To Biopsy or Not to Biopsy

My husband of eight years, Bear, is a veteran. We won’t be celebrating him today, but we will on Veterans Day. Today, we celebrate those who weren’t able to return to us, to marry, to have children or grandchildren, to further their education, or start the business of their dreams. Today, we celebrate those who never got the chance to discover and develop their art or their craft, the ones who didn’t grow older. Today is Memorial Day and we remember all those who fought so we didn’t have to. I’ve thrown in a couple of clichés because they work here; they’re meaningful. Thank you fallen warriors for your sacrifice and thank you to your families, too. 

There is no way to glide into today’s blog topic from the above tribute, so I’ll just plunge ahead. 

I read about people having kidney biopsies all the time and I wonder why I never had one. Mind you, I’ve been wondering this for well over a decade. It’s time to find out, don’t you think? 

For those who don’t recognize the term: 

“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.” 

Thank you to MedlinePlus for that information. MedlinePlus is part of the U.S. National Library of Medicine which, in turn, is part of the National Institutes of Health. 

Oh, a little more about pathologists. They study the causes and effects of diseases, so it makes sense that they would be the ones at the microscope.  

Let me give you an example of a biopsy. We all know I had pancreatic cancer. It was diagnosed via a fine needle aspiration. WebMD explains: 

“In fine needle aspiration, a thin needle is inserted into an area of abnormal-appearing tissue or body fluid. As with other types of biopsies, the sample collected during fine needle aspiration can help make a diagnosis or rule out conditions such as cancer. Fine needle aspiration is generally considered a safe procedure. Complications are infrequent.” 

Because the organ being biopsied was the pancreas, a needle could not be inserted into the skin. The pancreas is well hidden in the body, so an endoscopy was performed. That’s the opposite of a colonoscopy. [Lots of ‘scope’ or ‘scopy’ words today.] Instead of a long thin tube being inserted into the anus, it was inserted into the mouth and a fine needle was threaded through this tube to obtain the necessary tissue. 

Got it? Now, how is a kidney biopsy performed and why? Or in my case, why not? 

I turned to my trusted friend The MayoClinic for some answers. 

“A kidney biopsy may be done to: 

Diagnose a kidney problem that can’t otherwise be identified 

Help develop treatment plans based on the kidney’s condition 

Determine how quickly kidney disease is progressing 

Determine the extent of damage from kidney disease or another disease 

Evaluate how well treatment for kidney disease is working 

Monitor the health of a transplanted kidney or find out why a transplanted kidney isn’t working properly”  

Well, that all makes sense to me so why didn’t my nephrologist order one for me? [I’m starting to sound like the one kid in the class who wasn’t invited to the birthday party.] 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 clarified for me: 

“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.” 

Oh, I see. I didn’t have hematuria and my proteinuria was minimal. The cause of the problem seemed to be clear. I was getting older and so were my kidneys. [Maybe I really didn’t want to be invited to this birthday party after all.] 

I still wanted to know how the procedure was done. Was a needle really stuck through your skin? Did it hurt? The National Institute of Diabetes, and Digestive and Kidney Diseases, also part of the National Institutes of Health, offered an extremely detailed answer. 

“The procedure typically takes about an hour and includes the following steps: 

Most people will lie on their abdomen on an examination table. The technician will place a firm pillow or sandbag under a person’s body to support the abdomen and help push the kidneys up toward the person’s back and the surface of the skin. People who have a transplanted kidney lie on their backs because surgeons place transplanted kidneys in the front-lower part of the abdomen, to one side of the bladder. 

A nurse or technician will give the person sedatives through the IV. 

The health care provider will mark the point where the needle will enter the skin, clean the area, and inject a local anesthetic to numb the area. 

Next, the health care provider uses imaging techniques, such as ultrasound, to guide the biopsy needle into the kidney. Ultrasound uses a device called a transducer that bounces safe, painless sound waves off organs to create an image of their structure. Sometimes the health care provider uses a computerized tomography scan or magnetic resonance imaging to guide the needle into the kidney. 

The health care provider will ask the person to hold his or her breath and stay still as the health care provider inserts the biopsy needle and removes the kidney tissue. When the health care provider takes the biopsy, the instrument will make a clicking or popping noise. The health care provider may need to insert the needle three or four times. People most often will need to hold their breath for about 30 seconds or a little longer for each insertion. 

The health care provider uses imaging techniques such as ultrasound to guide the biopsy needle into the kidney. 

For people with bleeding problems, the health care provider uses a laparoscope—a thin tube with a video camera. This procedure is surgery that requires general anesthesia. The surgeon makes a small incision into the back and inserts the laparoscope to see the kidney. The surgeon can insert tiny tools through the laparoscope to collect tissue samples and can watch after the procedure through the camera to make sure that if there is any bleeding, he or she can stop it.” 

Now I know… and so do you. 

Until next week, 

Keep living your life! 

Missing the Connection

During this second week of National Kidney Month, we have another reader directed blog. She had stumbled across The Long Awaited Sulfa Blog and had some questions about it and NAC. Hold on, I’ll get to NAC in a moment. Let’s start with sulfite, which I had always thought was not the same as sulfa. Did our reader mistype? Her verbatim question was, “Have you heard anything about NAC and CKD with sulfite sensitivity?”

According to MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=27721:

“Sulfite sensitivity: Adverse reactions of an allergic nature to sulfites. Sulfites occur in fermentation and also occur naturally in a number of foods and beverages including wine. Sulfites are used for their preservative properties. Sulfite sensitivity occurs most often in asthmatic adults — predominantly women. It is uncommon in preschool children. Adverse reactions to sulfites in nonasthmatics are rare. Sulfite sensitivity reactions range from mild to severe and may include skin, respiratory, or gastrointestinal signs and symptoms. Bronchoconstriction with wheezing is the most common sensitivity response in asthmatics.”

While I do know this reader is a woman, I do not know if she is asthmatic or a wine drinker.

Let’s move along to NAC. Healthline at https://www.healthline.com/nutrition/nac-benefits#section12 (Yes, that is the same Healthline that chose SlowItDownCKD as best kidney blog two years in a row.) tells us, it is N-Acetyl Cysteine and explains what this supplement is and what it can do for you. I added asterisks next to definitions you may need.

“Cysteine is a semi-essential amino acid.

It’s considered semi-essential because your body can produce it from other amino acids, namely methionine and serine. It becomes essential only when the dietary intake of methionine and serine is low.

Cysteine is found in most high-protein foods, such as chicken, turkey, yogurt, cheese, eggs, sunflower seeds and legumes.

N-acetyl cysteine (NAC) is a supplement form of cysteine.

Consuming adequate cysteine and NAC is important for a variety of health reasons — including replenishing the most powerful antioxidant in your body, glutathione. These amino acids also help with chronic respiratory conditions, fertility and brain health.

Here are the top 9 health benefits of NAC.

  1. Essential for Making the Powerful Antioxidant Glutathione

NAC is valued primarily for its role in antioxidant production.

Along with two other amino acids — glutamine and glycine — NAC is needed to make and replenish glutathione.

*Glutathione is one of the body’s most important antioxidants, which helps neutralize free radicals that can damage cells and tissues in your body.

It’s essential for immune health and fighting cellular damage. Some researchers believe it may even contribute to longevity ….

Its antioxidant properties are also important for combatting numerous other ailments caused by oxidative stress, such as heart disease, infertility and some psychiatric conditions….

  1. Helps With Detoxification to Prevent or Diminish Kidney and Liver Damage

NAC plays an important role in your body’s detoxification process.

It can help prevent side effects of drugs and environmental toxins….

In fact, doctors regularly give intravenous (IV) NAC to people with an acetaminophen overdose to prevent or reduce kidney and liver damage ….

NAC also has applications for other liver diseases due to its antioxidant and anti-inflammatory benefits ….

  1. May Improve Psychiatric Disorders and Addictive Behavior

*NAC helps regulate levels of glutamate — the most important neurotransmitter in your brain….

While glutamate is required for normal brain action, excess glutamate paired with glutathione depletion can cause brain damage.

This may contribute to mental health conditions, such as bipolar disorder, schizophrenia, obsessive-compulsive disorder (OCD) and addictive behavior….

For people with bipolar disease and depression, NAC may help decrease symptoms and improve your overall ability to function. What’s more, research suggests that it may play a role in treating moderate to severe OCD ….

NAC supplements can also help decrease withdrawal symptoms and prevent relapse in cocaine addicts ….

  1. Helps Relieve Symptoms of Respiratory Conditions

NAC can relieve symptoms of respiratory conditions by acting as an antioxidant and expectorant, loosening mucus in your air passageways.

As an antioxidant, NAC helps replenish glutathione levels in your lungs and reduces inflammation in your bronchial tubes and lung tissue.

People with chronic obstructive pulmonary disease (COPD) experience long-term oxidative damage and inflammation of lung tissue, which causes airways to constrict — leading to shortness of breath and coughing.

NAC supplements have been used to improve COPD symptoms, exacerbations and lung decline ….

Those with chronic bronchitis can also benefit from NAC.

Bronchitis occurs when the mucous membranes in your lungs’ bronchial passageways become inflamed, swell and shut off airways to your lungs….

By thinning mucus in your bronchial tubes and boosting glutathione levels, NAC may help decrease the severity and frequency of wheezing, coughing and respiratory attacks ….

In addition to relieving COPD and bronchitis, NAC may improve other lung and respiratory tract conditions like cystic fibrosis, asthma and pulmonary fibrosis, as well as symptoms of nasal and sinus congestion due to allergies or infections ….

  1. Boosts Brain Health by Regulating Glutamate and Replenishing Glutathione

NAC’s ability to replenish glutathione and regulate brain glutamate levels can boost brain health.

*The brain neurotransmitter glutamate is involved in a broad range of learning, behavior and memory actions, while the antioxidant glutathione helps reduce oxidative damage to brain cells associated with aging….

Because NAC helps regulate glutamate levels and replenish glutathione, it may benefit those with brain and memory ailments ….

NAC supplements appear to improve both dopamine function and disease symptoms such as tremors ….

  1. May Improve Fertility in Both Men and Women

Approximately 15% of all couples trying to conceive are affected by infertility. In almost half of these cases, male infertility is the main contributing factor ….

Many male infertility issues increase when antioxidant levels are insufficient to combat free radical formation in your reproductive system. The oxidative stress can cause cell death and reduced fertility ….

In some cases, NAC has been shown to improve male fertility….

In addition, NAC may improve fertility in women with polycystic ovary syndrome (PCOS) by inducing or augmenting the ovulation cycle ….

  1. May Stabilize Blood Sugar By Decreasing Inflammation in Fat Cells

High blood sugar and obesity contribute to inflammation in fat tissue.

This can lead to damage or destruction of insulin receptors and put you at a higher risk of type 2 diabetes ….

  1. May Reduce Heart Disease Risk by Preventing Oxidative Damage

Oxidative damage to heart tissue often leads to heart disease, causing strokes, heart attacks and other serious conditions.

NAC may reduce heart disease risk by reducing oxidative damage to tissues in your heart ….

It has also been shown to increase nitric oxide production, which helps veins dilate and improves blood flow. This expedites blood transit back to your heart and can lower your risk of heart attacks ….

  1. Ability to Boost Glutathione Levels May Improve Immune Function

NAC and glutathione also boost immune health.

Research on certain diseases associated with NAC and glutathione deficiency suggests that immune function might be improved — and potentially restored — by supplementing with NAC….

High levels of NAC in your body may also suppress HIV-1 reproduction.

For your body to make the amino acid cysteine, you need adequate amounts of folate, vitamin B6 and vitamin B12. These nutrients can be found in beans, lentils, spinach, bananas, salmon and tuna.

While most protein-rich foods, such as chicken, turkey, yogurt, cheese, eggs, sunflower seeds and legumes, contain cysteine, some people choose to supplement with NAC to increase their cysteine intake.

NAC has low bioavailability as an oral supplement, meaning that it’s not well absorbed. The accepted daily supplement recommendation is 600–1,800 mg of NAC ….”

Okay, I don’t get it. Have I missed something about the connection between sulfite sensitivity and NAC? If you can find what I missed, please let us know.

Ah, if only I could have been more helpful.

Until next week,

Keep living your life!