Virginia, Crystal Gadegbeku, M.D., is a nephrology specialist in Philadelphia, Pennsylvania. She is Chief of the section of nephrology, hypertension and kidney transplantation, and Vice Chair of community outreach at Lewis Katz School of Medicine at Temple University. Her clinical interests include chronic kidney disease, hypertension in chronic kidney disease and pregnancy in chronic kidney disease. 

Eddie Greene, M.D.

Mayo Clinic internist and nephrologist Eddie Green, M.D., treats chronic kidney disease, heart disease and kidney cancer. His interests include chronic renal failure, cardiovascular disease in chronic renal failure and renal cell cancer. 

Susanne Nicholas, M.D.

Board certified in internal medicine and nephrology, Susanne Nicholas, M.D., has clinical interests in nephrology and hypertension. Her research over the past 15-plus years has led to the identification of a novel biomarker of diabetic kidney disease, which is being validated in clinical studies. 

Carmen Peralta, M.D.

Clinical investigator and association professor of medicine Carmen Peralta, M.D., is co-founder and executive director of the Kidney Health Research Collaborative. She is a leader in the epidemiology of kidney disease and hypertension. A graduate of Johns Hopkins University, her research activity focuses on three areas: 1) approaches to improving care of people with kidney disease and reducing racial and ethnic disparities; 2) hypertension, arterial stiffness and kidney disease; and 3) biomarkers for detection, classification and risk of early kidney disease. 

Neil Powe, M.D.

A graduate of Harvard Medical School, Neal Powe, M.D., is head of the University of California San Francisco Medicine Service at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital. This is one of the leading medicine departments in a public hospital with strong basic, clinical and health services research programs focused on major diseases affecting diverse patients locally, nationally and globally. His primary intellectual pursuits involve kidney disease patient-oriented research, epidemiology and outcomes and effectiveness research.“

Obviously, that’s not every Black that has contributed to the understanding and treatment of chronic kidney disease. The list above is just a few of them. Then I learned about Dr. E.M. Umeukeje on the American Journal of Kidney Disease [AJKD]’s blog:

“Ebele Umeukeje is an Assistant Professor of Medicine at Vanderbilt University Medical Center. She is a nephrologist and an epidemiologist passionate about improving health outcomes in vulnerable patients with kidney disease. Her research aims to understand the influence of novel psychosocial factors on adherence in patients with kidney disease, and inform evidence-based, patient-centered innovative approaches to improve adherence and critical outcomes in this patient population….”

Running around on the internet, I discovered the following on Encyclopedia.com:

“Velma Scantlebury-White…

In 1989 Dr. Velma Scantlebury-White becameAmerica’s first black female transplant surgeon. In her 16 years at the University of Pittsburgh Medical Center (UPMC) and subsequently at the University of Southern Alabama (USA), Scantlebury dedicated herself to increasing the number of kidney transplants for black patients. She took the lead in educating black Americans about donating organs and tissues for transplantation, and as of 2007, she had performed more than 800 cadaver and 200 living-donor transplant surgeries in children and adults. Scantlebury had coauthored more than 100 research publications, monographs, and book chapters and was twice named one of the America’s Best Doctors.”

The African American Registry reminded me about Dr. Samuel Kountz,

“He was appointed Professor of Surgery and Chairman of the Department at the State University of New York (SUNY), Downstate Medical Center in Brooklyn, New York, beginning in 1972 and Surgeon-in-Chief of Kings County Hospital. The University of Arkansas awarded him the honorary Juris Doctor in 1973. He developed the country’s largest kidney transplant research and training program at the University of California, San Francisco. Despite his success in human transplants, Dr. Kountz believes the chief source of healthy parts to replace malfunctioning ones will be primates because there are many problems in obtaining and matching human donors.”

Some of the doctors I’ve included today are those I’ve included on previous Black History Month blogs. They’re important and I wanted to remind you about them. There are others that are not included solely due to lack of space. Check the “topics” dropdown to the right of this blog and scroll down to “Black History Month” to learn more about other Blacks in Nephrology past and present.

Until next week,

Keep living your life!

Mom Had One

Years ago, when I was a young woman in my 20s, my mother had a fibroid in her uterus. Or, at least that was the way she explained it. Come to think of it, she didn’t explain. Rather, she simply announced she’d had it removed. My brother and I, both medically ignorant at the time, had no idea why that was such a big deal.

In the intervening decades, I’ve learned a lot. Most of that medical knowledge has come from researching for the blog. That’s how I learned that a fibroid is a tumor or, as Johns Hopkins puts it:

“Fibroids are growths made of smooth muscle cells and fibrous connective tissue. These growths develop in the uterus and appear alone or in groups. They range in size, from as small as a grain of rice to as big as a melon. In some cases, fibroids can grow into the uterine cavity or outward from the uterus on stalks.”

Notice the word tumor wasn’t used in this definition. It didn’t have to be because a tumor as defined by my all-time favorite dictionary, the Merriam-Webster, is:

“an abnormal benign or malignant new growth of tissue that possesses no physiological function and arises from uncontrolled usually rapid cellular proliferation”

Since they have no function and grow in the same way as cancer does, are they cancerous? Not according to Planned Parenthood, who also offers us the symptoms:

Photo by Sora Shimazaki on Pexels.com

“Uterine fibroids are almost never cancerous, and they don’t increase your risk for getting other types of cancer. But they can cause pelvic pain, heavy period bleeding, bleeding between periods, back pain, and in some cases, infertility or miscarriages. However, many people with fibroids don’t have any symptoms at all.”

My mother was not the type to want to know how the fibroid developed. As most people did 50 years ago, she just wanted it gone. But you might want to know. WebMD explained:

“Experts don’t know exactly why you get fibroids. Hormones and genetics might make you more likely to get them.

Hormones. Estrogen and progesterone are the hormones that make the lining of your uterus thicken every month during your period. They also seem to affect fibroid growth. When hormone production slows down during menopause, fibroids usually shrink.

Genetics. Researchers have found genetic differences between fibroids and normal cells in the uterus.

Other growth factors. Substances in your body that help with tissue upkeep, such as insulin-like growth factor, may play a part in fibroid growth. 

Extracellular matrix (ECM). ECM makes your cells stick together. Fibroids have more ECM than normal cells, which makes them fibrous or ropey. ECM also stores growth factors (substances that spur cell growth) and causes cells to change.”

Let’s get back to Mom wanting it gone. The question here is how? It turns out there are many, many different methods from different types of ablations, surgeries, and medications.

I know you want to know what this has to do with chronic kidney disease. That is actually what I wanted to know, too. According to The National Library of Medicine:

“Uterine fibroids constitute the most common tumor in women of reproductive age …. Significant morbidity secondary to fibroids is a rare event; however acute complications from fibroids may include thromboembolic events, acute torsion of pedunculated fibroids, acute abdominal pain, vaginal bleeding, intra-abdominal bleeding, acute urinary retention, and renal failure. [Gail here: I bolded that.] Uterine fibroids are associated with obstructive renal failure as they can physically compress the ureters, leading to acute urinary retention and postrenal nephropathy.”

I get it, but it took me a while to figure out what this meant. So I looked for a different, more easily understood  explanation… and found it on Fibroids.com:

“Although fibroids are made of muscle tissue found in the uterus, they can outgrow the space within the uterine walls and expand to a size large enough to affect the ureter. The ureter is the tube that connects the bladder and the kidney. When fibroids down [sic] on the ureter, the kidneys swell and develop a condition known as hydronephrosis.

Hydronephrosis is often associated with painful urination, an increased urge to urinate, as well as flank and back pain. In more severe cases, permanent kidney damage may also occur. If you are currently experiencing any of these symptoms or suspect your kidneys may be at risk due to your fibroids, consult with your doctor immediately.” 

Talkingfibroids,com tells us more about hydronephrosis:

“But if hydronephrosis persists for a long time, the nephrons (kidney cells) can die, and the result can be irreversible kidney damage. Even if the obstruction to the ureter is eventually removed, a kidney that has gotten to this point will not regain function.”

Hmmm, there must be a way to prevent this. I searched and searched until I found what I was looking for on India’s GAURI – Guna Associates in Urogynecology & Research for Incontinence:

“The removal of fibroids is crucial for those suffering kidney complications due to fibroids. Despite the prevalence of fibroid surgery like a hysterectomy or myomectomy [removal of only the fibroid], there is a less invasive procedure called uterine fibroid embolization (UFE) that eliminates the scars and trauma associated with surgery.

Fibroid embolization works by reducing the larger fibroid that is pushing on the ureter and causing kidney problems. It provides a quick and effective procedure with no chance of regrowth of the fibroid. By shrinking the fibroid instead of removing it, patients experience a quick and effective procedure.”

While that may sound scary, remember that surgery is another way to deal with fibroids but UFE is less invasive. There is also medication, but please do not take NSAIDS. That stands for non-steroidal anti-inflammatory and, as CKD patients, is not for us. And let’s not forget ablation.

As for diagnosing hydronephrosis, the usual blood and urine tests plus an ultrasound does the trick. The ultrasound will let you see if the kidney is swollen. The urine test will rule out infection or urinary stones. And the blood test will evaluate your kidney function. I wonder whether Mom underwent these tests.

Until next week,

Keep living your life!

Have Some Water

Water, water, everywhere. [Thank you to Samuel Taylor Coleridge for allowing us to borrow from Rime of the Ancient Mariner.] But each kind seems to be different. For example, we drink Arrowhead brand. In New York, it was Poland Springs, although we had delicious, safe tap water. That’s something we don’t have in Arizona unless you buy a filtering system.

And that’s what today’s blog is about: another reader’s question. This one is about distilled water. It hadn’t occurred to me that you can drink it. I use it for my sleep apnea BiPAP. Maybe we should talk about what distilled water is first.

Ready for a little trip to my favorite dictionary. This is the Merriam-Webster’s definition of distilled water:

“water that has been freed of dissolved or suspended solids and from organisms by distillation (as for medical or chemical purposes)”

Back to the dictionary for the definition of distillation. [Let’s hope we’re not falling into a rabbit hole.]

“the process of purifying a liquid by successive evaporation and condensation”

I thought I’d like to know more about how this is done. The ever popular How Stuff Works explained:

“Making a batch of homemade distilled water is a straightforward process. After you’ve gathered your materials (a large pot with a lid, a smaller pot or heat-safe bowl, water and some ice), you’re ready to get started.

1. Filling the large pot: Start by filling the large pot with water, but don’t fill it all the way to the top; leave some room to prevent it from boiling over. Place the smaller pot or bowl inside the large pot to collect the distilled water.
2. Setting up the lid: Flip the lid of the large pot upside down and place it back on top. This inverted lid acts as a surface for the steam to condense on. Placing fresh ice on top of the inverted lid is a helpful trick. The ice cools the lid, which enhances the condensation of the steam into water droplets, making the process more efficient.
3. Boiling and condensing: Heat the large pot until the water boils. The steam will rise, hit the cold, ice-cooled lid and condense into droplets. These droplets will then fall into the smaller pot or bowl.
4. Collecting the distilled water: Once you’ve collected enough distilled water, turn off the heat and let the setup cool. Carefully remove the hot smaller pot or bowl, which now contains your distilled water.
5. Storing distilled water: Pour the distilled water into a clean, sterilized container and store it in a cool, dark place to keep it pure.”

That makes sense and seems simple enough, but extremely time consuming. That’s why home water distillation systems exist. From many sites, I began to understand that this is not only slow, but expensive. However, it is a natural method of filtering water without, well, a filter.

Let’s get to the kidney part of the blog. We have chronic kidney disease. Is distilled water safe for us to drink? Alerna Kidney Health, while a business, offered some pretty good advice:

“Distilled water, known for its purity and absence of contaminants, has been examined for its impact on kidney health. It is important to note that there is limited research on the direct impact of distilled water on kidney function, and most kidney specialists recommend water containing natural minerals for general hydration and support of kidney health.

The lack of essential minerals in distilled water might make it less suitable for supporting the kidneys’ optimal function. Alternatives like tap water, bottled mineral water, or filtered water, which contain beneficial minerals, are often recommended.”

I discovered some surprises on WebMD:

“Distilled water lacks even electrolytes like potassium and other minerals your body needs. So you may miss out on a bit of these micronutrients if you drink only the distilled stuff.

Some studies have found a link between drinking water low in calcium and magnesium and tiredness, muscle cramps, weakness, and heart disease. Also, distilled water may not help you stay hydrated as well as other kinds of water.”

This is becoming more of an issue than I’d expected. Take a look at the benefits of drinking distilled water that MedicineNet has laid out for us:

“Drinking distilled water does have an upside. These potential advantages may include:

• Cure Arthritis: Drinking water purified by distillation is believed by some to cure arthritis by washing out calcium and other minerals deposits in joints.
• Reducing the risk of heart diseases:  Observational epidemiological studies have linked water hardness and cardiovascular disease risk. The hardness or softness of water is determined by the mineral content of both calcium and magnesium. When distillation eliminates these two, and the result is soft water.
• Cleanses the body: Because distilled water is pure, it can detoxify the body and improve your health.
• Prevents kidney stones: Kidney stones are hard deposits of minerals that form in the kidney and are painful when passing. Drinking distilled water prevents mineral build-up that can lead to kidney stone formation.
• Prevents teeth discoloration: Distillation removes minerals from water, thus protecting your teeth from too much fluoride exposure, responsible for teeth discoloration.”

While there are benefits to drinking distilled water, the only one for the kidneys seems to be preventing kidney stones. Now this is a minor point, but as a coffee drinker, I think other coffee drinkers should know that it is not recommended to use distilled water to make coffee. It negatively affects the flavor of coffee… and foods.

Did you know that distilled water is used in dialysis machines? Healthline tells us it is usually used in the following, too:

• “steam irons
• aquariums (mineral supplements should be added to the fish food)
• watering plants
• car cooling systems
• laboratory experiments
• certain medical devices, such as continuous positive airway pressure (CPAP) devices for sleep apnea [and my BiPAP, as already mentioned]”

I’m not an authority, but if I were making the decision, I wouldn’t choose a distilled water system for my house. It would affect my cooking [rather Bear’s cooking] and coffee flavors. It also wouldn’t provide me with the electrolytes I need. I hope this helped.

Until next week,

Keep living your life!

Loyal Reader Strikes Again!

This man asks some really intricate questions. This time, he asked me about ileus. I’d never heard of it, but WebMD certainly has:

“Ileus is a temporary condition where your intestine can’t push food and waste out of your body. Your intestine is a long and winding tube inside of your body that attaches your stomach to your anus. It has two parts, small and large. The small intestine’s main job is to break down the food you eat. The large intestine, or colon, absorbs water and uses strong, wavelike movements to push broken-down food and waste to your anus so you can poop. When your intestine stops making those wavelike movements for a while, ileus occurs. It usually lasts 1-3 days.”

Side rant: What ever happened to defecate? When did that become poop? This is akin to urine now being referred to as pee.

Back to the subject. I think WebMD was straight forward, but I’d like to add two items. First is the definition of anus. Not everyone knows that technical term. Now why isn’t it called poop hole instead? That would fit in quite nicely with poop instead of defecate and pee instead of urine.

Ready for my favorite dictionary to come to the rescue? This is from the Merriam-Webster Dictionary:

“the posterior opening of the digestive tract”

The second item is that there we are not looking at obstruction. That’s when there is a physical object blocking your intestines.

Just thought of a third. There are several other types of ileus. They are postoperative, paralytic, meconium, and gallstone.

I wanted to know what can cause ileus. Healthline gave me the answer:

• “intestinal cancer
• diverticulitis
• Parkinson’s disease, which affects muscles and nerves in the intestines
• Crohn’s disease, which rarely causes a blockage but may cause the intestinal walls to thicken due to autoimmune inflammation”

Certain drugs can slow down, but not stop the movement of food and liquid through your intestines.

However, the symptoms are of ileus are unmistakable. I turned to Medical News Today to see what they are:

• “stomach cramps and pain
• bloated or swollen stomach
• nausea
• vomiting
• constipation or passing small amounts of watery stool
• loss of appetite
• feeling full
• inability to pass gas”

If you think this sounds terrible, Loyal Reader gave me a first hand account of his symptoms and how very ill they made him. Honestly, I cannot image going through these symptoms.

Obviously, something must be done. But what?

“Treatment of an ileus requires time and supportive management. Bowel rest, intravenous (IV) fluid therapy, and, if warranted, nasogastric (NG) decompression are important steps. Historically these treatments were thought to lower complications and improve outcomes, but a recent review of the evidence shows otherwise….Chewing gum has been studied and seems to be a cheap, well-tolerated way to potentially help with ileus as it stimulates the cephalocaudal reflex, which promotes peristalsis and inhibits inflammation…. Unfortunately, these are the only options we currently have as pharmacologic agents have been ineffective.”

[Gail here: Chewing gum? I wondered if it had to be a specific kind.]

Thank you to The National Center for Biotechnology Information for the above material. We probably need a few definitions in order to understand it a little better. For example, nasogastric decompression. That is when a tube is inserted through the nose and snaked down to your stomach via the esophagus. It is used to drain the stomach.

MedlinePlus has a wonderfully simple explanation of peristalsis:

“Peristalsis is a series of muscle contractions. These contractions occur in your digestive tract. Peristalsis is also seen in the tubes that connect the kidneys to the bladder.

Peristalsis is an automatic and important process. It moves:

• Food through the digestive system
• Urine from the kidneys into the bladder
• Bile from the gallbladder into the duodenum

Peristalsis is a normal function of the body. It can sometimes be felt in your belly (abdomen) as gas moves along.”

Loyal Reader was especially interested in whether those who have CKD were more prone to ileus since WebMD cited the following as one of the causes of ileus:

• “Health issues such as kidney failure, heart attack, and hypothyroidism (when your thyroid gland doesn’t make enough of certain important hormones)”

I couldn’t find further information about the prevalence of CKD patients who had ileus as opposed to non-CKD patients. I did find this in the American Journal of Gastroenterology:

“Patients undergoing kidney transplant are more likely to develop ileus than patients who did not have kidney transplant surgery, confirming known reports documenting ileus in the early post-operative period. This cohort of patients who developed ileus following transplant have greater odds of post-operative complications, as well as increased morbidity, resource utilization and economic burden.”

Notice the words “more likely.” That doesn’t mean definitely.

Let’s do some speculating. We already know that CKD patients do seem to have quite a bit of constipation. Constipation could be a cause of ileus. Would it stand to reason that those with CKD caused constipation would develop ileus? I think so, but I’m not a doctor. Maybe this is something to discuss with your nephrologist.

In all honesty, I did find two articles that touched upon a possibility that ileus is more common amongst CKD patients, but one was from 1918 [that tickled my fancy] and the other from 1935. Considering I prefer to use only as recent information as I can find, these two were way out of my ball park.

There is so much more to know about ileus. I now think of it as something that we, as chronic kidney disease patients, need to keep in mind should we need a transplant. Thank you, Loyal Reader, for making us aware that this even exists.

Until next week,

Keep living your life!

So Silly!

For months, my daughter and I have been talking about what I thought was Jardiance. That’s a diabetes medication. For some unknown reason, I asked her to spell it. You’ll never guess. It wasn’t Jardiance at all. I was talking about Jardiance; she was talking about Janumet. While this is still a diabetes medication, it was neither the one I thought we were talking about, nor one I knew anything about. Silly of me, isn’t it? So, of course, Janumet became the topic of today’s blog.

Now, while we know diabetes is the foremost cause of chronic kidney disease, have you ever wondered why? In my very first book about kidneys, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I included the following information, which may be more than you ever wanted to know. [Hey, did you score your free copy of this book on New Year’s Day?]

“Thank you to the National Kidney Foundation for exactly the answer I was looking for:

• Blood vessels inside your kidneys. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged. Without enough blood, the kidneys become damaged and albumin (a type of protein) passes through these filters and ends up in the urine where it should not be.
• Nerves in your body. Diabetes can also cause damage to the nerves in your body. Nerves carry messages between your brain and all other parts of your body, including your bladder. They let your brain know when your bladder is full. But if the nerves of the bladder are damaged, you may not be able to feel when your bladder is full. The pressure from a full bladder can damage your kidneys.
• Urinary tract. If urine stays in your bladder for a long time, you may get a urinary tract infection. This is because of bacteria. Bacteria are tiny organisms like germs that can cause disease. They grow rapidly in urine with a high sugar level. Most often these infections affect the bladder, but they can sometimes spread to the kidneys.”

Okay then, time to turn to Medical News Today to find out what Janumet is.

“Janumet and Janumet XR contain the active ingredients sitagliptin and metformin. Janumet and Janumet XR are available only as brand-name medications. They’re not currently available in generic form.

Sitagliptin and metformin are available separately as generic medications. However, they aren’t available together as a combination generic drug.

A generic drug is an exact copy of the active ingredient in a brand-name medication. Generics usually cost less than brand-name drugs.”

Reminder: XR means extended release or slowly released into your body and long lasting. The opposite is IR or immediate release into your body and fast acting.

Let’s take the active [That means what makes the medication work.] ingredients one by one. This is from the Mayo Clinic:

“Sitagliptin helps to control blood sugar levels by increasing substances in the body that make the pancreas release more insulin. It also signals the liver to stop producing sugar (glucose) when there is too much sugar in the blood. This medicine does not help patients who have insulin-dependent or type 1 diabetes.”

Obviously not for me since I only have ¼ of my pancreas left after cancer surgery. I also noticed that a bunch of medications I take would also prevent from taking sitagliptin. Oh, it’s sold as Januvia. So it’s possible to use a sitagliptin only medication.

And Metformin? Medline Plus informs us:

“Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body’s response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood).”

Wait a minute. What are biguanides? Let’s let the Cleveland Clinic explain:

“Biguanides (better known as metformin) are a type of oral diabetes medication that helps lower blood sugar levels for people with Type 2 diabetes. Healthcare providers prescribe this medication for other conditions, as well, like PCOS and gestational diabetes.”

Metformin is the only biguanide. Hmm, you can use medication that is solely metformin, just as you can use medication that is solely sitagliptin. Actually, I’m wondering why Metformin isn’t labeled biguanide. It is sold under five different brand names. And why isn’t sitagliptin sold as sitagliptin? This is confusing to me.

Anyway, finally, we arrive at Janumet, not the only diabetes medication to contain both Sitagliptin and Metformin. What is the benefit of taking both? Back to the Mayo Clinic for us:

“Metformin and sitagliptin combination is used to treat high blood sugar levels caused by type 2 diabetes. Metformin reduces the absorption of sugar from the stomach, reduces the release of stored sugar from the liver, and helps your body use sugar better. Sitagliptin helps to control blood sugar levels by increasing substances in the body that make the pancreas release more insulin. It also signals the liver to stop producing sugar (glucose) when there is too much sugar in the blood. This medicine does not help patients who have insulin-dependent or type 1 diabetes….”

In the words of a former student, “Ah, so it’s a double whammy!” I’d have to agree. Be sure to ask your nephrologist or endocrinologist if you’re interested in changing your medication.

Until next week,

Keep living your life!

Happy New Year!

Here’s hoping you enjoyed your Christmas, Kwanzaa, and/or Boxing Day. I’m sure there are some other holidays that were celebrated which I missed. I hope you enjoyed them, too. We were thrilled, as usual, to have our Arizona kids with us. Nothing like children to make a holiday festive. And now it’s a new year and we begin all over again. To help you with that, my new year’s gift to you is that What is It and How did I Get It? Early Stage Chronic Kidney Disease is free on Amazon all day today.

A young friend of mine said she doesn’t want a new her this year [You know: new year, new me.] but to better love the her she already has. I’m with this young friend. However, I wouldn’t mind some new help for chronic kidney disease. Let’s see if there is any.

Jardiance is a term I’ve heard often, but I don’t really know much about it.  Boehringer Ingelheim, tells us:

“JARDIANCE is a prescription medicine used to:

• reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure, when the heart cannot pump enough blood to the rest of your body
• reduce the risk of further worsening of kidney disease, end-stage kidney disease (ESKD), death due to cardiovascular disease, and hospitalization in adults with chronic kidney disease
• reduce the risk of cardiovascular death in adults with type 2 diabetes who also have known cardiovascular disease
• lower blood sugar along with diet and exercise in adults and children who are 10 years of age and older with type 2 diabetes”

Boehringer Ingelheim is self-described as “… the privately-held company [that] has been committed to researching, developing, manufacturing and marketing novel treatments for human and veterinary medicine.”

Jardiance is one of the flozins I wrote about on 8/23/21. Here, let me remind you what was written:

“MedlinePlus: 

Empagliflozin is used along with diet and exercise, and sometimes with other medications, to lower blood sugar levels in people with type 2 diabetes …. Empagliflozin is also used to reduce the risk of stroke, heart attack, or death in people who have type 2 diabetes along with heart and blood vessel disease. It is in a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors. Empagliflozin lowers blood sugar by causing the kidneys to get rid of more glucose in the urine. It is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic ketoacidosis (a serious condition that may develop if high blood sugar is not treated). 

Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, includingheart [sic] disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.” 

Hmm, that was back in 2021. So, what’s new about Jardiance? PR News Wire answered that question for us in June of this past year:

“The U.S. Food and Drug Administration (FDA) has approved Jardiance^® (empagliflozin) 10 mg and 25 mg tablets to lower blood sugar along with diet and exercise in children 10 years and older with type 2 diabetes, Boehringer Ingelheim and Eli Lilly and Company (NYSE: LLY) announced….

‘As the burden of type 2 diabetes increases among young people, so does the need for additional treatment options with proven clinical benefits,’ said Lennart Jungersten, M.D., Ph.D., senior vice president, Medicine & Regulatory Affairs, Boehringer Ingelheim. ‘This FDA approval, which is based on the efficacy results and safety data from the DINAMO trial, marks an important milestone in helping address a clear unmet need for oral treatment options, in addition to metformin, to lower A1c in this rapidly rising population.’

Type 2 diabetes represents a significant and growing health concern among young people in the U.S. Over the past two decades, the prevalence of type 2 diabetes in people aged 10-19 has nearly doubled. New treatment options are critical to help address the over 5,700 new cases of type 2 diabetes in this population each year in the U.S.”

This is why the FDA approval is so important:

“Empagliflozin is the first and only SGLT2 inhibitor approved for this patient population
– More than 5,700 young people are diagnosed with type 2 diabetes annually in the U.S.”

Keep in mind that diabetes is the foremost cause of chronic kidney disease. Also, CKD can cause heart disease.

The Mayo Clinic is metaphorically tugging on my pants leg now. Let’s see what that’s all about. This is from March 2023:

“Dr. Naim Issa, a Mayo Clinic transplant nephrologist says there is a class of medications to help people with chronic kidney disease ….

Most people don’t have symptoms of chronic kidney disease until it’s at an advanced stage.

‘Early detection of chronic kidney disease may help us actually treat and prevent patients ahead of time before the need for dialysis or kidney transplantation,’ says Dr. Issa.

He says a new class of drugs, SGLT2 inhibitors, is being called a game changer. The drugs were originally designed to treat diabetes — a main cause of chronic kidney disease.

Medicines in the SGLT2 inhibitor class include canagliflozin, dapagliflozin and empagliflozin.

‘In large trials, we observed groundbreaking success with those medications in slowing down the progression of chronic kidney disease, to the extent of avoiding dialysis and the need for kidney transplantation,’ Dr. Issa says.

The medications are used whether the patient is diabetic or not.

‘They are actually game-changer medications that help us prevent the progression of chronic kidney disease,’ says Dr. Issa.”

What an encouraging way to start the new year. Here’s to even more new help for CKD.

Until next week,

Keep living your life!

My Kind of Gift

Someone who has been very active in the kidney community, and has even guest blogged, had some questions she wanted answered. Consider this blog my Christmas gift to her. Here’s hoping you all have a Merry Christmas, Happy Kwanzaa, and/or Boxing Day – whichever you observe. In our house, it’s Chanukah – which has already passed – and Christmas. We really don’t celebrate except when the children and grandchildren are here. The other times, we reminisce about the holidays when they were here. But I digress.

Have you ever heard of Norvasc? It’s one of the brand names for the generic amlodipine. Drugs.com tells us:

“Norvasc (amlodipine) belongs to a class of medications called calcium channel blockers. Amlodipine lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard.

Norvasc is used to treat certain types of angina (chest pain) and other conditions caused by coronary artery disease (narrowing of the blood vessels that supply blood to the heart).

Norvasc controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain.

Norvasc is also used alone or in combination with other medicines to treat high blood pressure (hypertension) in adults and children at least 6 years old. Lowering blood pressure may lower your risk of a stroke or heart attack.”

Notice that most of the definition deals with your heart and chest pain. That’s often the reason Norvasc is prescribed. Also note the last line of the definition which deals with high blood pressure. That’s why many kidney transplantees are taking this drug.

But there are other reasons for high blood pressure. One of them is arterial stenosis. I turned to the United Kingdom’s National Health Service for a clear explanation of how this works:

“Narrowing of the artery connected to the donated kidney, known as arterial stenosis, can sometimes happen after a kidney transplant. Sometimes, it can develop months, or even years, after the transplant.

Arterial stenosis can cause a rise in blood pressure. The artery often needs to be stretched to widen it, and a small metal tube called a stent may be placed inside the affected artery to stop it narrowing again.”

For some reason, this made me wonder if the donated organ had anything to do with rejection. I found some interesting information which deals with the donor kidney and high blood pressure on Science Daily,

“Cosio suspects that the condition of the blood vessels in a transplanted kidney affect’s [sic] the organ’s ability to regulate blood pressure.

Whenever a kidney is removed from a donor, the organ’s blood supply is momentarily lost, reducing the supply of oxygen to the blood-vessel cells and damaging them to some degree.

This is particularly true when the kidney comes from a person who has died and whose circulation is maintained artificially.

This subtle damage may then inhibit that kidney’s ability to efficiently maintain blood pressure following transplantation.

Looked at another way, high blood pressure after transplantation may sometimes reflect the degree of damage to the blood vessels of the kidney after it is removed from the donor, he said.

Cosio’s research was funded by grants from the National Institutes of Health.”

Cosio is “Fernando Cosio, professor of internal medicine at Ohio State University and leader of the study.”

Let’s backtrack a little to learn about rejection of the kidney. News Medical Life Science explains why immune suppression medications are needed.

“The immune system of the body perceives the kidney as a foreign object [Gail here: the new kidney, that is.] or tissue and mounts a reaction against it. This may lead to massive damage to the new kidney. Early signs of rejection include fever and soreness at the site of the new kidney and reduction in the amount of urine production. To prevent rejection reaction immune suppressing medications are prescribed right after the operation.”

Time for a recap to make sure we understand this process. Your native kidney fails. You place yourself on the list for a new kidney or find a compatible donor yourself. Testing begins for both you and your donor. You receive a new kidney [hopefully] either from a living donor or a deceased donor. You need to start taking anti-rejection medication, also called immunosuppressants, immediately. You may develop high blood pressure. You take medication for that, too. You may develop rejection of the donor kidney. This does not mean it will necessarily stop working, but it does mean the rejection requires medical treatment. By now, you are taking quite a few pills. If you miss even one dose, you can cause damage to the new kidney.

Now, please remember that I am not a doctor. I can research and rephrase what I find into reader friendly language, but that’s it. Your nephrologist and/or your transplant team are your best friends once you have a kidney transplant.

Let me leave you with this reminder: high blood pressure MAY lead to rejection, but that doesn’t necessarily mean that it will. There is treatment available should you start to reject that may stop that process. Our old friend, The Cleveland Clinic, elaborates:

“If your healthcare provider determines that a kidney rejection is occurring, they’ll adjust your prescription for immunosuppressant medication to prevent further complications. You may require additional medications or treatments for a short time, specifically for a rejection. Some people receive treatment for a rejection in a hospital for as long as five days. Others can receive treatment in an outpatient setting.

Since immunosuppressants, or antirejection medications, work by lowering (suppressing) your immune system to weaken how hard it can fight, treatment for a kidney rejection typically involves increasing the dosage of immunosuppressants….”

Until next week [or should I say next year?],

Keep living your life!

That’s a Mouthful

This week, I promised a reader I would find what I could about Progressive Multifocal Leukoencephalopathy. Now you see why this blog’s title refers to a mouthful. We’ll make life easier by referring to this by its acronym PML. Let’s go to my all time favorite dictionary, The Merriam-Webster, for a definition:

“a progressive and often fatal demyelinating disease of the central nervous system that typically affects immunocompromised individuals and that is characterized especially by muscle weakness and loss of coordination with impairments in speech, vision, and cognitive function and that commonly progresses to paralysis and coma”

If you’re anything like me, you wonder what that all means. First of all, I want to reassure my reader that although this may be a fatal disease, it can be slowed down.

Okay, now we can precede. Actually, let’s back up a little for the definition of demyelinating:

“causing or characterized by the loss or destruction of myelin”

Now we’re getting some place, but I can see we’re starting to fall down the rabbit hole by defining words in definitions, so let’s deal with what PML has to do with chronic kidney disease instead. With all these new terms, I wanted to know how you contact PML and I’m sure my reader does, too. Thank you to the Cleveland Clinic for the answer to the question:

“Progressive multifocal leukoencephalopathy (PML) is a rare brain infection. PML causes the cells that produce myelin to break down. Myelin is a substance in the brain that protects nerve cells. PML causes brain damage. This damage can lead to mental impairment, visual symptoms and difficulty moving. Because PML is a progressive disorder, it will get worse over time. Some people can slow the disease’s progression with timely treatment. PML typically only occurs in people who have severely weakened immune systems. You may be at risk of developing PML if you have:

• HIV/AIDS.
• Leukemia (cancer in blood and bone marrow).
• Lymphoma (cancer in the lymph system).
• A donor organ and have taken immunosuppressant medicines (drugs to keep your body from rejecting the organ).

Progressive multifocal leukoencephalopathy is rare. It affects about 1 in every 200,000 people.”

What causes progressive multifocal leukoencephalopathy (PML)?

PML occurs because of the JC virus (JCV) — named after the initials of the first patient identified with it. Up to 85% of all adults have the JC virus. Experts aren’t certain how people contract JCV. There is evidence that children may pick it up through food or water. In most people, JCV remains inactive and causes no symptoms. But in people with a weak immune system, the virus may progress into PML.”

Let’s jump over to Healthline to see if we can find out anything else,

“… the JC virus is quite common. In fact, up to 85 percent of adults in the general population have the virus. You can get the JC virus at any time in your life, but most of us are infected during childhood. A normal, healthy immune system has no trouble keeping the virus in check. The virus usually remains dormant in the lymph nodes, bone marrow, or kidneys throughout our lifetime. Most people with the JC virus never get PML. If the immune system becomes severely compromised for any reason, the virus can be reactivated. Then it makes its way to the brain, where it multiplies and begins its attack on myelin.

As myelin is damaged, scar tissue begins to form. This process is called demyelination. The resulting lesions from the scar tissue interfere with electrical impulses as they travel from the brain to other parts of the body. That communication gap can create a variety of symptoms affecting virtually any part of the body.”

You’ve probably already figured out that the connection between PML and CKD is having a weak immune system. [That’s what has kept us off planes for the last four years, not PML, but being immunocompromised due to CKD.] But those of us who have gone beyond CKD, had a transplant, and are taking immunosuppressant medications are also open to PML. Keep in mind that one in 200,000 is a very small percentage.

Last month, the National Institute of Neurological Disorders and Stroke posted the following on their page. I retrieved quite a bit of information from them,

“The symptoms of PML, which vary according to the location and amount of damage in the brain, may evolve over the course of several weeks to months. The most prominent symptoms are:

• Clumsiness
• Progressive weakness
• Visual, speech, and sometimes personality changes

The progression of deficits leads to life-threatening disability and (frequently) death. 

A diagnosis of PML can be made following brain biopsy or by combining observations of a progressive course of the disease, consistent white matter lesions visible on a magnetic resonance imaging (MRI) scan, and the detection of the JC virus in spinal fluid.

Currently, the best available therapy is reversal of the immune-deficient state, since there are no effective drugs that block virus infection without toxicity. Reversal may be achieved by using plasma exchange to accelerate the removal of the therapeutic agents that put people at risk for PML. 

…. Several new drugs that laboratory tests found effective against infection are being used in people with PML with special permission of the U.S. Food and Drug Administration (FDA).

The outlook for individuals with PML depends on the severity of the underlying disease and treatment received. In general, PML has a mortality rate of 30 to 50 percent in the first few months following diagnosis. Those who survive the disease may be left with severe neurological disabilities.”

Just a few reminders for my special reader before I sign off:

1. The disease can be slowed down by timely treatment.
2. There are drugs available by special permission of the FDA.
3. As usual, no two patients require the same treatment or have the same prognosis.

I wish you and your husband the best. While I can do a bit of research for you, I am not a doctor. He or she is the one to ask specific questions for your specific patient.

Until next week,

Keep living your life!

To Toast or Not to Toast

Happy Chanukah! With Chanukah here, Christmas can’t be far behind. And with Christmas almost here, we know Kwanzaa will be soon after. One thing all three celebrations have in common is libation – a drink.

I don’t drink, never have. I just don’t like the smell of liquor under my nose, nor the taste of it in my mouth [no judgement, folks]. Bear can’t drink due to the medications he takes. That got me to wondering since everything seems to have a connection to the kidneys, does having chronic kidney disease mean you can’t drink? I turned to the Mayo Clinic to begin my search for an answer. They stated the answer simply:

“Heavy alcohol consumption was associated with faster progression of CKD.”

Okay, that was succinct, but – being who I am – I had loads of questions about that statement. For instance, what is considered ‘heavy alcohol consumption’? The Centers for Disease Control defines it this way:

“Excessive drinking includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21.

• Binge drinking, the most common form of excessive drinking, is defined as consuming
  • For women, 4 or more drinks during a single occasion.
  • For men, 5 or more drinks during a single occasion.
• Heavy drinking is defined as consuming
  • For women, 8 or more drinks per week.
  • For men, 15 or more drinks per week.

Most people who drink excessively are not alcoholics or alcohol dependent….”

Then I wondered, how much alcohol is considered one drink? I’m going to stick with the CDC since their explanation is a good one:

“In the United States, a standard drink contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in

• 12-ounces of beer (5% alcohol content).
• 8-ounces of malt liquor (7% alcohol content).
• 5-ounces of wine (12% alcohol content).
• 1.5-ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey) …^.”

As a non-drinker, I found this interesting, but I’m more interested in the alcohol/kidney connection. I figured the best place to start was The National Kidney Foundation:

“The kidneys have an important job as a filter for harmful substances. One of these substances is alcohol. The kidneys of heavy drinkers have to work harder. Alcohol causes changes in the function of the kidneys and makes them less able to filter the blood. Alcohol also affects the ability to regulate fluid and electrolytes in the body. When alcohol dehydrates (dries out) the body, the drying effect can affect the normal function of cells and organs, including the kidneys. In addition, alcohol can disrupt hormones that affect kidney function.

Too much alcohol can also affect your blood pressure. People who drink too much are more likely to have high blood pressure. And medications for high blood pressure can be affected by alcohol. High blood pressure is a common cause of kidney disease. More than two drinks a day can increase your chance of developing high blood pressure. Drinking alcohol in these amounts is a risk factor for developing a sign of kidney disease, protein in the urine (albuminuria). The good news is that you can prevent this by not drinking too much alcohol.”

My father and Zady [Yiddish for grandfather] used to have a drink or two of schnapps or Wild Turkey when they were together. Now I see why they kept it to a drink or two.

I stumbled upon the website for American Addiction Centers and was glad I did. I found even more about the connection between alcohol and the kidneys:

“Kidney disease has many causes that are not related to alcohol, but alcoholism is an undeniable factor in the development of kidney disease, especially because people who drink too much often have unhealthy lifestyles (e.g., not getting enough exercise, eating too much or too little, abusing other substances, etc.) that significantly increase the risk of kidney disease or failure. Other issues, like a family history of related conditions (not limited to kidney problems, such as obesity, heart and/or cardiovascular issues, high blood pressure, or genetics) make some people more inclined toward the development of kidney failure than others. Alcohol, whether in moderation or excess, exacerbates kidney problems to the point of actual kidney disease.”

But what does actually happen to the kidneys if you drink too much? Another addiction center, Gatehouse Treatment, got to the heart [You know I mean kidney] of the matter:

“Alcohol can also cause damage to the glomeruli, which are the tiny filters within the kidneys responsible for filtering waste and fluid. Once the glomeruli thicken with scars, the liver function impairment begins, and the condition may progress to chronic kidney disease. Additionally, there may be blood in the urine….

Chronic alcohol consumption can interfere with the kidneys’ ability to maintain acid-base balance, resulting in renal tubular acidosis. Your renal tubes stop secreting acid from the body, meaning your body quite literally becomes toxic. This functional breakdown can cause metabolic acidosis, leading to fatigue, weakness, vomiting, loss of appetite, bone abnormalities, and electrolyte imbalances.”

Yet again, I wanted to know more. The Recovery Village Columbus brought up a point I haven’t seen mentioned before:

“Alcohol affects how your brain releases a hormone called vasopressin, suppressing how much is released. Vasopressin directly acts on your kidneys, reducing urine production. When alcohol suppresses normal vasopressin levels, your kidneys will increase urine production to higher levels. High urine output (called diuresis) occurs, increasing strain on the kidneys by forcing them to alter their normal levels of function.”

I was hoping I’d be able to find something on this topic that Bear suggested the other day. Instead, I found myself working ridiculously hard to narrow down all the information I found so that the blog was coherent and informative. Surprise, surprise.

Until next week,

Keep living your life!

PFA Doesn’t Mean Professional Fashionista Association

I hope that was good for a laugh. The man I call Constant Reader [Let me know if you’re ready for me to use your name.] has been wondering about PFAs lately. I don’t mean Protection from Abuse, Professional Footballers Association, nor any of the 96 other meanings for the acronym. We need the chemical definition of PFA. Which is, according to the United States Environmental Protection Agency [EPA]:

“PFAS are manufactured chemicals that have been used in industry and consumer products since the 1940s. Because of their widespread use and their persistence in the environment, many PFAS are found in the blood of people and animals all over the world. There are thousands of different PFAS, some of which have been more widely used and studied than others.”

WHAT! The Centers for Disease Control and Prevention [CDC] explains:

“The per-and polyfluoroalkyl substances (PFAS) are a group of chemicals used to make fluoropolymer coatings and products that resist heat, oil, stains, grease, and water. Fluoropolymer coatings can be in a variety of products. These include clothing, furniture, adhesives, food packaging, heat-resistant non-stick cooking surfaces, and the insulation of electrical wire. Many PFAS, including perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA), are a concern because they:

• do not break down in the environment,
• can move through soils and contaminate drinking water sources,
• build up (bioaccumulate) in fish and wildlife.

PFAS are found in rivers and lakes and in many types of animals on land and in the water.”

My family uses neither Teflon products nor Scotchgard products. I’d forgotten why since we haven’t used them in so long. Thanks for reminding me, EPA and CDC.

Now I want to know what other products contain PFAs. Time, which describes itself as “… a global media brand built on 100 years of unparalleled trust and authority, with an audience of more than 100 million people worldwide across our platforms. Created in 1923, TIME began as the first weekly news magazine: a digest of world events, for busy people to read.” exposed us to a sampling of these products:

“Body care products including shampoo, dental floss, toilet paper, tampons, and pads …

Soft contact lenses … 

Beauty products including nail polish and eye makeup …

Cell phones …

Mattress pads …

Wall paint …

Household dust …

Carpeting …

Food …

Yoga pants and sports bras…

Tap water …

Plumber’s tape … 

Guitar strings …

Candy wrappers …

Bicycle chain lubricant …

Microwave popcorn bags …

Dishwasher and laundry detergent “

Okay, it’s everywhere! So why be concerned? I turned to the National Institute of Environmental Health Sciences to find out:

“Multiple health effects associated with PFAS exposure have been identified and are supported by different scientific studies. Concerns about the public health impact of PFAS have arisen for the following reasons:

• Widespread occurrence. Studies find PFAS in the blood and urine of people, and scientists want to know if they cause health problems.
• Numerous exposures. PFAS are used in hundreds of products globally, with many opportunities for human exposure.
• Growing numbers. PFAS are a group of nearly 15,000 synthetic chemicals, according to a chemicals database (CompTox) maintained by the U.S. Environmental Protection Agency.
• Persistent. PFAS remain in the environment for an unknown amount of time.
• Bioaccumulation. People may encounter different PFAS chemicals in various ways. Over time, people may take in more of the chemicals than they excrete, a process that leads to bioaccumulation in bodies.”

Wow, just wow. Omnipresent. But what, if anything, does this have to do with our kidneys? The PFA Project Lab answers that question:

“As for some of the epidemiologic studies reviewed, several reported a significant association between PFAS exposure with poorer overall kidney health in humans, marked by a significant link between PFAS exposure with a lower estimated glomerular filtration rate and a higher prevalence of chronic kidney disease. This relationship was also seen in children….”

Back to the EPA for a minute to see how people’s health can be affected by PFAs:

“Current peer-reviewed scientific studies have shown that exposure to certain levels of PFAS may lead to:

• Reproductive effects such as decreased fertility or increased high blood pressure in pregnant women.
• Developmental effects or delays in children, including low birth weight, accelerated puberty, bone variations, or behavioral changes.
• Increased risk of some cancers, including prostate, kidney [Gail here, I bolded that.], and testicular cancers.
• Reduced ability of the body’s immune system to fight infections, including reduced vaccine response.
• Interference with the body’s natural hormones.
• Increased cholesterol levels and/or risk of obesity.”

Furthermore, Frontiers, self-described as “… the 3rd most-cited and 6th largest research publisher and open science platform,” explains:

“Based on the biodegradability and bioaccumulation of perfluorooctanoic acid in the human body, there are increasing concerns about the adverse effects of perfluorooctanoic acid exposure on kidneys. Research shows that kidney is the main accumulation organ of Perfluorooctanoic acid, and Perfluorooctanoic acid can cause nephrotoxicity and produce adverse effects on kidney function, but the exact mechanism is still unknown.”

While this is probably alarming to you, I must tell you that every piece of research I looked at mentioned that more studies were necessary. What surprised me was that these ‘forever’ particles live up to their name: they do not dissipate. However, there has been recent legislation – both state and national – on PFAs in drinking water. Ladies and gentlemen, you have to start somewhere.

Until next week,

Keep living your life!

Keep Those Questions Coming, Folks!

Today we have another kidney disease and transplant awareness advocate’s question. I doubted I could answer this one. It has to do with renal transplant possibly causing the need for a gall bladder removal. It came about because two of the other kidney disease and transplant awareness advocates with kidney transplants recently both needed their gall bladder removed. Oh, wow, I think I did find an answer.

First, I thought you might enjoy an origin story. According to Indiana University School of Medicine:

“In a pivotal moment in medical history, Dr. John Stough Bobbs conducted the first documented gallbladder surgery back in 1869. This groundbreaking procedure took place in his third-floor office on the south side of Indianapolis, where he successfully removed stones from a 31-year-old woman who had suffered for four years.” 

So, how did we get from this to gall bladder removal and why is it performed? The University of California, San Fransico, Department of Surgery, Gastrointestinal Surgery tells us:

“Cholecystectomy (Gallbladder Removal)

A cholecystectomy is a surgical procedure to remove the gallbladder, a small, pear-shaped organ located in the upper right abdomen—the area between the chest and hips—below the liver. The gallbladder collects and stores bile, a digestive fluid produced in the liver. Cholecystectomy may be required where there is pain from gallstones that block the flow of bile.“

Gallstones are not the only reason for a cholecystectomy. Healthline lays them out for us:

“Other conditions that could make you a candidate for gallbladder removal include:

• Biliary dyskinesia. This occurs when the gallbladder doesn’t empty bile correctly due to a defect in its motion.
• Choledocholithiasis. This happens when gallstones have moved to the common bile duct where they may be stuck, causing a blockage that doesn’t allow the gallbladder or rest of the biliary tree to drain.
• Cholecystitis. This is inflammation of the gallbladder.
• Pancreatitis. This is inflammation of the pancreas.”

I know. I know. What does this have to do with kidney transplant? A small study in the Annals of Transplantation explains:

“Cholelithiasis [Gail here. This means gallstones.]  is one of the most common gastroenterological diseases with a frequency of 10–15% in the general population …. The indications for cholecystectomy are symptomatic gallbladder stones; however, in diseases such as diabetes and sickle cell disease, and in patients undergoing solid organ transplantation [Gail here, like the kidneys], prophylactic removal of the gallbladder is nowadays considered …. The treatment of choice is laparoscopic cholecystectomy. It has been proven that in patients with end-stage chronic kidney disease (CKD) on hemodialysis or after kidney transplantation (KTx), the frequency of cholelithiasis increases [I bolded these words.] …. Moreover, patients after KTx receiving immunosuppression due to delayed diagnosis resulting from obscured symptomatology of inflammatory diseases and patients with decreased immune response may be at higher risk of complications of cholecystitis….”

Well, how is the gall bladder removed? The laparoscopic surgery mentioned above is performed like this:

“The surgeon makes a few small incisions on the right side of your abdomen (belly). The surgeon uses one incision to insert a laparoscope, a thin tube with a camera on the end. This shows your gallbladder on a screen. The gallbladder then gets removed through another small incision.”

Thank you to the Cleveland Clinic for that information. There is another option, which is called an open cholecystectomy. However, the recovery time is longer. The following information is from the Mayo Clinic:

“During an open cholecystectomy, the surgeon makes a 6-inch, or 15-centimeter, incision in your abdomen below your ribs on your right side. The muscle and tissue are pulled back to reveal your liver and gallbladder. Your surgeon then removes the gallbladder. The incision is closed, and you’re taken to a recovery area.”

It’s also suggested that having this surgery at the transplant center will lower the number of deaths. Allow me to introduce HBP Journal. Their website states:

“HPB is an international forum for clinical, scientific and educational communication.

Now that we know who they are, this information from the journal becomes more important:

“… transplant recipients undergoing cholecystectomy experienced no significant increase in mortality compared to the general population. Overall KTx suffered a higher morbidity compared to the general population, but this increased morbidity was eliminated in transplant centers.”

I suspected that the immunosuppression drugs transplants need to take have something to do with the increased need for cholecystectomy in kidney transplants. Sometimes known as anti-rejection medications, Columbia Surgery states that they include:

• “Cyclosporines (Neoral®, Gengraf®, Sandimmune®)
• Tacrolimus (Prograf®, FK506)
• Mycophenolate mofetil (CellCept®)
• Prednisone
• Azathioprine (Imuran®)
• Sirolimus (Rapamune®)
• Daclizumab and Basiliximab (Zenapax® and Simulect®)
• OKT3® (monoclonal antibody)
• Anti-Fungal Medications (Mycelex Troche®, Nystatin® Swish and Swallow, and Diflucan®)
• Antiviral Medications: Zovirax® (acyclovir), Cytovene® (ganciclovir), and Valcyte® (valganciclovir)
• Diuretics: Lasix® (furosemide)
• Antibiotics: Bactrim® (septra)
• Anti-Ulcer Medications: Prilosec® (omeprazole), Prevacid® (lansoprazole), Zantac® (ranitidine), Axid® (nizatidine), Carafate®(sucralfate), Pepcid®”

Finally, Science Direct addresses our original question:

“One unique patient population at increased risk for need of cholecystectomy are kidney transplant recipients (KTR). KTR are at higher risk of developing gallstones and biliary disease than the general population due to their history of renal failure and immunosuppressive medications such as calcineurin inhibitors…^. This risk, combined with improved post-transplant survival, translates to a higher incidence of cholecystectomy in the kidney transplant population.”

I have got to say that, when presented with the original question, I never expected to find an answer. Yet, Science Direct’s answer is clear and straightforward. Yes, a renal transplant can possibly cause the need for a cholecystectomy. A hearty thank you to Leesa Thompson for asking the question.

Until next week,

Keep living your life!

Now There’s Long Covid

Back in 2021, I wrote a bit about Covid. It’s even on Spotify as a podcast. But now, we have Long Covid. I thought it was time to write about that, but doubted there was much research. Boy, was I wrong! Of course, I only wanted to write about Long Covid and chronic kidney disease. Again, I thought narrowing the topic would leave me with little research. Again, I was wrong.

Let’s start at the beginning. Although Covid has been our constant companion for a bunch of years, let’s see exactly what it is [other than possibly fatal, that is]. If you remember way back in 2019, It was called Covid-19. The 19 refers to the year: 2019. Now for the covid part. That was originally referred to as Coronavirus Disease. It was cleverly shortened to: Co for Corona; Vi for virus; D for disease. Notice I am not citing any sources here. That’s because this is from my memory. I hope I got it right.

So, how did Covid begin? According to Northwest Medicine:

“Though initially discovered in Wuhan, China, in late 2019, COVID-19 entered the conversation in the U.S. in January 2020, when the Centers for Disease Control and Prevention (CDC) alerted the nation of the outbreak abroad. Later that month, the first national case of COVID-19 was reported in the state of Washington; by January 24, the virus had made its way to Chicago.

The outbreak escalated quickly from there, during a period of uncertainty about how the virus was transmitted, how quickly it could spread and how much of a threat it was to public health.

By March 2020, the World Health Organization (WHO) had declared COVID-19 a global health emergency and named the virus ‘severe acute respiratory syndrome coronavirus 2’ or ‘SARS-CoV-2.’ It was also in March that WHO officially declared the COVID-19 outbreak a pandemic.”

But now we have Long Covid. What is that? The American Medical Association [AMA] tells us:

“Most people recover from SARS-CoV-2, the virus that causes COVID-19, within a couple of weeks, but others may experience new or lingering symptoms, even after recuperating from COVID-19. Although, there is no universal clinical case definition for these lingering symptoms the CDC labels long COVID, also known as post-COVID conditions, as a wide range of new, returning or ongoing health problems people can experience four or more weeks after first being infected with SARS-CoV-2.”

Well, how does Covid affect the kidneys. I turned to Johns Hopkins Medicine for the possible answer:

“The impact of COVID-19 on the kidneys is complex. Here are some possibilities doctors and researchers are exploring:

Coronavirus might target kidney cells

The virus itself infects the cells of the kidney. Kidney cells have receptors that enable the new coronavirus to attach to them, invade, and make copies of itself, potentially damaging those tissues. Similar receptors are found on cells of the lungs and heart, where the new coronavirus has been shown to cause injury.

Too little oxygen can cause kidneys to malfunction

Another possibility is that kidney problems in patients with the coronavirus are due to abnormally low levels of oxygen in the blood, a result of the pneumonia commonly seen in severe cases of the disease.

Cytokine storms can destroy kidney tissue

The body’s reaction to the infection may be responsible as well. The immune response to the new coronavirus can be extreme in some people, leading to what is called a cytokine storm.

When that happens, the immune system sends a rush of cytokines into the body. Cytokines are small proteins that help the cells communicate as the immune system fights an infection. But this sudden, large influx of cytokines can cause severe inflammation. In trying to kill the invading virus, this inflammatory reaction can destroy healthy tissue, including that of the kidneys.

COVID-19 causes blood clots that might clog the kidneys

The kidneys are like filters that screen out toxins, extra water and waste products from the body. COVID-19 can cause tiny clots to form in the bloodstream, which can clog the smallest blood vessels in the kidney and impair its function.”

We need a definition of Long Covid before we continue.

“Long COVID, also known as Post-COVID Conditions (PCC), refers to the wide range of symptoms and conditions that some people experience four or more weeks after an initial infection by SARS-CoV-2, the virus that causes COVID-19. The symptoms and conditions, which may last for weeks, months, or years, can be persistent (meaning they developed during an acute COVID-19 illness and haven’t gone away), recurrent (meaning they may go away after the initial illness then return), or new (meaning they were not present initially but developed later).”

Thank you to Yale Medicine for the definition .

And CKD? What’s the connection with Long Covid? The National Institutes of Health’s The National Center for Biotechnology Information tells us:

“There is a bidirectional relationship between chronic kidney disease and COVID-19 disease. Chronic kidney diseases due to primary kidney disease or chronic conditions affecting kidneys increase the susceptibility to COVID-19 infection, the risks for progression and critical COVID-19 disease (with acute or acute-on-chronic kidney damage), and death. Patients who have survived COVID-19 face an increased risk of worse kidney outcomes in the post-acute phase of the disease. Of clinical significance, COVID-19 may predispose surviving patients to chronic kidney disease, independently of clinically apparent acute kidney injury (AKI).”

There is so much more information about CKD and Long Covid that I urge you to go to each of the links and poke around on that website. It’s amazing how much, yet how little, is known about Long Covid.

Let me leave you with this succinct information from the National Library of Medicine:

“… COVID-19 can directly infect kidney cells and induce cell injury with subsequent fibrosis [Gail here: that’s scarring.] …. data may explain both acute kidney injury and transition to chronic kidney disease in long-COVID-19.”

You couldn’t be more clear if your life depended on it… and it just might.

Until next week,

Keep living your life!

Dream a Little Dream with Me

It seems to me that I find answers to questions and solutions to problems in my dreams, usually just before I wake up. I suspect I’m not the only one. This week, my problem [for the first time in years] was the topic of today’s blog. The answer was IGA. I had no idea what that meant, so today we find out together.

Aha! It’s not IGA, which is the Independent Grocers Alliance, but IgA. It’s also known as Berger’s Disease after one of its two discoverers. That makes more sense since I don’t dream about groceries, but I do dream about kidneys. Johns Hopkins gave me the definition:

“IgA nephropathy is a chronic kidney disease. It progresses over 10 to 20 years, and can lead to end-stage renal disease. It is caused by deposits of the protein immunoglobulin A (IgA) inside the filters (glomeruli) in the kidney.”

I needed this definition broken down into little bits in order to understand it. Adding nephropathy to IgA put it in my ballpark. Nephro means kidney. Pathy means disease or disorder. Combine the two and you have a disease or disorder of the kidneys. IgA tells us which disease or disorder it is.

The definition tells us that IgA is a “protein immunoglobulin.” Great, what’s that mean? Immuno must be something to do with the immune system and globulin sounds like blood. Right? Let’s find out from a reliable source instead of relying on my knowledge of word roots. Healthline informs us that immunocompromised means:

“Immunoglobulins, also called antibodies, are molecules produced by white blood cells that help your body defend against infections and cancer. Their primary function is to bind to foreign cells like bacteria and viruses. This binding helps neutralize the foreign cell and signals to your white blood cells to destroy them.”

And protein? Thank you to MedlinePlus for this definition:

“Proteins are large, complex molecules that play many critical roles in the body. They do most of the work in cells and are required for the structure, function, and regulation of the body’s tissues and organs.”

Now it’s understandable. Add the two definitions and you get working antibodies. I think. Maybe that’s too simplistic a definition. At any rate, let’s see what these protein immunoglobins have to do with your kidneys. I turned to PennMedicine to see how the condition develops:

“IgA is a protein, called an antibody, that helps the body fight infections. IgA nephropathy occurs when too much of this protein is deposited in the kidneys. IgA builds up inside the small blood vessels of the kidney. Structures in the kidney called glomeruli become inflamed and damaged.

The disorder can appear suddenly (acute), or get worse slowly over many years (chronic glomerulonephritis).”

Of course, then I wanted to know who is at risk. Who better than the Cleveland Clinic to offer that information?

Photo by Min An on Pexels.com

• “Family history of IgA nephropathy.
• Family history of IgA vasculitis, (Henoch-Schönlein purpura).
• Being a young adult male (teens to late 30s).
• Asian or European ethnicity.”

So, how do you know if you have IgA Nephropathy? What are the symptoms? The Mayo Clinic lists possible symptoms for us:

“IgA nephropathy often doesn’t cause symptoms early on. You might not notice any health effects for 10 years or more. Sometimes, routine medical tests find signs of the disease, such as protein and red blood cells in the urine that are seen under a microscope.

When IgA nephropathy causes symptoms, they might include:

• Cola- or tea-colored urine caused by blood. You might notice these color changes after a cold, sore throat or respiratory infection.
• Blood that can be seen in the urine.
• Foamy urine from protein leaking into the urine. This is called proteinuria.
• Pain on one or both sides of the back below the ribs.
• Swelling in the hands and feet called edema.
• High blood pressure.
• Weakness and tiredness.”

NephCure explains how this disease is diagnosed:

“The presence of blood or protein in the urine through a routine urinalysis is usually the first step in diagnosing IgA Nephropathy. Blood test for serum creatinine can be used to calculate glomerular filtration rate (GFR), which reads how well your kidneys are filtering wastes from the blood. To confirm a diagnosis, however, it is necessary to do a kidney biopsy.”

And now the biggie – how is this disease of the kidneys treated? The National Kidney Foundation offers the following:

• “Urine test: A urine test will help find protein and blood in your urine.
• Blood test: A blood test will help find levels of protein, cholesterol, and wastes in your blood.
• Glomerular filtration rate (GFR): A blood test will be done to know how well your kidneys are filtering the wastes from your body.
• Kidney biopsy:  In this test, a tiny piece of your kidney is removed with a special needle, and looked at under a microscope. The kidney biopsy may show if you have a certain type of a protein that helps your body fight infection, called an IgA antibody, in the glomerulus.

You should know that IgA or IgAN [the N stand for nephropathy.] is an autoimmune disease. According to WebMD, this means:

“Autoimmune diseases result when your immune system is overactive, causing it to attack and damage your body’s own tissues.

Normally, your immune system creates proteins called antibodies that work to protect you against harmful substances such as viruses, cancer cells, and toxins. But with autoimmune disorders, your immune system can’t tell the difference between invaders and healthy cells.”

I hope you’ve learned as much as I did from today’s blog. Sometimes, my dreams open up whole new worlds for me.

Until next week,

Keep living your life!

I Hardly Expected this Connection.

Just about three years ago I wrote about how chronic kidney disease could cause a sinus infection, also known as sinusitis. The English teacher part of me knew what sinusitis meant since ‘itis’ is a suffix [letters added at the end of a word to change its meaning]. It means inflammation. I’ve got the entire etymology of the word, but that’s not what you came here for today.

Now poor Bear has yet another sinus infection. He’s had quite a few in the last several years. He also has developed CKD in the last few years. That got me to thinking. We know CKD can cause sinus infections but could all these sinus infections have caused his CKD. Let’s take a look.

First off, what is a sinus infection? We don’t even need a medical dictionary for that definition. Let’s go to my all-time favorite dictionary, the Merriam-Webster:

“inflammation of a sinus of the skull”

 Of course, now we need the definition of sinus:

“a narrow elongated tract extending from a focus of suppuration [Gail here: that means forming pus] and serving for the discharge of pus”

Now what? Combining the information from all the sites I visited, the consensus seems to be that it’s not the sinusitis itself that can cause CKD, but rather that the treatment of sinusitis may be the culprit. It also seems that this is rare and only applies to long term, untreated cases of sinusitis. Yet, today’s blog may prove interesting.

What do I mean? Well, a severe case of sinusitis will require strong antibiotics. Are you sure your doctor is using antibiotics that are safe for your kidneys and in the correct strength. I clearly remember going to the ER with a bladder infection years ago. They insisted I take sulfur medication until my nephrologist called them screaming that I could not do that. It’s probably the same for other severe infections. I turned to AARP for more information, knowing full well that this site is for retired people:

“If you have kidney disease, understand what your kidney function is before you take an antibiotic.  That will help you and your doctor determine the dosage.  Owen [Derek Owen, a clinical pharmacist with the kidney team at the University of Chicago Department of Medicine] says that some medications used to treat viruses can cause kidney injury.  It’s important, he says, to stay hydrated when taking medications like acyclovir or valacyclovir.  When dehydrated, the medication can clump together and create crystals that prevent you from urinating properly, he says.

Some people, Owen says, may have allergic reactions to antibiotics in their kidneys. The reaction is sometimes just in the kidneys and at other times can cause a rash or a fever. Such a reaction in the kidneys is caused by inflammation and irritation. Owen stresses the importance of letting your health care team know if you have any changes in how much you urinate after any course of antibiotics.

If not taken as directed or in doses that are too high, antibiotics can be dangerous and more likely to cause problems. People with decreased kidney function should be taking smaller doses than others.” 

Suppose your sinusitis becomes severe and the infection goes beyond the sinuses. Your other organs may become infected, too. Your kidneys are organs. Then again, if the infection is carried via your blood, your kidneys are in danger since your kidneys filter your blood… and in this case, the infection that flows in your blood. Remember, your kidneys are already damaged, so they are not doing the best job possible to filter your blood before it runs through your body again. The National Kidney Foundation clarifies the worst-case scenario, that of the infection becoming sepsis:

“Sepsis is a life-threatening emergency. It is a severe response to an infection or injury. This can include blood clots, leaky blood vessels, and drops in blood pressure. Sepsis can stop oxygen and nutrients from reaching your kidneys…

• Sepsis can overwhelm the body. This can cause vital organs to shut down. This usually starts with the kidneys.
• Blood pressure can drop dangerously low. This can cause less oxygen and nutrients to reach your kidneys.
• Blood clots can form within the body. This can also slow down the flow of oxygen to the kidney.”

Let’s say the infection does not go beyond your sinuses. Your kidneys may still be damaged. Your immune system deals with infections. If the sinusitis is that severe, your immune system may go into overdrive. Uh-oh, you may end up with inflammation throughout the rest of your body… including your kidneys. Tampa General Hospital does a job of explaining than I could do:

“Nephritis causes one or both kidneys to become inflamed and leak protein into the urine. 

Nephritis is an inflammation of the kidneys. These important organs clean the blood by filtering out excess fluid and toxins, then eliminate those waste products from the body in the form of urine. Healthy kidneys do not remove proteins from the blood, which help the body absorb water. However, inflamed kidneys can leak protein into the urine, which can impair the body’s ability to absorb water and lead to tissue swelling.”

Nephritis is most often caused by an autoimmune disease which is discussed below, but it may be caused by infections.

Something else to consider is that your chronic sinusitis may be caused by an underlying condition. Could it be one that may affect your kidneys… like an autoimmune disease? The Mayo Clinic offers a good example of how one kidney disease may be caused by autoimmunity:

“Lupus nephritis is a problem that occurs often in people who have systemic lupus erythematosus, also called lupus.

Lupus is a disease in which the body’s immune system attacks its own cells and organs, called autoimmune disease. Lupus causes the immune system to make proteins called autoantibodies. These proteins attack tissues and organs in the body, including the kidneys.

Lupus nephritis occurs when lupus autoantibodies affect parts of the kidneys that filter out waste. This causes swelling and irritation of the kidneys, called inflammation. It might lead to blood in the urine, protein in the urine, high blood pressure, kidneys that don’t work well or even kidney failure.”

Keep in mind that, while possible, sinusitis is not often a cause of CKD. Sorry, Bear.

Until next week,

Keep living your life!

At the Heart of The Matter

A reader who is a blogger in her own right was asked this question by one of her readers. Since the question was not exactly in her field, she asked me if I would be able to write about it. Thank you, Leesa, and the answer is yes. Now, the question, “Why do heart and kidney diseases go together?”

The question reminded me that my cardiologist requests my presence annually, although I’ve never had a problem with my heart. He does an electrocardiogram and I chat. I like that my specialist takes such good care of me.

Wait a minute. Are you aware of how your heart works? How about a reminder? The National Institutes of Health’s National Institute of Heart, Lung, and Blood explains:

“The heart is an organ about the size of your fist that pumps blood through your body. It is made up of multiple layers of tissue.

Your heart is at the center of your circulatory system. This system is a network of blood vessels, such as arteries, veins, and capillaries, that carries blood to and from all areas of your body. Your blood carries the oxygen and nutrients that your organs need to work properly. Blood also carries carbon dioxide to your lungs so you can breathe it out. Inside your heart, valves keep blood flowing in the right direction.

Your heart’s electrical system controls the rate and rhythm of your heartbeat. A healthy heart supplies your body with the right amount of blood at the rate needed to work well. If disease or injury weakens your heart, your body’s organs will not receive enough blood to work normally. A problem with the electrical system — or the nervous or endocrine systems, which control your heart rate and blood pressure — can also make it harder for the heart to pump blood.”

You know, as long as we’re dealing with reminders, how about one dealing with the kidney’s function? Where better to find this information than the National Kidney Foundation:

“You have two kidneys, each about the size of an adult fist, located on either side of the spine just below the rib cage. Although they are small, your kidneys perform many complex and vital functions that keep the rest of the body in balance. For example, kidneys:

• Help remove waste and excess fluid
• Filter the blood, keeping some compounds while removing others
• Control the production of red blood cells
• Make vitamins that control growth
• Release hormones that help regulate blood pressure
• Help regulate blood pressure, red blood cells, and the amount of certain nutrients in the body, such as calcium and potassium.”

Keeping it simple, let’s take a look at “Filter the blood, keeping some compounds while removing others.” We were reminded at the beginning of today’s blog that “If disease or injury weakens your heart, your body’s organs will not receive enough blood to work normally. A problem with the electrical system — or the nervous or endocrine systems, which control your heart rate and blood pressure — can also make it harder for the heart to pump blood.”

This seems to indicate that only lower blood supply to the kidneys is a problem. But the electrical system controls blood pressure. Blood pressure and kidneys go together. So, does that mean that a heart problem can cause kidney disease?

Leesa very kindly included a website in the DM she sent me. According to The British Heart Foundation:

“Relatively recent research has shown that heart failure is a significant risk factor for kidney disease. When the heart is no longer pumping efficiently it becomes congested with blood, causing pressure to build up in the main vein connected to the kidneys and leading to congestion of blood in the kidneys, too. The kidneys also suffer from the reduced supply of oxygenated blood. 

When the kidneys become impaired, the hormone system, which regulates blood pressure, goes into overdrive in an attempt to increase blood supply to the kidneys. The heart then has to pump against higher pressure in the arteries, and eventually suffers from the increase in workload.” 

This reminds me of a closed system, one in the form of a loop. Heart, main vein, kidneys, arteries, heart. That high blood pressure is the second most common cause of kidney disease keeps running through my mine, too. This sounds terrible!

But, have hope. As you probably already know, this breaking down of the proper function of the heart and the kidneys can be treated. [I must admit that even though the original condition is called high blood pressure, it took me a long time to connect the heart to it, thinking only of the arteries.]

I discovered that the risk factors for chronic kidney disease are the same for congestive heart failure [CHF]. Yep: hypertension and diabetes. Diabetes? How? I turned to the Centers for Disease Control and Prevention:

“Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease.”

Don’t panic. Everything can be treated. You already know [or should] the medications you can take for CKD. They can also treat your heart. Healthline reminds us:

“Medications to lower high blood pressure and reduce fluid levels include diuretics, which make the kidneys excrete more sodium and fluids as urine.

Other blood pressure-lowering medications that may be prescribed include beta-blockers, which also help the heart beat more slowly and with less force, and ACE inhibitors.

Medications that help bring blood glucose levels into a healthy range include glucophage (Metformin) and other oral or injectable drugs.”

Since CHF may have different origins or be caused by another condition you suffer, there are other medications offered. In addition, diet and lifestyle changes may be helpful. If you already have CHF, but not CKD, speak with your doctor to discover its cause and how your particular kind of CHF can be treated. While this doesn’t guarantee that you won’t develop CKD due to your CHF, you’ll have a much better chance of avoiding the CKD.

Until next week,

Keep living your life!

Opting Out of Dialysis

Last week, Steve Belcher RN interviewed me on his new podcast Health Talk: Conversations For A Better Life Podcast. During the podcast, he mentioned Renal Conservative Therapy. I didn’t know what that was. Listeners’ questions about it started appearing on the screen, too. Of course, it then became clear what the topic of today’s blog would be.

As to what Renal Conservative Therapy is, let’s turn to the UK’s National Kidney Foundation for their easily understood explanation:

“The aim of treatment conservative care is your wellbeing and quality of life.

Conservative care (also called supportive care) aims to:

• treat and reduce any physical symptoms of CKD such as:
– tiredness
– feeling sick
– itching
– swelling and breathlessness

• protect and maintain any remaining kidney function (where possible) by:
– controlling your blood pressure
– changes to your diet
– changes to your medication

• provide emotional, social and spiritual support
• plan for the future

Your care will be shared between the Renal Unit, your GP [Gail here: that’s what we call PCP or primary care provider here in the US.] and community services you may need. You will be seen in clinic, or have an appointment by telephone or video call, by a doctor and/or a specialist nurse, who will see you as little or as often as needed. The nurse specialist for supportive care will support you and your family at home and liaise with other services you may need.”

I understand what it means now, but honestly, I couldn’t figure out why anyone would choose this rather than dialysis or a transplant. Now, you’ve got to remember that I have neither been on dialysis nor had a transplant, so I didn’t really know what I was talking about.

The National Institute of Diabetes and Digestive and Kidney Diseases made the reasoning behind this choice clear to me:

“People who wish to focus their care on the quality of their life may choose conservative management.

For most people, dialysis may extend and improve quality of life. For others, this is not true. Dialysis may not lengthen life for all people who have kidney failure and can feel like an added burden, especially for people who have other serious health problems. Dialysis may not prolong or improve the quality of life for people who

• are elderly and frail
• have other serious health problems, such as dementia, heart failure, or cancer”

I couldn’t help but wonder if choosing Renal Conservative Therapy would shorten your life. I turned to KidneyCare UK for help in answering my question:

“It is difficult to be accurate about life expectancy, as this depends on your individual medical conditions, general level of health and the speed that your kidney disease has progressed.”

I found that interesting since some trusted sites mentioned a year or two, while others made it clear that your age, general health, comorbidities, and living conditions all will affect how long you may live with Renal Conservative Therapy.  

Steve mentioned that Renal Conservative Therapy is not palliative care. The National Institutes of Health explained why:

“You may hear conservative management called comprehensive conservative care, supportive care, nondialytic care, and comfort care. You also might hear the term ‘palliative care,’ which is one part of conservative management. Palliative care addresses the physical, psychological, and spiritual needs of someone with a serious illness.”

Frankly, I found this confusing since some of the sites I looked at considered the two to be synonymous.

Hospice kept popping up in my searches. That made no sense to me since Renal Conservative Therapy is to keep you comfortably alive as long as possible, while hospice exists to help you die comfortably. Back to The National Institute of Diabetes and Digestive and Kidney Diseases for a definition of hospice:

“Hospice is a program of care and support for people at the end of life. A trained team of health professionals and caregivers provide symptom and pain relief as well as emotional and spiritual support. The hospice team also supports family caregivers.

With hospice care, you may choose to die at home or in a home-like hospice setting instead of in a hospital.

Medicare, the federal health insurance program, covers hospice care.”

What we’ve figured out here is that Renal Conservative Therapy is not hospice and may or may not be considered palliative care depending upon your source.

Let’s see what else I can find out about Renal Conservative Therapy for us. PubMed seems to summarize the information I’d been looking for:

“At a certain point, patients with kidney failure will need to decide whether or not to start kidney replacement therapy, i.e. dialysis or kidney transplantation. An increasing number of patients choose to forgo dialysis or transplantation and opt for conservative care. In part, this trend is explained by the ageing population of patients with kidney failure and a more limited survival benefit for dialysis in older patients. Conservative care is a holistic, patient-orientated treatment, aimed at quality of life, advance care planning, reducing symptom burden, and slowing the deterioration of kidney function. As such, conservative care is an active treatment and not merely forgoing kidney replacement therapy….”

I’m interested in the history of this type of kidney failure treatment but was unable to find any information about that. Please let me know if you have any information about this. However, the following from the Mayo Clinic posted last month may be a clue:

“If your kidneys can’t keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.

• Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood.

In peritoneal dialysis, a thin tube inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a time, the dialysis solution drains from your body, carrying the waste with it.

• Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors.

After a transplant, you’ll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don’t need to be on dialysis to have a kidney transplant.

For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).”

Notice that conservative measures, what we’ve been referring to as Renal Conservative Therapy, is treated as an add on rather than an established therapy.

Until next week,

Keep living your life!

Ectopic

Ectopic: “occurring in an abnormal position or in an unusual manner or form” Thank you to my favorite dictionary of all time, The Merriam-Webster, for that definition. You may have heard of an ectopic pregnancy. Healthline explained what that is:

“From fertilization to delivery, pregnancy requires a number of steps in a woman’s body. One of these steps is when a fertilized egg travels to the uterus to attach itself. In the case of an ectopic pregnancy, the fertilized egg doesn’t attach to the uterus. Instead, it may attach to the fallopian tube, abdominal cavity, or cervix.

While a pregnancy test may reveal a woman is pregnant, a fertilized egg can’t properly grow anywhere other than the uterus. According to the American Academy of Family Physicians (AAFP), ectopic pregnancies occur in about 1 out of every 50 pregnancies (20 out of 1,000).”

While that’s interesting, it’s not what I’ll be writing about today. Rather, I’ll be writing about an ectopic kidney. From the above, we can already figure out that this means the kidneys were in the wrong place. The National Institutes of Health can explain better than I can:

“What is an ectopic kidney? An ectopic kidney is a kidney located below, above, or on the opposite side of the kidney’s normal position in the urinary tract. The two kidneys are usually located near the middle of your back, just below your rib cage, on either side of your spine.”

This didn’t sound so good to me. What causes an ectopic kidney, I wondered. According to National Institute of Diabetes and Digestive and Kidney Diseases:

“During fetal development, a baby’s kidneys first appear as buds inside the pelvis, near the bladder. As the fetal kidneys develop, they climb gradually toward their normal position near the rib cage in the back. Sometimes, one of the kidneys fails to make the climb. It may stop after making part of the climb. Or it may remain in the pelvis. Rarely does a child have two ectopic kidneys. Some kidneys climb toward the rib cage, but one may cross over so that both kidneys are on the same side of the body. When a crossover occurs, the two kidneys may grow together and become fused.”

Having two little grandchildren, I found this fascinating. How are such things not common knowledge? I realize that’s an unrealistic attitude.

So, here we have a poor little baby and unsuspecting parents. How do they become aware of the condition? The Urology Care Foundation listed the symptoms to keep watch for:

“The most common symptoms linked to the ectopic kidney are:

• Urinary Tract Infections (UTI)
• Belly pain
• A lump in the abdomen

A kidney in an abnormal spot may still work properly. But because of the change, it may have problems draining. Up to 1 out of 2 ectopic kidneys are at least partly blocked. Over time, these blockages can lead to serious problems, such as:

• Urinary Tract Infections (UTIs)
• Kidney Stones
• Kidney Failure

Ectopic kidneys are also linked to vesicoureteral reflux (VUR). VUR is a condition where urine backs up from the bladder through the ureters into the kidneys. Over time, VUR can lead to infections. Infections can cause damage to the kidney that can’t be fixed. The non-ectopic kidney can also have problems like blockages or VUR.”

Uh-oh, I know of a little baby with VUR. What’s to be done if a baby does have an ectopic kidney? Wait, I think you first need to know that there are two types of ectopic kidneys. Associates in Nephrology had a nice, simple description of the two for us. [Remember that renal and kidney are the same.]:

“Renal ectopia is divided into two types. A simple renal ectopia is marked by a kidney sitting on each side of the spine, but above or below its normal placement. The other type is a crossed renal ectopia, which occurs when both kidneys develop on the same side of the spine. Crossed renal ectopic kidneys sometimes fuse together.

The condition doesn’t cause any health problems or symptoms if one or both kidneys function properly. In fact, most people don’t know they have an ectopic kidney until it’s detected by medical tests for another disorder.

Yet some people experience pronounced symptoms stemming from renal ectopia that could produce a urinary tract infection; pain and/or a lump in the abdomen; bloody urine; frequent urination; or a burning sensation when you urinate.”

Don’t lose hope! There are remedies for this condition [if any is required]. The National Kidney Foundation was helpful here:

“An ectopic kidney only needs treatment if it causes problems with your urine flow. If this is the case, your healthcare provider will need to evaluate your kidney.  If the problem is caught soon enough, your healthcare provider can treat it. This includes treating the infection, removing the blockage, or fixing the urine flow before kidney damage happens. Sometimes surgery may be needed. This can correct the position of the kidney. That will lead to better drainage of urine.

If the kidney is severely damaged and not working properly, your healthcare provider may suggest removing it.  This will only be done if your other kidney is working well. “

Urine flow? What does that have to do with anything? MedlinePlus explained the usual urine flow:

“Urine flows from each kidney through tubes called ureters and into the bladder. When the bladder is full, it squeezes and sends the urine out through the urethra. No urine should flow back into the ureter when the bladder is squeezing. Each ureter has a one-way valve where it enters the bladder that prevents urine from flowing back up the ureter.

But in some people, urine flows back up to the kidney. This is called vesicoureteral reflux.

Over time, the kidneys may be damaged or scarred by this reflux.…”

You may notice that this blog was meant to be published last Monday. Between health and computer problems, obviously, it wasn’t. Apologies.

The things you learn! I started this blog 13 years ago and never once was I in the position of not having a topic to write about. Thank you to those who suggested topics and to all who read the blog.

Until next week,

Keep living your life!

I Checked This on a Whim

It looks like I’m on track for a hip replacement, as if pancreatic cancer weren’t enough to have happened to my poor body. I have this theory that everything is connected to the kidneys. That’s probably what’s kept me blogging for the last 13 years. But I thought a connection between hip replacement and the kidneys might be a little too far out. I researched anyway just for the sake of being thorough. Oh, my gosh! There is a connection. No kidding.

Since I didn’t know what was involved in a hip replacement, I speculated that you might not either. So, let’s take care of that before we get to its relation to the kidneys. The Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases was extremely helpful here.

“Hip replacement surgery, or hip arthroplasty, is a surgical procedure in which an orthopaedic surgeon removes the diseased parts of the hip joint and replaces them with new, artificial parts. These artificial parts mimic the function of the normal hip joint….

The hip joint is a ball and socket joint and is one of the largest joints in the body. The upper end of the femur (thigh bone) meets the pelvis to create the joint. The ‘ball’ at the end of the femur is called the femoral head and fits into the ‘socket’ (the acetabulum) in the pelvis.

During a hip replacement, the surgeon makes an incision over the thigh and removes the diseased or damaged bone and cartilage from the hip joint. Next, the surgeon replaces the head of the femur and acetabulum with new, artificial parts. Surgeons have learned how to perform hip replacement with smaller incisions over time to limit the amount of trauma to the soft tissues.:

While that seems straightforward, there is a chance of Acute Kidney Injury [AKI] after this kind of surgery.
How? According to MedPageToday:

“Multiple mechanisms may contribute to postoperative kidney injury following total hip arthroplasty, including inflammation, use of potentially nephrotoxic medications such as angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and nonsteroidal anti-inflammatory drugs, and also hemodynamic factors. Furthermore, risk factors that have previously been shown to be associated with postsurgical kidney injury include cardiovascular disease, diabetes, and creatinine above 2 mg/dL, along with obesity, metabolic syndrome, and perioperative antibiotic use.”

Uh-oh, I have diabetes, obesity, and metabolic syndrome. On the other hand, I sincerely doubt the surgeon will use nephrotoxic medications once I tell him I have chronic kidney disease.

What are the symptoms? How will I even begin to suspect I’ve developed AKI? The American Kidney Fund lays the symptoms out for us:

• “Urinating (peeing) less often.
• Swelling in your legs, ankles or feet.
• Feeling weak and tired.
• Feeling like you cannot catch your breath.
• Feeling confused.
• Feeling sick to your stomach.
• Feeling pain or pressure in your chest.
• Seizures or coma (in severe cases of AKI)”

Now I was worried about AKI following the hip replacement. I wanted to know what, if anything, I could do to avoid it. A trusted source, the Cleveland Clinic’s Journal of Medicine, offered some suggestions.

“Yes, there are ways to reduce the risk of acute kidney injury (AKI) after hip replacement surgery. According to a review article published in the Cleveland Clinic Journal of Medicine, some of the factors that increase the risk of AKI after primary total joint arthroplasty include older age, higher body mass index, chronic kidney disease, comorbidity, anemia, perioperative transfusion, aminoglycoside prophylaxis and treatment, preoperative heart murmur, and renin-angiotensin-aldosterone system blockade….

To reduce the risk of AKI after hip replacement surgery, you can consider the following measures:

1. Avoid nephrotoxic medications: Avoid taking medications that can damage your kidneys. Your doctor will advise you on which medications to avoid.
2. Stay hydrated: Drink plenty of fluids to maintain adequate intravascular volume.
3. Avoid hypotension: Careful avoidance of medications that lead to hypotension.
4. Effective comorbidity management: Effective management of comorbidities such as cardiac, vascular, pulmonary, renal, and diabetes ….
5. Patient education: Educate yourself about the risks and preventive measures for AKI.”

For some reason, I was unnerved by how user-friendly these suggestions were. Just in case they didn’t work, I took a tentative peek at the results of what untreated AKI could be. Yale Medicine bluntly stated,

“If left untreated, AKI has a very high mortality rate. If the underlying cause is diagnosed and treated, your prognosis will depend on how much damage has been done to the kidneys.” 

I was really worried now and didn’t want to leave any AKI after the surgery untreated, not that I would have anyway.  It seems to me that I really need to speak to the surgeon. Who knows? Maybe they won’t even do the surgery since I’m stage 3b chronic kidney disease and type 2 diabetic. I found myself both a little scared and really annoyed that my appointment with the surgeon is not until the middle of next month, his earliest appointment.

Non surgery alternatives are not for me. I tried steroid injections to mask the pain and my blood glucose went through the roof. Unacceptable. The Spine and Pain Center of California listed even more reasons steroids may not be for you:

“According to a 2020 study, between 12 and 15 percent of American adults over 60 complain of hip pain. A steroid injection to treat this pain is often the first line of defense after conservative treatments have failed to work.

But for many people, this isn’t an effective solution. For one, steroid injections aren’t a long-term treatment, and many patients need continued shots over time to experience pain relief. Also, this treatment can potentially cause many concerning side effects. These may include:

• Infection
• Allergic reactions
• Increase in blood sugar
• Weakened tendons and ligaments
• Cartilage damage
• Nerve damage
• Thinning of nearby bones”

The second line for non-surgery intervention is strong NSAIDS. You know why that’s out of the question, right? I have CKD, possibly even caused by NSAIDS. Then there’s physical therapy. I did try that, but it was so painful that the therapist and I agreed it wasn’t doing me any good. I really need that appointment.

Until next week,

Keep living your life!

What a Lot of Inhibition

I received a complicated question from another constant reader. I was gratified that she prefaced her question by stating that she was not looking for medical advice, but information. That’s good because that’s all I can offer since I’m not a doctor. Her question dealt with ACE, ARB, and SG12 inhibitors and both eGFR and creatinine.

Photo by Karolina Grabowska on Pexels.com

Let’s start with some definitions so these don’t remain just alphabet soup to us. The Mayo Clinic is a good place to start. This is their definition of ACE inhibitor:

“Angiotensin-converting enzyme (ACE) inhibitors are medicines that help relax the veins and arteries to lower blood pressure. ACE inhibitors prevent an enzyme in the body from making angiotensin 2, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder. Angiotensin 2 also releases hormones that raise blood pressure.”

Aha! So, we’re dealing with blood pressure here. Let’s see if that’s true of ARB inhibitors, too. I turned to Healthline for the following:

“Blood vessels supply blood and oxygen to the heart. This constant supply helps the heart function. Angiotensin II is a hormone made by our body, and it tightens the muscles of our blood vessels.

Angiotensin II also contributes to salt and water retention in our bodies. Increased salt in the body and tightened blood vessels may cause our blood pressure to rise. High blood pressure harms blood vessels.

Both ARBs and ACE inhibitors act on angiotensin II. But while ACE inhibitors limit the formation of angiotensin II, ARBs block certain receptors of angiotensin II. These receptors, known as AT1 receptors, are found in the heart, blood vessels, and kidneys.

When blood vessels tighten, they become narrow. This puts blood under greater pressure as it’s forced to move through a smaller-than-normal space. When ARBs block angiotensin II, this reduces the tightening of blood vessels. Blood pressure is then lowered.”

Hmm, so now we’re not only dealing with blood pressure, but also our heart and kidneys. Did you know that your nephrologist may prescribe either or both even if you don’t have blood pressure problems? That would be to protect your kidneys.

SG12 doesn’t start with an ‘a’. Is that significant? It turned out to be… and to actually be SGLT2, which stands for Sodium-glucose transport protein 2. The National Institutes of Health explained:

“SGLT2 inhibitors function through a novel mechanism of reducing renal tubular glucose reabsorption, producing a reduction in blood glucose without stimulating insulin release. Other benefits may include favorable effects on blood pressure and weight.” 

Well, this one may also affect blood pressure, but its primary purpose has to do with blood glucose. By the way, these are also called flozins: gliflozin, canagliflozin, bexagliflozin, dapagliflozin, empagliflozin, and ertugliflozin.

What probably would be helpful here is to remind you that diabetes and high blood pressure are the two most important causes of chronic kidney disease. Now, the remainder of the question had to do with these medications and slow eGFR decline and/or creatinine increase. Another reminder: as eGFR reduces, creatinine rises and vice-versa.

I’ll let the National Kidney Foundation start us off:

“ACE inhibitors and ARBs are known to slightly lower the estimated glomerular filtration rate (eGFR), a measure of how well your kidneys work. This might seem strange since the medicines are supposed to help people living with kidney disease.

In kidney disease, the kidneys are working under high stress. They work extra hard to keep filtering the blood. Unfortunately, this leads to faster ‘burnout’ or damage to the glomeruli (small filters in the kidneys) and speeds up worsening kidney disease.

These medicines lower the pressure in the kidneys. This gives the glomeruli (small filters in the kidneys) a chance to rest. In exchange, the eGFR goes down a little. However, this is not a sign of kidney disease getting worse. Over the long-term, people taking ACE inhibitors or ARBs have seen a much slower worsening of their CKD than people who are not taking either medicine, despite the small decrease in eGFR when starting the medicine.

In rare cases, your eGFR may go down too much after starting an ACE inhibitor or ARB. If this happens, your doctor may lower your dose or temporarily stop the medicine and investigate the cause.

Your doctor will likely check your eGFR before you start this medicine and again a few weeks after. Be sure to complete your blood tests as recommended by your doctor.”

What about SGL2? This one was a little harder to pinpoint. I went to as many websites as I could find that discussed SGL2 and eGFR. The consensus seems to be that eGFR will dip in the first two weeks, but if the drug is continued, will rise again within 12 weeks. It was also considered that this is quite effective, so it is worth it to ride out the initial dip. Again, a reminder that as eGFR lowers, creatinine rises.

I think the National Library of Medicine sums the topic up nicely:

“ACE inhibitors/angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors can be used in combination to slow the rate of decline in GFR.”

Hopefully, today’s information was helpful not only to the reader who requested it, but also to all the other readers who hadn’t realized they wanted this information. I was delighted to learn how ACE/ARB works since I’m more a how than a why person.

Until next week,

Keep living your life!

That’s Weird

That was my first thought when a reader asked me to write about nail fungus and chronic kidney disease. It was something I’d not only never thought about but had never occurred to me might be somehow connected to CKD.

Photo by Monstera Production on Pexels.com

Surprise! It is. Let’s start exploring it in our usual manner – with a definition. This is from the Mayo Clinic:

“Nail fungus is a common infection of the nail. It begins as a white or yellow-brown spot under the tip of your fingernail or toenail. As the fungal infection goes deeper, the nail may discolor, thicken and crumble at the edge. Nail fungus can affect several nails.”

This did not sound good at all. How, in heaven’s name, did this happen? WebMD had that topic thoroughly covered:

“You get an infection when a crack in your nail or the skin around it allows fungus to get inside and grow.

Since fungus thrives in dark, warm places, your toenails are more likely to be affected than your fingernails. Your toes also have less blood flow than your fingers, which makes it harder for your body to pick up on and prevent an infection.

You’re more likely to get a fungal nail infection if you:

• Are a man
• Are older, since nails become more brittle and likely to crack as you age 
• Have a weak immune system or ongoing health problems like diabetes
• Wear shoes that make your feet hot and sweaty
• Walk barefoot through gym showers, swimming pools, and locker rooms –places where fungus spreads easily 
• Live with someone who has a fungal infection
• Have athlete’s foot, as the fungus that causes it can spread to your nails 
• Recently had an injury or surgery on your nail, or had a previous infection
• Wear plastic gloves or keep your hands wet for long periods” 

As an older diabetic, I was getting a little bit more nervous the more I researched. I felt I needed to know the symptoms of nail fungus just as much as my reader did. So, I turned to Health.com only to find out there are different types of nail fungus with different symptoms:

“Any toenail fungus causes a range of symptoms, but some of the most common are: …

• Nail thickening
• Yellowing, browning, or discoloration
• Nail crumbling
• Abnormal or frequent breakage
• Unusually shaped nails
• Separation of the nail from the nail bed
• Pain
• Odor or bad smell

Different types of infections often cause various symptoms. For example, many mold infections aren’t painful, but yeast infections can be.

And you may notice a dark debris build-up under the nail with distal subungual toenail fungus. On the other hand, you’re more likely to see white spots or patches on the nail’s surface with white superficial toenail fungus….”

I also learned this was not something you could treat by yourself. According to the CDC:

“Fungal nail infections can be difficult to cure, and treatment is most successful when started early. Fungal nail infections typically don’t go away on their own, and the best treatment is usually prescription antifungal pills taken by mouth. In severe cases, a healthcare professional might remove the nail completely. It can take several months to a year for the infection to go away.

Fungal nail infections can be closely associated with fungal skin infections. If a fungal infection is not treated, it can spread from one place to the other. Patients should discuss all skin concerns with their healthcare provider to ensure that all fungal infections are properly treated.

Even after treatment, fungal nail infections can come back. This is more common in people who have conditions like diabetes that make them more likely to get a fungal nail infection. If you suspect an infection has returned, contact your healthcare provider.”

I was way more than halfway through writing this blog when I realized I hadn’t touched upon CKD’s role in nail fungus. It was time to rectify that. Where better to find this information than the National Nail Fungus Organization:

“Abnormal changes in nails are expected on people who are suffering from chronic kidney disease as their normal diets have also changed. Unless the patients are able to manage or slow down the progress of their kidney disease, their nails are not likely to improve.

Unfortunately, having CKD also makes them susceptible to acquiring nail fungus infection, and the risk increases for older persons and diabetic patients. For people with chronic kidney disease, they have limited options of nail fungus treatment. As their kidneys cannot flush out the toxins and clear the medications off their body, they must obtain their doctors’ approval and prescription for oral fungicidal medications.

They have the option of using topical treatments, though. And depending on the products’ ingredients, topical medications can just be as effective as oral ones without the side effects.”

While this was not exactly what I had been looking for, I deemed it important information for us to know. I also discovered that CKD does have other effects on your nails. I wanted to know why. Reset Kidney Health explained:

“The kidneys act as a filtration system, ridding our body of waste and delivering essential nutrients into our bloodstream. Unfortunately, as kidney disease progresses and function decreases, toxic substances will build up in our bloodstream and cause our nails to change color, form, and texture. High levels of nitrogen in the bloodstream often cause these physical changes.

Sometimes, chronic kidney disease sufferers will be placed on diets meant to slow the progression of the disease by limiting specific nutrient quantities to prevent a system overload on the already taxed kidneys. Unfortunately, that can result in nutrient deficiencies affecting keratin production, a protein responsible for nail strength.”

Makes sense to me. That could account for concave nails, yellow coloring, white streaking, Beau’s lines, detached, or brittle nails. I must admit I thoroughly enjoy learning about this particular side effect of CKD. I just don’t want to experience it, and I certainly hope you don’t either.

Until next week,

Keep living your life!

Tipsy Is as Tipsy Does

I don’t drink. I just don’t like the taste of liquor. My husband doesn’t drink. It interferes with his medication. My young friend doesn’t drink. She’s breast feeding. Her cousin doesn’t drink. He’s allergic to alcohol. There’s another reason people don’t drink: they have chronic kidney disease.

I wanted to know how that worked, so learn along with me. My first stop was at the ever-trustworthy Healthline. By quoting the National Kidney Foundation, Healthline made it clear that drinking alcohol may affect healthy kidney function too and lead to CKD:

Photo by Chris F on Pexels.com

“At first, you might not have any symptoms of kidney damage from regular alcohol consumption. As the kidneys become overworked from heavy alcohol consumption, they will be less able to filter blood and maintain the correct water balance in the body.

As a result, you may experience the following symptoms:

• fatigue
• swelling of the legs, ankles, and feet due to fluid retention
• loss of appetite
• change in urine
• kidney pain”

Oh my. If that’s what can happen to healthy kidneys, what can happen to our damaged kidneys?

The National Kidney Foundation had a simple answer for us:

“Drinking alcohol affects many parts of your body, including your kidneys. A little alcohol—one or two drinks now and then—usually has no serious effects. However, excessive drinking–more than four drinks daily—can affect your health and worsen kidney disease. When experts talk about one drink, they are talking about one 12–ounce bottle of beer, one glass of wine, or one ounce (one shot) of ‘hard liquor.’”

I found that surprising because I had assumed all liquor was a no-no for CKD patients. My brother used to tell me repeatedly, “Assuming makes an ass out of you and me.” I guess he was right. Thanks, Paul.

Fresenius Kidney Care, [dialysis centers], explained more:

“Healthy kidneys work to remove excess waste, toxins, and fluid from your blood. When functioning properly, alcohol is one of the toxins that your kidneys filter from your body. However, alcohol can dehydrate your system, impairing your kidneys’ ability to function and maintain the right balance of fluids in your blood. Excessive alcohol consumption can also weaken or damage your kidneys, preventing them from filtering your blood properly. Drinking alcohol excessively can also increase your blood pressure, which over time, can cause damage to your kidneys.”

While all of this was interesting, it didn’t really get to the nitty-gritty of what alcohol does to the kidneys. It occurred to me that I could approach this from the other side, so I went to Recovery by the Sea’s website, an alcoholism recovery center, to see what they had to say about alcohol’s affect on the kidneys.

“Alcohol is one of the toxins that kidneys filter from the blood. While a drink or two on occasion is not going to be problematic, binge drinking and excessive, chronic drinking is likely to wreak havoc on the kidneys. Alcohol interferes with the kidneys’ toxin-filtering capability, thereby setting the stage for damage and an increased risk of health complications.

In addition to the kidneys’ ability to filter toxins, they also help maintain the right amount of fluid in the body. Alcohol has a dehydrating effect, one that markedly impairs the kidneys’ capacity to maintain fluid balance.

Another adverse effect of alcohol consumption on the kidneys is related to blood pressure. Drinking alcohol in excess can result in an increase in blood pressure both temporarily and over time. Alcoholics are more likely to have hypertension than those who drink moderately or not at all. Eventually, this can lead to chronically elevated blood pressure and is one of the most common causes of kidney disease.

It’s well-known that there’s also a risk of developing liver disease as a result of chronic drinking. The kidneys need adequate blood flow maintained at a certain level to filter the blood properly. Among alcoholics and persons with liver disease, the delicate balance of blood flow and blood filtering by the kidneys is disturbed.”

Did you know that alcohol may also be part of the problem in developing kidney stones? I didn’t until I read the following on The Asian Institute of Medical Sciences:

“The more you drink alcohol, the greater the chances of your getting kidney stones. The reason is very simple. Substituting alcohol for water can dehydrate you as it acts as a diuretic. You can prevent getting kidney stones by drinking copious quantities of water. Substituting water with alcohol would be counterproductive as your body would be constantly losing water. If your diet has too much salt in conjunction with high alcohol consumption, then your chances of developing kidney stones increase as it causes greater quantity of calcium in your urine. Further, you need to avoid foods high in phosphates like beans, dairy products, and nuts; and those which are high in oxalate, such as potato chips, French fries, beets, spinach, and nuts like the plague if your uric acid level is high. This combination of calcium and oxalates leads to the formation of renal calculi.
Alcohol might adversely affect magnesium exchange in the kidney tubules caused by a marked increase of magnesium excretion in the urine, leading to hypomagnesemia.”

KIdneyCareUK’s Kidney Kitchen has some sound advice for us:

“If you regularly drink as much as 14 units per week, it’s best to spread your drinking evenly over three or more days.

If you have one or two heavy drinking episodes a week, you increase your risk of death from long-term illness and injuries. Try to have several alcohol-free days over the week.

Avoid becoming dehydrated by making sure you consume non-alcoholic drinks in between the alcohol-containing ones.

Choose water, soda water, diet fizzy drinks (avoiding cola-style drinks) or no-added-sugar squash as healthier alternatives.

Red wine contains a little more potassium than white, so consider white wines rather than a glass of red with your meal if you are on a low-potassium diet.

Spirits are low in potassium and phosphate as well as lower in volume, so a good option if you need to restrict your fluid, but be mindful of the units. Consider using diet mixers or soda water if you have diabetes or are trying to lose weight (avoiding cola-style mixers due to their phosphate additive content).

Many wines, beers and lagers contain added phosphates and ciders are high in potassium so be mindful of this if you have been advised to lower potassium and/or phosphate in your diet.

Remember to incorporate other fluids you may be having into your fluid allowance, such as gravy, soups, ice creams, custards, creams and yoghurts.

For people with diabetes and CKD, alcohol may be safe to drink if you have your blood sugar level under control.

It’s always wise to check with your doctor or dietitian before incorporating alcohol into your diet and it is recommended that you combine your alcohol with food. Alcohol on an empty stomach can cause blood sugar levels to drop in those with diabetes. Additional ingredients in mixed drinks may also add carbohydrate that must be considered.

Finally, if you want to drink alcohol, please discuss this with your pharmacist and doctor as some medications do interact with alcohol.”

For a non-drinker, I now know more about alcohol than I’d ever wanted to. It’s worth it if you learned as much as I did.

Until next week,

Keep living your life!

Oh, Those Pearly Whites

Of course, that means we’ll be learning about something related to your teeth today – specifically what fluoride does to and/or for you. Loyal Reader’s been very active this month. This is one of his suggestions. Thanks, Loyal Reader.

Let’s start at the beginning as usual. What is fluoride and why is it supposed to be good for us; maybe we should first narrow that one down to what is fluoride. According to the National Institutes of Health’s Office of Dietary Supplements:

“Fluoride, a mineral, is naturally present in many foods and available as a dietary supplement. Fluoride is the ionic form of the element fluorine, and it inhibits or reverses the initiation and progression of dental caries (tooth decay) and stimulates new bone formation ….”

Down the rabbit hole we go! What’s fluorine mean? Ionic? I turned to Chemicool for help here since I knew I was out of my element [Get it? Element? Periodic Table?]:

“Fluorine is a pale yellow, diatomic, highly corrosive, flammable gas, with a pungent odor.”

I don’t know about you, but I wouldn’t want that in my body. Maybe ionic ameliorates the fluorine in some way. I was so lost that I immediately turned to my old favorite the Merriam-Webster Dictionary for the definition of ‘ion,’ since the ‘ic’ suffix just means of or about.

“an atom or group of atoms that carries a positive or negative electric charge as a result of having lost or gained one or more electrons.”

But wait a minute. Do we know how fluorine turns into fluoride? ThoughtCo., a site devoted to science, tech, and math explains:

“ Fluorine is a chemical element. In pure form, it is a highly toxic, reactive, yellowish-green gas. The fluorine anion [Remember the anion gap on your blood tests?] F^–, or any of the compounds containing the anion are termed fluorides. When you hear about fluoride in drinking water, it comes from adding a fluorine compound (usually sodium fluoride, sodium fluorosilicate, or fluorosilicic acid) to drinking water, which dissociates to release the F^– ion. Stable fluorides are also found in fluoridated toothpaste and mouthwash.”

Well, does it work? The ever trustworthy Cleveland Clinic answers the question:

“Fluoride, a mineral that occurs naturally in many foods and water, helps prevent tooth decay. Fluoride reverses early decay and remineralizes your tooth enamel. While fluoride can be harmful in large quantities, it’s difficult to reach toxic levels due to the low amount of fluoride in over-the-counter products like toothpastes and mouth rinses.”

Got it, but there’s one thing you may not be aware of and that’s what Loyal Reader brought to my attention via Mount Sinai Hospital’s School of Medicine:

“…  a child’s body excretes only 45 percent of fluoride in urine via the kidneys, while an adult’s body clears it at a rate of 60 percent, and the kidneys accumulate more fluoride than any other organ in the body.

‘While the dental benefits of fluoride are widely established, recent concerns have been raised regarding the appropriateness of its widespread addition to drinking water or salt in North America,’ said the study’s first author Ashley J. Malin, PhD, postdoctoral fellow in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai. ‘This study’s findings suggest that there may be potential kidney and liver health concerns to consider when evaluating fluoride use and appropriate levels in public health interventions.’”

An article in Sage Journal [It’s really for healthcare professionals] offered additional information:

“During the last few decades, the role of kidney in the metabolism and elimination of fluoride from the body has been researched and documented to some extent…^. Consumption of optimal amount of fluoride in drinking water or diet does not increase the risk of developing CKD in humans…and this has been proven using animal studies too…^.At the same time, it is repeatedly proven that an impaired kidney negatively affects the metabolism as well as excretion of fluoride from the kidney, leading to further damage to the kidneys…^. Therefore, especially people with kidney disorders should avoid consumption of excess amounts of fluorides either through drinking water or other sources such as food, drugs, or toothpaste… “

I kept reading articles that mentioned fluoride is available in food. Which food? I’d never run across this statement before researching for this week’s blog. Harvard T.H. Chan School of Public Health provided a list:

“Trace amounts of fluoride are found naturally in various foods, though people obtain most fluoride from fluoridated water and toothpastes. Brewed black tea and coffee naturally contain fluoride as the plants absorb the mineral in soil. Shellfish may contain fluoride that collects in their shells and muscles.

• Brewed black tea and coffee
• Fluoridated water
• Canned shellfish like shrimp and blue crab
• Oatmeal
• Raisins
• Potatoes”

Fascinating! The things I learn writing this blog are amazing. But I did want to know exactly how the kidneys were affected. Luckily, The National Library of Medicine could help, although this seems to have the opposite point of view from the article in the Sage Journal:

“With the exception of the pineal gland, the kidney is exposed to higher concentrations of fluoride than all other soft tissues. Therefore, exposure to higher concentrations of fluoride could contribute to kidney damage, ultimately leading to chronic kidney disease (CKD). Among major adverse effects on the kidneys from excessive consumption of fluoride are immediate effects on the tubular area of the kidneys, inhibiting the tubular reabsorption; changes in urinary ion excretion by the kidneys disruption of collagen biosynthesis in the body, causing damages to the kidneys and other organs; and inhibition of kidney enzymes, affecting the functioning of enzyme pathways.”

Before you become worried, notice it’s excessive exposure to fluoride that causes the problem. Stage 3B or not, I have never noticed any effects of fluoride in my body. Nor have any of my doctors, including my nephrologist. Rest easy but bring this up to your nephrologist if you find this information upsetting.

Until next week,

Keep living your life!

Loyal Reader Asked

Loyal Reader is still very much around and still bringing up some unusual topics. [Bless him!] One he brought up months ago was HBM. There were a bunch of other topic requests before his, but there was also no way I was going to omit one of his topics. Ladies and Gentlemen, may I present hydroxy-beta-methylbutyrate. And, yes, that is English and it will be explained. Let’s begin with what it does and doesn’t do to our bodies.

“Supplementation with HMB will lead to an improvement in body composition, seeing this improvement from the first month of supplementation. Likewise, it will improve the levels of Prealbumin and IGF-1 as an anabolic hormone. To observe a greater effect on muscle mass with an HMB module…, regular physical activity should be prescribed, since a possible effect of supplementation without it, may only have the effect of slowing down catabolism.”

It’s clear that today’s blog will need a glossary of sorts, so here it is.

Anabolic:

1. Pertaining to a chemical reaction in which small 

molecules, such as amino acids, are combined to 

form larger molecules, such as proteins.

2. Of any substance that increases the rate of 

metabolism of a cell or organism.

3. Of a drug, such as a male sex hormone, that 

promotes body bulk. The Medical-Dictionary

Catabolism: “degradative metabolism involving the release of energy and resulting in the breakdown of complex materials (such as proteins or lipids) within the organism” Merriam-Webster [You didn’t think I’d ignore my favorite dictionary, did you?]  

HMB: “Suzette Pereira, PhD, an Abbott researcher specializing in muscle health, explains that HMB stands for beta-hydroxy-beta-methylbutyrate, and as scientific as that sounds, its purpose is easier to understand when you realize it’s been part of your diet for a long time.

HMB is naturally produced in small amounts when your body breaks down leucine, an essential amino acid that you can get through eating protein foods including milk and Greek yogurt, soybeans, beef and chicken. It can also naturally be found in very small amounts in foods like avocado, grapefruit, cauliflower and catfish. But it’s difficult to get amounts found to support muscle health just by diet alone and is often found in nutrition supplements.”

IGF-1: ”IGF-1 is a hormone that manages the effects of growth hormone (GH) in your body. Together, IGF-1 and GH promote normal growth of bones and tissues.” MedlinePlus

Prealbumin: “Prealbumin is a protein that is made mainly by your liver. Your body uses it to make other proteins. Prealbumin also carries thyroid hormones in the blood.” University of Rochester Medical Center.

Interesting, but I can just about hear you asking what all this has to do with chronic kidney disease. But first, I found some material about how HMB functions in connection with the kidneys:

“HMB, a water-soluble metabolite of leucine, is excreted in the urine and is not reabsorbed by the kidneys back into the bloodstream. Studies have shown that approximately half of the supplemented HMB is lost through urine. Since the kidneys don’t reabsorb HMB, dividing the daily HMB dosage into three separate doses throughout the day may help to maintain steadier levels of HMB in the blood and thereby enhance its effectiveness….”

Thank you, Examine.com. I did have a hard time finding any information about taking HMB with damaged kidneys, but this paragraph leads me to believe that damaged kidneys may not cause the HMB to be totally excreted from your body.

I was able to locate a positive conclusion from a study published in the BioMedical Journal of Scientific and Technical Research. There was only one problem; the study had a population of ONE person:

“Adequate nutritional advice together with an increase in physical activity, abandoning a sedentary lifestyle, constitute the necessary tools to preserve a good functionality in CKD patients. Weight loss together with an active life will favor the functional capacity of patients with CKD. Supplementation with HMB will lead to an improvement in body composition, seeing this improvement from the first month of supplementation. Likewise, it will improve the levels of Prealbumin and IGF-1 as an anabolic hormone. To observe a greater effect on muscle mass with an HMB module, as in our case, regular physical activity should be prescribed, since a possible effect of supplementation without it, may only have the effect of slowing down catabolism.”

Furthermore, Western New York Urology Associates warned, “However, full safety studies have not been performed, so HMB should not be used by young children, pregnant or nursing women, or those with severe liver or kidney disease, except on the advice of a physician.” Loyal Reader, take heed.

Photo by Nashua Volquez-Young on Pexels.com

That said, WebMd offered possible uses of HMB while also cautioning us of the lack of ‘good’ scientific validity of these uses:

“HMB might promote muscle growth. It can be found naturally in small amounts in grapefruit, alfalfa, and catfish. It’s also naturally made in the body.

People use HMB for building muscle or preventing age-related muscle loss. It’s also used for athletic performance, muscle loss due to HIV/AIDS, muscle strength, obesity, and many other purposes, but there is no good scientific evidence to support these uses.”

However, there is an alternative. That is to eat your HMB. VeryWellHealth tells us:

“You can obtain HMB from a few foods. Your body can also make HMB from leucine, which can also be found in foods.

HMB is produced by the body when leucine is broken down. You may be able to increase HMB by eating more foods that contain leucine.”

Foods like grapefruit, alfalfa, and catfish are said to contain HMB. However, these foods may only contain very small amounts of HMB.

Leucine is a part of most proteins and is more easily found in foods than HMB. Leucine is present in animal products in higher amounts than plant-based foods. You can find leucine in….

• Beef
• Pork
• Chicken
• Turkey
• Dairy products
• Fish
• Legumes (beans, lentils, peas)
• Grains (buckwheat, oats, millet)
• Nuts (cashews, pine nuts, hazelnuts, almonds)
• Certain fruits and vegetables

Here’s hoping there was enough pro and con re HMB for Loyal Reader – and anyone else considering the use of HMB – to make an informed decision.

Until next week,

Keep living your life!

ABCDEFGHIJKLMNOP

I bet you can figure out why I stopped at P. You’re right! That’s what I wrote about for today’s blog. But first, I wanted to know why it’s called pee. I grew up thinking the only word for it was urine. I turned to a very old friend, Etymonline, for the answer. It turns out my age had a lot to do with calling it urine as a youngster.

“pee (v.) [Gail here. V for Verb – an action word, experience, or condition]

1788, ‘to spray with urine’ …, euphemistic abbreviation of piss. Meaning ‘to urinate’ is from 1879. Related: Peed; peeing. Noun [Gail again. This is a person, place, thing, idea, or state of being] meaning ‘act of urination’ is attested by 1902; as ‘urine’ by 1961. Reduplicated form pee-pee is attested by 1923.

also from 1788

Entries linking to pee

piss (v.)

‘to urinate, discharge the fluid secreted by the kidneys and stored in the urinary bladder,’ c. 1300, pissen, from Old French pissier ‘urinate’ (12c.), from Vulgar Latin *pissiare, of imitative origin. To piss away (money, etc.) is from 1948. Related: Pissed; pissing…. “

There was also a chart on the page showing when the word pee started becoming popular. It was in 1961 when I was already 14. By 2019, pee was the preferred word over urine.

And just why is pee so important to us? We’re chronic kidney patients, that’s why! Pee, or urine as I still call it, can tell us so much about what is going on with our kidneys. Did you notice in the definition of piss above that the phrase ‘secreted by the kidneys’ was used?

Let’s take a look at just what a urinalysis is and what it can tell us about the state of our bodies’ health. The Cleveland Clinic defines the test for us:

“A urinalysis (also known as a urine test) is a test that examines the visual, chemical and microscopic aspects of your urine (pee). It can include a variety of tests that detect and measure various compounds that pass through your urine using a single sample of urine.

Healthcare providers often use urinalysis to screen for or monitor certain common health conditions, such as liver disease, kidney disease and diabetes, and to diagnose urinary tract infections (UTIs)….”

I thought it would be best to separate the three parts of a urinalysis to examine each.  Let’s start with the visual aspect of the urine test. The National Kidney Foundation was helpful here.

“The urine will be looked at for color and clearness. Blood may make urine look red or the color of tea or cola. An infection may make urine look cloudy. Foamy urine can be a sign of kidney problems.”

This is something you are probably familiar with since all we need to do is look in the toilet bowl after urination to see if our urine is colored, cloudy, or foamy. Of course, I’m not suggesting that you do a visual urinalysis yourself. But you might notice something concerning. Then it’s time to call your doctor.

WebMD explained the purpose of the chemical aspect of a urine test:

Photo by Edward Jenner on Pexels.com

“A microscopic exam checks for things too small to be seen otherwise. Some of the things that shouldn’t be in your urine that a microscope can find include:

• Red blood cells
• White blood cells
• Bacteria
• Crystals (clumps of minerals, a possible sign of kidney stones)”

Finally, we come to the chemical aspects of your urine. You may be familiar with the term, ‘dipstick.’ [I realized that immediately made me think of checking the oil level in my car. Funny, but not apt for today’s blog. Still…] A strip of chemically sensitive paper is dipped into your urine. It turns different colors when the following is present:

• “Acidity (pH): This is the acid-base or pH level of your urine, which is measured on a scale of 1-14 with 1 being the most acidic and 14 being the most basic.
• Bilirubin This is a substance produced when the body breaks down red blood cells. It is not normally found in the urine.
• Concentration/specific gravity: This measures the concentration of particles in your urine and can be related to fluid levels in the body.
• Glucose: This is a type of sugar that is used to provide energy to cells.
• Enzymes: A dipstick test may check for the presence of an enzyme called leukocyte esterase that is found in white blood cells.
• Ketones: These develop when the body uses fat instead of glucose for energy production.
• Nitrites: These are a type of chemical produced when bacteria are present in the urinary system.
• Protein: These molecules help the body carry out vital functions. Proteins are usually found in the blood and only in small amounts in the urine.
• Blood cells: Dipstick tests can be used to look for evidence of blood and blood cells in the urine.”

Thank you to Testing.com for the above information. Oh, I was the one who italicized the word ‘kidneys’ in the source material above, not the author of the material.

We are CKD patients. We need to know what our urine can tell us. If you are also diabetic, like me, you doubly need to know what our urine tests can tell us about how well our kidneys are working. But what if you are a transplant? What good will a urine test do you then?

I found site after site explaining the research studies re urine test uncovering acute kidney transplant rejection, but no definitive information. I gather this is still being tested. Although the kidney biopsy is considered the golden standard for determining acute kidney transplant rejection, just as with kidney disease, the idea is that the quicker the problem is diagnosed, the quicker you can start treating it. My apologies to those who wanted something more definitive, but I cannot be more helpful here.  Perhaps one of you can?

Until next week,

Keep living your life!

Parkinson’s Revisited

It must be about six years since I wrote about Parkinson’s Disease [PD]and chronic kidney disease. It’s a biggie for me because both my brothers had this disease. One is now deceased. The other presently suffers Parkinson’s dementia. Hmm, three siblings: two with PD, one with CKD. Time to see what the connection, if any, is.

Last year, a study published in the American Journal of Managed Care [AJMC] stated:

“Reduced kidney function in patients with type 2 diabetes (T2D) may increase the risk of developing Parkinson disease (PD), according to study findings published in Parkinsonism & Related Disorders.

Affecting 1 in 11 adults worlwide [stet], T2D shares several pathophysiology [Gail here. That means disease or injury related disorder of the physiological processes.] similarities with PD, including mitochondrial dysfunction, endoplasmic reticulum stress, inflammation, and altered metabolism.”

If you’re anything like me, you need more of these terms defined. The Children’s Hospital of Philadelphia offers the definition of mitochondrial disorder:

“Mitochondrial disease, or mitochondrial disorder, refers to a group of disorders that affect the mitochondria, which are tiny compartments that are present in almost every cell of the body. The mitochondria’s main function is to produce energy. More mitochondria are needed to make more energy, particularly in high-energy demand organs such as the heart, muscles, and brain. When the number or function of mitochondria in the cell are disrupted, less energy is produced and organ dysfunction results.”

Once again, it’s clear that I’m not a doctor [and never have claimed to be one]. I am learning along with you. While I’d seen the term ’mitochondrial disorder’ before and thought I knew what It meant, I didn’t.

Okay, we need more definitions, don’t we? According to The National Library of Medicine endoplasmic reticulum stress [ER] is:

“ER stress occurs when the capacity of the ER to fold proteins becomes saturated.” 

As for altered metabolism, we know what altered means so let’s define metabolism. Thank you to my favorite dictionary, the Merriam-Webster:

“the sum of the processes in the buildup and destruction of protoplasm

specifically:the chemical changes in living cells by which energy is provided for vital processes and activities and new material is assimilated”

I have type 2 diabetes, so this study does mean something to me. It might mean something to you if you also have type 2 diabetes and CKD. I’m going to mention the study to my nephrologist when next I see him.

Something from a PubMed article caught my eye:

“However, neurological consequences are also attributed to this disease. Among these, recent large epidemiological studies have demonstrated an increased risk for Parkinson’s disease (PD) in patients with CKD.” 

Oh no, maybe I’ll come to PD from a different point of origin than those of my brothers. Come to think of it, I don’t know how they developed PD. Anyway, I don’t want to come to PD from any point of origin.

I wanted to know more, as usual. While not exactly what I’d been looking for the University of Florida Health made an interesting comparison between PD and CKD:

“This situation of a ‘threshold’ of cell loss that must be eclipsed for appearance of symptoms can be compared to what may occur in patients who experience kidney failure.  When a kidney begins to malfunction, approximately 75% or more of its cells are lost, and those cells are unrecoverable.  Frustratingly, for kidney failure failure [stet] patients, the routine laboratory tests are almost never abnormal, and only hint abnormality when the failure process has already begun.  In Parkinson’s disease, as in kidney failure, a ‘threshold’ of cells must be lost before one manifests symptoms.”

Never have I ever been so loathe at a possible comparison between my big brothers and me. It hit too close to home and, somehow, made me miss my brothers even more.

This is an except from a 2020 article by Melendez-Flores and Estrada Bellmann, neurologists at Autonomous University of Nuevo León in Mexico, on Springer:

“… we explored the association of CKD and PD and linked the components of the former to propose potential pathways explaining a future increased risk for PD, where renin-angiotensin system, oxidative stress, and inflammation have a main role.”

Wait a minute. Renin-angiotensin system? That sounds familiar. Britannica reminds us what it is:

“renin-angiotensin system, physiological system that regulates blood pressure.

Renin is an enzyme secreted into the blood from specialized cells that encircle the arterioles at the entrance to the glomeruli of the kidneys (the renal capillary networks that are the filtration units of the kidney). The renin-secreting cells, which compose the juxtaglomerular apparatus, are sensitive to changes in blood flow and blood pressure. The primary stimulus for increased renin secretion is decreased blood flow to the kidneys, which may be caused by loss of sodium and water (as a result of diarrhea, persistent vomiting, or excessive perspiration) or by narrowing of a renal artery.”

And this system has a main role in possible increased risk for PD???? This is getting too close for comfort. However, the same article concluded:

“More preclinical studies are needed to confirm the potential link of CKD conditions and future PD risk, whereas more interventional studies targeting this association are warranted to confirm their potential benefit in PD.”

I was glad to read that. Personally, I’m not willing to take on Parkinson’s in addition to my CKD and type 2 diabetes. Then again, is anyone? I hope I’ve both opened a new topic for you and put your mind at ease.

Until next week,

Keep living your life!

To Fast or Not to Fast

There’s been quite a buzz about intermittent fasting [IF] in the news lately. Even those with chronic kidney disease are interested. I am, but it wasn’t until a reader asked about it that I decided to write about it. Elizabeth, this one’s for you… and me.

I wanted to know exactly what it was instead of working on what I thought it was. I turned to the trusted Cleveland Clinic for a definition [and a bit more]:

“Intermittent fasting is when you alternate between periods of eating and fasting. This type of eating is often described as ‘patterns’ or ‘cycles’ of fasting.

Intermittent fasting isn’t about starving yourself — it’s about cutting way back on calories for short time periods. The belief is that your body becomes satisfied with smaller portions while also reducing cravings for unhealthy snack foods. That is, as long as you maintain a healthy diet while trying it all out. “ 

I’d heard different people speak about different ways to do this. Healthline explained them:

• “Time-restricted eating. Involves fasting every day for 12 hours or longer and eating in the remaining hours. A popular example is the 16/8 method. It features a daily 16-hour fast and an 8-hour eating window wherein you can fit in 2, 3, or more meals.
• The 5:2 diet. The 5:2 diet involves eating as you normally do 5 days of the week and restricting your calorie intake to 500–600 on the remaining 2 days.
• Eat Stop Eat. Eat Stop Eat involves a 24-hour fast once or twice per week.
• Alternate-day fasting. With alternate-day fasting, the goal is to fast every other day.
• The Warrior Diet. The Warrior Diet was among the first popular diets to include a form of intermittent fasting. It involves eating small amounts of raw fruits and vegetables during the day and eating one large meal at night.”

 I wondered if losing weight was the only reason people wanted to fast in one way or another. According to the Mayo Clinic:

“Losing weight and being physically active help lower your risk of obesity-related diseases, such as diabetes, sleep apnea and some types of cancer. For these diseases, intermittent fasting seems to be about as beneficial as any other type of diet that reduces overall calories.

Some research suggests that intermittent fasting may be more beneficial than other diets for reducing inflammation and improving conditions associated with inflammation, such as:

• Alzheimer’s disease
• Arthritis
• Asthma
• Multiple sclerosis
• Stroke”

This was starting to sound almost too good, so I started looking for side effects. This is what Harvard Health Publishing had to offer:

Photo by Liza Summer on Pexels.com

“#1. Intermittent fasting may make you feel sick.

Depending on the length of the fasting period, people may experience headaches, lethargy, crankiness, and constipation. To decrease some of these unwanted side effects, you may want to switch from adf fasting to periodic fasting or a time restricted eating plan that allows you to eat everyday within a certain time period.

#2. It may cause you to overeat.

There’s a strong biological push to overeat following fasting periods because your appetite hormones and hunger center in your brain go into overdrive when you are deprived of food.

It’s human nature for people to want to reward themselves after doing very hard work, such as exercise or fasting for a long period of time, so there is a danger of indulging in unhealthy dietary habits on non-fasting days. 

Two common effects of calorie-restricted diets—a slowed metabolism and increased appetite—are just as likely when people practice intermittent fasting as when they cut calories every day. And in studies of time-restricted eating, evidence is accumulating that eating that misaligns with a per­son’s circadian rhythm (your body’s natural daily pattern) may led to metabolic trouble.

#3. Intermittent fasting may cause older adults to lose too much weight.

While intermittent fasting shows promise, there is even less evidence about the benefits or how fasting might affect older adults. Human studies have looked mostly at small groups of young or middle-aged adults, for only short periods of time.

But we do know intermittent fasting could be risky in some cases. If you’re already marginal as far as body weight goes, I’d be concerned that you’d lose too much weight, which can affect your bones, overall immune system, and energy level.

#4. It may be dangerous if you’re taking certain medications.

If you want to give intermittent fasting a try, make sure to discuss it with your doctor first. Skipping meals and severely limiting calories can be dangerous for people with certain conditions, such as diabetes. Some people who take medications for blood pressure or heart disease also may be more prone to imbalances of sodium, potassium, and other minerals during longer-than-normal periods of fasting.

People who need to take their medications with food — to avoid nausea or stomach irritation — may not do well with fasting.”

Time to get specific. Is IF off limits for those with CKD? I found information about diabetics at Harvard’s T. H. Chan’s School of Public Health:

“Individuals with the following conditions should abstain from intermittent fasting:

• Diabetes
• Eating disorders that involve unhealthy self-restriction (anorexia or bulimia nervosa)
• Use of medications that require food intake
• Active growth stage, such as in adolescents
• Pregnancy, breastfeeding”

How many of us with CKD have diabetes, the foremost cause of CKD? But what about CKD by itself? As Emily Campbell, RD CDE MScFN, puts it:

“… there has not been enough research in those with CKD, and current studies have inconclusive results for if intermittent fasting can improve eGFR. It is best to speak with your healthcare team or renal dietitian for personalized recommendations to improve your kidney function.”

I did come across some research, but it was either on mice – which we are not – or fasting during the holiday of Ramadan, which not all of us observe. I’ll stick with my nephrologist’s advice on fasting.

I’m pretty sure what goes for intermittent fasting is also true for total fasting.

Until next week,

Keep living your life!

No Use Crying Over Spilled Milk, uh, I Mean Protein

A very active reader – who happens to be a transplantee – asked me to write about spilling protein. As a CKD patient, I’ve never been told I was doing that. However, one of my daughters was told she was spilling urine. She does not have chronic kidney disease. Hmmm.

Way back in 2020, I became interested in proteinuria simply because, while I knew the meaning of the word, I didn’t really know what the definition meant. In other words, I could break down the parts of the word [protein and urine] but didn’t get what they meant when combined. I found this information from The Mayo Clinic useful in helping me to understand:

“Protein in urine — known as proteinuria (pro-tee-NU-ree-uh) — is excess protein found in a urine sample. Protein is one of the substances identified during a test to analyze the content of your urine (urinalysis).

Low levels of protein in urine are normal. Temporarily high levels of protein in urine aren’t unusual either, particularly in younger people after exercise or during an illness.

Persistently high levels of protein in urine may be a sign of kidney disease.”

Oh, maybe this explained why my daughter was spilling protein into her urine. Perhaps she was ill or had just exercised before the test not realizing that would affect the results.

I wondered precisely what it was that healthy kidneys did do. The American Kidney Fund explained a bit more:

“Healthy kidneys remove extra fluid and waste from your blood, but let proteins and other important nutrients pass through and return to your blood stream. When your kidneys are not working as well as they should, they can let some protein (albumin) escape through their filters, into your urine. When you have protein in your urine, it is called proteinuria …. Having protein in your urine can be a sign of nephrotic syndrome, or an early sign of kidney disease.”

There’s another reason you don’t want to have proteinuria as WebMD clarifies:

“Protein is an important component of every cell in the body. Hair and nails are mostly made of protein. Your body uses protein to build and repair tissues. You also use protein to make enzymes, hormones, and other body chemicals. Protein is an important building block of bones, muscles, cartilage, skin, and blood.”

I thought I’d throw this tidbit in since I just spent two weeks writing about biopsies. The paper Patient education: Kidney (renal) biopsy (Beyond the Basics) written by William L Whittier, MD, FASN and Stephen M Korbet, MD, MACP published on UpToDate informs us:

““The following are the most common reasons for kidney biopsy. You may have one or more of these problems, but not everyone with these problems needs a kidney biopsy: 

●Blood in the urine (called hematuria). … 

●Protein in the urine (called proteinuria) – This occurs in many people with kidney problems. A kidney biopsy may be recommended if you have high or increasing levels of protein in the urine or if you have proteinuria along with other signs of kidney disease…. 

●Problems with kidney function – If your kidneys suddenly or slowly stop functioning normally, a kidney biopsy may be recommended, especially if the cause of your kidney problem is unclear.” 

Take a look at the second reason for having a biopsy.

I think it would make sense to learn how the kidney becomes so damaged that it allows protein, which is meant to return to the blood, to spill into the urine. I turned to the Cleveland Clinic to find out:

“Protein gets into the urine if the kidneys aren’t working properly. Normally, glomeruli, which are tiny loops of capillaries (blood vessels) in the kidneys, filter waste products and excess water from the blood. 

Glomeruli pass these substances, but not larger proteins and blood cells, into the urine. If smaller proteins sneak through the glomeruli, tubules (long, thin, hollow tubes in the kidneys) recapture those proteins and keep them in the body. 

However, if the glomeruli or tubules are damaged, if there is a problem with the reabsorption process of the proteins, or if there is an excessive protein load, the proteins will flow into the urine.” 

‘Excessive protein load’ That’s why our protein intake is limited. We do not want to overwork and possibly damage our kidneys by relying on a diet of burgers, chicken, steak, and salmon. This doesn’t mean you cannot have these or similar foods; simply that you need to limit them each day. Your nephrologist or renal dietitian will tell you how much protein per day is the right amount for you.

I wondered if that was the only cause of damaged kidneys. According to the Mayo Clinic, it’s not. There’s also:

• “Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney’s filtering units (glomeruli)
• Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney’s tubules and surrounding structures
• Polycystic kidney disease or other inherited kidney diseases
• Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
• Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
• Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)”

Remember, CKD is at least three months of your kidney function declining.

Since the question was asked by a transplantee, let’s see if there’s anything to add specifically for this group of people. New York based Nao Medical made it easy to understand:

“There are several factors that can contribute to the development of proteinuria in kidney transplant patients. These include:

• Rejection of the transplanted kidney
• Infection
• Medications
• High blood pressure
• Diabetes”

Transplantees: Take note that rejection is not the only cause of proteinuria.

As for the treatment of proteinuria in transplantees, I am confused. I found research that stated Vitamin D would do the trick, others that recommended statins, and still other that said antihypertension drugs would help. I remind you that I am not a doctor and have never claimed to be one. In other words, speak with your nephrologist to discover which treatment is the best for your proteinuria.

I learned quite a bit today and hope you did, too.

Until next week,

Keep living your life!

More Needling

Last week’s blog about biopsies didn’t feel complete to me. Comments from readers indicate they felt the same way. This week, I thought I’d explore some of the issues they asked about.

The question most often asked was, “Does it hurt?” This is a tricky one since each person is unique. Let’s see what Mount Sinai had to say,

“Numbing medicine is used, so the pain during the procedure is often slight. The numbing medicine may burn or sting when first injected.

After the procedure, the area may feel tender or sore for a few days.

You may see bright, red blood in the urine during the first 24 hours after the test. If the bleeding lasts longer, tell your provider.”

Some readers have reported that they had, indeed, experienced soreness – but not necessarily pain – for several days after the procedure. On a personal note, I can sometimes have soreness from my insulin injections. Again, people are different.

Another reader wanted us to know that it was possible for a kidney biopsy to go wrong. I turned to Johns Hopkins to see what I could learn,

“As with any procedure, complications can happen including:

• Bruising and discomfort at the biopsy site
• On-going bleeding from the biopsy site, in the urine, or inside the body
• Puncture of nearby organs or structures
• Infection near the biopsy site

If the kidney biopsy is done with the aid of X-ray, the amount of radiation used is small. Therefore, the risk for radiation exposure is low.

If you are pregnant or think you may be, tell your healthcare provider. Talk to your healthcare provider about the risks to the fetus from being exposed to an X-ray. Pregnancy is not always contraindication for having a kidney biopsy. It may be important to maintain the health of the mother. Special precautions may be taken to protect both the mother and the fetus during a kidney biopsy.

You may not be able to have kidney biopsy if you have an active kidney infection, certain bleeding conditions, uncontrolled high blood pressure, or have only one working kidney.

There may be other risks depending on your specific medical condition. Be sure to raise any concerns with your healthcare provider before the procedure.”

I believe the reader in question had an infection. I can’t stress enough that although these readings report what most people experience, each of us is unique, different, and may have slightly different reactions.

As far as preparation for a kidney biopsy, The National Kidney Foundation covered that one:

“For most kidney biopsies, patients are advised to not take over-the-counter pain medicines such as aspirin, ibuprofen (Advil®, Motrin®), naproxen (Aleve®), or other medicines that may cause thinning of the blood for 2 weeks prior to the test. These medicines can change the way the blood clots and raise the risk of bleeding. For the same reason, you will likely be instructed to stop taking certain supplements such as fish oil.

Blood and urine samples are usually taken before the kidney biopsy to make sure you do not have an infection or other condition. Your doctor may also want you to change other medications before the biopsy. You may be told you should not eat or drink for eight hours before the procedure.”

I thoroughly enjoyed their use of the word ‘most’. However, I did wonder why a kidney patient would be taking NSAIDS [Nonsteroidal anti-inflammatory drugs] in the first place since they can harm your kidneys, even your transplanted kidneys.

I wasn’t that clear about the connection between bleeding and fish oil. Never fear! Mayo Clinic to the rescue,

“While generally safe, getting too much fish oil can increase your risk of bleeding and might affect your immune response. It’s not clear whether fish oil is safe for people who are allergic to seafood. Take fish oil supplements under a doctor’s supervision.”

All right, what have I left out? Let me think for a moment. Of course! Some readers wanted to know if they needed to be hospitalized for a kidney biopsy. Interestingly, some will. But most people will just need to be observed for a few hours before they go home to rest for a day or two.

I kept reading that the actual procedure takes only 15 minutes but with the preparation and the immediate after care, it takes an hour. Something else that was repeated on site after site was that that it’s preferred you don’t drive for a day or two after the procedure or operation.

A procedure refers to a medical intervention that doesn’t break the skin, while an operation does. For example, a closed [needle] biopsy is a procedure while an open biopsy is a surgery. Also, most readers thought a kidney biopsy was only used to evaluate the health of a kidney transplant. The Cleveland Clinic explained that there are other uses for a kidney biopsy,

“A kidney biopsy helps doctors identify the cause of kidney problems so they can treat the condition effectively. It can reveal scarring, inflammation (swelling), and protein deposits that cannot be identified with other tests, such as ultrasounds or blood and urine tests.”

Unfortunately, it can take anywhere from two to ten days to receive the results of the biopsy. It depends upon how many tests were being performed on the sample. As for whether or not you can go to the toilet after the test, the answer is no. You’ll be handed a bed pan. That’s so the doctor and/or nurse can see if you’re passing blood in your urine and, if so, how much. You’ll probably receive a blood transfusion if your overall blood loss is deemed too much.

I think I’ve covered everything I didn’t in last week’s blog. I urge you to remember that each patient is unique. That’s what is meant by ‘precision medicine.’ Your doctor will be the best person to make these decisions and discuss them with you.

Until next week,

Keep living your life!

Needling You

I haven’t had a kidney biopsy, but many of my readers have. One of them requested a blog about kidney biopsies. Looks like I’m going to learn along side of you again. Frankly, I enjoy the learning.

Okay now, what is a kidney biopsy? Obviously, whatever it is is performed on the kidney. Here’s how MedlinePlus explains the biopsy part of that phrase:

“A biopsy is a procedure that removes cells or tissue from your body. A doctor called a pathologist looks at the cells or tissue under a microscope to check for damage or disease. The pathologist may also do other tests on it.

Biopsies can be done on all parts of the body. In most cases, a biopsy is the only test that can tell for sure if a suspicious area is cancer. But biopsies are performed for many other reasons too.

There are different types of biopsies. A needle biopsy removes tissue with a needle passed through your skin to the site of the problem. Other kinds of biopsies may require surgery.”

Let’s see how a kidney biopsy is performed, courtesy of RadiologyInfo:

“Most areas of the body can be biopsied with a needle device. This is the least invasive option, and usually allows for the patient to return home the same day. Imaging guidance with x-ray, ultrasound, CT or MRI allows for accurate placement of the needle to locate the best place to take a tissue sample.

In hard to reach places, biopsies using surgery in a hospital operating room may sometimes be necessary. A surgeon will perform surgery to remove the tissue needed for the biopsy. The surgeon may use an instrument with a camera to help locate the best place to biopsy and remove the tissue sample.

Using imaging guidance, the doctor inserts the needle through the skin and advances it into the lesion.

They will remove tissue samples using one of several methods.

• In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
• In a core needle biopsy, the automated mechanism moves the needle forward and fills the needle trough, or shallow receptacle, with ‘cores’ of tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated several times.
• In a vacuum-assisted biopsy, the doctor inserts the needle into the site of abnormality. They activate the vacuum device, which pulls the tissue into the needle trough, cuts it with the sheath, and retracts it through the hollow core of the needle. The doctor may repeat this procedure several times.”

There’s quite a bit of medical terminology in the blog so far, so I concocted a little dictionary for us. Of course, I used my favorite dictionary [Let me know if you’re tired of me saying that.], the Merriam-Webster.

CT: a method of producing a three-dimensional image of an internal body structure by computerized combination of two-dimensional cross-sectional X-ray images. abbreviation CT. called also computed axial tomography, computerized axial tomography, computerized tomography

MRI: magnetic resonance imaging  –  a noninvasive diagnostic technique that produces computerized images of internal body tissues and is based on nuclear magnetic resonance of atoms within the body induced by the application of radio waves [Gail here: this is the one where you have to make sure you’re not wearing anything with metal in it.]

Ultrasound: 1 – vibrations of the same physical nature as sound but with frequencies above the range of human hearing 2 – the diagnostic or therapeutic use of ultrasound and especially a noninvasive technique involving the formation of a two-dimensional image used for the examination and measurement of internal body structures and the detection of bodily abnormalities. called also sonography, ultrasonography

x-ray: 1 – any of the electromagnetic radiations that have an extremely short wavelength of less than 100 angstroms and have the properties of penetrating various thicknesses of all solids, of producing secondary radiations by impinging on material bodies, and of acting on photographic films and plates as light does 2 – a photograph obtained by use of X-rays.

But we’ve got kidney disease. There’s something you should know about the contrast that may be ordered along with your CT if that’s the guiding imagery your doctor will be using to perform the biopsy. For example, I have a CT with contrast every six months to make sure the cancer hasn’t returned. Because I have kidney disease, a blood test comes first to find my creatinine level. If it’s over 1.1, no contrast would be used. This is the purpose of the contrast:

“In a CT scan, dense substances like bones are easy to see. But soft tissues don’t show up as well. They may look faint in the image. To help them appear clearly, you may need a special dye called a contrast material. They block the X-rays and appear white on the scan, highlighting blood vessels, organs, or other structures.

Contrast materials are usually made of iodine or barium sulfate. You might receive these drugs in one or more of three ways:

• Injection: The drugs are injected directly into a vein. This is done to help your blood vessels, urinary tract, liver, or gallbladder stand out in the image.
• Orally: Drinking a liquid with the contrast material can enhance scans of your digestive tract, the pathway of food through your body.
• Enema: If your intestines are being scanned, the contrast material can be inserted in your rectum.”

Thankyou for the above information, WebMD.

Hmm, since I haven’t had any, I wondered what the purpose of kidney biopsies was. The National Kidney Foundation tells us:

• “Blood (hematuria) or protein (proteinuria) in the urine 
• Abnormal blood test results
• Acute or chronic kidney disease (CKD) with no clear cause
• Nephrotic syndrome and glomerular disease (which happens when the filtering units of the kidney are damaged)
• See if kidneys are responding well to treatment
• Check if kidneys are permanently damaged
• Learn why a transplanted kidney is not working well
• See if a kidney tumor is cancerous
• Check for other unusual or special conditions
• See if any medications are hurting your kidneys”

There’s so much more to know about a kidney biopsy, but I’ve just plain run out of room today.

Until next week,

Keep living your life!

You’re So Vein. You Probably Think This Song Is About You.

Actually, in the Carly Simon song it’s vain. I just couldn’t resist using the homonym. Pardon me; that’s English teacher speak for two words having the same pronunciation, but different meanings. By the way, this blog is about you.

It seems to me that in all the years I’ve been writing the blog, I never really took a look at the veins dealing with the kidneys with you. They, of course, are called renal veins. As the National Center for Biotechnology Information informs us,

“Renal is an adjective, whereas kidney is a noun. The two words are not tautologies. The word, renal, is derived from Latin (ren). The words for kidney in French (rein), Italian (rene) and Spanish (rinon) are very similar to renal.”

Quick reminder:

An adjective describes a person, place, thing, or idea.                              

A noun is the person, place, thing, or idea.

 A tautology is saying the same thing but using different words.

I see now that being an English teacher for over 30 years is paying off. But I digress. Okay, back to the business at hand… or kidney in this case.

A little anatomy lesson may help us understand. This one was provided by VeryWellHealth,

“The kidneys are bean-shaped, with a concave central portion called the renal hilum. Each renal vein is formed by the confluence of several smaller veins which drain the different parts of the kidney and join together in the renal hilum. The other major structures in the renal hilum are the renal artery and renal pelvis (which carries urine away), both of which are located behind the renal vein.

The left renal vein is longer than the right. It courses in front of the aorta and behind the superior mesenteric artery (SMA) as it drains into the IVC… [Gail here: that’s the interior vena cava.] ^. The ascending lumbar vein, the left adrenal vein, and the left testicular or ovarian vein are smaller veins which typically drain into the left renal vein.

Variations in renal vein anatomy usually affect the left renal vein rather than the right. Although most patients with these anatomic variations are asymptomatic, it is important to know about them if kidney surgery is being planned.”

I didn’t know what an hilum was, so I turned to the Medical Dictionary included in the Free Dictionary by Farley.

“a depression or pit at the part of an organ where vessels and nerves enter.”

Healthline explained even more about how renal veins work.

“There are two renal veins, a left and a right. They branch off the inferior vena cava and drain oxygen-depleted blood from the kidneys.

As they enter the kidneys, each vein separates into two parts. The posterior veins assist in draining the back section of each kidney, while the anterior veins assist the front part. These veins also are responsible for draining blood from the ureter, which transports urine away from the kidneys to the urinary bladder.

These veins should not be confused with the renal aorta. Unlike veins, the renal aorta delivers oxygenated blood to the kidneys. To simplify, the aorta carries blood to the kidneys while veins move the blood away.”

It occurred to me that I really wasn’t sure what the interior vena cava was. Hello, WebMD.

“The inferior vena cava transports blood from your lower limbs, liver, digestive system, kidneys, reproductive system, and other organs and tissues of the body below the diaphragm….

The inferior vena cava goes up the abdomen on the right side of the spine (vertebral column). After connecting with the hepatic [liver] vein, it goes through the diaphragm, the muscle that helps you breathe and separates your chest cavity from your abdomen. In the chest, the inferior vena cava lies on the right side of the space between the lungs. Reaching the heart, it opens into the right atrium.”

How would we know if anything went wrong with your all important renal veins?  First, let’s take a look at the Merck Manual, Consumer Version, to see what could go wrong.

“Renal vein thrombosis is blockage of the renal vein, which carries blood away from the kidney, by a blood clot.

• The clot can damage the kidney.
• Symptoms may be minimal unless the clot develops suddenly.
• Diagnosis is with magnetic resonance angiography, Doppler ultrasonography, or computed tomography angiography.”

Symptoms? What symptoms? As Mount Sinai  explains,

“Symptoms may include:

• Blood clot to the lung
• Bloody urine
• Decreased urine output
• Flank pain or low back pain”

Although I’ve looked it up many times, I just couldn’t remember where the flank was specifically, so I turned to my very favorite dictionary. That’s right, the Merriam-Webster.  

“the fleshy part of the side between the ribs and the hip”

Well, that clears that up. Back to the renal veins.

Naturally, I wanted to know what you could do should these symptoms alert you that you were experiencing renal vein thrombosis. Stanford Medicine Health Care had the easiest explanation to understand.

“Renal vein thrombosis is generally treated medically with anticoagulant (keeps the blood from clotting) medication. Anticoagulants may be given intravenously (IV) for several days, then given orally for several weeks up to an indefinite period of time.”

Let’s finish up by looking at the possible causes of renal vein thrombosis with the help of Mount Sinai again.

“Renal vein thrombosis is an uncommon disorder. It may be caused by:

• Abdominal aortic aneurysm
• Hypercoagulable state: clotting disorders
• Dehydration (mostly in infants)
• Estrogen use
• Nephrotic syndrome
• Pregnancy
• Scar formation with pressure on the renal vein
• Trauma (to the back or abdomen)
• Tumor

In adults, the most common cause is nephrotic syndrome. In infants, the most common cause is dehydration.”

Wow, not being a doctor, I’ve learned as much as you have today.

Until next week,

Keep living your life!

There’s Nothing Vague About It

Now that I have your attention, I wonder if you’ve ever heard of the vagus nerve and its connection to your kidneys. It kept popping up in my dreams, so I thought it might be worth exploring. Of course, I needed to bring you along in my exploration.

Instead of going directly to my favorite dictionary, I turned to WebMD since I felt this term needed a simpler definition than even the dictionary could provide.

“The vagus (vagal) nerve is also known as the 10th cranial nerve or cranial nerve X. It starts in your medulla oblongata, a part of the brain that connects to the spinal cord, and splits off into many branches that extend down through your neck to your vital abdominal organs.

This long nerve makes up 3/4 of the nerve tissue in your parasympathetic nervous system. In fact, the vagus nerve is the longest of any of the 12 cranial nerves.”

Nice. But what does it actually do? I searched and found this explanation on Physiopedia, a UK charity organization that offers rehabilitation education:

“The vagus nerve has a very extensive distribution.

• Sensory: Innervates the skin of the external acoustic meatus and the internal surfaces of the laryngopharynx and larynx. Provides visceral sensation to the heart and abdominal viscera.
• Special Sensory: Provides taste sensation to the epiglottis and root of the tongue.
• Motor: Provides motor innervation to the majority of the muscles of the pharynx, soft palate and larynx.
• Parasympathetic: Innervates the smooth muscle of the trachea, bronchi and gastro-intestinal tract and regulates heart rhythm. Its cardiac branches act to slow the rate of heartbeat; its bronchial branch acts to constrict the bronchi; and its esophageal branches control involuntary muscles in the esophagus, stomach, gallbladder, pancreas, and small intestine, stimulating peristalsis and gastrointestinal secretions. …^”

Wait a minute. What about the kidneys? InKidney helped out here. InKidney was formed by healthcare professionals that are concerned about the wide spread of kidney disease worldwide.

“Emotional stress can be associated with faster progression of CKD. The kidneys have both sympathetic and parasympathetic innervation. Acute stress can worsen kidney function, while relaxation practices can promote kidney health. Stimulating the vagus nerve can turn on the parasympathetic nervous system, improving renal blood flow and modulating inflammation in CKD. Stress reduction and the natural stimulation of the vagus nerve can help delay the progression of kidney disease.”

How about a reminder of what sympathetic and parasympathetic systems are. Thanks to The Cleveland Clinic for this information:

“Your sympathetic nervous system is part of your autonomic nervous system. It could be called your ‘automatic’ nervous system, as it is responsible for many functions that you don’t have to think about to control. This can include control of your heart rate, blood pressure, digestion, urination and sweating, among other functions.

Your sympathetic nervous system is best known for its role in responding to dangerous or stressful situations. In these situations, your sympathetic nervous system activates to speed up your heart rate, deliver more blood to areas of your body that need more oxygen or other responses to help your [sic] get out of danger.”

“Your parasympathetic nervous system is part of your autonomic nervous system. It could be called your ‘automatic’ nervous system, as it’s responsible for many functions that you don’t have to think about to control. This can include control of your heart rate, blood pressure, digestion, urination and sweating, among other functions.

The parasympathetic part of your autonomic nervous system balances your sympathetic nervous system. While your sympathetic nervous system controls your body’s ‘fight or flight’ response, your parasympathetic nervous system helps to control your body’s response during times of rest.”

Hopefully, these two definitions helped you to understand the connection between your kidneys and the vagus nerve. I must admit, they did help me.

Healthline gave me some insight into the varied possible symptoms of a damaged vagus nerve:

“Damage to the vagus nerve can result in a range of symptoms because the nerve is so long and affects many areas.

Potential symptoms of damage to the vagus nerve include:

• difficulty speaking
• loss or change of voice
• difficulty swallowing
• loss of the gag reflex
• low blood pressure
• slow or fast heart rate
• changes in the digestive process
• nausea or vomiting
• abdominal bloating or pain
• depression and anxiety in people with breathing problems or heart disease

The symptoms someone might have depend on what part of the nerve is damaged.”

I wanted to know how you stimulate the vagus nerve. I had a vision of a doctor reaching into a body incision and using their hands to do so. I doubt that’s how it’s done, though. Back to the ever helpful Cleveland Clinic for us:

“Meditation

Turn to this practice to help calm your mind and focus on deep breathing. While doing meditation, try extending your exhales, making them longer than your inhales. This will help slow your heart rate.

‘Meditation can regulate your autonomic nervous system,” says Dr. Estemalik. “It has a good effect on lowering rapid breathing, rapid heart rate and cortisol levels.’

Yoga can also be helpful for the same reasons. Just make sure you pay attention on your breathing.

Exercise

…. Working out and getting your body moving can affect your vagus nerve, research shows. Interval training and endurance training can increase your vagus nerve activity and improve your heart rate variability.

Massage

Research shows that reflexology (a kind of massage) can increase vagal tone and even decrease blood pressure.

‘Massage can reduce some of the heightened activity in the vagus nerve,’ says Dr. Estemalik.

Try giving yourself a foot massage by rotating your ankle, rubbing your sole in short strokes and gently stretching your toes back and forth.

Music

Music can help motivate us, bring us joy and tap into our emotions. When it comes to the vagus nerve, the research is mixed on how music affects it.

Your vagus nerve is connected to your vocal cords, the muscles at the back of your throat and passes through your inner ear.

Try humming or singing or just listening to calm, soothing music. Those sounds and vibrations may stimulate your vagus nerve.

Cold-water immersion

…. Research shows that cold-water immersion may help with stress by slowing your heart rate and directing blood flow to your brain. Try placing an ice pack on your face or neck or taking a cold shower.”

There is also a device that can be implanted under your skin, but I believe that is used for stroke victims, epilepsy, and migraines. That’s much more involved with this device, but that’s a whole other blog.

Remember: Stress leads to inflammation. Inflammation may lead to kidney disease.

Until next week,

Keep living your life!

This Nutcracker is Not the One in the Nutcracker Suite

Today is my second grandson’s first birthday. So, I thought I’d look for some music he might like. There was always The Nutcracker Suite, I thought. Although it was written in 1892 by Tchaikovsky, it’s been a favorite of children everywhere ever since. I’m guessing that’s due to the ballet.

But I’m not writing about that nutcracker. I’m writing about nutcracker syndrome today. I promise this is not a joke. There is such a condition. This is the first time I’ve heard of it even though I’ve been writing about all things kidney since 2010, so don’t feel bad if you’ve never heard of it.

Let’s start at the beginning with a definition. One of my trusted sites, the Cleveland Clinic, explains it this way:

“Nutcracker syndrome is a condition that affects your left renal vein. This is the vein that carries blood away from your left kidney and back to your heart. Nutcracker syndrome is a type of extrinsic vein compression syndrome. In these syndromes, the structure of your blood vessels puts pressure on one of your veins.

If you have nutcracker syndrome, two arteries in your belly compress part of your left renal vein. This compression raises the blood pressure in your renal vein and forces some blood to flow in the wrong direction. As a result, nearby veins swell, causing symptoms and potentially leading to complications.”

Frankly, this sounds painful. I didn’t know which to explore first, symptoms or causes. I chose alphabetically. Remember, I was an English teacher for many, many years. So, causes it was.

India’s Icliniq, a second opinion site, offered both causes and risk factors:

“The specific causes of nutcracker syndrome vary from person to person. Sometimes, people are born with variations in the blood vessels that can result in the symptoms of nutcracker syndrome. The symptoms of nutcracker syndrome are commonly seen in females in their 20s and 30s. The factors that increase the risk of nutcracker syndrome are listed below:

1. Pancreatic tumors increase the risk of nutcracker syndrome because the vessels supplying the pancreas become damaged and compress the renal veins, resulting in nutcracker syndrome.
2. Curvature in the lower spine.
3. Tumors in the tissues present in the inner lining of the abdominal wall.
4. Nephroptosis (a condition in which the kidneys drop into the pelvis while standing).
5. Aneurysm in the abdominal aorta.
6. Sudden changes in the weight and height.
7. Enlargement of abdominal lymph nodes.
8. Pregnancy.”

I’d had a pancreatic tumor, but I didn’t develop nutcracker syndrome. I guess that makes me one of the lucky ones. I constantly marvel how we, as humans, find the good in everything: pancreatic cancer? Bad. No development of nutcracker syndrome: good. By the way, I also have curvature in the lower spine, but that doesn’t seem to be affecting anything.

Time to find out the symptoms now. MedicalNewsToday had that covered:

“The symptoms of NS [nutcracker syndrome] can vary depending on the extent of LRV [left renal vein] recompression. Some people do not experience any symptoms.

When symptoms occur, they may include:

• pain in the left flank, abdomen, or groin
• blood in the urine
• protein in the urine
• urinary tract infections
• kidney damage
• high blood pressure
• varicose veins
• enlarged veins in the testicles in males”

Wait a minute. Flank pain, protein in the urine, and high blood pressure may also be signs of chronic kidney disease. Is nutcracker syndrome considered a kidney disease? After a little digging, I found it is, indeed, a kidney disease although a rare one.

Since it is a rare disease, I wondered how it was diagnosed. Healthline to the rescue:

“First, your doctor will perform a physical exam. Next, they’ll take a medical history and ask about your symptoms to help them narrow down a possible diagnosis.

If they suspect nutcracker syndrome, your doctor will take urine samples to look for blood, protein, and bacteria. Blood samples can be used to check blood cell counts and kidney function. This will help them narrow down your diagnosis even further.

Next, your doctor may recommend a Doppler ultrasound of your kidney area to see if you have abnormal blood flow through your veins and arteries.

Depending on your anatomy and symptoms, your doctor also may recommend a CT scan or MRI to look more closely at your kidney, blood vessels, and other organs to see exactly where and why the vein is compressed. They might also recommend a kidney biopsy to help rule out other conditions that can cause similar symptoms.”

Let’s say [heaven forbid] that you or someone you love is born with or develops nutcracker syndrome. What can be done about it? Thank you to UCLA Health for the following:

“Patients with mild symptoms may be observed. Children may be given time to grow and weight gain can help others. For patients with severe symptoms, one of several procedures may be recommended based on anatomy, symptoms, age, and odds of symptom relief…. 

• Open or laparoscopic/robotic surgery involving repositioning of the renal vein in a way that frees it from compression (renal vein transposition)

• Open or laparoscopic/robotic surgery involving bypass of the compressed renal vein
• Autotransplantation of the left kidney to the pelvic vessels
• Endovascular approaches including placing a stent in the left renal vein”

I can’t help but wonder what the outcomes could be. After all, this is a rare disease. I turned to Orphanet for an answer. This is the portal for rare diseases and orphan drugs.

“As this is a benign condition, overall prognosis is excellent. In highly symptomatic patients, with severe pain, frank/recurrent hematuria requiring blood transfusion, active intervention needs to be considered. Prognosis following intervention is excellent.”

For those of you wondering, this is not a disease for which a change of lifestyle will help.

Now comes the information you’ve been waiting for. Why is it called nutcracker syndrome? We all know what a nutcracker looks like, right? Imagine a nutcracker squeezing your left renal vein. Ouch!

Until next week,

Keep living your life!

It’s Such a Warped Connection

I have a new painful condition but making the connection between chronic kidney disease and this condition had me laughing while seated at my computer. You’ll see. It is a warped connection. Ah, I haven’t told you what that condition is yet. It’s spinal stenosis.

Hold on there. Of course, I’ll explain what it is. Spinal simply means of or about the spine. Stenosis means narrowing. I’ll bet you’re glad I had a thorough English language education at Hunter College a long, long time ago.

We both know narrowing of the spine really doesn’t make sense, so let’s find a more precise definition of this condition. Hello, WebMD:

“Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or vertebrae) and shock-absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects your brain to your body. The cord rests in the canal formed by your vertebrae.”

Not only does it occur in adults over 50, but it occurs more often in women. That’s me… well over 50 and a woman. I wondered why it occurs more often in women, but that’s a blog for another day.

Simply adding the word ‘canal’ made the definition clearer. So, what’s happening here is that the canal, not the spine itself, is narrowing. How? NYU‘s Langone Health, part of NYU – a #1 hospital – explains:

“For most people diagnosed with spinal stenosis, the spinal canal narrows because of degeneration in the spine that occurs as a natural part of aging. These degenerative changes most frequently affect the vertebral joints, also called facet joints, and the spongy discs that lie between vertebrae.

As the spine ages, intervertebral discs slowly lose fluid in a process called degenerative disc disease. Degeneration may cause a disc to bulge into the spinal canal, putting pressure on nerves or the spinal cord. If the outer wall of a disc breaks down completely and a disc fragment slips into the spinal canal, it’s called a herniated disc.

In addition, degeneration of the facet joints caused by osteoarthritis of the spine often leads to the development of bone spurs. These small, hard growths may protrude into the foramen or the spinal canal, constricting the exiting nerves or the spinal cord. Increased friction within joints may also irritate nearby ligaments, causing them to swell and take up more space in the spinal canal.

A facet joint can degenerate to such an extent that it no longer provides stability to the vertebra, which may slip out of place and move forward. In this condition, called spondylolisthesis, the vertebra can slip too far forward, putting pressure on the spinal cord or nerve roots.

Rarely, people are born with a narrow spinal canal or have a developmental condition that leads to a narrowing of the spinal canal. These include achondroplasia, scoliosis, and spina bifida, in which symptoms appear before age 50. Spinal stenosis may also be caused by a spine tumor.

A trauma to the spine, such as an injury from a car accident, that results in a dislocation or a fracture may also constrict nerves or the spinal cord at any point in the spine.”

Hmmm, I have degenerative disc disease and osteoarthritis of the spine. Add that to being a woman over the age of 50 and….

Now what? Let’s take a look at the symptoms, courtesy the Mayo Clinic:

“Spinal stenosis often causes no symptoms. When symptoms do occur, they start slowly and get worse over time. Symptoms depend on which part of the spine is affected.

In the lower back

Spinal stenosis in the lower back can cause pain or cramping in one or both legs. This happens when you stand for a long time or when you walk. Symptoms get better when you bend forward or sit. Some people also have back pain.

In the neck

Spinal stenosis in the neck can cause:

• Numbness
• Tingling or weakness in a hand, leg, foot or arm
• Problems with walking and balance
• Neck pain
• Problems with the bowel or bladder”

Uh-oh, I neglected to mention that spinal stenosis can also occur in the neck.

Okay, here comes the part of the blog that deals with CKD. It’s in the treatment.  While these are not the only treatments, they are the most often tried first. Healthline lays them out for us:

“There is no cure for spinal stenosis, but there are treatments to help relieve symptoms. Over-the-counter anti-inflammatory medications can ease swelling and pain. If they don’t do the trick, your doctor can prescribe higher-dose medication.

Your doctor may also recommend cortisone injections. This anti-inflammatory drug is injected directly into the area of the spinal stenosis. Cortisone can significantly ease inflammation and pain. Its effects may be temporary, however, and you shouldn’t have more than three injections in a single year.”

Marvelous, just marvelous. The OTC medications they’re referring to are NSAIDS. You know, the pain relief that our kidneys have adverse reactions to. The National Kidney Foundation reminds us:

“Many analgesics should not be used if there is decreased kidney function, because they reduce the blood flow to the kidney. “

Well, maybe something stronger? Cortisone? There’s a problem with that, too, if you have diabetes, the foremost cause of chronic kidney disease. My rheumatologist suggested we try one shot and see what happened to my blood sugar. What happened was almost textbook, according to VeryWellHealth:

“If you’re diagnosed with diabetes and receiving a cortisone injection, be aware of the potential for elevated blood sugars. Talk to your healthcare provider about the best way to manage this, as you may need to adjust your insulin dosage.

Remember these temporary elevations tend to resolve without treatment, but seek treatment if your blood sugars appear to be behaving in an extreme or unexpected manner.”

I don’t mean to mislead you. Physical therapy, exercise, weight loss, and the use of a cane and/or walker may also alleviate the pain. So, all is not lost even if you have CKD or diabetes along with spinal stenosis.

Until next week,

Keep living your life!

Yet Another Connection

“So the foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone.”

So goes the Skeleton Song Dance from Walt Disney’s 1929 Silly Symphony. But did you realize that your organs are connected too? Maybe not physically, but what happens to one organ affects the others. For example, this week a dear friend mentioned a condition I’d never heard of before. So, of course, I wanted to know if it affects the kidneys? Or was it if the kidneys affect this condition?

It’s called lichen planus. Do you know it? Here’s how Johns Hopkins defines the condition:

“Lichen planus is a common disease that causes inflammation (swelling and irritation) on your skin or inside your mouth. On your skin, lichen planus causes a rash that is usually itchy. Inside your mouth, it may cause burning or soreness.”

I get the feeling there are more symptoms. According to the Cleveland Clinic, there are:

“Lichen planus symptoms depend on where it’s affecting your body:

• Tiny, raised dots may develop on your skin, including your genitals. The dots are about the size of the tip of a pin (0.4 mm), and they may grow to the width of a pencil (1 cm). They may also develop into sores.
• Tiny white dots may develop on the skin inside of your cheeks, your tongue or your lips.
• Your nails may change colors, crack or split, stop growing or fall off.

Lichen planus doesn’t hurt. However, if you scratch your rash, you may break your skin, leading to an infection that can cause pain.”

That would explain why my friend had no idea she had this autoimmune disease. Wait a minute, what makes it an autoimmune disease? Maybe the American Institute of Healthcare Compliance can help us out here:

“The trigger of lichen planus is a hyperactive immune system. This condition occurs when the immune system begins to attack mucous membrane or skin cells which are not actually a threat to your body. This is an idiopathic condition, meaning there is no precisely known cause. However, medical professionals are aware of several conditions that may trigger it. “

“Trigger it”? I turned to eMedicineHealth to find out just what these triggers might be:

“Triggers for lichen planus may include: 

• Certain medications
  • Antimicrobials
  • Antihistamines (H2-blockers)
  • Antihypertensives/antiarrhythmics such as ACE inhibitors and beta-blockers
  • Antimalarial drugs
  • Antidepressants/antianxiety drugs/antipsychotics
  • Anticonvulsants
  • Diuretics
  • Antidiabetics
  • Metals
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Proton pump inhibitors (PPIs)
  • Lipid lowering drugs
  • Tumor necrosis factor-alpha antagonists
  • Monoclonal antibodies 
• Metal dental fillings (oral lichen planus)
• Stress
• Infection, such as hepatitis C virus infection”

The one trigger that jumped out at me was mental dental fillings. My buddy and I are of an age when the only dental fillings available were metal. Could it really be that simple?

Something bothered me, though. It seemed to me that lichen planus was caused by too much of a good thing. The good thing was your immune system helped keep you healthy by fighting off foreign entities – like germs – in your body. A hyperactive immune system means it was working overtime and attacking parts of you that were necessary. Yep, too much of a good thing.

So, what do you do about lichen planus? By the way, my friend has the oral form. This is more prevalent in females and if there’s anything to be glad of about this disease it’s that it is most usually encountered in middle aged people. Hah! We are so far past middle age that it’s a compliment to be associated with anything middle aged…. or not.

Anyway, as to what you do about lichen planus, the answer is nothing. It usually disappears by itself within two years. I thought that weird and did my best to find out why. I drew a blank. So, let’s move on to what, if anything, this has to do with chronic kidney disease.

“OLP has been associated with numerous systemic connotations such as metabolic syndrome, diabetes mellitus, hypertension, thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer.”

Thanks to the National Center for Biotechnology Information for the above, well, information.

Do you remember what metabolic syndrome is? Just in case, The National Heart, Lung, and Blood Institute explains:

“Metabolic syndrome is a group of conditions that together raise your risk of coronary heart disease, diabetes, stroke, and other serious health problems. Metabolic syndrome is also called insulin resistance syndrome.

You may have metabolic syndrome if you have three or more of the following conditions.

• A large waistline: This is also called abdominal obesity or ‘having an apple shape.’ Extra fat in your stomach area is a bigger risk factor for heart disease than extra fat in other parts of your body.
• High blood pressure: If your blood pressure rises and stays high for a long time, it can damage your heart and blood vessels. High blood pressure can also cause plaque, a waxy substance, to build up in your arteries. Plaque can cause heart and blood vessel diseases such as heart attack or stroke.
• High blood sugar: This can damage your blood vessels and raise your risk of getting blood clots. Blood clots can cause heart and blood vessel diseases.
• High blood triglycerides: Triglycerides are a type of fat found in your blood. High levels of triglycerides can raise your levels of LDL cholesterol, sometimes called bad cholesterol. This raises your risk of heart disease.
• Low HDL cholesterol, sometimes called good cholesterol: Blood cholesterol levels are important for heart health. ‘Good’ HDL cholesterol can help remove ‘bad’ LDL cholesterol from your blood vessels. ‘Bad’ LDL cholesterol can cause plaque buildup in your blood vessels.”

Knowing that diabetes and hypertension [high blood pressure] are the two leading causes of CKD, we can see the connection between lichen planus and CKD now. However, do not panic! This doesn’t mean you will definitely develop CKD.

Until next week,

Keep living your life!

They’re a Couple

Have you ever noticed how many people with chronic kidney disease [CKD] also have chronic obstructive pulmonary disease [COPD]? I first became aware of that when my children’s father had both. I have CKD, but not COPD. Why him and not me?

The National Center for Biotechnology Information iterates that there is a connection between the two diseases.

“During the past decade, a strong association between COPD and CKD has emerged. CKD is more common in individuals suffering from COPD compared to age-matched controls, and COPD patients with comorbid CKD are at a greater risk of adverse outcomes.”

I’m guessing that means I should keep my eyes open for any symptoms of COPD. Of course, I’d need to know what they are first. The Cleveland Clinic answered that unasked question for me.

• “Cough with mucus that persists for long periods of time.
• Difficulty taking a deep breath.
• Shortness of breath with mild exercise (like walking or using the stairs).
• Shortness of breath performing regular daily activities.
• Wheezing.”

Not being too aware of any respiratory diseases, that sounded a lot like asthma to me. I think it’s time for a definition of COPD. I found it on the Centers for Disease Control and Prevention (CDC)’s website.

“Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis. COPD makes breathing difficult for the 16 million Americans who have this disease. Millions more people suffer from COPD, but have not been diagnosed and are not being treated. Although there is no cure for COPD, it can be treated.”

Hmm, I wasn’t right, but I wasn’t that wrong either.  My children’s father had been a heavy smoker since he’d been 16. Maybe that’s why him and not me? I’d been a social smoker off and on for over 20 years. It was far more off than on, and I stopped entirely when I was diagnosed with CKD 15 years ago. His CKD diagnose was not that long before his demise; that’s when he stopped being a heavy smoker.

Am I off base here? I turned to the World Health Organization (WHO) for help.

“Several processes can cause the airways to become narrow and lead to COPD. There may be destruction of parts of the lung, mucus blocking the airways, and inflammation and swelling of the airway lining.

COPD develops gradually over time, often resulting from a combination of risk factors:

1. tobacco exposure from active smoking or passive exposure to second-hand smoke.
2. occupational exposure to dust, fumes or chemicals.
3. indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking and heating in low- and middle-income countries with high levels of smoke exposure. 
4. early life events such as poor growth in utero, prematurity, and frequent or severe respiratory infections in childhood that prevent maximum lung growth.
5. asthma in childhood; and
6. a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause COPD at a young age.”

I don’t remember much of what he’d told me about his childhood, so I think I’ll just leave this alone right now.

In my wanderings on the internet, I hadn’t seen anything about CKD causing COPD. But I have found quite a bit of information about COPD causing or affecting CKD. For example, The American Journal of Respiratory and Critical Care Medicine explained,

“Studies have reported that COPD is an independent predictor of reduced kidney function and that it is the severity of emphysema, rather than airflow limitation, that may be most closely associated with reduced glomerular filtration rate….”

As Healthline puts it:

“But at this time, experts know that the presence of both conditions increases the risk of mortality, and that chronic inflammation is a common factor in both conditions.”

Okay, I get it: COPD has an effect on CKD, but it’s not terribly clear to me just what that effect is. It’s clear it has something to do with inflammation and that some of the same comorbidities cause each of these two diseases.

AJMC, self-described as “The American Journal of Managed Care is the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms,” explains further,

“They [the authors of the study] added that the underlying mechanisms of this finding are likely complex and include increased systemic inflammation, physiological interaction between lungs and kidneys, or network effects between various comorbidities and cardiovascular diseases. CKD impacts other manifestations of COPD, including malnutrition, osteoporosis, and cardiovascular disease, which negatively affect exercise capacity and could explain these results, explained the researchers.”

Let’s take a look at the “physiological interaction between lungs and kidneys.” The National Library of Medicine makes it clear,

“The close relationship between lung and kidney is evidence of a homeostatic connection between all organs and systems in an attempt to maintain the body system balance. Lung and kidney are main players in the effort to maintain such balance in both physiological and pathological conditions.”

While I don’t claim to fully understand this [not being a doctor certainly has its drawbacks], the National Institutes of Health goes all the way back to the womb to help us understand the connection between COPD and CKD,

“Lung and kidney functions are intimately related in both health and disease. The regulation of acid-base equilibrium, modification of partial pressure of carbon dioxide and bicarbonate concentration, and the control of blood pressure and fluid homeostasis all closely depend on renal and pulmonary activities. These interactions begin in fetal age and are often responsible for the genesis and progression of diseases. In gestational age, urine is a fundamental component of the amniotic fluid, acting on pulmonary maturation and growth. Moreover, in the first trimester of pregnancy, the kidney is the main source of proline, contributing to collagen synthesis and lung parenchyma maturation. Pathologically speaking, the kidneys could become damaged by mediators of inflammation or immuno-mediated factors related to a primary lung pathology or, on the contrary, it could be the renal disease that determines a consecutive pulmonary damage.”

Until next week,

Keep living your life!

One Causes the Other and the Other Causes the One

You can be immunocompromised without being a transplant. I know because I live with someone who is. Let’s just suppose he developed chronic kidney disease [Oh, no!]. Let’s see if this would further his CKD, or if his CKD would further the being immunocompromised.

We know that CKD is the progression of the decline of your kidney function for three months or more. Let’s go to my favorite dictionary yet again, the Merriam-Webster, for a definition of immunocompromised:

“having the immune system impaired or weakened (as by drugs or illness)”

Just in case the information is needed, let’s define the immune system, too.

“the bodily system that protects the body from foreign substances, cells, and tissues by producing the immune response and that includes especially the thymus, spleen, lymph nodes, special deposits of lymphoid tissue (as in the gastrointestinal tract and bone marrow), macrophages, lymphocytes including the B cells and T cells, and antibodies”

Well that certainly seems to cover it. Time to see what CKD and being immunocompromised have to do with each other, if anything. The National Institutes of Health starts us off on this exploratory journey:

“Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response.”

You know, I’m not so sure I accepted that I’m immunocompromised before reading that. I feel more validated for still quarantining as much as possible and wearing a mask now. As usual, I want more information, so let’s find it.

PubMed offers us this information:

“Cardiovascular disease and infections are directly or indirectly associated with an altered immune response, which leads to a high incidence of morbidity and mortality, and together, they account for up to 70% of all deaths among patients with chronic kidney dysfunction. Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response.”

This bit of information from the National Library of Medicine surprised me. Not only does CKD affect being immunocompromised, but being immunocompromised affects your CKD.

“The immune system and the kidneys are closely linked. In health the kidneys contribute to immune homeostasis, while components of the immune system mediate many acute forms of renal disease and play a central role in progression of chronic kidney disease.” 

We’re still not quite there. I want to know the mechanism of CKD causing us to be immunocompromised and vice-versa. I think I found the answer in Nature Reviews, but I’m not sure I understand it:

“The kidneys are frequently targeted by pathogenic immune responses against renal autoantigens or by local manifestations of systemic autoimmunity. Recent studies in rodent models and humans have uncovered several underlying mechanisms that can be used to explain the previously enigmatic immunopathology of many kidney diseases. These mechanisms include kidney-specific damage-associated molecular patterns that cause sterile inflammation, the crosstalk between renal dendritic cells and T cells, the development of kidney-targeting autoantibodies and molecular mimicry with microbial pathogens. Conversely, kidney failure affects general immunity, causing intestinal barrier dysfunction, systemic inflammation and immunodeficiency that contribute to the morbidity and mortality of patients with kidney disease.”

Hmm, maybe some definitions would help us understand. Let’s try that.

Pathogenic: specific causative agent (such as a bacterium or virus) of disease [Merriam-Webster Dictionary]

Autoantigens: Autoantigens are markers on cells inside your body that your immune system attacks even though they shouldn’t. Autoantigens cause autoimmune diseases. [Cleveland Clinic]

Sterile inflammation: Inflammation in the absence of pathogens and their products is referred to as sterile inflammation. [Annual Review]

Dendritic Cells: Dendritic cells are sentinels that constantly survey the kidney microenvironment for injury or infection; they recruit and regulate immune effector cells such as macrophages, T cells and neutrophils to protect the host. [Nature Reviews]

T-Cells: T cell, also called T lymphocyte, type of leukocyte (white blood cell) that is an essential part of the immune system. [Britannica]

Wow. That did work. I understand the mechanism now. Do you?

What would tip you off that you’re immunocompromised besides having CKD? Remember that CKD is not the only cause of being immunosuppressed. You probably want to keep an eye on other symptoms for those you care for. According to the Mayo Clinic:

• “Frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections
• Inflammation and infection of internal organs
• Blood disorders, such as low platelet count or anemia
• Digestive problems, such as cramping, loss of appetite, nausea and diarrhea
• Delayed growth and development
• Autoimmune disorders, such as lupus, rheumatoid arthritis or type 1 diabetes”

CKD or not, you want to deal with that lack of immunity. VeryWellHealth has some advice that almost sounds like common sense to me:

“In general, it’s the cause of the immunodeficiency that’s treated, not the immunodeficiency itself. One treatment for immunodeficiency may be a bone marrow transplant. However, that’s only an appropriate treatment for individuals whose bone marrow isn’t producing enough immune cells.

When the immunodeficiency itself isn’t treatable, there are still other options. For example, there are therapies available that can help individuals fight off certain infections. You may also be more likely to need antibiotics or antiviral medications to fight diseases that immunocompetent people can ward off without treatment.”

You know what to do. You have chronic kidney disease. You need to treat it. Adhere to the kidney diet, get enough sleep, take your high blood pressure medication, exercise, avoid drinking, stop smoking, and keep yourself hydrated. The treatment for your immune deficiency is the same as the treatment for your CKD.

Here’s hoping you all realize that you are immunocompromised by virtue of having chronic kidney disease and treat yourself accordingly.

Until next week,

Keep living your life!

Kidney Diffuse Parenchymal Disease Bilateral

Yep, that was my reaction too when a reader asked me what this was. I took a bunch of guesses and then asked her to please speak with her nephrologist about this. Sometimes, I get asked doozies. I turned to the National Kidney Foundation for a simple explanation of this condition:

“’Bilateral renal parenchymal disease’ is a doctor term for scarring changes in the substance of both kidneys.”  

I did look for a simple explanation, but that’s too simple for me. For instance, what are these ‘scarring changes’?

Oh, wait. Dr. Prashant C Dheerendray at Dharma Kidney Care in Bangalore, India, tells us something we should be aware of before we start investigating anything about this condition:

““Renal parenchymal disease” is a term used to describe the appearance of the kidneys on ultrasound. It doesn’t give the complete information about the functioning of kidneys in a given patient. Hence, as a nephrologist, I need more information from blood and urine tests before deciding whether it is dangerous or not.”

Time to hear from my favorite dictionary for some help:

“of, relating to, or affecting the right and left sides of the body or the right and left members of paired organs”

That makes perfect sense since bi is from Latin and means two, while lateral is also from Latin and means side. Most people have one kidney on each side of their body. Hence, bi for two and lateral for sides. Many thanks to the Merriam-Webster Dictionary, as usual.

Uh-oh, we forgot ‘diffuse.’ Back to the dictionary:

“spread or cause to spread over a wide area or among a large number of people”

I suspect including diffuse means the scarring is spreading. We’ll find out in just a little bit. So far, I’ve defined two not necessarily medical words. We know that renal and kidney are the same, so we’re left with ‘parenchymal.’ It does remind me of the term for an elephant, but I kind of doubt that’s the case here. We’re really working the dictionary today:

“relating to or affecting the functional tissue of an organ”

Oh, that’s where the scarring comes in. Let’s see if we can figure out exactly how, though.

Healthmatch, according to their website, is:

“… a diverse team of doctors, engineers, scientists and people dedicated to challenging the status quo of medical research.

We are united by a passion to deliver better healthcare options, for all, regardless of location, background or means. This means access to trials and the revolutionary treatments that come from them.”

 It tells us:

“The kidneys comprise various components and structures that contribute to their bodily function. Within the kidney’s anatomy is the parenchyma, which is responsible primarily for the filtration of blood that passes through the kidneys and the excretion of waste in the form of urine.”

So, the scarring interferes with the blood filtration and excretion of waste, two of the most primary of the kidney’s many functions. Let’s see if can figure out how this scarring happens. I lucked on to Nicklaus Children’s Hospital’s information about the parenchyma:

“The renal parenchyma is the functional part of the kidney that includes the renal cortex (the outermost part of the kidney) and the renal medulla.

• The renal cortex contains the approximately 1 million nephrons (these have glomeruli which are the primary filterer of blood passing through the kidney, and renal tubules which modify the fluid to produce the appropriate amount/content of urine).
• The renal medulla consists primarily of tubules/ducts which are the beginning of the collecting system that allows the urine to flow onwards to being excreted.

Renal parenchyma disease describes medical conditions which damage these parts of the kidney.”

Now that I know what this condition or disease is, I’d like to know what causes it. I,Cliniq, the Virtual Hospital to the rescue!

“The causes of the renal parenchymal disease include:

• High blood pressure.
• Kidney stones.
• Diabetes.
• Genetic conditions such as polycystic kidney disease.
• Bacterial and viral infections.
• Family history of the disease.
• Autoimmune diseases such as lupus nephritis.
• Drug-related and others.”

We don’t know what the ‘others’ are, but I was surprised to see two non-kidney causes in this list: ‘bacterial and viral infections’ and ‘drug- related’. This is starting to sound like something you want to deal with a.s.a.p. But how?

According to Healthmatch:

“Doctors offer no single common solution or plan for the management and treatment of renal parenchymal disease. Each approach to helping an individual with renal parenchyma disease will take into account their condition, what symptoms they are experiencing, and the severity of the damage to the renal parenchyma.

The reality is that there is no cure for renal parenchyma disease but rather medical management of the symptoms as best as possible to try and prevent further deterioration and damage to the kidneys and your overall health.”

No cure? We’re living with chronic kidney disease which has no cure, but we can slow down its progress and do our best to keep it from being dangerous. Is renal parenchyma disease dangerous? Is CKD dangerous?

The National Kidney Foundation has a revelation for us:

“Renal parenchymal disease means the same thing as chronic kidney disease (CKD).  It is just another way of saying CKD.”

Everything you’ve learned about CKD is true about renal parenchymal disease bilateral, too. You can call me Gail, Mom, or Bubby, but I’m still the same person. You can call this disease renal parenchymal disease bilateral or CKD, but it’s still the same disease.

Until next week,

Keep living your life!  

Uncertainty

Leesa Thompson, a recent guest blogger on SlowItDownCKD, and I were going back and forth about transplant. She’s had one; I haven’t. I finally asked her how she felt when she was told she needed one. She answered, “Uncertainty!”… and that became today’s blog. 

Gail seems to start with the dictionary. I seem to start with Facebook (fb).  

On my fb group, KidneyStories, I asked the question, “How did you feel when you first heard that you needed a kidney transplant?” The answers were as varied as the people. They ranged from tears of sadness to tears of joy and all kinds of tears in between. The sadness was primarily from thinking that life was over. The joy was from trusting that being approved for a kidney transplant would mean the opportunity of renewed life. My range of emotions spanned the same gamut.  

I felt very uncertain the day that I first found out that I’d either need dialysis or a transplant. My doctor was holding his copy of my labs and I had mine. He went carefully over each number. Some had gone up and others down. He looked at me with concern and said, “According to these numbers, the time has come.”  

I started to shake and cry uncontrollably. My partner escorted me to the car where I just kept crying. There was nothing he could do or anyone else could do. I just couldn’t stop crying.  I noticed the metal taste in my mouth and started feeling nauseous. My body was clearly full of toxins. Sweat was pouring from my limp body. My partner said nothing. I was hoping he’d say something reassuring but there was nothing reassuring to say. Finally, he asked, “Do you want to go home?”  

“No!” I said, “let’s get a strong drink”. We drove to a nearby bar and tried to drown my troubles. There really was no easy answer, but I was going to die if I didn’t get an answer soon. I either needed to have a kidney transplant or start dialysis. Neither choice was going to be a good one.  

Would I find a donor? How? Who? What if I didn’t? Would I be able to do dialysis long enough to wait for a donor? What would happen if I just did hospice? How lousy would I feel and for how long? These thoughts kept racing through my head. Diiiialysis. It would be best just to be out of pain and end it all. 

I posted my plight on fb. My friend answered very quickly and put me in touch with his friend who instilled confidence in me. He told me about getting his kidney six months earlier. He said I needed to focus on why my life was worth living … write a story about who I am and why someone should care about saving my life. Not necessarily by giving me their kidney, but by sharing the compelling story on my website. He helped reframe my thinking.  

Considering that this is Mental Health Month, let’s stay focused on the mental turmoil. As days slowly passed by, I found that when I was accomplishing what was within my control, I was ok for a few minutes. However, most tasks that needed my attention would shortly become frustrating and I burst into tears or rage, sometimes both at the same time. I knew myself well enough to know that I couldn’t get through these feelings alone.  

I called the mental health number on my insurance card. They put me in touch with a kind, compassionate male therapist roughly my age. He had me come to his office where I tried telling him what was going on and did a lot of crying. He was always very honest. He didn’t have answers and wasn’t going to be my cheerleader. However, he was going to be there for me, to listen and give me a safe place to cry, yell, rant, complain, help me plan and support me while I got through this.  

He made it clear that if I chose to give up, he wasn’t going to stop me but that he hoped that the strategies he provided would help me get through whatever came. Looking back, it seems that when I spent time ruminating on the “what ifs?” I’d end up in a corner with no way out. However, if I could stay focused on the task and carry out something – no matter how small – I’d gradually move forward. Then, if I kept track of these minute accomplishments it would give me hope that I could accomplish the next small task. He also helped me think of additional solutions and resources for completing the next set of tasks.  

By staying focused on what I was able to control and getting those goals met instead of focusing on the things that I could not control I was able to reach the finish line. It was helpful to have him check in weekly. I suggest that if you’re struggling emotionally as I was, you might want to do the same.  

I was part of District 46 Toastmasters Conference’s panel on mental health this year. A presenter described a five-minute meditation program that is worth mentioning. It seems that there are quite a few versions of this technique. The one I like is free on YouTube. It’s called 5-Min Relaxing Meditation to Open Your Heart by John Davisi. Research shows that this really works. I also find keeping a journal, especially a gratitude journal, helpful in reminding myself that in spite of my daily struggle there’s a lot to be grateful for. 

I hope these few techniques will help you get through and beyond this difficult part of your journey. I believe you’ll find that whatever challenges you’re facing, you can find a way to live your best life ever! 

Never having been in this position, there’s nothing I can add to Leesa’s blog. But, I do appreciate the bit of insight into the mind of someone who’s been told they need a transplant. 

Until next week, 

Keep living your life! 

Steroids… Again

Back in January, I wrote about steroids. Here’s a little basic information about them from Wordnik, the world’s largest online dictionary:

“Any of a group of steroid hormones, such as cortisone, that are produced by the adrenal cortex, are involved in carbohydrate, protein, and fat metabolism, and have anti-inflammatory properties.” 

I can just about hear you thinking, “You already wrote about steroids. Why write about them again?” The truth of the matter is that while I did write about steroids before, that blog had a different focus. Then, I focused on what they are. Today, I’ll be focusing on how long-term use of steroids affects the kidneys. Why? You guessed it. One of my very favorite readers asked me to. This is her email:

“I am 82. Full of osteoarthritis. Have had at least 20 surgeries for this disease. At my age, I no longer am a good candidate for more orthopedic surgeries. I also have stage 3b CKD. My drs are willing to inject me with steroids to help minimize the pain. 

I don’t think one injection would necessarily hurt me but what about many injections (at different times). My gut is telling me to do some research. 

I am reaching out to you.”

Of course, we’ll be referring to artificial steroids rather than those your body produces naturally. Sometimes, that’s just not enough to deal with inflammation. But I also want to make certain that you realize the steroids I’m writing about are not the anabolic steroid weightlifters may be using.

Not to frighten you, but more to get it out of the way, we need to know the possible side effects of steroids. eMedicine Health [owned by WebMD] has plenty to say about side effects:

“Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. 

Call your doctor at once if you have: 

• (after injection into a joint space) increased pain or swelling, joint stiffness, fever, and general ill feeling; 
• blurred vision, tunnel vision, eye pain, or seeing halos around lights; 
• unusual changes in mood or behavior; 
• swelling, rapid weight gain, feeling short of breath; 
• stomach cramps, vomiting, diarrhea, bloody or tarry stools, rectal irritation; 
• sudden numbness or weakness (especially on one side of the body); 
• a seizure (convulsions); 
• severe headache, blurred vision, pounding in your neck or ears; 
• increased pressure inside the skull–severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes; or 
• Signs of low adrenal gland hormones–flu-like symptoms, headache, depression, weakness, tiredness, diarrhea, vomiting, stomach pain, craving salty foods, and feeling light-headed. 

Certain side effects may be more likely with long-term use or repeated doses of triamcinolone injection.“

It’s almost enough to make you forget the whole idea of taking steroids for your pain and inflammation, especially long term. But, as we all know, these are possible side effects and, I suspect, not that common.

Let’s see what more we can find about a long-term regime of steroids. According to the National Kidney Organization:

“Steroid drugs, such as prednisone, work by lowering the activity of the immune system. The immune system is your body’s defense system. Steroids work by slowing your body’s response to disease or injury. Prednisone can help lower certain immune-related symptoms, including inflammation and swelling.”

Wait a minute. So, you can reduce inflammation and swelling long term, but you’re lowering the body’s defense system. Then how can a doctor, in good consciousness, prescribe this regime?

I turned to Drugs.com for help. Oh, my.

“Long-term use of prednisone may lead to bone loss and osteoporosis. It can cause changes in the distribution of body fat which together with fluid retention and weight gain may give your face a moon-like appearance.

Stretch marks, skin thinning, and excessive facial hair growth are also not uncommon. Women who are pregnant or planning a pregnancy should let their doctor know before they take prednisone. Prednisone may be given in low doses to women who are breastfeeding a baby for the treatment of certain conditions such as asthma, rheumatoid arthritis, inflammatory bowel disease, or for an allergic reaction.

Children are particularly susceptible to prednisone’s side effects. Prednisone may suppress growth and development, an unfortunate effect that may be helped by alternate day treatment or growth hormone therapy. Prednisone may also cause sleeplessness and affect your moods. People with diabetes may find their blood glucose control is not as good as it usually is while they are taking prednisone.”

As of that weren’t enough, GoodRxHealth tells us:

“Here are nine possible effects of long-term corticosteroid [a type of steroid] use.

1. Weight gain….

2. Osteoporosis and fractures….

3. Infection risk….

4. Cataracts and glaucoma….

5. High blood pressure and heart disease….

6. Blood sugar….

7. Stomach problems….

8. Sleep and mental health problems….

9. Steroid withdrawal….”

Just about every website I searched stated that prolonged steroid use could be harmful to the kidneys. And then, don’t forget the high blood pressure and blood glucose problems [High blood sugar for prolonged period is diabetes.] are the two leading causes of chronic kidney disease.

You must remember that I am not a doctor, but I am getting a bit nervous about this. I know steroids are used as anti-rejection drugs in kidney transplant and that’s a good thing. But without a transplant? The University of North Carolina’s Kidney Center surprised me:

“Corticosteroids are used to treat a variety of inflammatory diseases. Kidney diseases treated with this medication include lupus nephritis, systemic vasculitis, and other forms of glomerulonephritis.”

None of which this reader has. One thing we must keep in mind is that doctors will often prescribe medications with possible negatives for the patient because they feel this particular medication will do more good than harm for the patient.

I’d recommend a more in-depth conversation with the doctor who wants to prescribe steroids before either agreeing or refusing. Readers, what do you think?

Until next week,

Keep living your life!