It’s Not Cancer

We have a habit of using the dining room table as our desks when we both want to work yet be together while doing so. But it is our dining room table. That means each time we have company over for dinner, we need to clear the table. Bear brings his papers into his office, and I bring mine into my office. I’ve really slowed down since the pancreatic cancer, so sometimes papers are piled upon the papers I haven’t yet organized from the last time we had dinner guests.

Here in the USA, last weekend was Mother’s Day. Hello to my lovely daughter, her husband, and the two little boys. And there goes another bunch of papers into my office. This is not my usual way. I like neat. I like organized. I couldn’t stand it anymore so I started cleaning them up. At the very bottom of one pile, I found the word ‘angiomyolipoma’ on a piece  of scrap paper. That was it, nothing other than that word. Of course, I just had to know what it meant [which might have given me a clue as to why it was there on my desk at all].

I discovered that it’s also called ‘renal angiomyolipoma.’ Aha! Renal, that means kidney. Of course, I needed to know more so I turned to The Cleveland Clinic.

“A renal angiomyolipoma (AML) is a type of tumor in your kidney. Almost all are benign (noncancerous), but they can hemorrhage, which can be life-threatening. A tumor occurs when cells grow and divide more than they should. A renal angiomyolipoma is made of blood vessels, muscle cells and fat.”

Why would that happen, I wondered. Turns out I wasn’t the only one wondering. After perusing many sites, I realized no one knew what really caused renal angiomyolipoma. However, the American Hospital in Paris offered the following as possible causes:

• “ Tuberous sclerosis (TS), also known as Bourneville disease: a rare genetic disease that stimulates the development of angiomyolipomas. Patients with TS frequently present with multiple angiomyolipomas affecting both kidneys.
• Associated genetic syndromes: Angiomyolipomas may be linked to other genetic diseases, such as Cowden syndrome.
• Feminine gender: statistics show that women are more likely than men to develop angiomyolipomas. This increased prevalence in women suggests that hormones may influence the growth of these tumors.”

Maybe I’ll do better looking for the symptoms. Bingo! VerywellHealth offers the following:

“It is common to have an angiomyolipoma without any symptoms. More than 80% of these tumors are found by chance during imaging tests for other issues…^.

Though rare, symptoms typically occur when the tumor grows to 40 millimeters (mm) (a little over 1.5 inches) or larger and begins to spread. In tumors of this size, symptoms can occur in 80% of cases and can include the following…:

• Flank pain (pain between your back and abdomen on one or both sides of your body)
• A palpable mass (a mass that can be felt)
• Hematuria (blood in your urine)
• Newly diagnosed high blood pressure
• Anemia
• Urinary tract infection (UTI)
• Renal (kidney) failure

A 40 mm or larger angiomyolipoma can cause spontaneous retroperitoneal hemorrhage, also called Wunderlich syndrome. This rare but potentially life-threatening condition involves bleeding in the area behind your abdominal cavity. It affects fewer than 15% of people who have these tumors…^.”

I wonder if there’s any connection between the fact that chronic kidney disease often has no symptoms and now we find that is also true of renal angiomyolipoma? But that’s a blog for another day.

What about diagnosis? How is that made? According to MedicineNet:

“The preliminary diagnosis of angiomyolipoma is usually done either incidentally while the patient is undergoing imaging tests for other reasons or directly by ultrasound, CT scan, and/or MRI scan. Urologists, radiologists, and emergency medicine physicians are often the first doctors to suspect and/or diagnose these tumors. In addition, ob-gyn doctors may find such tumors while doing ultrasound studies on pregnant females; angiomyolipoma bleeding problems are rare but possible in pregnancy.”

Let’s see now. We’ve looked at what it is, what may cause it, what the symptoms may be, and diagnosis. What’s next? Of course, it’s the treatment. Hmmm, time to check MedicalNewsToday:

“In some cases, particularly when the angiomyolipoma causes symptoms, a doctor may suggest the following:

• Selective renal artery embolization: A minimally invasive procedure that involves inserting a catheter through an artery into the leg and guiding it to the renal arteries. The surgeon then injects particles into the blood vessels around the tumor, blocking its blood flow and reducing its size.
• Nephron-sparing surgery: This procedure removes the tumor while preserving as much kidney tissue as possible.
• Complete nephrectomy: This is a type of surgery that removes the entire kidney.
• Ablation: Some methods include cryoablation and radiofrequency techniques. These procedures involve using extreme cold or heat to destroy tumor tissue.
• Treatment with mTOR inhibitors: These medications may help individuals with TSC manage their angiomyolipomas.”

Time to switch topics. I’d promised Elizabeth Oldham I’d let you know about the Cleveland Asian Festival only to find out it was this past weekend. Why not keep your eyes on her Facebook page to see what other kidney related festivals she’s volunteering at? Sorry, Elizabeth. BUT, here’s the next occasion Elizabeth has posted:

“Calling All Wellness Warriors!
Are you ready to level up your health game?  Join us at the Cleveland MOTTEP Workshop:

“How to Be a Wellness Warrior” and unlock the secrets to vibrant living!
Join us June 29th, 2024 at Centers for Dialysis Care East from 10am-1pm.

 Secure Your Spot:
Visit our website at (https://clevelandmottep.org) or dial 216-658-0727 to RSVP. Limited spots available—don’t miss out!

All participants will receive a gift card after completing the workshop!”

Hopefully those of you in Cleveland, Ohio, will be able to save that date.

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!

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!

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!

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!

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!

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!

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!