One Thing is Not Like the Other

I’d always thought that albuminuria and proteinuria were one and the same since the words are often use interchangeably. Guess who was wrong. While ‘uria,’ means:  

“a combining form with the meanings ‘presence in the urine’ of that specified by the initial element (albuminuria; pyuria), ‘condition of the urinary tract,’ ‘tendency to urinate as specified (polyuria).’’ 

according to Dictionary.com at https://www.dictionary.com/browse/-uria, albumin and protein are two different substances. 

I know they are closely related, but yet… still not the same. Let’s take a look at albumin: 

“Your liver makes albumin. Albumin carries substances such as hormones, medicines, and enzymes throughout your body.” 

Thank you to University of Rochester’s Medical Center’s Health Encyclopedia at bit.ly/3agVUO8 for this information. 

Wait a minute, the liver? I thought we were dealing with the kidneys. Let me think a minute. I know: we’ll go to the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Disease. This is what I found at bit.ly/3pDfmer

“Albuminuria is a sign of kidney disease and means that you have too much albumin in your urine. Albumin is a protein found in the blood. A healthy kidney doesn’t let albumin pass from the blood into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better.” 

Oh, so the albumin itself doesn’t harm the kidneys, but is a sign of kidney disease. Got it. But it’s a protein. Let’s take a look at the protein part of proteinuria and see if we can figure this out. 

In What Is It and How Did I Get It? Early Stage Kidney Disease, I defined protein as: 

“Amino acids arranged in chains joined by peptide bonds to form a compound, important because some proteins are hormones, enzymes and antibodies.”   

Look at that: hormones and enzymes are mentioned in both definitions. It would make sense to define these two words now. According to my first book on Chronic Kidney Disease, 

“Hormones: Gland produced chemicals that trigger tissues to do whatever their particular job is.” 

I need some examples. Hormone.org has an extensive list.  Some hormones you might recognize are: 

  • Adrenaline 
  • Cortisol 
  • Erythropoietin 
  • Estrogen 
  • Glucagon 
  • Insulin 
  • Melatonin 
  • Oxytocin 
  • Serotonin 
  • Testosterone 
  • Vitamin D 

What about enzymes? The Merriam Webster Dictionary can help us out here. 

“any of numerous complex proteins that are produced by living cells and catalyze specific biochemical reactions at body temperatures” 

I don’t know about you, but I’m better with examples. I took a short list from MedicalNewsToday: 

  • Lipases 
  • Amylase 
  • Lactase 

These terms may look familiar from your quarterly blood tests. 

I still don’t get it. If albumin is a protein, why isn’t it considered proteinuria? MDEdge, a new site for me, but one that seems credible, explains: 

“Proteinuria and albuminuria are not the same thing. Proteinuria indicates an elevated presence of protein in the urine (normal excretion should be < 150 mg/d), while albuminuria is defined as an ‘abnormal loss of albumin in the urine.’…. Albumin is a type of plasma protein normally found in the urine in very small quantities. Albuminuria is a very common (though not universal) finding in CKD patients; is the earliest indicator of glomerular diseases, such as diabetic glomerulosclerosis; and is typically present even before a decrease in the glomerular filtration rate (GFR) or a rise in the serum creatinine…. 

Albuminuria, without or with a reduction in estimated GFR (eGFR), lasting > 3 months is considered a marker of kidney damage. There are 3 categories of persistent albuminuria…. Staging of CKD depends on both the eGFR and the albuminuria category; the results affect treatment considerations.” 

The important part to remember is that both are indicators of Chronic Kidney Disease. 

Switch of topics here. Remember KidneyX? That’s, 

“The Kidney Innovation Accelerator (KidneyX), a public-private partnership between the U.S. Department of Health and Human Services (HHS) and the American Society of Nephrology (ASN), is accelerating innovation in the prevention, diagnosis, and treatment of kidney diseases.”   

Well, they have an announcement for you: 

“The U.S. Department of Health and Human Services (HHS) and the American Society of Nephrology (ASN) announced the eight winners of the KidneyX COVID-19 Kidney Care Challenge Round 1. The $300,000 challenge has identified solutions that could reduce the transmission of coronavirus among people with kidney disease and/or reduce the risk of kidney damage among people who contract the virus. 

‘We congratulate the Round 1 winners who have highlighted approaches to patient monitoring, patient education, and vaccine distribution,’ said HHS Acting Assistant Secretary for Health Rear Admiral Felicia Collins, MD, MPH. ‘We look forward to the subsequent round of rapid-response innovation that supports COVID-19 risk reduction in kidney patients and health professionals during the pandemic.’ 

Each winner will receive $20,000 in recognition of their solution…. The KidneyX Round 2 winners will be announced in February, 2021. 

COVID-19 Kidney Care Challenge Round 1 Winners 

The following submissions were selected as winners of the COVID-19 Kidney Care Challenge Round 1: 

  • 9 Remote Monitoring Platform to Reduce COVID-19 Risk for Hemodialysis Patients 
  • Free E-Learning Platform with CKD and COVID-19 Patient Education 
  • Immediate Rooming for Patients 
  • Canopy: the Next Generation, Reusable Respirator 
  • Characterizing and Targeting Vaccine Hesitancy Among End-Stage Kidney Disease (ESKD) Patients 
  • COVID-19 in Translation: Making Patient Education Accessible to Minorities 
  • The ‘Good Humoral’ Immunity Truck and Freezer Project 
  • Development of Telemedicine-Enhanced Peritoneal Dialysis Training Protocols During COVID-1″ 

Did you know that patients were involved in these projects? 

We’ve passed a sort of milestone with SlowItDownCKD: this is the 601st blog. If there were no Covid-19, I would invite you all to my house for a Renal Diet Bar-B-Q. We know that’s not going to happen any time soon, so – please – have a special meal at your home with those you love. Wear your masks, keep six feet apart, wash your hands often, keep it to a very small gathering of those who are in your pod (Our pod is very small, just Bear and me.), but have a good time anyway. 

Until next week, 

Keep living your life! 

Learning Every Day

 Chronic Kidney Disease is all over my world. You know when you have your ears open for a certain term, you seem to hear it all the time? That’s what my life has been like for the last dozen years. When I noticed a comment in a Facebook kidney disease support group about Action myoclonus–renal failure (AMRF) syndrome, I was stunned. Here was yet another possible kidney disease I’d never heard of. 

As defined by MedlinePlus, a division of the National Health Institutes (which is a division of the U.S. National Library of Medicine) at http://bit.ly/2KY6EI8,  

“Action myoclonus–renal failure (AMRF) syndrome causes episodes of involuntary muscle jerking or twitching (myoclonus) and, often, kidney (renal) disease. Although the condition name refers to kidney disease, not everyone with the condition has problems with kidney function.” 

I was intrigued and wanted to know more. So, I did what I usually do when that happens. I poked around everywhere I could think of on the internet. My first hit was on The National Center for Biotechnology Information (NCBI), which is part of The U.S. National Library of Medicine at https://www.ncbi.nlm.nih.gov/books/NBK333437/

“Action myoclonus – renal failure (AMRF) syndrome typically comprises a continuum of two major (and ultimately fatal) manifestations: progressive myoclonic epilepsy (PME) and renal failure; however, in some instances, the kidneys are not involved. Neurologic manifestations can appear before, simultaneously, or after the renal manifestations. Disease manifestations are usually evident in the late teens or early twenties. In the rare instances in which renal manifestations precede neurologic findings, onset is usually in late childhood / early adolescence but can range to the fifth or sixth decade.” 

Uh-oh, epilepsy. One of my children has that. Luckily for her, she doesn’t have CKD. But we still need more information… or, at least, I do. For instance, how does the illness progress? 

Rare Disease InfoHub at http://bit.ly/37Qgo0h answered this particular question. 

“The movement problems associated with AMRF syndrome typically begin with involuntary rhythmic shaking (tremor) in the fingers and hands that occurs at rest and is most noticeable when trying to make small movements, such as writing. Over time, tremors can affect other parts of the body, such as the head, torso, legs, and tongue. Eventually, the tremors worsen to become myoclonic jerks, which can be triggered by voluntary movements or the intention to move (action myoclonus). These myoclonic jerks typically occur in the torso; upper and lower limbs; and face, particularly the muscles around the mouth and the eyelids. Anxiety, excitement, stress, or extreme tiredness (fatigue) can worsen the myoclonus. Some affected individuals develop seizures, a loss of sensation and weakness in the limbs (peripheral neuropathy), or hearing loss caused by abnormalities in the inner ear (sensorineural hearing loss). Severe seizures or myoclonus can be life-threatening.” 

But we haven’t looked at the kidneys yet. How are they involved in those who develop kidney problems from this rare disease? Let’s go back to MedlinePlus to see what we can find. Don’t be surprised that the answer is fairly general: 

“When kidney problems occur, an early sign is excess protein in the urine (proteinuria). Kidney function worsens over time, until the kidneys are no longer able to filter fluids and waste products from the body effectively (end-stage renal disease).” 

Do you remember what proteinuria is? Here’s a reminder from my first CKD book – What Is It and How Did I Get It? Early Stage Chronic Kidney Disease – in case you’ve forgotten: 

“Protein in the urine, not a normal state of being” 

Hmmm, proteinuria is exactly what it sounds like. That got me to thinking: How does the protein get into the urine in the first place? 

“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.” 

Thank you to a trusted site, The Cleveland Clinic at http://cle.clinic/3nTjLZI for helping us out here.

The important point here is that proteinuria, or albumin as it is often called, prevents the substances that belong in your blood stream from fully remaining there to help you: 

“Blood contains two main kinds of proteins: albumin and globulins. Blood proteins help your body produce substances it needs to function. These substances include hormones, enzymes and antibodies. 

Usually, the amount of total protein in your blood is relatively stable.” 

I’d gone back to the reliable Cleveland Clinic for this information. 

I don’t know about you as you read today’s blog, but I found writing it exhausting. Of course, that may be due to the fact that Christmas Eve and Christmas Day have just passed. I’m not quite as vigilant as I usually am about the renal diet during certain celebrations. Considering that Bear’s Lutheran and I’m Jewish, that was a lot of celebrating. I see my exhaustion as an endorsement to get right back on the kidney diet. 

Here’s hoping your Chanukah, Christmas, Boxing Day, and Kwanza were as happy as you’d hoped under the restrictions of small group gatherings, six foot distancing, and mask wearing. We stayed home alone using the phone and Facetime to be with family.  

It was… different. But more importantly, it was safe. Keep in mind that you’re already immuno-compromised simply by having CKD. If you no longer have a spleen like me (Thanks, pancreatic cancer.), you’re even more immunocompromised. Hugs are the best, but they could be deadly for us. Stay safe. 

Until next week, 

Keep living your life! 

Feeling Nostalgic

It’s getting closer to the end of the year. Halloween and Thanksgiving have passed. Chanukah, Kwanzaa, and Christmas will be upon us sooner than we think. And then, the new year. But my nostalgia deals with the history of acknowledging and treating kidney disease. I was lucky enough to stumble across the following early history at https://hekint.org/2017/01/30/history-of-nephrology-beginnings/. It’s from Hektoen International, A Journal of Medical Humanities. I must warn you it’s a long article, but well worth the read. Enjoy: 

“History of nephrology: beginnings 

George Dunea 
Chicago, Illinois, United States 

 ….Mesopotamia 

Some of the earliest knowledge about kidney and urinary diseases comes from the cradle of Western civilization, Mesopotamia, from the cuneiform clay tablets of Akkadia, Assyria, and Babylon that contain references to urinary obstruction, stone, cysts, urethritis, stricture, and urethral discharge…. In ancient Babylon physicians made diagnoses depending on whether the urine looked like paint, wine dregs, beer, or beet juice. They treated symptoms with remedies derived from plants or minerals. They administered drugs by blowing them through a tube into the urethra, most likely also to relieve urinary obstruction, and using alcohol as an anesthetic. Much of the medical information generated in Mesopotamia was later transmitted to the Mediterranean, especially to Greece….  

Egypt 

In ancient Egypt priest-physicians have recorded many details of their patients’ symptoms on papyrus scrolls. Curiously, they cooked some of their old papyri books in oil and smeared them on their patients to relieve symptoms of dropsy or fluid retention…. They embalmed their dead, removing most of the viscera but leaving behind the kidneys and the heart. In the Ebers papyrus of 1550 BCE they refer to retention of urine, dysuria, and frequency. Hematuria, mentioned over 50 times, was probably due to schistosomiasis, then as now endemic in the valley of the Nile. Examination of mummies has led to discovery of kidney abscesses and stones, parasite ova, and congenital renal deformities. Treatments are listed in the Ebers papyrus in some 24 paragraphs under the heading: ‘Starting remedies to make disappear the retention of urine when the lower abdomen is full.’…  

Greece 

Records of urinary disorders are found in the Hippocratic Corpus, a collection of some 60 treatises that may represent the work of several medical writers. How much was written by Hippocrates himself remains uncertain. Nevertheless, Hippocrates of Cos (460–377 BCE) is regarded as the father of medicine, and many of the aphorisms attributed to him refer to diseases of the kidney: 

‘Bubbles appearing on the surface of the urine indicate disease of the kidneys and a prolonged illness.’ 
‘Colorless urine is bad.’ 
‘The sudden appearance of blood in the urine indicates that a small renal vessel has burst.’ 
‘Diseases of the kidney and of the bladder are difficult to cure in old age.’ 

Other comments concern cases where the urine was turbid or contained pus or blood, bran-like particles, or sandy sediment…. 

Aristotle, whose opinions dominated Western thought for over 2,000 years, also wrote about the kidney. From his observations on fish and birds he concluded that the kidneys were not essential to life, and from the rhesus monkey he incorrectly deduced that the right kidney was situated higher than the left. He thought the kidneys were there to anchor the blood vessels in the body, and also to secrete fluid not eliminated otherwise. He considered renal fat as the cause of cancer and of gangrene, and in De Partibus Animalium noted that ‘very often the kidneys are found to be full of stones, growths, and small abscesses.’… 

In the 3rd and 2nd century BCE other Greek physicians also made contributions, describing the prostate gland, declaring that urine was formed in the kidney, reporting on recto-vesical fistula, and performing operations. They applied pressure over the lower abdomen to relieve urinary retention, and recommended the use of poultices with soothing and diuretic properties over the kidneys…. 

Rome and Byzantium 

Physicians in Rome were often Greeks from Asia Minor who had studied in Alexandria…. Celsus (63 BCE–14 CE), though not a physician, wrote on many medical subjects, including lithotomy and the use of a bronze catheter…. In his writings, Pliny the Elder also refers to the kidney…. Areteus of Capadocia (81–138 CE), now remembered mainly for describing diabetes mellitus as the melting of the flesh into the urine, wrote about hydronephrosis, gout, renal colic, strangury, postobstructive diuresis, edema, and the anemia of renal insufficiency…. Dioscorides, also from Asia Minor and perhaps physician to emperor Nero, practiced in Rome during the first century and wrote an extensive pharmacopoeia, noting that certain poisons caused renal inflammation, and recommending enemas with ptisan or mallow for renal failure…. Galen of Pergamon (130–200 CE), physician to emperor Marcus Aurelius, referred in his extensive writings to renal cysts, breakage of the capillaries into the kidney, thrombosis, and inflammation. Called the father of experimental medicine, he ligated the ureters to prove that urine flowed from the kidneys to the bladder…. 

Among Byzantine physicians, Rufus of Ephesus in the first century CE described renal failure, abscesses, and calculi, recommending poultices of grilled cicadas as a diuretic, advising flushing the kidneys with large amounts of water, and prescribing urinating in a hot bath to relieve retention of urine. Somewhat later Oribasius (326–403), physician to emperor Julian the Apostate, wrote profusely on medical matters, summarizing the works of Galen and others in 70 books…. First to use the term ‘ureter,’ he treated dysuria and ureteral stone, did anatomical dissections, described the systemic and pulmonary circulation, discerned the existence of capillaries, and suggested that the kidneys absorbed urine from the blood stream…. 

In the 9th century Theophanes Nonus noted hematuria resulting from poisonous remedies and from the venom of serpents…. Other Byzantine physicians wrote right up to the 14th century about kidney inflammation and failure, emphasizing the changes in the appearance of the urine, developing the practice of uroscopy,… and often achieving fame as physicians to the Byzantine emperors. 

 Arabs 

The 9th and 10th centuries were a golden age for Arab medicine, in which several physicians achieved fame for their clinical acumen and perspicacious observations. Rhazes (865–925), a musician who later became a physician and was called the Galen of Islam,…described in his many clinical writings renal abscess or severe infections with pus in the urine, kidney stones, and renal failure from systemic diseases. Even more prolific was Avicenna (980–1037), poet, politician, and writer, whose works greatly influenced Western Renaissance medicine and who wrote extensively on the color, density, odor, and sediments of urine, foreshadowing the later uroscopists. Recommended treatments included inserting a bug or louse into the urethral meatus to stimulate micturition. He wrote several excellent descriptions of clinical cases, as did several other Arab authors until the 13th century…. 

There were also eminent Jewish physicians living in the Arab possessions around the Mediterranean, notably Moses Maimonides (1138–1204), born in Cordova but eventually settling down in Cairo and attending on the sultan Saladin. A renowned medieval rabbi, philosopher, astronomer, and physician, he wrote 10 treatises on medicine, including an entire chapter of aphorisms dealing with urinalysis. He discussed lower urinary tract obstruction, hesitancy, narrow stream, retention, pyuria, and hematuria. He agreed with Hippocrates that diseases of the kidney in the elderly were difficult to cure, and noted red urine in patients who probably had glomerulonephritis. In patients with blackwater fever he noted that ‘black urine and black sediment are extremely malignant and indicate serious illness. They occur in association with what resembles the death of natural resources . . . I have never seen anyone who urinated black urine who survived.’…  

Uroscopy 

Uroscopy, the naked eye examination of the urine for diagnosis, is as old as medicine itself, based on the assumption that diseases could be identified and treated following such visual inspection…. It was advocated by Hippocrates, though without much enthusiasm…. Several of the Greek physicians practiced uroscopy and helped develop a complex diagnostic model based on the theories of the four humors…. Many treatises on uroscopy were published in antiquity and later by Byzantine, Arab, and Latin physicians…. Uroscopic theory and practice reached an apogee between the 9th and 14th century in southern Italy at the medical school of Salerno, then a melting pot of different cultures…. There several masters of medicine or magistri wrote (or translated from Arabic) books on diagnostic uroscopy. One of its major exponents, Isaac Ebreus Isaac (880–940), assembled in his Guida Medicorum many of the principles of uroscopy. He was followed by Magister Maurus, according to whom fluids were separated in the body by the stomach and liver, with the generation of humors (1250 CE). Gilles de Corbeil, a Frenchman, went to Salerno, then returned to Paris and wrote Songs on Urinary Judgements, a composition in verse that remained popular until the 16th century.17 A 13th century anonymous manuscript titled De Urinis contains aphorisms such as: 

Clear urine, pale or almost green indicates pain in the stomach in males, but in women means inflammation or phlegm from the umbilicus to the throat, and thirst. 
Small volume urine which is sulphurous indicates diarrhea. 
Urine which is red with fluid beams indicates disease of the spleen. 
A red circulus means pain in the head due to blood. 
Urine of a vicious woman is quite colored, cloudy by night, and dense in the morning. 
Urine of a virgin is clear, white, light, and transparent, with very small bubbles on the surface….  

Sclerosis of the kidneys 

Hardening or sclerosis of the kidneys had been recognized as the hallmark of chronic renal failure since antiquity…. Thus Rufus of Ephesus compiled a treatise in which he noted that sclerosis of the kidneys was not painful, but might cause dropsy. He recommended rest, enemas, cupping of the loins, baths, refrigerant and sedative medicines given internally…. Aetius of Amida (502–575), court physician to emperor Justinian in Constantinople, based his Tetrabiblion largely on the works of Rufus, Hippocrates, and Galen, and also mentioned hardening of the kidneys…. Paul of Aegina (625–690), practicing in Alexandria even after the Arab conquest, also noted renal hardening and wrote in his seven books that ‘when hardness occurs in the kidneys it does not cause pain . . . but the limbs lose their strength, little urine is passed, and the whole habit resembles that of dropsical persons.’ He recommended emollients to soften the kidneys, frictions and fomentations, clysters to clear out the bowels, and diuretics such as nard, cassia, St. John’s wort pepper, sweet hay, boiled squill in wine and honey, moist alum, flakes of copper, and should all fail, ox dung dried and drunk (one spoonful every day)…. 

Also aware of sclerosis of the kidneys as a cause of illness were the Arab physicians Rhazes and Avicenna…. William of Saliceto (1210–1277) observed that hard kidneys (duritie in renibus) were difficult or even impossible to treat. He moved to Bologna in 1269 to become an outstanding teacher of medicine, and during his time taught more than 10,000 students…. He emphasized bedside instruction and wrote an extensive medical textbook, mentioning that hardness of the kidney could be the result of an abscess, an episode of high fever, or arise spontaneously. The hardness, he wrote, looks chalk-like. Its clinical signs were a reduction in urinary output, a dull pain or heaviness in the back and sides, and after a time enlargement of the belly and generalized edema…. 

Later, the Flemish physician Jan Baptiste Van Helmont (1579–1644) devoted much of his time to research, carrying out autopsies on patients who had died with gross ascites, noting that their kidneys were shrunken and hard, and concluding that the kidney was the cause of the edema …. 

Morgagni 

Giovanni Battista Morgagni (1682–1771), often regarded as the founder of pathological anatomy, made similar observations. After studying in Bologna with Valsalva, he moved to Padua, where he remained professor of theoretical medicine and anatomy for 50 years. He carried out many autopsies, correlating anatomical findings with the clinical symptoms. 

Towards the end of his career he published observations on cases he had studied over 50 years, including necropsy descriptions of diseased kidneys: solitary, asymmetrical, irregular, hardened, softened, suppuration, hydronephrosis, calculi, tumors, cysts…. Of particular interest, he described a patient who had suffered from nausea, vomiting, headache, and episodes of loss of consciousness, and who at autopsy had greatly shrunken, hard, irregularly shaped greyish kidneys. He concluded that these renal changes were the cause of the symptoms….  

Paracelsus 

Theophrastus Bombastus von Hohenheim (1493–1541), better known as Paracelsus, is perhaps the most colorful medical figure of the Renaissance. Born in Switzerland, he studied medicine in several European cities, practiced in Strasbourg and Basel, and eventually wandered through various German, Swiss, and Austrian towns. His death has often been subject of speculation, being variously attributed to murder, accident, congenital syphilis, liver failure, and also to kidney disease, as suggested by the finding of rickets in his exhumed skull in 1880…. 

Paracelsus wrote on urinalysis, proteinuria, hematuria, and gout. Particularly interested in dropsy, he described its symptoms and signs, commented on its prognosis, noted that in its advanced stages ‘the urine decreases and thickens,’ and was first to use mercury for treatment. He attempted chemical analysis of the urine, adding wine or vinegar or rennet to it and noting that it curdled and produced a precipitate. He also assessed urine by its weight, a precursor of measuring the specific gravity. He combined medicine with alchemy and astrology, and claimed to affect many cures with his Tincture of Philosophers. …  

Andreas Vesalius 

Born in Brussels, Andreas Vesalius (1514–64) studied in Paris and Padua, and on the day after graduation was appointed professor of anatomy at the University of Padua. There he carried out many dissections and became famous for his lectures and anatomical drawings. Between the ages of 24 and 27 he prepared a book of over 700 pages of anatomical illustrations, and eventually became physician to Emperor Charles V. In his famous plates he described the anatomy of the kidney, also attempting to understand its function, and concluding that urine extracted from the blood entered a cavity before being excreted into the urinary passages. His brilliantly illustrated textbook of anatomical illustrations has been reproduced for centuries….  

Marcello Malpighi 

Founder of microscopical anatomy, and professor of anatomy at Messina and later at Bologna, Marcello Malpighi (1628–94) was first to describe the renal glomerulus (Malpighian corpuscle). Using the microscope as avant-garde technology, he also studied the brain, liver, tongue, lung, and skeletal muscle, describing their architecture and postulating what their function might be. In the course of his studies of the frog’s mesentery, he discovered the presence of capillaries. In the kidney he described the pyramids of the renal medulla and the collecting ducts, and noted the opening of these ducts at the papilla. In the omentum of the porcupine he first noticed the red cells, which he interpreted as being fat globules or constituents of coagulated blood. Using a microscope with x30 magnification and sometimes with prior dye injection, he described the glomeruli, which when injected ‘turned black . . . hanging like apples from the blood vessels, which, swollen with the black fluid, look like a beautiful tree.’…” 

Many, many thanks to Dr. Dunea for what I consider fascinating history. And thank you for indulging my nostalgia. 

Until next week, 

Keep living your life! 

Stay in the Blood, PLEASE

Let’s finish out this lazy, hazy summer month of August with another reader question. This one was quite straight forward:

“Any advice to slow down protein leaking into urine. Hard to build muscle when you keep excreting protein”

The condition of leaking protein into your urine is called proteinuria. That’s almost self-explanatory. The root of the word actually says protein while the suffix (group of related letters added to the end of a word which changes its meaning) is defined as,

“-uria.

  1. suffix meaning the “presence of a substance in the urine”: ammoniuria, calciuria, enzymuria.
  2. combining form meaning “(condition of) possessing urine”: paruria, polyuria, pyuria.

Thank you to the Medical Dictionary at https://medical-dictionary.thefreedictionary.com/-uria for the definition of uria.

Okay, so we know that protein is leaking into the urine. Not good. Why? We need it in our blood, not excreted in our urine. The following is from a previous blog on proteinuria. I used the dropdown menu in “Topics” on the right side of the blog page to find it or any other topic listed there. You can, too.

“According to WebMD at https://www.webmd.com/men/features/benefits-protein#1:

‘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.’”

Got it. Our reader is correct; it is hard to build muscle if you’re “excreting protein.” Now what? I usually stick to medical sites but this comment from Healthfully at https://healthfully.com/170108-how-to-reduce-excess-protein-in-the-kidney.html caught my eye.

“Continue monitoring how much protein your kidneys are spilling for several months. Since colds and infections can cause transient increases in protein, you will want at least several months of data.”

As Chronic Kidney Disease patients, we usually have quarterly urine tests… or, at least, I do. My urine protein level is included. I did not know that colds and infections are a factor here. Here’s an old urine analysis of mine. You can see Protein, Urine fourth from the bottom.

Component Your Value Standard Range
Color, Urine Yellow Colorless, Light Yellow, Yellow, Dark Yellow, Straw
Clarity, Urine Clear Clear
Glucose, Urine Negative mg/dL Negative mg/dL
Bilirubin, Urine Negative Negative
Ketones, Urine Negative mg/dL Negative mg/dL
Specific Gravity, Urine 1.013 1.007 – 1.026
Blood, Urine Negative Negative
pH, Urine 7.0 5.0 – 8.0
Protein, Urine Negative mg/dL Negative mg/dL
Urobilinogen, Urine <2.0 mg/dL <2.0 mg/dL
Nitrite, Urine Negative Negative
Leukocyte Esterase, Urine Negative Negative

 

Let’s say our reader did not have a cold or infection. What else could she do to slow down this loss of protein via her urine?

The American Kidney Fund at http://www.kidneyfund.org/kidney-disease/kidney-problems/protein-in-urine.html suggests the following:

“If you have diabetes or high blood pressure, the first and second most common causes of kidney disease, it is important to make sure these conditions are under control.

If you have diabetes, controlling it will mean checking your blood sugar often, taking medicines as your doctor tells you to, and following a healthy eating and exercise plan. If you have high blood pressure, your doctor may tell you to take a medicine to help lower your blood pressure and protect your kidneys from further damage. The types of medicine that can help with blood pressure and proteinuria are called angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs).

If you have protein in your urine, but you do not have diabetes or high blood pressure, an ACE inhibitor or an ARB may still help to protect your kidneys from further damage. If you have protein in your urine, talk to your doctor about choosing the best treatment option for you.”

So far, we’ve discovered that frequent urine testing, determining if you have a cold or infection, keeping your diabetes and blood pressure under control, and/or ACE inhibitors may be helpful. But here’s my eternal question: What else can slow down the spilling of protein into our urine?

The Kidney & Urology Foundation of America, Inc. at http://www.kidneyurology.org/Library/Kidney_Health/Proteinuria.php has some more ideas about that:

“In addition to blood glucose and blood pressure control, restricting dietary salt and protein intake is recommended. Your doctor may refer you to a dietitian to help you develop and follow a healthy eating plan.”

As CKD patients, we know we need to cut down on salt intake. I actually eliminate added salt and have banned the salt shakers from the kitchen. No wonder no one but me likes my cooking. You do lose your taste for salt eventually. After all these years, I taste salt in restaurant food that makes that particular food unpalatable to me.

Hmmm, it seems to me that a list of high protein foods might be helpful here.

POULTRY…

  • Skinless chicken breast – 4oz – 183 Calories – 30g Protein – 0 Carbs – 7g Fat
  • Skinless chicken (Dark) – 4 oz – 230 Calories – 32g Protein – 0 Carbs – 5g Fat
  • Skinless Turkey (White) – 4 oz – 176 Calories – 34g Protein – 0 Carbs – 3.5g Fat
  • Skinless Turkey (Dark) – 4 oz – 211 Calories – 31g Protein – 0 Carbs – 8.1 g Fat

FISH…

  • Salmon – 3 oz – 119 Calories – 17g Protein – 0 Carbs – 5.5g Fat
  • Halibut – 3 oz – 91 Calories – 18g Protein – 0 Carbs – 3g Fat
  • Tuna – 1/4 cup – 70 Calories – 18g Protein – 0 Carbs – 0g Fat
  • Mackerel – 3 oz – 178 Calories – 16.1g Protein – 0 Carbs – 12g Fat
  • Anchovies (packed in water) – 1 oz – 42 Calories – 6g Protein – 1.3g Fat
  • Flounder – 1 127g fillet – 149 Calories – 30.7g Protein – 0 Carbs – 0.5g Fat (High Cholesterol)
  • Swordfish – 1 piece 106g – 164 Calories – 26.9g Protein – 0 Carbs – 1.5g Fat (High Cholesterol)
  • Cod – 1 fillet 180g – 189 Calories – 41.4g protein – 0 Carbs – 0.3g Fat (High Cholesterol)
  • Herring – 1 fillet 143g – 290 Calories – 32.9g Protein – 0 Carbs – 3.7g Fat (High Cholesterol)
  • Haddock – 1 fillet 150g – 168 Calories – 36.4g Protein – 0 Carbs – 0.3g Fat (High Cholesterol)
  • Grouper – fillet 202g – 238 Calories – 50.2g Protein – 0 Carbs – 0.6g Fat (High Cholesterol)
  • Snapper – 1 fillet 170g – 218 Calories – 44.7g Protein – 0 Carbs – 0.6g Fat (High Cholesterol)

BEEF…

  • Eye of round steak – 3 oz – 276 Calories – 49g Protein – 2.4g Fat
  • Sirloin tip side steak – 3 oz -206 Calories – 39g Protein – 2g Fat
  • Top sirloin – 3 oz – 319 Calories – 50.9g Protein – 4g Fat
  • Bottom round steak – 3 oz – 300 Calories – 47g Protein – 3.5g Fat
  • Top round steak – 3 oz – 240 Calories – 37g Protein – 3.1g Fat

PORK…

  • Pork loin – 3 oz – 180 Calories – 25g Protein – 0 Carbs – 2.9g Fat (High in cholesterol)
  • Tenderloin– 3 oz – 103 Calories – 18g Protein – 0.3g Carbs – 1.2g Fat (High in cholesterol)

GAME MEATS…

  • Bison – 3 0z – 152 Calories – 21.6g Protein – 0 Carbs – 3g Fat
  • Rabbit – 3 oz – 167 Calories – 24.7g Protein – 0 Carbs – 2.0g Fat
  • Venison (Deer loin broiled) – 3 oz – 128 Calories – 25.7g Protein – 0 Carbs – 0.7g Fat

GRAINS…

  • Cooked Quinoa – 1/2 cup – 115 Calories – 4.1g Protein – 22 Carbs – 2g Fat
  • Cooked Brown Rice – 1/2 cup – 106 Calories – 2.7g Protein – 23 Carbs – 0.7g Fat
  • Regular Popcorn (Air Popped no oil) – 1 cup – 60 Calories – 2g Protein – 11 Carbs – 0.6g Fat
  • Steel cut Oatmeal – 1 cup – 145 Calories – 7g Protein – 25g Carbs – 2.5g Fat
  • Multi grain bread – 1 slice – 68.9 Calories – 3.5g Protein – 11.3g Carbs – 0.2g Fat

BEANS (All nutrition values calculated for cooked beans)…

  • Tofu – 1/2 cup – 98 Calories – 11g Protein – 2g Carbs – 6g Fat
  • Lentils – 1/2 cup – 119 Calories – 9g Protein – 20g Carbs – 0.3g Fat
  • Black beans – 1/2 cup – 115 Calories – 7.8g Protein – 20 Carbs – 0.4g Fat
  • Kidney beans – 1/2 cup – 111 Calories – 7.2g Protein – 20.2 Carbs – 0.4g Fat
  • Lima beans – 1/2 cup – 110 Calories – 7.4g Protein – 19.7 Carbs – 0.3g Fat
  • Soy beans – 1/2 cup – 133 Calories – 11g Protein – 10 Carbs – 5.9g Fat

DAIRY…

  • Skim milk – 1 cup – 90 Calories – 9g Protein – 12g Carbs – 4.8g Fat
  • Low fat Yogurt – 1 cup – 148 Calories – 12g Protein – 17Carbs – 3.2g Fat
  • Non fat Yogurt – 1 cup – 130 Calories – 13g Protein – 16.9 Carbs – 0.4 Fat
  • Cheddar cheese – 1 oz – 116 Calories – 7g Protein – 0.4 Carbs – 9.2g Fat
  • Low fat Cottage Cheese – 1/2 cup – 82 Calories – 14g Protein – 3.1g Carbs – 0.7g Fat
  • One large egg – 73 Calories – 6.6g Protein – 0 Carbs – 6g Fat
  • Low fat Milk – 1 cup – 119 Calories – 8g Protein – 12 Carbs – 4.6g Fat

NUTS & SEEDS…

  • Raw Almonds – 1 oz about 22 whole – 169 Calories – 22g Carbs – 6.2g Protein – 1.1g Fat
  • Raw Pistachios – 1 oz about 49 Kernels – 157 Calories – 7.9g Carbs – 5.8g Protein – 1.5g Fat
  • Pumpkin seeds – 1 oz – 28g about 100 hulled seeds – 151 Calories – 5g Carbs – 6.0g Protein – 2.4g Fat
  • Raw Macadamia nuts – 1 oz about 10- 12 kernels – 203 Calories – 4g Carbs – 2.2g Protein – 3.4g Fat
  • Chia seeds – 1 oz – 137 Calories – 12.3g Carbs – 4.4g Protein – 0.9g Fat
  • Walnuts – 1 cup in shell about 7 total – 183 Calories – 3.8g Carbs – 4.3g Protein – 1.7g Fat
  • Raw Cashews1oz – 28g – 155 Calories – 9.2g Carbs – 5.1g Protein – 2.2g Fat

MORE HIGH PROTEIN FOODS…

  • Natural peanut butter – 1 oz – 146 Calories – 7.3g Protein – 10g Carbs – 1.6g Fat
  • Natural almond butter – 1 tbsp – 101 Calories – 2.4g Protein – 3.4 Carbs – 0.9g Fat
  • Natural cashew butter – 1 tbsp – 93.9 Calories – 2.8g Protein – 4.4 Carbs – 1.6g Fat
  • Hummus – 1 oz – 46.5 Calories – 2.2g Protein – 4.0g Carbs – 0.4g Fat
  • Tempeh Cooked – 1 oz – 54 Calories – 5.1g Protein – 2.6g Carbs – 1.0g Fat

There’s a vegan list on the same site. Be leery of protein sources that are not on your kidney diet.

Until next week,

Keep living your life!

 

But Why?

As Chronic Kidney Disease patients, we all know that proteinuria is one indication of our disease. Would you like a reminder about what proteinuria is? Here’s one from The American Kidney Fund at http://www.kidneyfund.org/kidney-disease/kidney-problems/protein-in-urine.html:

“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 (or albuminuria). Having protein in your urine can be a sign of nephrotic syndrome, or an early sign of kidney disease.”

I used to think that’s all it was: an indicator of CKD. That is until my occupational therapist and I got to talking about the edema caused by neuropathy.

Ah! Flash! We did also talk about Havimat which I wrote about last week and I checked on a number of sites to see if it were safe for an active tumor. The consensus of the sites agreed it was safe to use on someone with an active tumor that was being treated as long as it was not used on the location of the tumor itself. I feel better now about having had three sessions with Havimat since the occupational therapist was careful not to use it anywhere near my pancreas – the site of the tumor.

But I digress. Back to the topic at hand: proteinuria. It seems that protein is needed in the body, rather than being excreted in the urine. You guessed it. My question became the topic of today’s blog: But Why?

According to WebMD at https://www.webmd.com/men/features/benefits-protein#1:

“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.”

Okay, got it that protein is very necessary but what does that have to do with the chemotherapy I had that seemed to cause the proteinuria problem?  After looking at bunches of different sites (Today’s blog is taking a very long time to write.), I gleaned a little hint here and a little hint there until I figured out that certain types of chemotherapy may make proteinuria worse if you already have it, or cause it. Boo for me; I lost on that one since I already had proteinuria.

Well, what about the edema from the neuropathy? Was proteinuria affecting that in some way? Or did I have it backwards and it was the neuropathy that was causing the edema. I went to eMedicineHealth at https://www.emedicinehealth.com/neuropathy/article_em.htm#what_is_neuropathy for some help with this.

“Certain drugs and medications can cause nerve damage. Examples include cancer therapy drugs such as vincristine(Oncovin, Vincasar), and antibiotics such as metronidazole (Flagyl), and isoniazid (Nydrazid, Laniazid).”

This little tidbit is from MedicalNewsToday at https://www.medicalnewstoday.com/articles/323481.php :

“Chemotherapy can damage nerves that affect feeling and movement in the hands and feet. Doctors call this condition chemotherapy-induced peripheral neuropathy (CIPN). Symptoms can be severe and may affect a person’s quality of life.”

By the way, diabetic neuropathy is another form of peripheral neuropathy.

Uh-oh, now what do I do? The HonorHealth Research Institute in Scottsdale, Arizona, where I’m being treated offered both the gabapentin for the pain (which I skipped since I want to try non-drug treatment first) and occupational therapy. Let’s see what that might do for me. Please note that occupational therapy works at reducing the pain of the neuropathy.

I have a bag of toys. Each has a different sensory delivery on my hands and feet. For example, there’s a woven metal ring that I run up and down my fingers and toes, then up my arms and legs. I do the same with most of the other toys: a ball with netting over it, another with rubber strings hanging from it. I also have a box of uncooked rice to rub my feet and hands in… and lots of other toys. The idea is to desensitize my hands and feet.

I was also given physical exercises to do, like raising my fisted hands above my head and straightening out my fist several times.  This is one of many exercises. Do you remember the old TV show, E.R? It takes me slightly longer than one 43 minute episode to complete the exercises.

When I go to see the therapist, she uses the Havimat (electrical stimulation), another machine that sucks the chemo out (no kidding… and it doesn’t hurt either.), and a third that pulses. I am amazed at how the edema disappears when she uses these. But, unfortunately, the effect doesn’t stay very long. Compression socks have helped and, despite their not-so-pleasing appearance are quite comfortable.

Wow! Proteinuria is so much more than just an indication that you may have Chronic Kidney Disease.

Ready for a topic change? The following is part of an email I received from KDIGO (Kidney Disease – Improving Global Outcomes).

“We … invite your comments at any time.  Suggest topics, look for opportunities for KDIGO to implement its work in your area, bring new ideas to us, and help us become more relevant to the lives of patients like you. As a global organization, we seek to continue to develop communication channels to patients throughout the world.  This is difficult to do from one perspective, but if we work together we can build a robust base of individuals and ideas that will help us plan and carry out our mission.

KDIGO doesn’t have any members or local entities to whom we are accountable.  We only are accountable to you, our patients.  Outcomes of your care are our mission.  We can do it better if you work with us and give us your constructive input.

Again, thanks for letting us know you’d like to be a part of this global effort.  Your ideas are welcome and will be taken into account. “

Keep those comments coming, folks. Their email is kdigocommunications@kdigo.org.

Until next week,

Keep living your life!

Don’t Know Much about FSGS…

Being on chemotherapy is very tiring, so I stay home a lot and delve into anything that catches my eye, like FSGS. I’ve seen the letters before and had sort of a vague idea of what it might be, but what better time to explore it and whatever it may have to do with Chronic Kidney Disease than now?

Let’s start at the beginning. FSGS is the acronym for focal segmental glomerulosclerosis. Anything look familiar? Maybe the ‘glomerul’ part of glomerulosclerosis? I think we need to know the definition of glomerulosclerosis to be able to answer that question. The National Institutes of Health’s U.S. National Library of Congress’s Medline Plus at https://medlineplus.gov/ency/article/000478.htm defines it this way:

“Focal segmental glomerulosclerosis is scar tissue in the filtering unit of the kidney. This structure is called the glomerulus. The glomeruli serve as filters that help the body get rid of harmful substances. Each kidney has thousands of glomeruli.

‘Focal’ means that some of the glomeruli become scarred. Others remain normal. ‘Segmental’ means that only part of an individual glomerulus is damaged.”

So, we do know what the ‘glomerul’ part of glomerulosclerosis means. It refers to the same filters in the kidneys we’ve been discussing for the past eleven years: the glomeruli. This former English teacher can assure you that ‘o’ is simply a connective between the two parts of the word. ‘Sclerosis’ is a term you may have heard of in relation to the disease of the same name, the one in which the following occurs (according to Encarta Dictionary):

“the hardening and thickening of body tissue as a result of unwarranted growth, degeneration of nerve fibers, or deposition of minerals, especially calcium.”

Wait a minute. When I first started writing about CKD, I approached NephCure Foundation… not being certain what it was, but seeing Neph in its name. They were kind enough to ask me to guest blog for them on 8/21/11. By the way, as of August 15, 2014, NephCure Foundation became NephCure Kidney International. That makes the connection to our kidneys much more clear.

Back to FSGS. The NephCure Kidney International website at https://nephcure.org/ offers us this information:

“How is FSGS Diagnosed?

FSGS is diagnosed with renal biopsy (when doctors examine a tiny portion of the kidney tissue), however, because only some sections of the glomeruli are affected, the biopsy can sometimes be inconclusive.

What are the Symptoms of FSGS?

Many people with FSGS have no symptoms at all.  When symptoms are present the most common include:

Proteinuria – Large amounts of protein ‘spilling’ into the urine

Edema – Swelling in parts of the body, most noticeable around the eyes, hands and feet, and abdomen which causes sudden weight gain.

Low Blood Albumin Levels because the kidneys are removing albumin instead of returning it to the blood

High Cholesterol in some cases

High Blood Pressure in some cases and can often be hard to treat

FSGS can also cause abnormal results of creatinine in laboratory tests. Creatinine is measured by taking a blood sample. Everyone has a certain amount of a substance called creatinine floating in his or her blood. This substance is always being produced by healthy muscles and normally the kidneys constantly filter it out and the level of creatinine stays low. But when the filters become damaged, they stop filtering properly and the level of creatinine left in the blood goes up.”

Whoa! Look at all the terms we’ve used again and again in the last eleven years of SlowItDownCKD’s weekly blog: proteinuria, edema, albumin, cholesterol, high blood pressure, and creatinine. This is definitely something that we, as CKD patients, should know about.

Okay. Let’s say you are diagnosed with FSGS. Now what? The National Kidney Organization at https://www.kidney.org/atoz/content/focal was helpful here:

How is FSGS treated?

The type of treatment you get depends on the cause. Everyone is different and your doctor will make a treatment plan that is right for your type of FSGS. Usually, treatments for FSGS include:

  • Corticosteroids (often called “steroids”)
  • Immunosuppressive drugs
  • ACE inhibitors and ARBs
  • Diuretics
  • Diet change

Corticosteroids and immunosuppressive drugs: These medications are used to calm your immune system (your body’s defense system) and stop it from attacking your glomeruli.

ACE inhibitors and ARBs: These are blood pressure medications used to reduce protein loss and control blood pressure.”

Diuretics: These medications help your body get rid of excess fluid and swelling. These can be used to lower your blood pressure too.

Diet changes:  Some diet changes may be needed, such as reducing salt (sodium) and protein in your food choices to lighten the load of wastes on the kidneys.”

I think we need another definition here. Yep, it’s Plasmapheresis. Back to the Encarta Dictionary.

“a process in which blood taken from a patient is treated to extract the cells and corpuscles, which are then added to another fluid and returned to the patient’s body.”

Let’s go back to The NephCure Kidney International website at https://nephcure.org/ for a succinct summary of FSGS Facts.

“More than 5400 patients are diagnosed with FSGS every year, however, this is considered an underestimate because:

  • a limited number of biopsies are performed
  • the number of FSGS cases are rising more than any other cause of Nephrotic Syndrome…

NephCure estimates that there are currently 19,306 people living with ESRD due to FSGS…, in part because it is the most common cause of steroid resistant Nephrotic Syndrome in children,… and it is the second leading cause of kidney failure in children…

NephCure estimates that people of African ancestry are at a five times higher diagnosis rate of FSGS…

About half of FSGS patients who do not respond to steroids go into ESRD each year, requiring dialysis or transplantation…

Approximately 1,000 FSGS patients a year receive kidney transplants… however, within hours to weeks after a kidney transplant, FSGS returns in approximately 30-40% of patients….”

As prevalent and serious as this sounds, please remember that FSGS is a rare kidney disease. Knowing what we now know just may help you keep your eyes open for it.

Until next week,

Keep living your life!

Something New and Entirely Different

I sit here trying to write this week’s blog and being interrupted every five minutes by a long involved commentary about one thing or another. Why do I tolerate it? Because it’s Bear, my Bear, my husband who is interrupting. Why not just ask him not to, you say. Well, it’s involved. Basically, it’s because he has Alzheimer’s, doesn’t know how long winded he’s being, and feels terribly insulted when I ask him not to interrupt so I can write.

Sometimes, we can have a conversation without the interruptions and without the involved commentary. Obviously, not right now, but during one of these conversations, I explained to him that I had been asked to write about his Alzheimer’s but felt I needed to preserve his privacy. This good man blew that up. He said something to the effect that if it’s going to help even one person to know what he experiences, what I experience, with this disease, then I was obliged to write about it. His privacy wasn’t more important than that.

Now you have just an inkling of why I love him… and I do, Alzheimer’s or not. Since this is my kidney disease blog, it would make sense to look for any connections between Alzheimer’s and kidney disease. If they exist, that is.

I was not happy to find the following on The National Kidney Foundation’s page at https://www.kidney.org/news/ekidney/august08/Dementia_august08

“People with albuminuria were about 50% more likely to have dementia than people without albuminuria, Dr. Joshua I. Barzilay, at Emory University School of Medicine in Atlanta, Georgia, and his research team report. The association between the two conditions was still strong after controlling for age, education and risk factors, such as high blood pressure, diabetes, smoking, and cholesterol levels. There was a weaker relationship between albuminuria and mild cognitive impairment.”

By now it’s common knowledge to my readers that diabetes is the foremost cause of Chronic Kidney Disease with high blood pressure (hypertension) being the second.

How about some reminders right about now?

The American Diabetes Association at http://www.diabetes.org/diabetes-basics/common-terms/?loc defines the most common type of diabetes in the following manner:

“diabetes mellitus (MELL-ih-tus)
a condition characterized by hyperglycemia resulting from the body’s inability to use blood glucose for energy. In Type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In Type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly.”

As for high blood pressure, also known as hypertension, The National Library of Medicine PubMed Health was able to help us out:

“It happens when the force of the blood pumping through your arteries is too strong. When your heart beats, it pushes blood through your arteries to the rest of your body. When the blood pushes harder against the walls of your arteries, your blood pressure goes up.”

Keep this in mind for later. Here’s the definition of albumin from What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

Albumin: Water soluble protein in the blood.

As mentioned in SlowItDownCKD 2013, “according to the physicians’ journal BMJ: ‘albuminuria [is] leakage of large amounts of the protein albumin into the urine.’”

Many of us with CKD have albuminuria at one time or another. Does that mean that 50% of us are going to develop dementia? No, not at all. According to the National Kidney Foundation, that 50% of us with albuminuria are MORE LIKELY to develop dementia, not GOING TO.

I get it. By now, most of you are probably asking what Alzheimer’s has to do with dementia. I popped right over to the Alzheimer’s Association’s (my new best friend) website at https://www.alz.org/alzheimers-dementia/what-is-alzheimers  for an explanation.

“Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.”

I’ll bet you want a definition of dementia now. Let’s go to Healthline.com at https://www.healthline.com/health/dementia for one:

“Dementia is a decline in cognitive function. To be considered dementia, mental impairment must affect at least two brain functions. Dementia may affect:

  • memory
  • thinking
  • language
  • judgment
  • behavior”

It’s not surprising that the two definitions look so much alike. Alzheimer’s is one of the ten kinds of dementia that I know about. Different websites have different numbers for how many different kinds of dementia there are. I used the information from MedicineNet at https://www.medicinenet.com/dementia/article.htm#what_are_alzheimers_vascular_and_frontotemporal_dementia

Did you keep the definition of albumin in mind? The key word in that is protein… and that’s where the connection between Alzheimer’s and CKD lies. The information is from an unusual source for me to use, Science Magazine at https://www.sciencemag.org/news/2018/01/alzheimer-s-protein-may-spread-infection-human-brain-scans-suggest:

 “Tau is one of two proteins—along with β-amyloid—that form unusual clumps in the brains of people with Alzheimer’s disease. Scientists have long debated which is most important to the condition and, thus, the best target for intervention. Tau deposits are found inside neurons, where they are thought to inhibit or kill them, whereas β-amyloid forms plaques outside brain cells.”

I realize this is getting very technical and may concentrate on particular elements of this connection in future blogs, but right now, I’d like to remind you that the National Kidney Fund is hosting a webinar “Eating healthy with diabetes and kidney disease” in recognition of National Diabetes Awareness Month on Wednesday, November 28, 2018 from 1:00 – 2:00 p.m. EST.

Again, diabetes… the number one cause of Chronic Kidney Disease. Read more about CKD, diabetes, and hypertension (as well as many other topics) in the SlowItDownCKD series and What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. All eight books are available in print and digital on Amazon.com and B & N.com.

Did you know that the first day of Chanukah is December 3rd? We start celebrating Chanukah the night before the first day and celebrate for eight nights… and there are eight books. What a coincidence! (Just planting a seed here, folks.)

Until next week,

Keep living your life!

Rising to the Challenge

Remember Loyal Reader from a few years ago? He and I are still in touch and toss around ideas here and there. He sent me an article about Chronic Kidney Disease patients being at higher risk for Hepatitis C along with the comment, “Hmmm, I wonder why?” I know a challenge when I see one, so let’s find out.

Back to basics: what is Hepatitis C anyway? As I mentioned in SlowItDownCKD 2013, Hepatitis is from the … Greek word root, hepa, which means liver.” Interesting, but not enough information for our purposes.

According to our old friend the MayoClinic at https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278,

“Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood.”

The National Kidney Foundation at https://www.kidney.org/sites/default/files/HepC_Infographic.pdf explained why hepatitis C is associated with Chronic Kidney Disease:

“Hepatitis C infection is strongly associated with kidney disease. Hepatitis C is more common in people with kidney disease than the general population. Hepatitis C can be a cause of kidney disease, or make existing kidney disease worse. People receiving a kidney transplant, or donating a kidney, are routinely tested for hepatitis C.

Hemodialysis and Hepatitis C People receiving long-term hemodialysis have a risk of getting hepatitis C through transmission in the dialysis clinic. The risk is small because of strict standard health precautions used in dialysis units today. However, some cases of hepatitis C being spread between patients have been reported.”

By the way, NKF uses infographs which are easy to understand.

In SlowItDownCKD 2017, I explained what KDIGO is. We’re going to need that explanation in just a moment.

“This stands for KIDNEY DISEASE | IMPROVING GLOBAL OUTCOMES. Their homepage at KDIGO.org states, “KDIGO MISSION – Improving the care and outcomes of kidney disease patients worldwide through the development and implementation of global clinical practice guidelines.”

Here’s where KDIGO comes in. Way back in 2008, the following was published in the April issue of the official journal of the International Society of Nephrology, Kidney International, which supports the KDIGO:

“‘HCV infection is associated with an increased prevalence of reduced kidney function, albuminuria, and an increased risk of developing end stage renal disease,’ says Dr. Jaber, who is also vice chair for clinical affairs, Department of Medicine at Caritas St. Elizabeth’s Medical Center, ‘HCV infection is also associated with increased mortality among patients undergoing maintenance hemodialysis and among kidney transplant recipients.'”

But, in 2018, KDIGO updated their recommendations: “We recommend screening all patients for hepatitis C virus (HCV) infection at the time of initial evaluation of chronic kidney disease (CKD).”

Hmmm, as Loyal Reader would say, I wonder if this has something to do with the albuminuria Dr. Jaber mentioned in 2008.

Let’s see what we can find out. I found this in SlowItDownCKD 2015:

“Albumin is a protein.  It will show up as microalbumin in your urine test.  It may also show up as proteinuria since albumin is a protein.”

We can figure out that microalbumin is extremely small particles of albumin, but what about proteinuria? I went back, back, back to my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for the definition:

“Protein in the urine, not a normal state of being.”

Does anyone else feel like we’re going down the rabbit hole here? Of course it’s not normal! It means we have CKD. Now, if there’s any amount   of protein in our urine… and there may be since we do have Chronic Kidney Disease… it looks like Hepatitis C Virus can raise that amount and lower our GFR. Not good, not good at all.

So what do we do about it? WebMD at https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-c#2 held the least medicalese answer about the drugs that all the sites I viewed saw as the best treatment plan:

“Your treatment will depend on many things including what type of hepatitis C virus you have. In the U.S., the most common type is genotype 1, followed by genotypes 2 and 3. Genotypes 4, 5, and 6 are very rare in the U.S. Your doctor will help you figure out what’s right for you, based on your medical needs and insurance coverage. “

I know. I had the same question. What is a genotype? Hello, Dictionary.com, my old friend, at https://www.dictionary.com/browse/genotype.

“the genetic makeup of an organism or group of organisms with reference to a single trait, set of traits, or an entire complex of traits.”

Well, that makes sense. Just one more thing, though. Is it possible to know we have Hepatitis C before we’re diagnosed with CKD – at which time we should be tested for HCV – or even if we don’t have CKD? That is a loaded question. According to the Centers for Disease Control (CDC), fully 80% of those with acute or short term HCV won’t have any symbols. The other 20% may experience mild symptoms you might experience with any illness: fever, joint pain, being tired and/or nauseous, and the like. However with chronic or long term HCV, you might experience dark urine and/or jaundice of the skin and eyeballs. To complicate matters even more, there are three different kinds of hepatitis. You can read much more about hepatitis at https://www.cdc.gov/hepatitis/hcv/cfaq.htm

There’s one thing that I haven’t yet made clear. Your body rids itself of wastes and excess fluids through either the kidneys or the liver. If you have CKD, your kidneys are already not functioning as well as they should which means you’re not getting rid of either wastes or excess fluids efficiently. Guess what. One of the functions of the liver is to also clean your blood. Having two organs that are not effectively cleansing your blood is not a position you want to be in… ever.

This was a difficult blog to write. There were so many little pieces to link together. But thanks for the challenge, Loyal Reader, I learned a lot.

Switching topics now. Since the weather has been,uh, difficult lately (to say the least), I thought this might be helpful.  Use this link rather than clicking below: https://ecs.page.link/SVpB 

Until next week,

 

Keep living your life!