And, Finally … (Part 1)

As National Donate Life Month draws to a close, we have a guest blog from Uncle Jim. That’s the same Jim Myers who is off to Washington, D.C. to speak on our behalf, has more Facebook groups than I can count right now, has his own podcast, and is just always involved with kidney matters. We are lucky to have him on our team.

Jim has approached the same topic I wrote about several months ago, but his approach is much more detailed and more in-depth than the blog I wrote. Here is something kidney transfer recipients should keep in mind as you read today’s blog: Most kidney transplant patients experience hearing loss, especially at higher frequencies. Unfortunately, kidney transplantation may not significantly improve hearing problems.

Since Uncle Jim is so thorough, I’ve had to separate his guest blog into two blogs, so you know next week will be on the same topic. Take it away, Jim!

 THE CONNECTION BETWEEN CKD AND HEARING LOSS

In my lifetime I have lost the hearing in my right ear. Recently, I discovered that my hearing loss may be connected to my 42 years of CKD/PKD, so I wanted to share what I have learned. I did a broadcast on Friday, March 8, 2024 on Hearing Loss and Kidney Disease. Here are some of my thoughts.

According to experts, there is a connection kidney disease and loss of hearing. (Nature.com)
There are nearly 1.6 billion people that suffer from hearing loss & it is the third-leading cause of disability worldwide. Chronic kidney disease (CKD) is also a common condition that is associated with adverse clinical outcomes and high health-care costs. It affects 15% of US adults & 37 million x are estimated to have chronic kidney disease.

The question is whether or not there is a connection between the two.  The answer appears to be yes. According to experts, the kidneys and the hearing organs share a common morphogenetic (same cells, tissue & genetic structure) origin and rely on similar biological structures (for example, cilia) and processes (for example, specialized cellular transport mechanisms) to function. So, the same Genetic Abnormalities that cause CKD can also cause hearing loss, and vice versa.

The NIH states,” Inadequate excretion of metabolic waste products by the kidneys results in circulation of these toxic materials in the body. This can cause damage to tissues and organ systems including the auditory system which can lead to hearing loss.” According to Nature.com, “A strong, graded and independent relationship exists between kidney function and the risk of hearing loss; the highest risk is observed in patients on haemodialysis, but kidney transplant recipients and people with mild CKD are also at increased risk.” Because tissue in our ear is substantially similar to the tissue in our kidneys, the toxic build up that damages kidney tissue also is capable of damaging inner ear tissue.

This appears to be confirmed by a 2010 study in Australia, that not just specific kidney diseases, but kidney disease in general can cause hearing loss in kidney patients. “This study examined the medical records of 2,564 people aged 50 and over, 513 of whom had moderate chronic kidney disease. Some 54.4% of all the patients with chronic kidney disease had some degree of hearing loss, as compared to only 28.3% of those who had no kidney problems.” Even more interesting, 30% of the CKD patients had a severe hearing loss compared to just 10% in those patients without CKD.”

The study concluded, “The link can be explained by structural and functional similarities between tissues in the inner ear and in the kidney. Additionally, toxins that accumulate in kidney failure can damage nerves, including those in the inner ear.” Also, some treatments for kidney ailments are ototoxic, meaning they cause hearing loss.”

As stated earlier, this is readily found in patients that are on hemodialysis. Experts suggest that infants, children and  adults with malformation or dysfunction of their hearing organs should be evaluated for the presence of malformation or dysfunction of their kidneys, and people with kidney disease should have their hearing checked for loss.

Some types of kidney diseases are mentioned more prominently than others in the literature as causes of hearing loss and if you have one of these diseases you may wish to have your hearing checked as well as your  kidney function. These diseases include:

• Alport’s Syndrome
• Polycystic Kidney Disease
• Meniere’s Disease

Many people with Alport’s Syndrome have problems with their ears and eyes. Alport syndrome is a rare inherited disorder that damages the tiny blood vessels in the kidneys. It can also cause hearing loss and eye problems. Alport syndrome is an inherited form of kidney inflammation (nephritis). It is caused by a defect (mutation) in a gene for a protein in the connective tissue, called collagen. The disorder is rare. There are three genetic types:

• X-linked Alport syndrome (XLAS) — This is the most common type. The disease is more severe in males than in females.
• Autosomal recessive Alport syndrome (ARAS) — Males and females have equally severe disease.
• Autosomal dominant Alport syndrome (ADAS) — This is the rarest type. Males and females have equally severe disease.

The frequency in which hearing loss appears with Alport’s is striking. Studies show that, approximately, 70% of patients with AS suffer from progressive sensorineural hearing loss.  Over time, Alport syndrome also leads to hearing loss in both ears. By the early teens, it is more common in males with XLAS, though in females, hearing loss is not as common and happens when they’re adults. With ARAS, boys and girls have hearing loss during childhood. With ADAS, it occurs later in life. Hearing loss usually occurs before kidney failure. Approximately 80% of males with X-linked Alport syndrome (XLAS) develop hearing loss during their lifetime, often by their teens. Hearing loss in females with XLAS is less frequent and occurs later in life, although about 40% will experience hearing loss.

Studies have shown that Polycystic Kidney Disease can cause hearing loss. One study in particular found a family with ADPKD associated with bilateral sensorineural deafness in a pedigree of four affected members in four generations.

Gail here. I found myself wanting to read more, but this blog is already longer than usual. Keep yourself primed for the remainder of Uncle Jim’s guest blog next week.

By the way, have you listened to Uncle Jim interview me last Friday night? Here’s the YouTube of it:

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!

It’s National Kidney Month

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

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

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

HISTORY OF NATIONAL KIDNEY MONTH

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

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

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

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

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

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

NATIONAL KIDNEY MONTH TIMELINE

1984

National Organ Transplant Act Passes

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

1954

First Successful Kidney Transplant

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

1943

Dialysis Invented

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

1902

Animal Experiments

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

NATIONAL KIDNEY MONTH FAQS

What month is National Kidney Month?

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

Is there a ribbon for kidney disease?

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

What are the symptoms of chronic kidney disease?

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

HOW TO OBSERVE NATIONAL KIDNEY MONTH

1. Join the organ donor registry

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

2. Donate to a kidney non-profit

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

3. Be good to your kidneys

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

5 FASCINATING FACTS ABOUT KIDNEYS

1. You only need one kidney to live

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

2. Your kidneys are lopsided

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

3. You can drink too much water

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

4. Sausage casing and orange juice cans

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

5. Climate change may increase kidney disease

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

WHY NATIONAL KIDNEY MONTH IS IMPORTANT

1. It reminds us to be good to our bodies

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

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

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

3. It shows that science is awesome

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

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

Until next week,

Keep living your life!

I Hear Ya

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

The National Library of Medicine helped in starting my research:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MedlinePlus gives us an example one of the diseases involved:

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

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

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

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

“There are three types of hearing loss:

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

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

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

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

Until next week,

Keep living your life!

To Toast or Not to Toast

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

At the Heart of The Matter

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

I Checked This on a Whim

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

Oh, Those Pearly Whites

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

Needling You

I haven’t had a kidney biopsy, but many of my readers have. One of them requested a blog about kidney biopsies. Looks like I’m going to learn along side of you again. Frankly, I enjoy the learning.

Okay now, what is a kidney biopsy? Obviously, whatever it is is performed on the kidney. Here’s how MedlinePlus explains the biopsy part of that phrase:

“A biopsy is a procedure that removes cells or tissue from your body. A doctor called a pathologist looks at the cells or tissue under a microscope to check for damage or disease. The pathologist may also do other tests on it.

Biopsies can be done on all parts of the body. In most cases, a biopsy is the only test that can tell for sure if a suspicious area is cancer. But biopsies are performed for many other reasons too.

There are different types of biopsies. A needle biopsy removes tissue with a needle passed through your skin to the site of the problem. Other kinds of biopsies may require surgery.”

Let’s see how a kidney biopsy is performed, courtesy of RadiologyInfo:

“Most areas of the body can be biopsied with a needle device. This is the least invasive option, and usually allows for the patient to return home the same day. Imaging guidance with x-ray, ultrasound, CT or MRI allows for accurate placement of the needle to locate the best place to take a tissue sample.

In hard to reach places, biopsies using surgery in a hospital operating room may sometimes be necessary. A surgeon will perform surgery to remove the tissue needed for the biopsy. The surgeon may use an instrument with a camera to help locate the best place to biopsy and remove the tissue sample.

Using imaging guidance, the doctor inserts the needle through the skin and advances it into the lesion.

They will remove tissue samples using one of several methods.

• In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
• In a core needle biopsy, the automated mechanism moves the needle forward and fills the needle trough, or shallow receptacle, with ‘cores’ of tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated several times.
• In a vacuum-assisted biopsy, the doctor inserts the needle into the site of abnormality. They activate the vacuum device, which pulls the tissue into the needle trough, cuts it with the sheath, and retracts it through the hollow core of the needle. The doctor may repeat this procedure several times.”

There’s quite a bit of medical terminology in the blog so far, so I concocted a little dictionary for us. Of course, I used my favorite dictionary [Let me know if you’re tired of me saying that.], the Merriam-Webster.

CT: a method of producing a three-dimensional image of an internal body structure by computerized combination of two-dimensional cross-sectional X-ray images. abbreviation CT. called also computed axial tomography, computerized axial tomography, computerized tomography

MRI: magnetic resonance imaging  –  a noninvasive diagnostic technique that produces computerized images of internal body tissues and is based on nuclear magnetic resonance of atoms within the body induced by the application of radio waves [Gail here: this is the one where you have to make sure you’re not wearing anything with metal in it.]

Ultrasound: 1 – vibrations of the same physical nature as sound but with frequencies above the range of human hearing 2 – the diagnostic or therapeutic use of ultrasound and especially a noninvasive technique involving the formation of a two-dimensional image used for the examination and measurement of internal body structures and the detection of bodily abnormalities. called also sonography, ultrasonography

x-ray: 1 – any of the electromagnetic radiations that have an extremely short wavelength of less than 100 angstroms and have the properties of penetrating various thicknesses of all solids, of producing secondary radiations by impinging on material bodies, and of acting on photographic films and plates as light does 2 – a photograph obtained by use of X-rays.

But we’ve got kidney disease. There’s something you should know about the contrast that may be ordered along with your CT if that’s the guiding imagery your doctor will be using to perform the biopsy. For example, I have a CT with contrast every six months to make sure the cancer hasn’t returned. Because I have kidney disease, a blood test comes first to find my creatinine level. If it’s over 1.1, no contrast would be used. This is the purpose of the contrast:

“In a CT scan, dense substances like bones are easy to see. But soft tissues don’t show up as well. They may look faint in the image. To help them appear clearly, you may need a special dye called a contrast material. They block the X-rays and appear white on the scan, highlighting blood vessels, organs, or other structures.

Contrast materials are usually made of iodine or barium sulfate. You might receive these drugs in one or more of three ways:

• Injection: The drugs are injected directly into a vein. This is done to help your blood vessels, urinary tract, liver, or gallbladder stand out in the image.
• Orally: Drinking a liquid with the contrast material can enhance scans of your digestive tract, the pathway of food through your body.
• Enema: If your intestines are being scanned, the contrast material can be inserted in your rectum.”

Thankyou for the above information, WebMD.

Hmm, since I haven’t had any, I wondered what the purpose of kidney biopsies was. The National Kidney Foundation tells us:

• “Blood (hematuria) or protein (proteinuria) in the urine 
• Abnormal blood test results
• Acute or chronic kidney disease (CKD) with no clear cause
• Nephrotic syndrome and glomerular disease (which happens when the filtering units of the kidney are damaged)
• See if kidneys are responding well to treatment
• Check if kidneys are permanently damaged
• Learn why a transplanted kidney is not working well
• See if a kidney tumor is cancerous
• Check for other unusual or special conditions
• See if any medications are hurting your kidneys”

There’s so much more to know about a kidney biopsy, but I’ve just plain run out of room today.

Until next week,

Keep living your life!

Yet Another Connection

“So the foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone.”

So goes the Skeleton Song Dance from Walt Disney’s 1929 Silly Symphony. But did you realize that your organs are connected too? Maybe not physically, but what happens to one organ affects the others. For example, this week a dear friend mentioned a condition I’d never heard of before. So, of course, I wanted to know if it affects the kidneys? Or was it if the kidneys affect this condition?

It’s called lichen planus. Do you know it? Here’s how Johns Hopkins defines the condition:

“Lichen planus is a common disease that causes inflammation (swelling and irritation) on your skin or inside your mouth. On your skin, lichen planus causes a rash that is usually itchy. Inside your mouth, it may cause burning or soreness.”

I get the feeling there are more symptoms. According to the Cleveland Clinic, there are:

“Lichen planus symptoms depend on where it’s affecting your body:

• Tiny, raised dots may develop on your skin, including your genitals. The dots are about the size of the tip of a pin (0.4 mm), and they may grow to the width of a pencil (1 cm). They may also develop into sores.
• Tiny white dots may develop on the skin inside of your cheeks, your tongue or your lips.
• Your nails may change colors, crack or split, stop growing or fall off.

Lichen planus doesn’t hurt. However, if you scratch your rash, you may break your skin, leading to an infection that can cause pain.”

That would explain why my friend had no idea she had this autoimmune disease. Wait a minute, what makes it an autoimmune disease? Maybe the American Institute of Healthcare Compliance can help us out here:

“The trigger of lichen planus is a hyperactive immune system. This condition occurs when the immune system begins to attack mucous membrane or skin cells which are not actually a threat to your body. This is an idiopathic condition, meaning there is no precisely known cause. However, medical professionals are aware of several conditions that may trigger it. “

“Trigger it”? I turned to eMedicineHealth to find out just what these triggers might be:

“Triggers for lichen planus may include: 

• Certain medications
  • Antimicrobials
  • Antihistamines (H2-blockers)
  • Antihypertensives/antiarrhythmics such as ACE inhibitors and beta-blockers
  • Antimalarial drugs
  • Antidepressants/antianxiety drugs/antipsychotics
  • Anticonvulsants
  • Diuretics
  • Antidiabetics
  • Metals
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Proton pump inhibitors (PPIs)
  • Lipid lowering drugs
  • Tumor necrosis factor-alpha antagonists
  • Monoclonal antibodies 
• Metal dental fillings (oral lichen planus)
• Stress
• Infection, such as hepatitis C virus infection”

The one trigger that jumped out at me was mental dental fillings. My buddy and I are of an age when the only dental fillings available were metal. Could it really be that simple?

Something bothered me, though. It seemed to me that lichen planus was caused by too much of a good thing. The good thing was your immune system helped keep you healthy by fighting off foreign entities – like germs – in your body. A hyperactive immune system means it was working overtime and attacking parts of you that were necessary. Yep, too much of a good thing.

So, what do you do about lichen planus? By the way, my friend has the oral form. This is more prevalent in females and if there’s anything to be glad of about this disease it’s that it is most usually encountered in middle aged people. Hah! We are so far past middle age that it’s a compliment to be associated with anything middle aged…. or not.

Anyway, as to what you do about lichen planus, the answer is nothing. It usually disappears by itself within two years. I thought that weird and did my best to find out why. I drew a blank. So, let’s move on to what, if anything, this has to do with chronic kidney disease.

“OLP has been associated with numerous systemic connotations such as metabolic syndrome, diabetes mellitus, hypertension, thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer.”

Thanks to the National Center for Biotechnology Information for the above, well, information.

Do you remember what metabolic syndrome is? Just in case, The National Heart, Lung, and Blood Institute explains:

“Metabolic syndrome is a group of conditions that together raise your risk of coronary heart disease, diabetes, stroke, and other serious health problems. Metabolic syndrome is also called insulin resistance syndrome.

You may have metabolic syndrome if you have three or more of the following conditions.

• A large waistline: This is also called abdominal obesity or ‘having an apple shape.’ Extra fat in your stomach area is a bigger risk factor for heart disease than extra fat in other parts of your body.
• High blood pressure: If your blood pressure rises and stays high for a long time, it can damage your heart and blood vessels. High blood pressure can also cause plaque, a waxy substance, to build up in your arteries. Plaque can cause heart and blood vessel diseases such as heart attack or stroke.
• High blood sugar: This can damage your blood vessels and raise your risk of getting blood clots. Blood clots can cause heart and blood vessel diseases.
• High blood triglycerides: Triglycerides are a type of fat found in your blood. High levels of triglycerides can raise your levels of LDL cholesterol, sometimes called bad cholesterol. This raises your risk of heart disease.
• Low HDL cholesterol, sometimes called good cholesterol: Blood cholesterol levels are important for heart health. ‘Good’ HDL cholesterol can help remove ‘bad’ LDL cholesterol from your blood vessels. ‘Bad’ LDL cholesterol can cause plaque buildup in your blood vessels.”

Knowing that diabetes and hypertension [high blood pressure] are the two leading causes of CKD, we can see the connection between lichen planus and CKD now. However, do not panic! This doesn’t mean you will definitely develop CKD.

Until next week,

Keep living your life!

They’re a Couple

Have you ever noticed how many people with chronic kidney disease [CKD] also have chronic obstructive pulmonary disease [COPD]? I first became aware of that when my children’s father had both. I have CKD, but not COPD. Why him and not me?

The National Center for Biotechnology Information iterates that there is a connection between the two diseases.

“During the past decade, a strong association between COPD and CKD has emerged. CKD is more common in individuals suffering from COPD compared to age-matched controls, and COPD patients with comorbid CKD are at a greater risk of adverse outcomes.”

I’m guessing that means I should keep my eyes open for any symptoms of COPD. Of course, I’d need to know what they are first. The Cleveland Clinic answered that unasked question for me.

• “Cough with mucus that persists for long periods of time.
• Difficulty taking a deep breath.
• Shortness of breath with mild exercise (like walking or using the stairs).
• Shortness of breath performing regular daily activities.
• Wheezing.”

Not being too aware of any respiratory diseases, that sounded a lot like asthma to me. I think it’s time for a definition of COPD. I found it on the Centers for Disease Control and Prevention (CDC)’s website.

“Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis. COPD makes breathing difficult for the 16 million Americans who have this disease. Millions more people suffer from COPD, but have not been diagnosed and are not being treated. Although there is no cure for COPD, it can be treated.”

Hmm, I wasn’t right, but I wasn’t that wrong either.  My children’s father had been a heavy smoker since he’d been 16. Maybe that’s why him and not me? I’d been a social smoker off and on for over 20 years. It was far more off than on, and I stopped entirely when I was diagnosed with CKD 15 years ago. His CKD diagnose was not that long before his demise; that’s when he stopped being a heavy smoker.

Am I off base here? I turned to the World Health Organization (WHO) for help.

“Several processes can cause the airways to become narrow and lead to COPD. There may be destruction of parts of the lung, mucus blocking the airways, and inflammation and swelling of the airway lining.

COPD develops gradually over time, often resulting from a combination of risk factors:

1. tobacco exposure from active smoking or passive exposure to second-hand smoke.
2. occupational exposure to dust, fumes or chemicals.
3. indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is frequently used for cooking and heating in low- and middle-income countries with high levels of smoke exposure. 
4. early life events such as poor growth in utero, prematurity, and frequent or severe respiratory infections in childhood that prevent maximum lung growth.
5. asthma in childhood; and
6. a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause COPD at a young age.”

I don’t remember much of what he’d told me about his childhood, so I think I’ll just leave this alone right now.

In my wanderings on the internet, I hadn’t seen anything about CKD causing COPD. But I have found quite a bit of information about COPD causing or affecting CKD. For example, The American Journal of Respiratory and Critical Care Medicine explained,

“Studies have reported that COPD is an independent predictor of reduced kidney function and that it is the severity of emphysema, rather than airflow limitation, that may be most closely associated with reduced glomerular filtration rate….”

As Healthline puts it:

“But at this time, experts know that the presence of both conditions increases the risk of mortality, and that chronic inflammation is a common factor in both conditions.”

Okay, I get it: COPD has an effect on CKD, but it’s not terribly clear to me just what that effect is. It’s clear it has something to do with inflammation and that some of the same comorbidities cause each of these two diseases.

AJMC, self-described as “The American Journal of Managed Care is the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms,” explains further,

“They [the authors of the study] added that the underlying mechanisms of this finding are likely complex and include increased systemic inflammation, physiological interaction between lungs and kidneys, or network effects between various comorbidities and cardiovascular diseases. CKD impacts other manifestations of COPD, including malnutrition, osteoporosis, and cardiovascular disease, which negatively affect exercise capacity and could explain these results, explained the researchers.”

Let’s take a look at the “physiological interaction between lungs and kidneys.” The National Library of Medicine makes it clear,

“The close relationship between lung and kidney is evidence of a homeostatic connection between all organs and systems in an attempt to maintain the body system balance. Lung and kidney are main players in the effort to maintain such balance in both physiological and pathological conditions.”

While I don’t claim to fully understand this [not being a doctor certainly has its drawbacks], the National Institutes of Health goes all the way back to the womb to help us understand the connection between COPD and CKD,

“Lung and kidney functions are intimately related in both health and disease. The regulation of acid-base equilibrium, modification of partial pressure of carbon dioxide and bicarbonate concentration, and the control of blood pressure and fluid homeostasis all closely depend on renal and pulmonary activities. These interactions begin in fetal age and are often responsible for the genesis and progression of diseases. In gestational age, urine is a fundamental component of the amniotic fluid, acting on pulmonary maturation and growth. Moreover, in the first trimester of pregnancy, the kidney is the main source of proline, contributing to collagen synthesis and lung parenchyma maturation. Pathologically speaking, the kidneys could become damaged by mediators of inflammation or immuno-mediated factors related to a primary lung pathology or, on the contrary, it could be the renal disease that determines a consecutive pulmonary damage.”

Until next week,

Keep living your life!

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!  

Curiouser and Curiouser [as Alice said]

I got curious about something this past week. For some unknown reason, ADHD kept popping up in my life. This one would tell me her grandson was just diagnosed with it or that one would ask me what I knew about it. Considering I knew next to nothing about ADHD and that chronic kidney disease seems to be at the center of my knowledge, I began to wonder if there were any connection between the two.

What’s ADHD, you ask? Here’s how the National Institute of Mental Health explains it:

“Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

• Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.
• Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.”

How could such a disorder have anything to do with CKD? Poking around on the internet, I found article after article that seemed to suggest there is a connection. Frankly, they were too scientific for me to follow. I kept going. Now I really wanted to know if there were a connection. Give me an obstacle, and it will just make me dig deeper.

Finally, I did find something I understood in Nephrology New & Issues:

“Additionally, children with CKD were 32% more likely to be diagnosed with CKD, 3% more likely to be diagnosed with ADHD and 28% less likely to be diagnosed with anxiety compared with children of the general population.”

Photo by Luna Lovegood on Pexels.com

Come to think of it, all the articles I looked at dealt with children. While 3% doesn’t sound like a lot, that’s 3% more likely to have ADHD than children without CKD.

Most of the information I found had to do with AHDH medications and the kidneys. WebMD clarified:

“Most people who take medication for attention deficit hyperactivity disorder (ADHD) take a drug called a stimulant. Adderall and Ritalin are both in that category. They help control levels of two chemicals in your brain, dopamine and norepinephrine, that affect how well you concentrate.

Studies show that stimulants work well on ADHD symptoms for about 80% of people who take them. About half of those people get the same results from either Adderall or Ritalin. But for the other half, one drug works better than the other. This is because they work in different ways and can cause different side effects.”

Sounds like plausible… until you read this list of Adderall’s common side effects from RxList:

“nervousness

• agitation
• anxiety
• sleep problems (insomnia)
• stomach pain
• loss of appetite
• weight loss
• nausea
• vomiting
• dizziness
• palpitations
• headache
• vision problems
• increased heart rate
• increased blood pressure
• sweating
• skin rash
• psychosis, and
• numbness
• tingling

or

• cold feeling in your hands or feet.”

We already know how important sleep is to CKD patients and, as for increased blood pressure, that’s the second most common cause of CKD.

Recovery Village was a lot more direct:

“The FDA recently approved labeling changes for ADHD drugs and added rhabdomyolysis to the list of possible adverse side effects. This is a condition that causes the breakdown of muscle fibers. When this happens, a protein called myoglobin is released, which damages kidneys while they attempt to filter it from the blood.

Some of the symptoms of rhabdomyolysis include:

• Tenderness
• Pain
• Spasms
• Stiffness
• Muscle cramps

When someone suffers from rhabdomyolysis, it can cause kidney damage and kidney failure. In some instances, if there is kidney damage or failure due to long-term Adderall use or an Adderall overdose, a person may require dialysis or a kidney transplant.

Experiencing kidney pain after large amounts of this drug or over long-term use may be a sign of this serious side effect.”

From a multitude of websites, it became clear that Ritalin also can cause high blood pressure. It’s not the Ritalin itself that affects the kidneys, but the high blood pressure. I found other stimulants used to treat ADHD, but each one warned they may cause high blood pressure.

Don’t lose hope just yet if you have both ADHD and CKD. I found a bunch of non-stimulant ADHD medications that don’t raise blood pressure. I found them on ADDitudes’s website. A website specifically for ADHD patients. I’ve listed their side effects below:

“….. The most common side effects of Strattera include decreased appetite, nausea, vomiting, fatigue, dyspepsia (indigestion), dizziness, and mood swings….

The most common side effects of Intuniv are sleepiness, dry mouth, tiredness, difficulty sleeping, nausea, stomach pain, dizziness, irritability, slow heart rate, and low blood pressure….

The most common side effects of Kapvay are tiredness, cough, runny nose, sneezing, irritability, sore throat, nightmares, change in mood, constipation, increased body temperature, and ear pain….

The most common side effects of Qelbree include drowsiness or somnolence, decreased appetite, fatigue, nausea, vomiting, trouble sleeping, irritability. Qelbree may also increase suicidal thoughts and actions.”

Wow! Not only is there a connection between ADHD and CKD, but a number of medications used to treat it can affect your kidney disease. Never fails to amaze me how much more there is to learn about chronic kidney disease.

Until next week,

Keep living your life!

Another Connection I Hadn’t Expected

Wow, Christmas and Chanukah are over. Kwanzaa is today, as is Boxing Day. I know there are other holidays in December, too. I hope each one was [is] good to you. Unfortunately, that isn’t true for my husband. He may have pneumonia. 

Bear also vacillates between stage 2 and stage 3 chronic kidney disease. That, of course, got me to thinking. If he does have pneumonia, will it affect his ckd? Or did the ckd have something to do with his possibly developing pneumonia? 

According to the National Heart, Lung, and Blood Institute, 

“Pneumonia is an infection that affects one or both lungs. It causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus. Bacteria, viruses, or fungi may cause pneumonia. Symptoms can range from mild to serious and may include a cough with or without mucus (a slimy substance), fever, chills, and trouble breathing. How serious your pneumonia is depends on your age, your overall health, and what caused your infection.” 

Well, he’s older than I am and I’m 75, so if it is pneumonia, it could be serious. Bear is now on his second round of antibiotics, just in case it is bacterial. But wait a minute. We’re trying to figure out if pneumonia and ckd are in some way connected, not if my husband is in any trouble here.   

I took a chance and turned to the National Center for Biotechnology Information to find out since they often have helped me with information I needed. 

“Infections are a major cause of morbidity and mortality in chronic kidney disease (CKD) patients. The relationship is mutual: not only infections are [sic] severe and difficult to manage in CKD, but infections also contribute to the progression of CKD and complicate its management…. Lower respiratory tract infections e.g. Pneumonia are common occurrences in CKD patients and are associated with increased risk of hospitalization, cardiovascular events and mortality… 

CKD has long been considered an independent risk factor for pneumonia. The risk of pneumonia is up to 1.97 fold higher in CKD patients-1.4 times higher for outpatient pneumonia and even higher, i.e., 2.17 times for inpatient pneumonia compared with patients without CKD….” 

By the way, the previous source is part of the National Library of Medicine which, in turn, is part of the National Institutes of Health. The first source is also part of the National Institutes of Health. 

Let’s look at this a little bit more closely. Most importantly, there is a connection between pneumonia and ckd. 

Side note, I’ve had a lower respiratory infection. No one mentioned it was pneumonia. I wonder why? I’m certain I reported to the doctor that I had CKD. I always do. How did I not know about this? It is amazing to me that after 11 years of blogging about ckd, I’m still learning about it. 

Back to pneumonia. Let’s see if we can root out something about the mechanism. I had to really dig for some answers. Several explanations were too medicalese for me; I just didn’t understand them. Others talked only about acute kidney injury [AKI]. Yet others dealt more with only end stage kidney disease [ESRD]. I finally settled upon American Journal of Physiology-Lung Cellular and Molecular Physiology for this information: 

“Although chronic kidney disease is most commonly accompanied by cardiovascular diseases and diabetes, there is clear cross talk between the lungs and kidneys pH balance, phosphate metabolism, and immune system regulation. Our present understanding of the exact underlying mechanisms that contribute to chronic kidney disease-related pulmonary disease is poor.” 

Oh my, Doctors Health Press informs us that unbalanced Ph can affect: 

“Circulatory system…. 

Digestive system…. 

Urinary system…. 

Immune system…. 

Integumentary system…. 

Muscular system…. 

Nervous system…. 

Reproductive system…. 

Respiratory system…. 

Skeletal system….” 

Did you notice the respiratory system? That includes the lungs.  

Keeping in mind that phosphate helps filter waste from the kidneys, what does it have to do with the lungs and pneumonia? Here’s Springer Link’s explanation: 

“For a long time, phosphate, the anion [Gail here: that’s a negatively charged ion] that incorporates the element phosphorus, has been considered of minor relevance compared to its most studied parent calcium. However, the interest in phosphate metabolism has been remarkably increased in the last two decades. This has been mainly driven, among others, by two factors. The first one relates to the appreciation that hypophosphatemia (as well as hyperphosphatemia), has deleterious effects not only on bone but also on other organs and systems such as skeletal muscle, myocardium, the haematopoietic, respiratory and central nervous systems, in addition to sensory organs …. Further impetus has been fuelled by finding molecular mechanisms underlying congenital diseases characterized by hypo and hyperphosphatemia and discovery of drugs reversing the culprit mechanism.” 

Remember that hypo means low and hyper means high. Also, phosphatemia means of or about phosphate. I was hoping you would notice ‘respiratory’ included above. 

As for the immune system, Nature Views Immunology states, 

“The kidney has a central role in electrolyte homeostasis and the removal of toxins and so, when its function is compromised, normal immune effector cell function and intestinal microbial homeostasis are disturbed.” 

A different journal, Nature Immunology, offers the following: 

“Of all the sites of the body subject to incursion by pathogens, the lungs represent the most challenging immunological dilemma for the host. Not only do the lungs represent the environment most frequently targeted by pathogens, their role as the organ of gas exchange makes their normal functioning critical for health and intolerant of collateral damage.” 

Uh-oh, so it is possible for pneumonia and ckd to not only be associated, but each can worsen the other. Not what I was hoping to find, but information that will be helpful in treating my husband’s two illnesses. 

Until next year, 

Keep living your life!