Trump’s is Not the Only Trial

To me, it was a logical jump from the legal actions for and about kidneys that I wrote about last week to kidney disease research, and then to the clinical trials involved in this research. Of course, the fact that there’s something in the news about the former president’s trials daily helped a bit, too. That’s why today’s blog is about clinical trials. [Nifty thought process here.]

The American Kidney Fund devotes a rather long page on their site explaining everything you could ever want to know about clinical trials, although they do not list trials. Other sites do, however. The National Kidney Foundation offers this one, as well as others:

“Chronic Kidney Disease-Associated Pruritus (Itchy Skin)

KICK (CARA Therapeutics): The KICK studies are clinical trials testing difelikefalin (a tablet taken by mouth) to see if it helps reduce intensity of itching and the impact that itching has on your quality of life. An intravenous (IV) form of difelikefalin has been approved by the FDA to treat itching associated with CKD in adults who are undergoing dialysis. The KICK studies are testing a tablet form of the medication to see if it reduces itching in CKD patients who are not on dialysis. To learn more and see if you qualify, visit the KICK studies clinical trial page. (También se ofrece en español: la página de ensayos clínicos de los estudios KICK)”

The National Institutes of Health’s National Library of Medicine’s National Center for Biotechnology Information’s ClinicalTrials.gov [What a mouthful!] is the site for clinical trials. You can actually search for specific trials. The site will ask you for the following information:

“Condition/disease

Other terms

Intervention/treatment

Location

Top of Form

Search by address, city, state, or country and select from the dropdown list

Bottom of Form

Study Status 

All studies

Recruiting and not yet recruiting studies”

And, as if that is not enough narrowing down your search, they will offer you more filters.

In addition, hospitals conduct clinical trials. The following is just one of those from the Mayo Clinic:

“A Study to Assess Palliative Care Impact on Patients with End-stage Renal Disease Jacksonville, FL

The purpose of this study is to evaluate the impact of palliative care consultations on quality of life and advance care planning in end-stage renal disease patients on hemodialysis, evaluate hemodialysis patients’ and caregivers’ satisfaction with palliative care consultations, and to compare quality of life and advance directive completion in dialysis patients who have and have not received palliative care consultations.”

Let’s not forget that pharmaceutical companies also operate clinical trials. If you remember [and even if you don’t, hehe], I had pancreatic cancer. I’m still on a thirty year trial for one of the chemotherapy drugs that was used to save my life. I firmly believe in clinical trials and was actually part of six of seven of them during my cancer dance. Here’s comes a shameless plug. You can read about them in Cancer Dancer. Ahem, it had been number one in chemotherapy for a while. Anyway, the following trial is from Lilly:

“A Study of Tirzepatide (LY3298176) in Participants With Overweight or Obesity and Chronic Kidney Disease With or Without Type 2 Diabetes (TREASURE-CKD)

I8F-MC-GPIG – ClinicalTrials.gov – NCT05536804

We are doing this study to learn more about how tirzepatide may help fight chronic kidney disease in people with obesity with or without type 2 diabetes (T2D).”

Notice you could have also found this trial by going through ClinicalTrials.gov.

But that’s not all [as they used to say on the late night television advertisements]. Obviously, educational institutions also run clinical trials. That is one way to teach. For example, The University of California San Francisco operates the following clinical trial:

“a study on Chronic Kidney Disease, Kidney Disease, Focal Segmental Glomerulosclerosis

Summary

Eligibility

for people ages 18-75 (full criteria)

Location

at San Francisco, California and other locations

Dates

study started March 2022

completion around February 2025

Description

SUMMARY

This study is open to adults with a type of kidney disease called focal segmental glomerulosclerosis (FSGS). The purpose of this study is to find out whether a medicine called BI 764198 improves the health of the kidneys in people with FSGS. Three different doses of BI 764198 are tested in this study.”

Finally, there are the companies that were established to help you find clinical trials. I live in Glendale, Arizona. Healthmatch asks the following questions. They actually ask many more questions, but they were so patient specific that it made no sense to duplicate them here. It only took me 15-20 minutes to answer their questions.

 Start by selecting a condition

What’s your ZIP code?

What is your biological sex?

Why only these two? Clinical trial registries filter based on sex assigned at birth. Intersex patients should choose whichever option better aligns with their experience.

What is your date of birth?

What’s your name?

… what’s your email address?

What’s your phone number?

[Than a verification text will be sent to your phone.]Top of Form

Do you have chronic kidney disease (CKD) as diagnosed by a doctor?

CKD is a long-term condition that is characterized by persistent kidney damage or reduced kidney function, and is usually diagnosed with a blood test.

Would you be willing to use contraceptive methods (or continue using your contraception) if required by the clinical study policy?

If you are not of childbearing potential, or not engaging in activities that could result in pregnancy, disregard this question and answer ‘Yes’.

Do you have end-stage kidney disease?

Also known as kidney failure, renal failure, end-stage renal disease or CKD-5 (eGFR < 15)

Based on your current answers, there are no trials for Chronic Kidney Disease (CKD) that match your profile at this time. We’ll email you as new trials open that you may be a match for.”

Will you join me in participating in clinical trials? Just to nudge you, remember they saved my life.

Until next week,

Keep living your life!

Let’s Do This One Last Time

There’s a word banging around in my brain. Although I’ve looked it up several times, I still am not quite sure what it means or how to use it. Why not come along with me for what I’m hoping is the last time of figuring it out? Whoops, forgot to tell you what the word is. It’s amyloidosis.

I vaguely thought I remembered it was something on a blood test. I vaguely thought wrong. Okay, let’s go to the experts then. verywellhealth had this information:

“ Amyloidosis is sometimes called a protein misfolding disorder, in which misfolded [Gail here: never heard of this before. Have you?] proteins are the main reason the condition develops….

 The specific protein involved differs between types of amyloidosis.

The normal versions of amyloid proteins typically have jobs in the body, from supporting immunity to regulating fluid balance and body processes. When the normal proteins finish their assigned jobs, they leave the bloodstream. But with amyloidosis, they misfold, take on abnormal shapes, and get deposited into the organs. 

Amyloidosis is either systemic (widespread or affecting the whole body) or localized to one body area, and there are multiple subtypes. 

Systemic amyloidosis is more common and can affect multiple organs and body tissues…. Left untreated, it can lead to organ damage. Localized amyloidosis will affect one organ or only one area of the body.” 

That sounds terrible. Of course, the next question I had – since it isn’t part of a blood test as I’d originally thought – was: Are there symptoms? How do you know if you have amyloidosis? WebMd was right there with the answer:

Photo by Andrea Piacquadio on Pexels.com

“Symptoms of amyloidosis are often subtle. They can also vary greatly depending on where the amyloid protein is collecting in the body. It is important to note that the symptoms described below may be due to a variety of health problems. Only your doctor can make a diagnosis of amyloidosis.

General symptoms of amyloidosis may include:

• Changes in skin color
• Severe fatigue
• Feeling of fullness
• Joint pain
• Low red blood cell count (anemia)
• Shortness of breath
• Swelling of the tongue
• Tingling and numbness in legs and feet
• Weak hand grip
• Severe weakness
• Sudden weight loss”

Like many other people I’m certain, I have several of these symptoms. Therefore, I’m going to bold the warning above:

It is important to note that the symptoms described below may be due to a variety of health problems. Only your doctor can make a diagnosis of amyloidosis.

I don’t know about you, but that gives me a bit of relief. Yet, I still want to know how my doctor can diagnose amyloidosis. I turned to Johns Hopkins Medicine for the answer:

“To see if you have amyloidosis, your doctor will likely order tests. A urine test and a blood test may be followed by one or more imaging procedures to take a look at your body’s internal organs, such as an echocardiogram , nuclear heart test or liver ultrasound . A genetic test may be necessary to see if you have the familial form of amyloidosis.

You might undergo a biopsy, where the doctor takes a small sample of your bone marrow or another organ to examine under the microscope.”

Wait a minute. I got that you may have the symptoms, you see your doctor, and she/he runs tests. I’ve been reading that there’s no cure. I’ve also been reading that the kidneys are affected in several types of amyloidosis. What now? Healthline suggested these treatments:

“These medications can be used to help control amyloidosis symptoms:

• pain relievers
• drugs to manage diarrhea, nausea, and vomiting
• diuretics to reduce fluid buildup in your body
• blood thinners to prevent blood clots
• medications to control your heart rate”

Of course, I became curious about the different types of amyloidosis. Thank you to the Mayo Clinic for this information:

“Types of amyloidosis include:

• AL amyloidosis (immunoglobulin light chain amyloidosis). This is the most common type of amyloidosis in developed countries. AL amyloidosis is also called primary amyloidosis. It usually affects the heart, kidneys, liver and nerves.
• AA amyloidosis. This type is also known as secondary amyloidosis. It’s usually triggered by an inflammatory disease, such as rheumatoid arthritis. It most commonly affects the kidneys, liver and spleen.
• Hereditary amyloidosis (familial amyloidosis). This inherited disorder often affects the nerves, heart and kidneys. It most commonly happens when a protein made by your liver is abnormal. This protein is called transthyretin (TTR).
• Wild-type amyloidosis. This variety has also been called senile systemic amyloidosis. It occurs when the TTR protein made by the liver is normal but produces amyloid for unknown reasons. Wild-type amyloidosis tends to affect men over age 70 and often targets the heart. It can also cause carpal tunnel syndrome.
• Localized amyloidosis. This type of amyloidosis often has a better prognosis than the varieties that affect multiple organ systems. Typical sites for localized amyloidosis include the bladder, skin, throat or lungs. Correct diagnosis is important so that treatments that affect the entire body can be avoided.”

Okay, now I was getting a little [Okay, a lot] nervous so I checked out who would be at risk for this disease. Cedars-Sinai tells us:

“The risk of developing amyloidosis is greater in people who:

• Are older than 50
• Have a chronic infection or inflammatory disease
• Have a family history of amyloidosis
• Have multiple myeloma. Between 10 and 15% of people who have multiple myeloma develop amyloidosis.
• Have a kidney disease that has required dialysis for more than five years”

Don’t panic. I’ve read again and again that dialysis has advanced to the point that fewer and fewer dialysis patients are developing amyloidosis. As usual there’s much more information available, [There’s always more.] so I urge you to visit these sites yourself if the blog has got you thinking.

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!

So Silly!

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

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

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

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

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

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

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

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

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

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

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

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

And Metformin? Medline Plus informs us:

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

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

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

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

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

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

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

Until next week,

Keep living your life!

Happy New Year!

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

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

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

“JARDIANCE is a prescription medicine used to:

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

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

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

“MedlinePlus: 

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

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

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

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

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

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

This is why the FDA approval is so important:

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

Keep Those Questions Coming, Folks!

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

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

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

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

“Cholecystectomy (Gallbladder Removal)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Finally, Science Direct addresses our original question:

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

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

Until next week,

Keep living your life!

Dream a Little Dream with Me

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

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

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

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

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

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

And protein? Thank you to MedlinePlus for this definition:

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

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

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

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

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

Photo by Min An on Pexels.com

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

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

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

When IgA nephropathy causes symptoms, they might include:

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

NephCure explains how this disease is diagnosed:

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

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

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

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

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

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

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

Until next week,

Keep living your life!

I Hardly Expected this Connection.

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

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

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

“inflammation of a sinus of the skull”

 Of course, now we need the definition of sinus:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

Opting Out of Dialysis

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

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

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

Conservative care (also called supportive care) aims to:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

That’s Weird

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

Photo by Monstera Production on Pexels.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Until next week,

Keep living your life!

To Fast or Not to Fast

There’s been quite a buzz about intermittent fasting [IF] in the news lately. Even those with chronic kidney disease are interested. I am, but it wasn’t until a reader asked about it that I decided to write about it. Elizabeth, this one’s for you… and me.

I wanted to know exactly what it was instead of working on what I thought it was. I turned to the trusted Cleveland Clinic for a definition [and a bit more]:

“Intermittent fasting is when you alternate between periods of eating and fasting. This type of eating is often described as ‘patterns’ or ‘cycles’ of fasting.

Intermittent fasting isn’t about starving yourself — it’s about cutting way back on calories for short time periods. The belief is that your body becomes satisfied with smaller portions while also reducing cravings for unhealthy snack foods. That is, as long as you maintain a healthy diet while trying it all out. “ 

I’d heard different people speak about different ways to do this. Healthline explained them:

• “Time-restricted eating. Involves fasting every day for 12 hours or longer and eating in the remaining hours. A popular example is the 16/8 method. It features a daily 16-hour fast and an 8-hour eating window wherein you can fit in 2, 3, or more meals.
• The 5:2 diet. The 5:2 diet involves eating as you normally do 5 days of the week and restricting your calorie intake to 500–600 on the remaining 2 days.
• Eat Stop Eat. Eat Stop Eat involves a 24-hour fast once or twice per week.
• Alternate-day fasting. With alternate-day fasting, the goal is to fast every other day.
• The Warrior Diet. The Warrior Diet was among the first popular diets to include a form of intermittent fasting. It involves eating small amounts of raw fruits and vegetables during the day and eating one large meal at night.”

 I wondered if losing weight was the only reason people wanted to fast in one way or another. According to the Mayo Clinic:

“Losing weight and being physically active help lower your risk of obesity-related diseases, such as diabetes, sleep apnea and some types of cancer. For these diseases, intermittent fasting seems to be about as beneficial as any other type of diet that reduces overall calories.

Some research suggests that intermittent fasting may be more beneficial than other diets for reducing inflammation and improving conditions associated with inflammation, such as:

• Alzheimer’s disease
• Arthritis
• Asthma
• Multiple sclerosis
• Stroke”

This was starting to sound almost too good, so I started looking for side effects. This is what Harvard Health Publishing had to offer:

Photo by Liza Summer on Pexels.com

“#1. Intermittent fasting may make you feel sick.

Depending on the length of the fasting period, people may experience headaches, lethargy, crankiness, and constipation. To decrease some of these unwanted side effects, you may want to switch from adf fasting to periodic fasting or a time restricted eating plan that allows you to eat everyday within a certain time period.

#2. It may cause you to overeat.

There’s a strong biological push to overeat following fasting periods because your appetite hormones and hunger center in your brain go into overdrive when you are deprived of food.

It’s human nature for people to want to reward themselves after doing very hard work, such as exercise or fasting for a long period of time, so there is a danger of indulging in unhealthy dietary habits on non-fasting days. 

Two common effects of calorie-restricted diets—a slowed metabolism and increased appetite—are just as likely when people practice intermittent fasting as when they cut calories every day. And in studies of time-restricted eating, evidence is accumulating that eating that misaligns with a per­son’s circadian rhythm (your body’s natural daily pattern) may led to metabolic trouble.

#3. Intermittent fasting may cause older adults to lose too much weight.

While intermittent fasting shows promise, there is even less evidence about the benefits or how fasting might affect older adults. Human studies have looked mostly at small groups of young or middle-aged adults, for only short periods of time.

But we do know intermittent fasting could be risky in some cases. If you’re already marginal as far as body weight goes, I’d be concerned that you’d lose too much weight, which can affect your bones, overall immune system, and energy level.

#4. It may be dangerous if you’re taking certain medications.

If you want to give intermittent fasting a try, make sure to discuss it with your doctor first. Skipping meals and severely limiting calories can be dangerous for people with certain conditions, such as diabetes. Some people who take medications for blood pressure or heart disease also may be more prone to imbalances of sodium, potassium, and other minerals during longer-than-normal periods of fasting.

People who need to take their medications with food — to avoid nausea or stomach irritation — may not do well with fasting.”

Time to get specific. Is IF off limits for those with CKD? I found information about diabetics at Harvard’s T. H. Chan’s School of Public Health:

“Individuals with the following conditions should abstain from intermittent fasting:

• Diabetes
• Eating disorders that involve unhealthy self-restriction (anorexia or bulimia nervosa)
• Use of medications that require food intake
• Active growth stage, such as in adolescents
• Pregnancy, breastfeeding”

How many of us with CKD have diabetes, the foremost cause of CKD? But what about CKD by itself? As Emily Campbell, RD CDE MScFN, puts it:

“… there has not been enough research in those with CKD, and current studies have inconclusive results for if intermittent fasting can improve eGFR. It is best to speak with your healthcare team or renal dietitian for personalized recommendations to improve your kidney function.”

I did come across some research, but it was either on mice – which we are not – or fasting during the holiday of Ramadan, which not all of us observe. I’ll stick with my nephrologist’s advice on fasting.

I’m pretty sure what goes for intermittent fasting is also true for total fasting.

Until next week,

Keep living your life!

No Use Crying Over Spilled Milk, uh, I Mean Protein

A very active reader – who happens to be a transplantee – asked me to write about spilling protein. As a CKD patient, I’ve never been told I was doing that. However, one of my daughters was told she was spilling urine. She does not have chronic kidney disease. Hmmm.

Way back in 2020, I became interested in proteinuria simply because, while I knew the meaning of the word, I didn’t really know what the definition meant. In other words, I could break down the parts of the word [protein and urine] but didn’t get what they meant when combined. I found this information from The Mayo Clinic useful in helping me to understand:

“Protein in urine — known as proteinuria (pro-tee-NU-ree-uh) — is excess protein found in a urine sample. Protein is one of the substances identified during a test to analyze the content of your urine (urinalysis).

Low levels of protein in urine are normal. Temporarily high levels of protein in urine aren’t unusual either, particularly in younger people after exercise or during an illness.

Persistently high levels of protein in urine may be a sign of kidney disease.”

Oh, maybe this explained why my daughter was spilling protein into her urine. Perhaps she was ill or had just exercised before the test not realizing that would affect the results.

I wondered precisely what it was that healthy kidneys did do. The American Kidney Fund explained a bit more:

“Healthy kidneys remove extra fluid and waste from your blood, but let proteins and other important nutrients pass through and return to your blood stream. When your kidneys are not working as well as they should, they can let some protein (albumin) escape through their filters, into your urine. When you have protein in your urine, it is called proteinuria …. Having protein in your urine can be a sign of nephrotic syndrome, or an early sign of kidney disease.”

There’s another reason you don’t want to have proteinuria as WebMD clarifies:

“Protein is an important component of every cell in the body. Hair and nails are mostly made of protein. Your body uses protein to build and repair tissues. You also use protein to make enzymes, hormones, and other body chemicals. Protein is an important building block of bones, muscles, cartilage, skin, and blood.”

I thought I’d throw this tidbit in since I just spent two weeks writing about biopsies. The paper Patient education: Kidney (renal) biopsy (Beyond the Basics) written by William L Whittier, MD, FASN and Stephen M Korbet, MD, MACP published on UpToDate informs us:

““The following are the most common reasons for kidney biopsy. You may have one or more of these problems, but not everyone with these problems needs a kidney biopsy: 

●Blood in the urine (called hematuria). … 

●Protein in the urine (called proteinuria) – This occurs in many people with kidney problems. A kidney biopsy may be recommended if you have high or increasing levels of protein in the urine or if you have proteinuria along with other signs of kidney disease…. 

●Problems with kidney function – If your kidneys suddenly or slowly stop functioning normally, a kidney biopsy may be recommended, especially if the cause of your kidney problem is unclear.” 

Take a look at the second reason for having a biopsy.

I think it would make sense to learn how the kidney becomes so damaged that it allows protein, which is meant to return to the blood, to spill into the urine. I turned to the Cleveland Clinic to find out:

“Protein gets into the urine if the kidneys aren’t working properly. Normally, glomeruli, which are tiny loops of capillaries (blood vessels) in the kidneys, filter waste products and excess water from the blood. 

Glomeruli pass these substances, but not larger proteins and blood cells, into the urine. If smaller proteins sneak through the glomeruli, tubules (long, thin, hollow tubes in the kidneys) recapture those proteins and keep them in the body. 

However, if the glomeruli or tubules are damaged, if there is a problem with the reabsorption process of the proteins, or if there is an excessive protein load, the proteins will flow into the urine.” 

‘Excessive protein load’ That’s why our protein intake is limited. We do not want to overwork and possibly damage our kidneys by relying on a diet of burgers, chicken, steak, and salmon. This doesn’t mean you cannot have these or similar foods; simply that you need to limit them each day. Your nephrologist or renal dietitian will tell you how much protein per day is the right amount for you.

I wondered if that was the only cause of damaged kidneys. According to the Mayo Clinic, it’s not. There’s also:

• “Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney’s filtering units (glomeruli)
• Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney’s tubules and surrounding structures
• Polycystic kidney disease or other inherited kidney diseases
• Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
• Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
• Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)”

Remember, CKD is at least three months of your kidney function declining.

Since the question was asked by a transplantee, let’s see if there’s anything to add specifically for this group of people. New York based Nao Medical made it easy to understand:

“There are several factors that can contribute to the development of proteinuria in kidney transplant patients. These include:

• Rejection of the transplanted kidney
• Infection
• Medications
• High blood pressure
• Diabetes”

Transplantees: Take note that rejection is not the only cause of proteinuria.

As for the treatment of proteinuria in transplantees, I am confused. I found research that stated Vitamin D would do the trick, others that recommended statins, and still other that said antihypertension drugs would help. I remind you that I am not a doctor and have never claimed to be one. In other words, speak with your nephrologist to discover which treatment is the best for your proteinuria.

I learned quite a bit today and hope you did, too.

Until next week,

Keep living your life!

More Needling

Last week’s blog about biopsies didn’t feel complete to me. Comments from readers indicate they felt the same way. This week, I thought I’d explore some of the issues they asked about.

The question most often asked was, “Does it hurt?” This is a tricky one since each person is unique. Let’s see what Mount Sinai had to say,

“Numbing medicine is used, so the pain during the procedure is often slight. The numbing medicine may burn or sting when first injected.

After the procedure, the area may feel tender or sore for a few days.

You may see bright, red blood in the urine during the first 24 hours after the test. If the bleeding lasts longer, tell your provider.”

Some readers have reported that they had, indeed, experienced soreness – but not necessarily pain – for several days after the procedure. On a personal note, I can sometimes have soreness from my insulin injections. Again, people are different.

Another reader wanted us to know that it was possible for a kidney biopsy to go wrong. I turned to Johns Hopkins to see what I could learn,

“As with any procedure, complications can happen including:

• Bruising and discomfort at the biopsy site
• On-going bleeding from the biopsy site, in the urine, or inside the body
• Puncture of nearby organs or structures
• Infection near the biopsy site

If the kidney biopsy is done with the aid of X-ray, the amount of radiation used is small. Therefore, the risk for radiation exposure is low.

If you are pregnant or think you may be, tell your healthcare provider. Talk to your healthcare provider about the risks to the fetus from being exposed to an X-ray. Pregnancy is not always contraindication for having a kidney biopsy. It may be important to maintain the health of the mother. Special precautions may be taken to protect both the mother and the fetus during a kidney biopsy.

You may not be able to have kidney biopsy if you have an active kidney infection, certain bleeding conditions, uncontrolled high blood pressure, or have only one working kidney.

There may be other risks depending on your specific medical condition. Be sure to raise any concerns with your healthcare provider before the procedure.”

I believe the reader in question had an infection. I can’t stress enough that although these readings report what most people experience, each of us is unique, different, and may have slightly different reactions.

As far as preparation for a kidney biopsy, The National Kidney Foundation covered that one:

“For most kidney biopsies, patients are advised to not take over-the-counter pain medicines such as aspirin, ibuprofen (Advil®, Motrin®), naproxen (Aleve®), or other medicines that may cause thinning of the blood for 2 weeks prior to the test. These medicines can change the way the blood clots and raise the risk of bleeding. For the same reason, you will likely be instructed to stop taking certain supplements such as fish oil.

Blood and urine samples are usually taken before the kidney biopsy to make sure you do not have an infection or other condition. Your doctor may also want you to change other medications before the biopsy. You may be told you should not eat or drink for eight hours before the procedure.”

I thoroughly enjoyed their use of the word ‘most’. However, I did wonder why a kidney patient would be taking NSAIDS [Nonsteroidal anti-inflammatory drugs] in the first place since they can harm your kidneys, even your transplanted kidneys.

I wasn’t that clear about the connection between bleeding and fish oil. Never fear! Mayo Clinic to the rescue,

“While generally safe, getting too much fish oil can increase your risk of bleeding and might affect your immune response. It’s not clear whether fish oil is safe for people who are allergic to seafood. Take fish oil supplements under a doctor’s supervision.”

All right, what have I left out? Let me think for a moment. Of course! Some readers wanted to know if they needed to be hospitalized for a kidney biopsy. Interestingly, some will. But most people will just need to be observed for a few hours before they go home to rest for a day or two.

I kept reading that the actual procedure takes only 15 minutes but with the preparation and the immediate after care, it takes an hour. Something else that was repeated on site after site was that that it’s preferred you don’t drive for a day or two after the procedure or operation.

A procedure refers to a medical intervention that doesn’t break the skin, while an operation does. For example, a closed [needle] biopsy is a procedure while an open biopsy is a surgery. Also, most readers thought a kidney biopsy was only used to evaluate the health of a kidney transplant. The Cleveland Clinic explained that there are other uses for a kidney biopsy,

“A kidney biopsy helps doctors identify the cause of kidney problems so they can treat the condition effectively. It can reveal scarring, inflammation (swelling), and protein deposits that cannot be identified with other tests, such as ultrasounds or blood and urine tests.”

Unfortunately, it can take anywhere from two to ten days to receive the results of the biopsy. It depends upon how many tests were being performed on the sample. As for whether or not you can go to the toilet after the test, the answer is no. You’ll be handed a bed pan. That’s so the doctor and/or nurse can see if you’re passing blood in your urine and, if so, how much. You’ll probably receive a blood transfusion if your overall blood loss is deemed too much.

I think I’ve covered everything I didn’t in last week’s blog. I urge you to remember that each patient is unique. That’s what is meant by ‘precision medicine.’ Your doctor will be the best person to make these decisions and discuss them with you.

Until next week,

Keep living your life!

It’s Such a Warped Connection

I have a new painful condition but making the connection between chronic kidney disease and this condition had me laughing while seated at my computer. You’ll see. It is a warped connection. Ah, I haven’t told you what that condition is yet. It’s spinal stenosis.

Hold on there. Of course, I’ll explain what it is. Spinal simply means of or about the spine. Stenosis means narrowing. I’ll bet you’re glad I had a thorough English language education at Hunter College a long, long time ago.

We both know narrowing of the spine really doesn’t make sense, so let’s find a more precise definition of this condition. Hello, WebMD:

“Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or vertebrae) and shock-absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects your brain to your body. The cord rests in the canal formed by your vertebrae.”

Not only does it occur in adults over 50, but it occurs more often in women. That’s me… well over 50 and a woman. I wondered why it occurs more often in women, but that’s a blog for another day.

Simply adding the word ‘canal’ made the definition clearer. So, what’s happening here is that the canal, not the spine itself, is narrowing. How? NYU‘s Langone Health, part of NYU – a #1 hospital – explains:

“For most people diagnosed with spinal stenosis, the spinal canal narrows because of degeneration in the spine that occurs as a natural part of aging. These degenerative changes most frequently affect the vertebral joints, also called facet joints, and the spongy discs that lie between vertebrae.

As the spine ages, intervertebral discs slowly lose fluid in a process called degenerative disc disease. Degeneration may cause a disc to bulge into the spinal canal, putting pressure on nerves or the spinal cord. If the outer wall of a disc breaks down completely and a disc fragment slips into the spinal canal, it’s called a herniated disc.

In addition, degeneration of the facet joints caused by osteoarthritis of the spine often leads to the development of bone spurs. These small, hard growths may protrude into the foramen or the spinal canal, constricting the exiting nerves or the spinal cord. Increased friction within joints may also irritate nearby ligaments, causing them to swell and take up more space in the spinal canal.

A facet joint can degenerate to such an extent that it no longer provides stability to the vertebra, which may slip out of place and move forward. In this condition, called spondylolisthesis, the vertebra can slip too far forward, putting pressure on the spinal cord or nerve roots.

Rarely, people are born with a narrow spinal canal or have a developmental condition that leads to a narrowing of the spinal canal. These include achondroplasia, scoliosis, and spina bifida, in which symptoms appear before age 50. Spinal stenosis may also be caused by a spine tumor.

A trauma to the spine, such as an injury from a car accident, that results in a dislocation or a fracture may also constrict nerves or the spinal cord at any point in the spine.”

Hmmm, I have degenerative disc disease and osteoarthritis of the spine. Add that to being a woman over the age of 50 and….

Now what? Let’s take a look at the symptoms, courtesy the Mayo Clinic:

“Spinal stenosis often causes no symptoms. When symptoms do occur, they start slowly and get worse over time. Symptoms depend on which part of the spine is affected.

In the lower back

Spinal stenosis in the lower back can cause pain or cramping in one or both legs. This happens when you stand for a long time or when you walk. Symptoms get better when you bend forward or sit. Some people also have back pain.

In the neck

Spinal stenosis in the neck can cause:

• Numbness
• Tingling or weakness in a hand, leg, foot or arm
• Problems with walking and balance
• Neck pain
• Problems with the bowel or bladder”

Uh-oh, I neglected to mention that spinal stenosis can also occur in the neck.

Okay, here comes the part of the blog that deals with CKD. It’s in the treatment.  While these are not the only treatments, they are the most often tried first. Healthline lays them out for us:

“There is no cure for spinal stenosis, but there are treatments to help relieve symptoms. Over-the-counter anti-inflammatory medications can ease swelling and pain. If they don’t do the trick, your doctor can prescribe higher-dose medication.

Your doctor may also recommend cortisone injections. This anti-inflammatory drug is injected directly into the area of the spinal stenosis. Cortisone can significantly ease inflammation and pain. Its effects may be temporary, however, and you shouldn’t have more than three injections in a single year.”

Marvelous, just marvelous. The OTC medications they’re referring to are NSAIDS. You know, the pain relief that our kidneys have adverse reactions to. The National Kidney Foundation reminds us:

“Many analgesics should not be used if there is decreased kidney function, because they reduce the blood flow to the kidney. “

Well, maybe something stronger? Cortisone? There’s a problem with that, too, if you have diabetes, the foremost cause of chronic kidney disease. My rheumatologist suggested we try one shot and see what happened to my blood sugar. What happened was almost textbook, according to VeryWellHealth:

“If you’re diagnosed with diabetes and receiving a cortisone injection, be aware of the potential for elevated blood sugars. Talk to your healthcare provider about the best way to manage this, as you may need to adjust your insulin dosage.

Remember these temporary elevations tend to resolve without treatment, but seek treatment if your blood sugars appear to be behaving in an extreme or unexpected manner.”

I don’t mean to mislead you. Physical therapy, exercise, weight loss, and the use of a cane and/or walker may also alleviate the pain. So, all is not lost even if you have CKD or diabetes along with spinal stenosis.

Until next week,

Keep living your life!

Common Complications during Peritoneal Dialysis

Last week, I wrote about common complications during hemodialysis. Tonie, one of my readers, requested a blog about common complications during peritoneal dialysis. Folks, fair is fair in my book [Great pun, don’t you think?] or as my father used to say, “What’s good for the goose is good for the gander.” In other words, sure Tonie, if I can write about hemodialysis complications, I can do the same for peritoneal dialysis. 

Let’s start at the beginning, as usual. What is peritoneal dialysis? According to the Mayo Clinic, 

“Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can’t adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis. 

During peritoneal dialysis, a cleansing fluid flows through a tube (catheter) into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded. 

These treatments can be done at home, at work or while traveling….” 

The National Institute of Diabetes and Digestive and Kidney Disease tells us there is more than one kind of peritoneal dialysis. 

“You can choose the type of peritoneal dialysis that best fits your life: 

• continuous ambulatory peritoneal dialysis (CAPD) 
• automated peritoneal dialysis 

The main differences between the two types of peritoneal dialysis are 

• the schedule of exchanges 
• one uses a machine and the other is done by hand 

If one type of peritoneal dialysis doesn’t suit you, talk with your doctor about trying the other type. 

CAPD doesn’t use a machine. You do the exchanges during the day by hand. 

You can do exchanges by hand in any clean, well-lit place. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch television, or sleep. With CAPD, you keep the solution in your belly for 4 to 6 hours or more. The time that the dialysis solution is in your belly is called the dwell time. Usually, you change the solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up at night to do an exchange. 

During an exchange, you can read, talk, watch television, or sleep. 

Automated peritoneal dialysis. A machine does the exchanges while you sleep. 

With automated peritoneal dialysis, a machine called a cycler fills and empties your belly three to five times during the night. In the morning, you begin the day with fresh solution in your belly. You may leave this solution in your belly all day or do one exchange in the middle of the afternoon without the machine. People sometimes call this treatment continuous cycler-assisted peritoneal dialysis or CCPD.” 

This sounded so much more attractive to me than hemodialysis that I wondered why more patients didn’t choose these types of treatment. There must be reasons. The Cleveland Clinic informs us what they are… and answers Tonie’s question. 

“Some people develop skin infections around the catheter. You’re also at risk for peritonitis, an infection that occurs when bacteria get inside the abdomen through the catheter. You may experience fever, abdominal pain, nausea and vomiting. 

Using the abdominal catheter and pumping your belly full of fluid can weaken abdominal muscles over time. You may develop a hernia. This condition occurs when an organ like the small intestine pokes through the abdominal muscles. You may feel a bulge near the belly button or in the groin area between the abdomen and upper thigh. Your doctor can repair a hernia with surgery. 

During peritoneal dialysis, your body absorbs dextrose, a sugar, from the dialysis solution. Over time, this extra sugar can lead to weight gain.” 

My husband, Bear, was reading over my shoulder and asked me if this catheter was like the PowerPort I had during chemotherapy. Azura Vascular Care explains it’s not, 

“PD catheter placement is typically performed as a minimally invasive procedure in an outpatient setting…. Percutaneous catheter placement is performed using fluoroscopy—an imaging technique that uses X-rays to help your vascular specialist view the inside of your abdomen…. This procedure requires only local anesthesia and sedation…. 

Your vascular specialist begins by using a fine needle to make a series of small punctures in your skin to access the peritoneum…. The PD catheter is then passed through a small tunnel in your belly into the peritoneum and secured in place. 

A PD catheter is made of silicone or another soft, flexible medical-grade material….Your catheter will have cuffs on it to prevent it from shifting and moving around, and that helps keep bacteria out of the tunnel and exit site. The PD catheter exit site is typically placed to the left or right of your belly button, you should discuss your personal placement preferences with your vascular specialist…. As you recover, your tissue will grow around and fill in part of the exit site as well to prevent the catheter from moving. 

After the PD catheter has been inserted, your vascular specialist will place sutures around the catheter on the outside of your abdomen and cover the site with a sterile dressing. 

PD catheter placement can usually be performed in under one hour…. However, you may spend additional time in the recovery room before going home so your vascular access team can monitor you for complications after the procedure.” 

Note from me: Some nephrologists and radiologists are trained in this surgery. 

Other complications may be: 

“Peritoneal Dialysis related infections, including peritonitis, exit‐site infections (ESI), and tunnel infections, are important complications, resulting in significant morbidity and risk of death.  

Early complications related to peritoneal access are divided into mechanical (bleeding, visceral perforation, dialysate leaks, catheter dysfunction, hernia formation, cuff extrusion) and infectious (early peritonitis, surgical wound, tunnel and exit site infections). 

…. Holding fluid in your abdomen for long periods may strain your muscles. 

Inadequate dialysis. Peritoneal dialysis can become ineffective after several years. You might need to switch to hemodialysis.” 

Thank you to Dialysis Care Centers (DCC) for this information. 

Good topic, Tonie. I’m glad you suggested it. 

Final note: SlowItDownCKD 2022 is out in print now! AND it’s free on Kindle Unlimited. I do request reviews, though. 

Until next week, 

Keep living your life! 

The Valsartan/Hyperkalemia Connection

My wonderful nephrologist and I had a Telemedicine appointment this past week. Last time we had one, six months ago, he prescribed Valsartan since my usual blood pressure was 139/78. That was too high.  

I had forgotten to record my blood pressure for a few days prior to this appointment. I most often did that to give him an average, so I quickly took it when I awoke that day. Let’s remember that both CKD brain fog and chemo brain took their toll on me. 

It was 158/69. Okay, I figured, I’ll take the drug and see what happens with my blood pressure before the call. I was astounded. After taking the Valsartan, my blood pressure went down to 129/67. It had been less than three hours. 

Well, you’ve probably figured out by now that Valsartan is a blood pressure drug. Let’s see what GoodRX has to say about this drug.    

“Diovan (valsartan) is a medication used to lower blood pressure. It can also help protect the kidneys, so it is a good first-line option for people with both hypertension and diabetes.” 

Diovan is the brand name. Valsartan is the generic name. I have hypertension, diabetes, and chronic kidney disease, so I won on all three [some victory, huh?]. Of course, now I wanted to know how it worked. I went straight to WebMD. 

“Valsartan belongs to a class of drugs called angiotensin receptor blockers (ARBs). It works by relaxing blood vessels so that blood can flow more easily. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.” 

A little more on ARBs, I thought. The Mayo Clinic offered this information: 

“Angiotensin is a chemical in your body that narrows your blood vessels. This narrowing can increase your blood pressure and force your heart to work harder. 

Angiotensin II receptor blockers block the action of angiotensin II. As a result, the medication allows your veins and arteries to widen (dilate).” 

Now I understand why this works for hypertension, kidney disease, diabetes, and even heart failure. 

During this appointment, my nephrologist reminded me to watch my potassium since I was taking valsartan. Huh? I didn’t remember him telling me about the valsartan/potassium connection during our last appointment. Was it brain fog and chemo brain at work again? 

Apparently, this is important. Healthline even has what they actually call important warnings: 

“Low blood pressure warning: This drug can cause your blood pressure to drop too low. This can cause dizziness, lightheadedness, and headache. You may have a higher risk if you’re dehydrated or take high doses of diuretics (water pills). 

High blood potassium warning: This drug can increase your potassium levels. Your risk may be higher if you have kidney problems or heart failure. Your doctor may check your potassium levels with blood tests while you’re taking this drug.” 

Do you remember what potassium is? No problem if you don’t. Medline Plus, will remind us. 

“Potassium is a mineral that your body needs to work properly. It is a type of electrolyte. It helps your nerves to function and muscles to contract. It helps your heartbeat stay regular. It also helps move nutrients into cells and waste products out of cells. A diet rich in potassium helps to offset some of sodium’s harmful effects on blood pressure…. 

Your kidneys help to keep the right amount of potassium in your body. If you have chronic kidney disease, your kidneys may not remove extra potassium from the blood. Some medicines also can raise your potassium level. You may need a special diet to lower the amount of potassium that you eat.” 

My nephrologist – and every other doctor I see – does check my electrolyte levels. As mentioned by Medline Plus, potassium is an electrolyte. High potassium is called hyperkalemia. The National Kidney Foundation tells us the most common causes of hyperkalemia are: 

“Kidney Disease. Hyperkalemia can happen if your kidneys do not work well. It is the job of the kidneys to balance the amount of potassium taken in with the amount lost in urine. Potassium is taken in through the foods you eat and the liquids you drink. It is filtered by the kidneys and lost through the urine. In the early stages of kidney disease, the kidneys can often make up for high potassium. But as kidney function gets worse, they may not be able to remove enough potassium from your body. Advanced kidney disease is a common cause of hyperkalemia. 

A diet high in potassium. Eating too much food that is high in potassium can also cause hyperkalemia, especially in people with advanced kidney disease. Foods such as cantaloupe, honeydew melon, orange juice, and bananas are high in potassium. [Noooooo, I love these fruits.]  

Drugs that prevent the kidneys from losing enough potassium. Some drugs can keep your kidneys from removing enough potassium. This can cause your potassium levels to rise. [like Valsartan]” 

This does not paint a pretty picture. I need Valsartan to control my blood pressure, but it may cause damage to my kidneys and my heart. I can avoid the foods that have high potassium even though they’re my favorites. I get my electrolytes tested often enough to feel like a pin cushion. Make no mistake: hyperkalemia can be life-threatening. 

There’s no avoiding that everything is our bodies is connected. To help our hearts and kidneys, we may actually be doing the opposite. That’s why I’m glad I’m not a doctor and see specialists to make sure everything is balanced and safe. Of course, I asked questions until I understood the answers, but I trust my doctors. My life is too important for a layperson [me] to make decisions about balancing the actions of my organs. 

Until next week,  

Keep living your life! 

Clearing Out

I’m pretty sure you’ve all heard about clearing out the clutter in your home by now. Apparently, clutter is the newest enemy of the home. Marie Kondon has written a best seller about it and even has her own show concerning clutter clean out. So, maybe we can presume that clearing out is important to our lives. 

Today, we’ll be looking at a different kind of clutter clearing. It has to do with a colonoscopy. For those, ah, younger readers who are not yet acquainted with the term, a colonoscopy needs an uncluttered colon.  

The Mayo Clinic informs us that: 

“A colonoscopy (koe-lun-OS-kuh-pee) is an exam used to look for changes — such as swollen, irritated tissues, polyps or cancer — in the large intestine (colon) and rectum. 

During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon. 

If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.” 

I’ve got to admit my first reaction to the thought of a colonoscopy is, “Why would anyone want to subject themselves to such a procedure? MedicalNewsToday answers that question. 

“A colonoscopy is the main way in which doctors investigate lower gastrointestinal symptoms, such as: 

• bleeding from the rectum 

• chronic constipation 
• chronic diarrhea 
• stomach pain 

The medical community also considers colonoscopy the gold standard of screening for colorectal cancer. This type of cancer is one of the most common types in both males and females in the U.S. 

A colonoscopy can detect early stage colorectal cancer before symptoms develop. Early detection can improve treatment outcomes. 

A doctor may recommend a colonoscopy for those who: 

• have a first degree relative with a history of colon polyps or colon cancer 
• are at higher risk due to their personal medical history 
• are aged 50 or older, even if no other risk factors are present” 

Bear and I are both over 50. Let’s make that well over 50. Our recent colonoscopies were not our first rodeos, so to speak. 

Let’s allow The National Institue of Diabetes and Digestive and Kidney Disease [NIDDK] to describe the procedure for us. 

“A doctor performs a colonoscopy in a hospital or an outpatient center. A colonoscopy usually takes 30 to 60 minutes. 

A health care professional will place an intravenous (IV) needle in a vein in your arm or hand to give you sedatives, anesthesia, or pain medicine, so you won’t be aware or feel pain during the procedure. The health care staff will check your vital signs and keep you as comfortable as possible. 

For the procedure, you’ll lie on a table while the doctor inserts a colonoscope through your anus and into your rectum and colon. The scope inflates your large intestine with air for a better view. The camera sends a video image to a monitor, allowing the doctor to examine your large intestine. 

The doctor may move you several times on the table to adjust the scope for better viewing. Once the scope reaches the opening to your small intestine, the doctor slowly removes the scope and examines the lining of your large intestine again…. 

 Colon polyps are common in adults and are harmless in most cases. However, most colon cancer begins as a polyp, so removing polyps early helps to prevent cancer.” 

Obviously, the doctor has to see clearly. That’s where the cleaning out comes in. There is preparation that will help him/her to do just that. Harvard Health explains: 

“The afternoon or evening before the colonoscopy, drink a liquid that will trigger bowel-clearing diarrhea. The exact colonoscopy prep instructions depend on the bowel prep your doctor prefers, the time of your colonoscopy, and any prior experience you’ve had with colon preps (if one didn’t work before, you’ll likely be prescribed a different one). 

You can read about some common bowel preparations approved by the American Gastroenterological Association, American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy. Contact your clinician to discuss the one that is best for you.” 

Aha! There is something you should know about bowel preparation as a kidney disease patient. I went to the National Kidney Foundation for more specifics about an FDA warning. 

“The FDA warning is for bowel cleansing agents called sodium phosphate (OSP) products. These can be used as laxatives as well as in preparation for colonoscopy. OSPs are available both with and without a prescription and are taken by mouth. It is possible that phosphate crystals might be deposited in the kidneys when these products are used by some people. This can cause the loss of kidney function, which can lead to kidney failure. The medical term for this condition is acute phosphate nephropathy. 

People with chronic kidney disease are at risk, but other people are also at increased risk. These include people over age 55, people who have bowel obstructions or active colitis, and people who have hypovolemia or decreased intravascular volume (ask your doctor if you have these problems which can be caused by dehydration, bleeding, or the use of certain medicines, as well as other things). Also, some medicines can increase your risk, such as some hypertension drugs, including diuretics, angiotensin converting enzyme inhibitors, or angiotensin receptor blocker drugs. Ask your doctor if you are taking one of these medicines. Some over-the-counter medicines for pain or fever might also lead to increased risk. These are nonsteroidal anti-inflammatory drugs [NSAIDs]), like ibuprofen or naproxen. You can read the label on these pain relievers to see if one of these medicines is in the pill you take.” 

Wait a minute. You’re urged to undergo a colonoscopy, but the prep is not good for your kidneys? What’s a CKD patient to do? 

There are other preparations that are safe for kidney patients, and you don’t even need to check with your nephrologist. Your gastroenterologist or other doctor who will be performing the colonoscopy can tell you about them. For example, I took MiraLAX [OTC laxative] and Dulcolax [another OTC laxative]. They were more than effective, if you know what I mean. 

Until next week, 

Keep living your life! 

Lupus Joins the Family

There’s been a wedding in the family and the bride has lupus. Now there’s something I’d never thought about. I mean lupus, not weddings. Looks like it’s time to do just that. I’d heard the word and had my ideas as to what it meant, but let’s allow my favorite dictionary, the Merriam-Webster, define the disease for us:

Photo by Trung Nguyen on Pexels.com

“any of several diseases characterized by skin lesions”

That’s a little too general for me. Let’s see if we can get more specific. The Lupus Foundation was tremendously helpful here:

“Systemic lupus erythematosus (SLE)

Systemic lupus is the most common form of lupus—it’s what most people mean when they refer to ‘lupus.’ Systemic lupus can be mild or severe.

Cutaneous lupus erythematosus

This form of lupus is limited to the skin and can cause many types of rashes and lesions.

Drug-induced lupus erythematosus

This is a lupus-like disease caused by certain prescription drugs.

Neonatal lupus

Neonatal lupus is not a true form of lupus. It is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb.”

Of course, this is a kidney disease blog, so I wanted to know what, if anything, lupus had to do with the kidneys. By a process of elimination, we must mean SLE. We’re not interested in solely the skin, drugs, or newborns.

Notice, this is Systemic Lupus Erythematosus. You’re right; we need another definition. This time I turned to Dictionary.com for the definition of erythematosus:

“abnormally inflamed or reddened”

This is caused by the capillaries under the skin being dilated by accumulated blood.

Hmm, did you realize that the word ‘systemic’ was also a clue that this is the kind of lupus that affects the kidneys? Maybe a reminder of what the renal system is would be a good idea here. Oh, you should know that the renal system is also called the urinary system. Britannica.com offers a simple explanation of what this is:

“renal system, in humans, organ system that includes the kidneys, where urine is produced, and the ureters, bladder, and urethra for the passage, storage, and voiding of urine.”

We need another piece of information. Healthline has it:

“The immune system normally fights off dangerous infections and bacteria to keep the body healthy. An autoimmune disease occurs when the immune system attacks the body because it confuses it for something foreign. There are many autoimmune diseases, including systemic lupus erythematosus (SLE).”

Whoa! So, our bodies can attack our renal systems [among other systems]. If it does, what happens to us? The Mayo Clinic answers this question for us:

“Lupus nephritis is a frequent complication in people who have systemic lupus erythematosus — more commonly known as lupus.

Lupus is an autoimmune disease. It causes your immune system to produce proteins called autoantibodies that attack your own tissues and organs, including the kidneys.

Lupus nephritis occurs when lupus autoantibodies affect structures in your kidneys that filter out waste. This causes kidney inflammation and may lead to blood in the urine, protein in the urine, high blood pressure, impaired kidney function or even kidney failure.”

Reminder: nephritis means inflammation of the kidneys. Let’s see if we can get an explanation that draws this information together. The CDC has just the one:

“Systemic lupus erythematosus (SLE), is the most common type of lupus. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. There is no cure for lupus, but medical interventions and lifestyle changes can help control it.”

We haven’t looked at the symptoms yet:

“SLE may first appear as extreme tiredness (fatigue), a vague feeling of discomfort or illness (malaise), fever, loss of appetite, and weight loss. Most affected individuals also have joint pain, typically affecting the same joints on both sides of the body, and muscle pain and weakness. Skin problems are common in SLE. A characteristic feature is a flat red rash across the cheeks and bridge of the nose, called a “butterfly rash” because of its shape. The rash, which generally does not hurt or itch, often appears or becomes more pronounced when exposed to sunlight. Other skin problems that may occur in SLE include calcium deposits under the skin (calcinosis), damaged blood vessels (vasculitis) in the skin, and tiny red spots called petechiae. Petechiae are caused by a shortage of cells involved in clotting (platelets), which leads to bleeding under the skin. Affected individuals may also have hair loss (alopecia) and open sores (ulcerations) in the moist lining (mucosae) of the mouth, nose, or, less commonly, the genitals.”

Thank you to MedlinePlus for the above information.

How can life style changes affect lupus, I wondered. Ah, but then I found WebMD’s list of triggers for a flare [episode]:

“Common lupus triggers include:

Overwork

Lack of sleep

Stress

Sun exposure

Fluorescent or halogen lights

Infection

Injury

Stopping your lupus medicines

Other lupus drugs”

The same site has suggestions for dealing with lupus on a daily basis.

Okay, all there is to cover now is diagnosing lupus. Hah! There’s so much more information available. A new site for us, National Institute of Arthritis and Musculoskeletal and Skin Diseases, offers the following as far as diagnosing:

“Asking about your medical history and symptoms, and, if necessary, reading your previous medical records.

Asking if anyone in your family has lupus or other autoimmune diseases.

Performing a complete physical exam.

Taking samples of blood for laboratory tests, such as:

Antinuclear antibodies (ANA), a sensitive test for lupus. Almost all people with lupus with [sic] have a positive ANA. However, having a positive ANA does not mean you have lupus since totally healthy people can have a positive ANA.

Antiphospholipid antibodies, anti-smith, and anti-double-strand DNA antibodies, which doctors order when you have a positive ANA and can help determine if you have lupus.

Complete blood counts, to check for low platelet counts, low red blood cell counts, and low white blood cell levels, which can happen if you have lupus.

Metabolic panel to look for changes in kidney function.

Taking urine samples to check for abnormal levels of protein in the urine.

Performing a biopsy of the skin or kidney (when labs indicate there may be a problem with the kidney) by taking a small sample of tissue to examine under a microscope.”

Notice the mention of the kidneys.

Until next week,

Keep living your life!

Back to Peds

For someone who never planned to write about pediatric kidney issues, here I am again writing about pediatric kidney issues. It seems the mothers of all those babies in my life I’ve mentioned before like to visit me. One of them was a bit upset during her visit, so – being me – I asked what was wrong. 

Her answer was surprising. It seems her little one [I think he’s about five months old] was born with urine reflux in both kidneys. I’d heard of reflux before, but urine reflex? She explained and I wondered why she wasn’t more upset. She explained that, too. But, as usual, I’m getting ahead of myself. 

Let’s start with what it is. First of all, she used the term VUR before telling me it was urine reflux. Well, what’s the ‘V’ stand for?  Turns out the medical term for this condition is VUR or Vesicoureteral Reflux. Okay, so what’s that? I turned to one of my old reliable sources for the answer, NIDDK, which is the National Institute of Diabetes and Digestive and Kidney Diseases. 

“Vesicoureteral reflux (VUR) is a condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys. VUR is most common in infants and young children. Most children don’t have long-term problems from VUR. 

Normally, urine flows down the urinary tract, from the kidneys, through the ureters, to the bladder. With VUR, some urine will flow back up—or reflux—through one or both ureters and may reach the kidneys…. 

VUR can cause urinary tract infections (UTI) [Gail here: A UTI may be the signal to test for VUR.] and, less commonly, kidney damage. The two main types of VUR are primary VUR and secondary VUR. Most children have primary VUR.” 

Oh, then what’s secondary VUR? Thank you to the Cleveland Clinic for the following information: 

Photo by Anna Shvets on Pexels.com

“Secondary VUR occurs when a blockage in the urinary tract causes an increase in pressure and pushes urine back up from the urethra into your child’s bladder, ureters and even kidneys. The blockage could result from an abnormal fold of tissue in the urethra that keeps urine from flowing freely out of your child’s bladder. Another cause of secondary VUR might be a problem with nerves that cannot stimulate the bladder to release urine. Children with secondary VUR often have bilateral reflux.” 

I asked the dad – since I felt I was leaving him out of the conversation – if the baby had bilateral reflux. Yes, he did. But then the dad explained that there are five grades of VUR. This is starting to get a bit complicated. I turned to The Urology Care Foundation for help in understanding this: 

“Grade I: urine reflux into the ureter only 

Grade II: urine reflux into the ureter and the renal pelvis (where the ureter meets the kidney), without distention (swelling with fluid, or hydronephrosis) 

Grade III: reflux into the ureter and the renal pelvis, causing mild swelling 

Grade IV: results in moderate swelling 

Grade V: results in severe swelling and twisting of the ureter” 

This diagram is The Urology Care Foundation’s, too. I found it helpful. Hoping you will, too. 

 
Let’s say VUR is suspected. What now? Cedars-Sinai explained: 

• “Voiding cystourethrogram (VCUG). A VCUG is a type of X-ray that examines the urinary tract. The healthcare provider puts a thin, flexible tube (catheter) in the urethra. This tube drains urine from the bladder to the outside of the body. The provider fills the bladder with a liquid dye. X-ray images are taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys. 
• Renal ultrasound (sonography). This is a painless test that uses sound waves and a computer to create images of body tissues. During the test, a healthcare provider moves a device called a transducer over the belly in the kidney area. This sends a picture of the kidney to a video screen. The healthcare provider can see the size and shape of the kidney. He or she can also see a growth, kidney stone, cyst, or other problems.” 

Wait a minute. I’d forgotten that each of the parents had explained this to me at different times. 

Of course, my primary concern was what do you do about VUR? Again, the parents of the baby had explained, but I wanted to give you a medical source, in addition, so I went to Mayo Clinic: 

“UTIs require prompt treatment with antibiotics to keep the infection from moving to the kidneys. To prevent UTIs, doctors may also prescribe antibiotics at a lower dose than for treating an infection. 

A child being treated with medication needs to be monitored for as long as he or she is taking antibiotics. This includes periodic physical exams and urine tests to detect breakthrough infections — UTIs that occur despite the antibiotic treatment — and occasional radiographic scans of the bladder and kidneys to determine if your child has outgrown vesicoureteral reflux. 

Surgery 

Surgery for vesicoureteral reflux repairs the defect in the valve between the bladder and each affected ureter. A defect in the valve keeps it from closing and preventing urine from flowing backward. 

Methods of surgical repair include: 

Open surgery. Performed using general anesthesia, this surgery requires an incision in the lower abdomen through which the surgeon repairs the problem. This type of surgery usually requires a few days’ stay in the hospital, during which a catheter is kept in place to drain your child’s bladder. Vesicoureteral reflux may persist in a small number of children, but it generally resolves on its own without need for further intervention. 

Robotic-assisted laparoscopic surgery. Similar to open surgery, this procedure involves repairing the valve between the ureter and the bladder, but it’s performed using small incisions. Advantages include smaller incisions and possibly less bladder spasms than open surgery. 

But, preliminary findings suggest that robotic-assisted laparoscopic surgery may not have as high of a success rate as open surgery. The procedure was also associated with a longer operating time, but a shorter hospital stay. 

Endoscopic surgery. In this procedure, the doctor inserts a lighted tube (cystoscope) through the urethra to see inside your child’s bladder, and then injects a bulking agent around the opening of the affected ureter to try to strengthen the valve’s ability to close properly. 

This method is minimally invasive compared with open surgery and presents fewer risks, though it may not be as effective. This procedure also requires general anesthesia, but generally can be performed as outpatient surgery.” 

Don’t miss the key word in today’s blog: OUTGROWN. It is possible for babies to outgrow VUS. 

Until next week,

Keep living your life!

It’s Seasonal

Now that I’m getting older [oh, all right, old], I see loads of specialists for my comorbidities. One of them, my rheumatologist, has mentioned several times that eGFR is lower in the summer and higher in the winter. I wondered why, but she’d already gone on to discussing my arthritis by the time I formulated my question. It seems like now is a good time to answer that question. Want to explore it with me? 

A few reminders first. According to Medical News Today: 

“A rheumatologist is an internal medicine doctor who specializes in diagnosing and treating inflammatory conditions that affect the joints, tendons, ligaments, bones, and muscles. 

Rheumatologists diagnose and treat musculoskeletal conditions, but they do not perform surgery.” 

I started seeing her for osteoarthritis decades ago. 

And eGFR? SelfCode, a site that is new to me which helps you decode your lab results, has that covered: 

“Glomerular Filtration Rate (GFR) is the amount of blood filtered every minute by tiny filters in the kidneys called glomeruli. Although it may sound complicated, in essence, it measures how well your kidneys are working….” 

Ready to explore the seasonal up and down of eGFR now? The first site that I could understand [Let’s remember I’m not a doctor and never claimed to be one.] which explained the connection between eGFR lowering during the summer was from the European Renal Association.  

Photo by Ketut Subiyanto on Pexels.com

“In general, our body has various ways of regulating the body temperature and releasing excess heat. The best-known method is through sweating. If the temperature control centre in our brain, known as the ‘hypothalamus’, detects that our comfort body temperature of 37 degrees [That’s Celsius; it’s 98.6 Fahrenheit.] exceeded, the sweat glands in the skin are stimulated to produce more. We consequently give off heat by ‘evaporating’ the sweat on the surface of the body. In addition, the body dilates our skin vessels. The heart pumps more warm blood into the dilated skin vessels, which also dissipates heat. 

The increased sweating naturally leads to a loss of fluid and important body salts, the so-called electrolytes. The lack of fluid and the heat-induced widening of the vessels lead to a drop in blood pressure. The heart no longer pumps enough blood through the body and the kidneys,” explains Professor Dr. Christoph Wanner, Head of Nephrology at the German University Hospital in Würzburg and President of the European Renal Association (ERA). ‘If you don’t compensate for this fluid loss, you become dehydrated. This can result in kidney failure. The risk to develop urinary stones and urinary tract infections is also bigger when the body is dehydrated.’” 

Now this may look like it doesn’t address the question, but remember we need to keep hydrated to keep the eGFR up. Increased sweating is a factor. Losing fluid and electrolytes is a factor. Widening of the vessels is a factor. A drop in blood pressure is a factor. The kidneys not receiving enough blood is a factor.  

Well, it seems my rheumatologist is right about lower eGFR in the summer. Wait a minute. That means she’s correct about a higher eGFR in the winter. Logically, if something is lower in some instances, it’s higher in others. Medically, we can work this backwards. 

If the kidney disease patient is not abundantly sweating, then they are not losing fluid and electrolytes. If they are not losing fluid and electrolytes, their blood vessels are not widening. If their blood vessels are not widening, their blood pressure is not dropping. If their blood pressure is not dropping, the kidneys are receiving enough blood. If the kidneys are receiving enough blood, your eGFR will be higher than it would be if none of this were the case. Voila! There we have a higher [than summer] eGFR in the winter. 

I thought it was interesting that blood pressure is also usually lower during the summer. The Mayo Clinic has the information on this: 

“Blood pressure can be affected in summer weather because of the body’s attempts to radiate heat. High temperatures and high humidity can cause more blood flow to the skin. This causes the heart to beat faster while circulating twice as much blood per minute than on a normal day. 

The greatest risks are when the temperature is above 70 degrees F and the humidity is more than 70%. The higher the humidity, the more moisture in the air. 

Some people are at higher risk of being affected by humidity, including people over 50; those who are overweight; or those who have heart, lung or kidney conditions. 

Heat and sweating also can lower the amount of fluid in the body, which can reduce blood volume and lead to dehydration. This can interfere with the body’s ability to cool off and may create strain on the heart. 

Other risk factors include: 

• Adults with heart, lung and kidney problems 
• Seniors who follow a low-salt or low-sodium diet 
• People who have a circulatory disease or problems with circulation 
• Adults who take diuretics, sedatives and blood pressure medication” 

Well now I understand why I thought I was going to pass out in Cuba. I live in Arizona, which has very low humidity. Cuba is high humidity. Lots of sweating going on at the time. Lots of drinking water, too, but apparently not enough.  

We knew that high blood pressure could cause chronic kidney disease. Now we know that low blood pressure can affect your CKD. 

Until next week, 

Keep living your life! 

Support Groups

I was speaking with my junior high school buddy, Joanne, the other morning. We don’t speak that often, but our conversations do tend to be at least an hour. Yes, this is the same Joanne I wrote about in Cancer Dancer. She told me about the support groups she belongs to. No, not Facebook groups, but zoom groups that started out as in person support groups and what she gets from them. 

I soon realized I’ve written pretty much only about the Facebook support groups. Well, it seems it’s time to write about in person or zoom groups. Some of these support groups were solely in person until the pandemic began, at which time they began offering zoom meetings. Some offer both: in person and zoom meetings. 

As someone who is a loner, I wanted to know what I could tell my readers about the benefits of support groups. MayoClinic to the rescue! 

“Benefits of participating in a support group may include: 

Feeling less lonely, isolated or judged 

Reducing distress, depression, anxiety or fatigue 

Talking openly and honestly about your feelings 

Improving skills to cope with challenges 

Staying motivated to manage chronic conditions or stick to treatment plans 

Gaining a sense of empowerment, control or hope 

Improving understanding of a disease and your own experience with it 

Getting practical feedback about treatment options 

Learning about health, economic or social resources” 

They do have a lot to offer. My buddy also mentioned how good she felt when another member of the support group said something like, “As Joanne mentioned….” She felt like she helped someone. I can see that. 

Photo by Tima Miroshnichenko on Pexels.com

What about medical support groups? Are they different in any way? According to HelpGuide: 

“When you’re going through a challenging or traumatic time, family members and friends may sympathize, but they don’t always know what to say or the best ways to help. Doctors and health professionals may sometimes offer minor emotional support, but their primary focus is always medical. 

Support groups developed to join people together who are dealing with similar difficult circumstances. That may be coping with a specific medical condition, such as cancer or dementia, a mental health issue like depression, anxiety, bereavement, or addiction, for example, or caring for a family member or friend facing such a problem. Whatever issues you or a loved one are facing, though, the best medicine can often be the voice of people who have walked in your shoes. 

A support group offers a safe place where you can get information that’s practical, constructive, and helpful. You’ll have the benefit of encouragement, and you’ll learn more about coping with your problems through shared experiences. Hearing from others facing similar challenges can also make you feel less alone in your troubles.” 

Hmmm, maybe we should look at the different kinds of zoom support groups now. By the way, I like the easily understood way Study.com delineated these: 

“Member-only/Self-help/Peer Support Groups 

Some support groups do not have a professionally trained leader. These are called member-only, self-help, or peer support groups. … there is usually no professionally trained leader. These support groups are beneficial because members can tell their own stories, listen to other people’s stories, and support and provide advice or strategies for one another. Sometimes members of these groups may feel more free to honestly share their thoughts than people in groups with a professionally trained facilitator, although this is not always the case. 

Professionally Facilitated Support Groups 

Professionally facilitated support groups are usually well-organized and have a leader who is professionally trained to help members deal with the group’s core issues…. while the facilitator might or might not have personally experienced the issue at the core of the support group, they would be professionally trained and experienced in supporting people who are dealing with these issues. These support groups are beneficial because members can share their own experiences, listen to other people’s experiences, provide support to one another, and receive professional advice and opinions about how to handle their particular issues. Members may also receive strategies to cope or improve from other group members. Some groups have leaders who have experienced the problem the group supports and who are professionally licensed to provide therapy to others. 

Members of a support group work together to help one another and to receive support. 

Online Support Groups 

Online support groups may have a professionally trained leader, a leader who has experienced the issue, or no clear leader. These groups, like other support groups, can have any number of purposes…. The benefits could be the same as in-person support groups, such as providing an outlet to express feelings, the chance to help others, the opportunity to get advice and coping techniques, and an increase in positive feelings. A unique benefit of online support groups is that people who live anywhere can join as can people who have physical disabilities that limit their mobility. 

Depending on the criteria involved in joining the online support group, one challenge could be making sure that members genuinely had the problem the support group was centered around. Online support groups that are not run effectively might be unmonitored, which could increase the chance of problems, rather than benefits, for members. However, overall, online support groups are effective tools for support.” 

I think we should spend a little time on where to find these support groups. Of special interest to us would be those for chronic kidney disease, dialysis, and/or transplant. A good place to start is the National Kidney Foundation. Their support group is asynchronous, meaning not all the members are online at the same time. You leave a comment or question, and other members answer when they can. 

The AAKP, or American Association of Kidney Patients, offers a list of online support groups by state. At last count, there were 11 different groups. Some of them were further specialized as to transplant, men only, and end stage renal disease. Some even offered telephone entry to the group for those without computers. 

RSNHope, the Renal Support Network, offers their own online support group. Many of the hospitals where you’ve been treated may also offer online support groups. Or you can ask your nephrologist if they can help you find one. Remember, if it’s online, it doesn’t have to be local. 

What do you say we all give Joanne a big thank you for suggesting today’s topic. 

Until next week, 

Keep living your life! 

Another New Concept

Let’s see how many of you know this new concept. Well, it’s new to me anyway: DUTCH.  I’ll bet it doesn’t ring any bells for you either. I’ll give you a hint. It’s an acronym, not an adjective. Ugh! I keep forgetting not everyone was an English teacher. An acronym is when you use just the first letters of a phrase rather than spelling each word out. An adjective describes a noun [person, place, thing, or idea].  

I gave in and started researching it. Dr. Lisa Watson, a naturopathic doctor from Canada, explains: 

“DUTCH is an acronym that stands for Dried Urine Test for Comprehensive Hormones. It is a simple, but sophisticated test that looks not just at your hormones, but how your body processes and metabolizes them. 

The DUTCH test looks not just at your reproductive hormones (although it does look at those quite thoroughly), but it also looks at your stress hormones, your androgens (male pattern hormones), your melatonin and the new DUTCH test also looks at organic acids – markers for mood and nutritional balance in the body.” 

Of course, then I wanted to know what dried urine had to do with it. I found the answer at DUTCH test complete collection instructions: 

“Complete all information on each collection device. 

 Saturate the filter paper by urinating directly on it OR use a clean cup and dip the filter paper. Leave the collection device open to dry for at least 24 hours.  

Once dry, close each collection device. Place all devices in the resealable plastic bag and return in the provided envelope….”  

So now we know what it is and how to do it, but what does it have to do with us? The answer may be in what it is that the D.U.T.C.H. looks at. The Holland Clinic [fortunate name for this test information, isn’t it?] lists the following hormones: 

• “Cortisol 
• Cortisone 
• Estradiol 
• Estrone 
• Estriol 

• Progesterone 
• Testosterone 
• DHEA 
• Melatonin 

This test also measures cortisol and cortisone rhythms and levels, and estrogen metabolism pathways.” 

Before we get to how any of these affect the kidneys or diabetes, here’s a reminder of what hormones are from The Cleveland Clinic: 

“Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it. Hormones are essential for life and your health.” 

Cortisone is synthetic cortisol, so let’s deal with cortisol. 

Does cortisol look familiar? No? Maybe The Mayo Clinic can be helpful here: 

“Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues.” 

Blood sugar or glucose has to do with diabetes. For example, when my NY daughter had a problem and I couldn’t go there to help her with it, I had high blood sugar until it was resolved. And what does high blood sugar do to you? I turned to Healthline to see if I could find an answer… and I did: 

“If high blood sugar levels go untreated for too long, glucose will build up in your bloodstream and your cells will be starved for fuel. Your cells will use fat for fuel instead. 

When your cells use fat instead of glucose, the process produces a byproduct called ketones: 

People with diabetes can develop diabetic ketoacidosis (DKA), a potentially deadly condition that causes the blood to become too acidic. Because of poorly functioning insulin in people with diabetes, ketone levels aren’t kept in check and can rise to dangerous levels very quickly. DKA can result in diabetic coma or death.” 

Whoa, baby! How do we recognize this dangerous state before it puts us in a coma or kills us? 

“Early symptoms include the following: 

Thirst or a very dry mouth 

Frequent urination 

High blood glucose (blood sugar) levels 

High levels of ketones in the urine 

Then, other symptoms appear: 

Constantly feeling tired 

Dry or flushed skin 

Nausea, vomiting, or abdominal pain. Vomiting can be caused by many illnesses, not just ketoacidosis. If vomiting continues for more than two hours, contact your health care provider. 

Difficulty breathing 

Fruity odor on breath 

A hard time paying attention, or confusion” 

Thank you to Diabetes.org for the above information. 

So, is D.U.T.C.H. worth your time, effort, and money? That’s between you and your doctor. I do need to let you know I found both nutritionists and endocrinologists online who felt the test was not worth the $119-$600 it costs. It is not covered by insurance. I’ve also read that they feel this test is useless since other tests can offer the same information in their results. So many pros and cons! 

Time to switch topics for a little bit. The AAKP [American Association of Kidney Patients] National Patient Meeting 2022 is coming up on September 21-23. You may register on their website at https://aakp.org/programs-and-events/national-patient-meeting/ 

In their own words: 

“Each year, AAKP hosts a timely and interactive virtual meeting featuring a diverse line-up of speakers crossing all sectors of the kidney community including the top influencers in kidney care from Federal government, medical professionals, academia, private industry and non-profit professional organizations in the kidney community; along with a virtual exhibit hall which will allow participates to engage with various kidney-related companies/organizations. 

All 2022 AAKP events will be held virtually to ensure the safety of all participants.” 

Unsure what this is all about? You can also view YouTubes of the last two National Patient Meetings through their website. Still have questions? Call AAKP at (800) 749-2257 or (813) 636-8100. 

Well, it’s time for this internationally famous blogger and author [as one interviewer called me] to go finish the laundry. 

Until next week, 

Keep living your life!  

Nailed It!

Every so often, my friend Geo asks pertinent questions or tells me about something he’s read. This week he told me about an article he’d read on nail fungus and CKD. My initial reaction was to wonder what nail fungus could possibly have to do with chronic kidney disease. Of course, what followed was my determination to find out. 

Let’s start with nail fungus. I found the Mayo Clinic has a good explanation: 

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

If your condition is mild and not bothering you, you may not need treatment. If your nail fungus is painful and has caused thickened nails, self-care steps and medications may help. But even if treatment is successful, nail fungus often comes back. 

Nail fungus is also called onychomycosis (on-ih-koh-my-KOH-sis). When fungus infects the areas between your toes and the skin of your feet, it’s called athlete’s foot (tinea pedis).” 

I think we need one more thing before we see how CKD is involved and that is the definition of fungus. I was surprised to discover that the National Cancer Institute had the most easily understood definition of the term: 

“A plant-like organism that does not make chlorophyll. Mushrooms, yeasts, and molds are examples. The plural is fungi.” 

The thought of something like that growing on my nails is more than a little creepy. What’s even creepier is that CKD might have something to do with it. 

I found this on ResearchGate: 

“Abnormalities of the skin and its appendage are commonly encountered in renal patients…. Other frequently observed onychomycopathies in CKD patients include onychomycosis, onycholysis, leukonychia, clubbing, and brittle nails. Onychomycosis, a commonly encountered fungal infection, also often manifests among CKD patients. Nail diseases in patients on maintenance hemodialysis are common and may affect up to 71.4 % of these patients. There is no direct relation between the dose and duration of hemodialysis and the increased prevalence of nail abnormalities. A significant incidence of nail changes among renal transplant recipients has also been described with a reported overall frequency of 56.6 %. Nail pathology increases with age and correlates with longer duration of immunosuppression. The most commonly encountered nail changes in renal transplant recipients include leukonychia, absence of lunula, onychomycosis, longitudinal ridging, and Muehrcke lines.” 

Now before you start wondering why I’m taxing you with all these medical terms, the only one you need to deal with is “onychomycosis,” which, as the Mayo Clinic has already explained, is also called nail fungus. 

Seems pretty clear to me so far… except for what CKD has to do with it. The Global Nail Fungus Organization remedied that problem: 

“CKD patients may experience abnormal fingernail and toenail changes due to malnutrition. Nails are made up of protein, which people suffering from chronic kidney disease are likely lacking of in their diet. As damaged kidneys lose their ability to excrete wastes and toxins out of the body, they cause sufferers to lose vitamins and other nutrition, all of which are necessary for healthy growth of nails. They are also at high risk of zinc deficiency, which is related to nail changes. 

Therefore, CKD sufferers often experience abnormal nail changes, which include getting brittle nails, pitted nails, yellow or white coloring, and white streaks or spots on the nails. The most common nail disorders people with CKD often get are absent lunula (the crescent-shaped white area of the bed of a nail) and half and half nails (half white and half red, pink or brown color appearance of the nail with an apparent demarcation line). 

Since abnormal changes to the nail are consequences of having chronic kidney disease, even with known nail treatments, the nails are unlikely to go back to normal unless the kidney disease is treated successfully. 

Onychomycosis in Patients with Chronic Renal Failure 

Patients with chronic renal failure may also experience onychomycosis, or nail fungi infection. In one study aiming to assess the frequency of onychomycosis in CKD patients undergoing hemodialysis (the process of filtering wastes and other toxins from the body using a machine), it found out that the frequency of nail fungi infection among the 100 patients was 39%. The risk of acquiring the onychomycosis went up by 1.9% for each additional year in age, with diabetic patients 88% more likely to develop the infection than non-diabetic patients. 

The study did not find the association of the development of onychomycosis with the duration of hemodialysis treatment.” 

Conversely, our nails can tip us off that we have kidney disease. Walk-In Lab explains: 

“When people have kidney disease, nitrogen waste products build up in our bodies. Your kidneys are not filtering those products out properly. This can lead to changes in the look and structure of both fingernails and toenails. It’s not the ONLY cause of change though. Malnutrition and taking some medications can also contribute…. 

There are three different types of nails to be on the lookout for when it specifically comes to chronic kidney disease. 

Beau’s lines 

The name comes from a French physician, Joseph Honore Simon Beau, who first described the condition in 1846. Beau’s lines are deep grooved lines that run horizontally from side to side on the finger or toenail…. These can be signs of acute kidney disease that interferes with the growth of the nail. They can also be signs of diabetes and vascular disease.  

Ridged nails 

The official name for this is koilonychia. These are rough looking nails with ridges that are frequently spoon-shaped and concave. In the early stages of this condition, the nails may be brittle, chipping easily. Ridged nails happen when you have iron-deficiency anemia…. These type of nails can also be a sign of heart disease or hypothyroidism.   

White streaks/spots 

The medical name for this type of nail is leukonychia, which comes from the Greek words that mean ‘white nails.’ This is when white lines or dots appear on your finger or toenails. They can be many dots on one nail or it might be one larger spot that stretches across the nail…. Injury is the largest cause of white spots, but they can also be indicative of heart disease, psoriasis and arsenic poisoning, as well as kidney disease.   

Other things to look for in nails are loosening nails, black lines, redness around the nail bed, half-and-half nails (also known as Lindsay’s nails) as they can indicate other diseases besides kidney disease. 
If you look down at your nails and see any of these patterns, check with your local healthcare provider. They may want to run tests on you to see if it’s something minor or the start of something serious.” 

Well, I’m glad Geo asked. I suspected there was a connection but hadn’t expected it to be so complex. 

Until next week, 

Keep living your life! 

It’s Just Not Fair

We all know I’m a medical mess. But now, I’m a disgruntled medical mess. You see, when you take insulin, you gain weight. I have diabetes and I take insulin, so I gained weight. Healthline explains: 

“Weight gain is a normal side effect of taking insulin. Insulin helps you manage your body sugar by assisting your cells in absorbing glucose (sugar). Without insulin, the cells of your body are unable to use sugar for energy. You’ll eliminate the extra glucose in your bloodstream through your urine or have it stay in the blood, causing high blood sugar levels. 

You may experience weight loss before you start insulin therapy. The loss of sugar in your urine takes water with it, so some of this weight loss is due to water loss. 

Also, unmanaged diabetes can make you extra hungry. This can lead to eating an increased amount of food even when you start insulin therapy. And when you start insulin therapy and begin getting your blood sugar under control, the glucose in your body is absorbed and stored. This causes weight gain if the amount you eat is more than you need for the day.” 

Okay, I was warned by my endocrinologist. I didn’t like it, but I wasn’t going to waste the life that had just been saved for me. Pancreatic cancer, remember? 

So, what is not fair? It seems there’s a new drug you can take to lose weight when you’re on insulin and are type 2 diabetes. Yay! I can’t take it. Boo! I went to The Mayo Clinic to explore this drug and discovered more than I’d expected to: 

“Some diabetes medications that help regulate blood glucose levels — including metformin (Fortamet, Glucophage, others), exenatide (Byetta), liraglutide (Victoza), albiglutide (Tarzeum), dulaglutide (Trulicity), sitagliptin (Januvia), saxagliptin (Onglyza), canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance) and pramlintide (Symlin) — may promote weight loss and enable you to reduce your insulin dosage.” 

I was surprised that all of these might help with weight loss, but then I remembered I had tried several of them as a pre-diabetic and did not do well on them. It was a while ago, but nausea as a side effect sticks out in my mind. 

I decided to do a search for the latest drug that both treated type 2 diabetes and helped with weight loss. Reminder: Type 1 diabetes is when you don’t produce enough insulin and type 2 is when you are insulin resistant. Healthline also provided this information: 

“A once-weekly injectable recently approved to treat type 2 diabetes may hold major potential as a weight loss medication for people with obesity, too, a study suggests. 

Overweight or obese participants without type 2 diabetes who took the drug, called tirzepatide (sold as the diabetes drug Mounjaro), lost an average of nearly 21 percent of their body weight at the highest dose studied. Scientists presented their findings at the American Diabetes Association (ADA)’s annual meeting in New Orleans and published the study in The New England Journal of Medicine. 

‘Definitely, the weight loss in this study is far more what we had ever seen with other FDA-approved medications in term of the absolute amount of weight lost or percentage of weight lost,’ says Osama Hamdy, MD, PhD, an associate professor at Harvard Medical School and medical director of the obesity clinical program at the Joslin Diabetes Center in Boston…. 

Tirzepatide is the first drug in a new family of medicines that target two hormones — glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) — that are involved in maintaining healthy blood sugar levels and sending signals from the gut to the brain when people are full. 

The U.S. Food and Drug Administration (FDA) approved tirzepatide in May to help manage blood sugar in people with type 2 diabetes; the diabetes treatment is called Mounjaro. 

A head-to-head clinical trial found tirzepatide in this setting to be more effective at controlling blood sugar and spurring weight loss in type 2 diabetes patients than semaglutide (Ozempic), an injected GLP-1 receptor agonist, or two commonly used forms of insulin, according to the FDA. 

In this earlier trial, tirzepatide reduced so-called hemoglobin A1C levels, which reflect average blood sugar levels over about three months, by 0.5 percent more than semaglutide and by about 1 percent more than insulin, the FDA said. 

The 15 mg dose of tirzepatide helped type 2 diabetes patients with obesity lose 12 pounds more than semaglutide, and 27 to 29 pounds more than the two forms of insulin evaluated, the FDA noted.” 

I’m impressed, so much so that I wanted to try this new drug. My endocrinologist said no. I was disgruntled about that. She explained that I only have one quarter of my pancreas [and here I thought I had two thirds, but I hadn’t realized the pancreas also has a neck. That was removed along with the body and tail leaving me only the head during the surgery to rid me of cancer.] So? What does that have to do with anything? 

PharmarcyTimes supplied the answer: 

“The drug has not been studied in patients with a history of pancreatitis and is not indicated for use in patients with type 1 diabetes mellitus, according to Eli Lilly.” 

Oh, I see. She wasn’t willing to take the chance of damaging my remaining one quarter of my pancreas. I had never had pancreatitis but did have pancreatic cancer. This sounds like a case of don’t poke the sleeping dog. I’ll admit that I am leery of anything that may have the slightest chance of causing another cancer in my body. Therefore, I will accept my endocrinologist’s decision although life just isn’t fair in this case. But, hey, I’m alive so why complain? 

Until next week, 

Keep living your life!  

They Can be a Pair

Last week, I was back in surgery… but for a welcome reason this time. After almost three years of remission, my oncologist felt it was safe to remove my PowerPort. That’s where the harsh chemotherapy drugs entered my body. I was glad to have it gone because it was attached to my jugular vein and that made me nervous. 

While I was in pre-op, one of the nurses looked at my chart and asked me about my chronic kidney disease. After I explained, she told me she had had a pancreas/kidney transplant. I was captivated to the point of almost being disappointed when it was time for my procedure, and she hadn’t finished relating her story. So, I decided to do what I usually do. Research it myself. 

I had all sorts of theories in my head about why the two might be transplanted together. I was curious to see if they were anywhere near the truth. The Mayo Clinic was helpful here: 

“Combined kidney-pancreas transplant. Surgeons often may perform combined (simultaneous) kidney-pancreas transplants for people with diabetes who have or are at risk of kidney failure. Most pancreas transplants are done at the same time as a kidney transplant.” 

Aha! Not only does that make sense, but it was one of my theories. I have diabetes, type 2 and I have CKD. Does that make me a candidate for a pancreas/kidney transplant. Actually, since the pancreatic cancer, I only have the head of my pancreas, does that affect the situation? 

I turned to The National Kidney Foundation to find out: 

“Adults who have kidney failure because of type 1 diabetes are possible candidates for a kidney-pancreas transplant. In type 1 diabetes, the pancreas does not make enough insulin, a hormone that controls the blood sugar level in your body. The transplanted pancreas can make insulin and correct this type of diabetes. 

In order to become active on the transplant waiting list you must be: 

18 years or older 

Have both Type 1 diabetes and kidney failure 

Complete evaluation and be approved by transplant center for a kidney and pancreas transplant” 

Well, that lets me out. Kidney failure is when your kidneys don’t work well enough to keep you alive. My GFR has lowered since my cancer dance, but at 41%, the kidneys are still doing their job. Nor do I have type 1 diabetes, the kind in which your pancreas produces insufficient insulin. Although I only have the head of my pancreas remaining, I’m producing enough insulin to be insulin resistant. [Gee, how lucky for me, she thought sarcastically.] 

The nurse I spoke with said her pancreas/kidney transplant had been redone. It was originally done the “old way” that caused her problems and needed to be done the “new way.” That’s when I was wheeled to the operating room. Darn! You know my curiosity was aroused. What was the old way? The new way? What problems had been caused by doing the operation the old way? 

I came across this discussion in Pub Med Central’s Annals of Surgery, May 1999: 

“Dr. John C. McDonald (Shreveport, Louisiana): This is a detailed report on the current outcome of simultaneous kidney-pancreas transplantation, and is another fine presentation from the Memphis group… (which) has led the field in reestablishing the concept that best results are obtained when endocrine activity is delivered through the portal system and exocrine function through the GI tract. This concept was thought correct intuitively in the early efforts of transplanting the pancreas but was soon abandoned because of technical complications.” 

I needed a little assistance understanding it. I offer you the same assistance. 

Endocrine means “relating to or denoting glands which secrete hormones or other products directly into the blood.” 

 The portal system is “the system of blood vessels consisting of the portal vein with its tributaries and branches.  

Exocrine? That’s “relating to or denoting glands that secrete their products through ducts opening onto an epithelium rather than directly into the bloodstream.” 

 Epithelium means “the thin tissue forming the outer layer of a body’s surface and lining the alimentary canal and other hollow structures.” 

And, finally, the alimentary canal is “the whole passage along which food passes through the body from mouth to anus. It includes the esophagus, stomach, and intestines — that runs from the mouth to the anus.” 

I’d like to think I knew all this, but instead I need to thank the various dictionaries I consulted for these definitions. Now, the way I’m reading this discussion seems to be saying that the original method of delivering the blood containing the glandular production via the portal and the other glands’ secretions via the GI tract. Hmmm, so first that was the best way to transplant the pancreas, then it wasn’t, then it was again. Well, what came in between? Or, since this discussion is from 1999, is there a new method now?  

This is from a MedlLinePlus article published last year: 

“The person’s diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the person’s abdomen. Blood vessels from the new pancreas are attached to the person’s blood vessels. The donor duodenum (first part of the small intestine right after the stomach) is attached to the person’s intestine or bladder.” 
 

Look at that. Blood to the blood and exocrine secretions to the epithelium. I think that’s what the above means, but I wouldn’t swear to it. Wait a minute. The nurse did say that the new pancreas had been attached to her intestine which caused her trouble. Then it was removed from the intestine to be reattached to the bladder, which rectified the situation for her. So, I guess the current method is the original. 

I hate to leave you hanging, but I feel I just don’t understand enough to explain any more. Hopefully, what I have written will be of some help to those facing, or curious about, a pancreas/kidney transplant. Although, I didn’t really write much about a kidney transplant since I’ve written about that several times already. 

Until next week, 

Keep living your life!  

It’s the Month of….

World Kidney Day was March 10^th this year. While I publicized it widely on social media, I didn’t blog about it because I have just about every year for the last 11 years or so. Just scroll to ‘World Kidney Day’ on the topics dropdown to the right of the blog and you can read last year’s blog about it. 

By now, we all know March is National Kidney Month as well as Women’s History Month. Did you know it’s also National Nutrition Month? National Day Calendar tells us there is much more being celebrated this month: 

“Asset Management Awareness Month 

Developmental Disabilities Awareness Month 

Endometriosis Awareness Month 

Irish-American Heritage Month 

Multiple Sclerosis Awareness Month 

National Athletic Training Month 

National Brain Injury Awareness Month 

National Breast Implant Awareness Month 

National Caffeine Awareness Month 

National Celery Month 

National Cerebral Palsy Awareness Month 

National Cheerleading Safety Month 

National Craft Month 

National Colorectal Cancer Awareness Month 

National Credit Education Month 

National Flour Month 

National Frozen Food Month 

National Kidney Month 

National Noodle Month 

National Nutrition Month 

National Peanut Month 

National Sauce Month 

National Trisomy Awareness Month 

National Umbrella Month 

National Women’s History Month 

National Social Work Month” 

I’ll admit I had to look up Trisomy. I figured it was three something since tri means three. The Medical Dictionary backed me up: 

“the presence of an additional (third) chromosome of one type in an otherwise diploid cell (2n +1).”   

Now, I’ll agree with you that some of these seem pretty silly, but I also think it’s no accident that National Kidney Month and National Nutrition Month are both in March. Wait, before I forget, you can also use the topic dropdown to read last year’s blog on National Women’s History Month. 

I haven’t written about the basics of chronic kidney disease treatment in a while, but nutrition is one of them. I’ll let the National Kidney Foundation explain about the first of the ‘3 Ps and 1 S’ as I called them in my first CKD book, What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. 

“Protein 

Your body needs protein to help build muscle, repair tissue, and fight infection. If you have kidney disease, you may need to watch how much protein you eat. Having too much protein can cause waste to build up in your blood, and your kidneys may not be able to remove all the extra waste. If protein intake is too low, however, it may cause other problems so it is essential to eat the right amount each day. 

The amount of protein you need is based on: 

your body size 

your kidney problem  

the amount of protein in your urine 

Your dietitian or healthcare provider can tell you how much protein you should eat.” 

My first nephrologist limited me to 5 ounces of protein daily 13 years ago. That still hasn’t changed. 

What about that one S? I thought the National Kidney Fund would be helpful here and they were, as long as you remember sodium, the 1 S, is one of the two elements of table salt: 

“Salt makes you thirsty and can make your body retain fluid. Having more fluid in your body can raise your blood pressure. When you have high blood pressure, your kidneys must work harder to filter blood. Over time, this can lead to kidney damage. 

Too much fluid in your body also puts more strain on your heart, lowers your protein levels, and leads to difficulty breathing. Taking steps to limit excess fluid buildup, and thereby controlling blood pressure, is vital to improving your health. 

If you have high blood pressure, eating a low or no added salt diet can help to lower it. Increasing your daily physical activity and taking blood pressure medicines if prescribed by your doctor are other ways to manage your blood pressure. Taking steps to keep your blood pressure at a healthy level may help keep kidney disease from getting worse.” 

2 Ps to go. One of them is potassium. I went right to my old and trusted site WebMD for information: 

“Every time you eat a banana or a baked potato with the skin on (not just the tasty buttered insides), you’re getting potassium. This essential mineral keeps your muscles healthy and your heartbeat and blood pressure steady. 

If you have a heart or kidney condition, though, your doctor may recommend a low-potassium diet. Your kidneys are responsible for keeping a healthy amount of potassium in your body. If they’re not working right, you may get too much or too little. 

If you have too much potassium in your blood, it can cause cardiac arrest — when your heart suddenly stops beating. 

If you have too little potassium in your blood, it can cause an irregular heartbeat. Your muscles may also feel weak.” 

Hang on, here’s the last P – phosphorous. That’s the one element you usually don’t find on food labels. For CKD patients, that’s pretty annoying since you may have to keep track of all 3 Ps and 1S at your nephrologist’s or renal dietitian’s direction. Mayo Clinic, another trusted site I’ve been consulting for over a dozen years, explains: 

“Phosphorus is a mineral that’s found naturally in many foods and also added to many processed foods. When you eat foods that have phosphorus in them, most of the phosphorus goes into your blood. Healthy kidneys remove extra phosphorus from the blood. 

If your kidneys don’t work well, you can develop a high phosphorus level in your blood, putting you at greater risk of heart disease, weak bones, joint pain and even death …. 

How much phosphorus you need depends on your kidney function. If you have early-stage kidney disease or you’re on dialysis, you may need to limit phosphorus. Nearly every food contains some phosphorus, so this can be hard to do.” 

While National Nutrition Month is for everyone, we – as CKD patients – need to pay more than usual attention to our nutrition if we don’t want our chronic kidney disease to go spiraling out of control. Naturally, our diets need to be individualized based on the stage of our disease and diet is not all there is to slowing down the progression of the decline of your kidney function (the definition of CKD), but it’s a start. 

Until next week, 

Keep living your life!  

What Are the Basics, Anyway?

Happy New Year! You know, the only way for it to be happy is for you to make it happy. For us, that includes taking care of our chronic kidney disease in the most basic ways. “Remind me; what are those?” my good buddy asked when I said that to her. So, this will be a back to basics blog to begin the new year. 

We all know that what we eat has a lot of influence on our kidneys. Way back when I was writing What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, I called this influence “the three p’s and an s.” That’s an easy way to remember what I’ll explain next. Remember though, we are each unique patients and you and your nephrologist will decide to what extent you follow these suggestions.  

Okay then. Let’s start. MedlinePlus has a comprehensive explanation of potassium: 

“Potassium is a mineral that your body needs to work properly. It is a type of electrolyte. It helps your nerves to function and muscles to contract. It helps your heartbeat stay regular. It also helps move nutrients into cells and waste products out of cells. A diet rich in potassium helps to offset some of sodium’s harmful effects on blood pressure…. 

Your kidneys help to keep the right amount of potassium in your body. If you have chronic kidney disease, your kidneys may not remove extra potassium from the blood…. You may need a special diet to lower the amount of potassium that you eat.” 

Then there’s protein. We’re pretty familiar with the definition, but what does it has to do with your kidneys? The National Kidney Foundation has that one covered: 

“…. Protein is used to build muscle, heal, fight infection, and stay healthy. Protein needs vary based on your age, sex and overall general health. Protein in the diet comes from both animal and plant sources…. 

You need protein every day to meet your body’s needs, but if you have kidney disease, your body may not be able to remove all the waste from the protein in your diet. Excess protein waste can build up in your blood causing nausea, loss of appetite, weakness, and taste changes…. 

The more protein waste that needs to be removed, the harder the kidneys need to work to get rid of it. This can be stressful for your kidneys, causing them to wear out faster. For people with kidney disease who are not on dialysis, a diet lower in protein is recommended.” 

The final ‘p’ is phosphorous. I turned to WebMD for help with this one: 

“Phosphorus is a mineral, likeiron [sic] or potassium. You have more of this mineral in your body than any other except calcium…. 

It plays an important role in keeping you healthy, so it’s an important part of your diet. One of its main tasks is to serve as a building block for healthy teeth and bones. You may think that’s calcium’s job. But calcium needs phosphorus to make your teeth and bones strong. 

Phosphorus also helps your nerves and muscles do their jobs. It’s a buffer that keeps the pH level in your blood balanced. Phosphorus also helps you turn fat, carbs, and protein into energy…. 

When they work well, your kidneys remove extra phosphorus your body can’t use. 

If you have a kidney condition like chronic kidney disease, you may have high levels of phosphorus. This can cause your bones to lose calcium or calcium deposits to form in your blood vessels, eyes, heart, and lungs. If you have too much phosphorus in your body for a long period of time, your chance of a heart attack or stroke goes up.” 

Wow, and we’re not done yet. There’s sodium, too.  The to the MayoClinic for the following: 

“The body needs some sodium to function properly. Sodium plays a role in: 

The balance of fluids in your body 

The way nerves and muscles work 

The kidneys balance the amount of sodium in the body. When sodium is low, the kidneys hold on to it. When sodium is high, the kidneys release some in urine. 

If the kidneys can’t eliminate enough sodium, it builds up in the blood. Sodium attracts and holds water, so the blood volume increases. The heart must work harder to pump blood, and that increases pressure in the arteries. Over time this can increase the risk of heart disease, stroke and kidney disease. 

Some people are more sensitive to the effects of sodium than are others. That means they retain sodium more easily, which leads to fluid retention and increased blood pressure.” 

Now you can understand the plethora of kidney diet cookbooks. Or you can limit these electrolytes yourself. That’s what I did until I developed diabetes. I’ve had CKD for 14 years, so some of the estimating had become rote. Honestly, now I’m back to needing help to combine the renal and diabetes diet. 

Dealing with “the three p’s and one s” is the beginning of taking care of your CKD. There’s also exercise, sleep, avoiding stress, rest, watching your weight, avoiding alcohol and smoking, and keeping tight control of your diabetes, heart disease, and high blood pressure. Oh, limiting your sodium will help you with your high blood pressure, too.  

There isn’t enough space in this particular blog to write about each of those. Let me know if you’d like a blog explaining more about the items in the previous paragraph. Meanwhile, see what you [or you and doctor] can do to help with them. 

Welcome to 2022, the year you take a bigger part in making yourself happy by taking care of your CKD. 

Until next week, 

Keep living your life! 

That’s Not Pair Of, But Para

Thanks for waiting, Beth. This one’s for you. Beth asked if I’d covered hyperparathyroidism and chronic kidney disease. Lo and behold, I hadn’t. Haven’t a clue how I missed that one. Let’s rectify that right now. 

The Merriam-Webster Dictionary, still my favorite after all these years, defines the parathyroid as:  

“any of usually four small endocrine glands that are adjacent to or embedded in the thyroid gland and

produce parathyroid hormone” 

Wonderful, a definition that leaves us with other words that need to be defined. Using the same dictionary, we have the following meanings: 

“Endocrine: secreting internally, specifically: producing secretions that are distributed in the body by way of the bloodstream 

Hormone: a product of living cells that circulates in body fluids (such as blood) or sap and produces a specific often stimulatory effect on the activity of cells usually remote from its point of origin 

Parathyroid hormone: a hormone of the parathyroid gland that regulates the metabolism of calcium and phosphorus in the body   

Thyroid: a gland at the base of the neck that produces hormones which affect growth, development, and the rate at which the body uses energy” 

Now it makes sense. But wait a minute. Beth asked about hyperparathyroidism. No problem. We know hyper means overactive, so we’ll be dealing with an overactive parathyroid gland. 

Now let’s see what symptoms there are. The Mayo Clinic has that covered: 

“Hyperparathyroidism is often diagnosed before signs or symptoms of the disorder are apparent. When symptoms do occur, they’re the result of damage or dysfunction in other organs or tissues due to high calcium levels in the blood and urine or too little calcium in bones. 

Symptoms may be so mild and nonspecific that they don’t seem related to parathyroid function, or they may be severe. The range of signs and symptoms include: 

Osteoporosis 

Kidney stones 

Excessive urination 

Abdominal pain 

Tiring easily or weakness 

Depression or forgetfulness 

Bone and joint pain 

Frequent complaints of illness with no apparent cause 

Nausea, vomiting or loss of appetite” 

Calcium? Now we’re getting to the part ckd plays in hyperparathyroidism. Reminder: ckd is a decrease in the function of your kidneys for at least three months.  

I went to Kidney Health Australia for more information about calcium and the kidneys: 

“If you have kidney disease your body is not able to keep the levels of calcium and phosphate at healthy levels. When your kidneys start to fail they cannot remove the excess phosphate from your body. Kidney disease also leads to an increase in production of parathyroid hormone. This also leads to too much phosphate in your body. The phosphate builds up in your body and binds to calcium. This causes your calcium levels to decrease, which may weaken your bones. The phosphate and calcium can narrow your blood vessels and increase your risk of heart disease and stroke. It can also cause skin ulcers and lumps in your joints.” 

So, we see that it’s not only calcium involved in hyperparathyroidism but also phosphate. Think of it like the scales of justice. Calcium goes down and phosphate goes up. Conversely, phosphate goes down and calcium goes up. 

The National Kidney Foundation explains: 

“Normal working kidneys can remove extra phosphorus in your blood. When you have chronic kidney disease (CKD), your kidneys cannot remove phosphorus very well. High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak.” 

Phosphate and phosphorous are used interchangeably in discussing kidney function, although they’re not exactly the same thing. 

There may also be confusion in another area as noted by Medline Plus: 

“Though their names are similar, the thyroid and parathyroid glands are completely different. The parathyroid glands make parathyroid hormone (PTH), which helps your body keep the right balance of calcium and phosphorous.” 

You should also know there are three kinds of hyperparathyroidism. The first – primary – is not kidney related so we’ll skip that and let Healthline demystify the other two: 

“Secondary Hyperparathyroidism 

Treatment involves bringing your PTH level back to normal by treating the underlying cause. Methods of treatment include taking prescription vitamin D for severe deficiencies and calcium and vitamin D for chronic kidney failure. You might also need medication and dialysis if you have chronic kidney failure.

Photo by Alena Shekhovtcova on Pexels.com

What Are the Complications Associated with Hyperparathyroidism? 

If you suffer from hyperparathyroidism, you might also have a condition called osteoporosis which is also sometimes referred to as “thinning” of the bone. Common symptoms include bone fractures and height loss due to vertebral body (spinal column) fractures. This can develop when excess PTH production causes too much calcium loss in your bones, making them weak. Osteoporosis typically occurs when you have too much calcium in your blood and not enough calcium in your bones for a prolonged period. 

Osteoporosis puts you at a higher risk for bone fractures. Your primary care provider can check for signs of osteoporosis by taking bone X-rays or doing a bone mineral density test. This test measures calcium and bone mineral levels using special X-ray devices…. 

Tertiary Hyperparathyroidism 

This type occurs when your parathyroid glands keep making too much PTH after your calcium levels return to normal. This type usually occurs in people with kidney problems. 

This is looking serious. How do you know if you have hyperparathyroidism? I’ll let WebMD handle this one: 

“Your doctor will ask about your medical history and look for symptoms including a swollen thyroid, a fast pulse, moist skin, and shaking in your hands or fingers. They’ll give you tests that might include: 

Thyroid panel. This blood test measures levels of thyroid hormones and thyroid-stimulating hormone (TSH). 

Thyroid scan. A technician injects a small amount of radioactive iodine into your bloodstream. Your thyroid absorbs it, and a special camera takes pictures of the gland to look for nodules or other signs of problems. 

Ultrasound. A technician runs a device called a transducer over your neck. It uses sound waves to create images of your thyroid. 

Radioactive iodine uptake test. You swallow a small amount of radioactive iodine. A device called a gamma probe measures how much of the iodine collects in your thyroid. If this uptake is high, you probably have Graves’ disease or thyroid nodules.” 

Consider these as Chanukah gifts

For treatment – as mentioned – there’s drugs, radioactive iodine, surgery, and more. Treatment is individualized, so that will be between you and your doctor. Aren’t you glad Beth asked for this blog? 

Until next week, 

Keep living your life! 

Sweet Dreams Are Made of This

Today’s title probably made you think of the British group, Eurythmics (Annie Lenox & Dave Stewart). True, they did release an album by that name in 1983 with the lead song having the same name, but that’s not what I had in mind. I was thinking more of blood glucose, or blood sugar as it’s sometimes called. That’s the ‘sweet’ part of the title. ‘Dreams’ refers to the night. 

This week, I discovered that your blood glucose may rise in the early morning hours. That explains why mine was always so high when I woke. I could stop scratching my head about that, but it also got me to thinking my usual question: why?  

This phenomenon even has its own name: the dawn effect. WebMD explains: 

“It’s tied to whether the hormone insulin, which removes glucose from the blood, is working the way it’s supposed to. Blood sugar levels surge while you’re sleeping, usually around 4 to 8 a.m. for someone with a normal sleep schedule…. In a healthy person, insulin can handle the surge by telling muscle, fat, and liver cells to absorb the glucose from the blood, which keeps your levels stable. 

For people who have diabetes or who are likely to get it, insulin can’t do that job very well, so blood sugar levels will rise higher.” 

I wasn’t quite satisfied with the answer, so I turned to my old buddy, The Cleveland Clinic for more: 

“Your body uses glucose (sugar) for energy and it is important to have enough extra energy to be able to wake up in the morning. So for a period of time in the early morning hours, usually between 3 a.m. and 8 a.m., your body starts churning out stored glucose to prepare for the upcoming day. 

At the same time, your body releases hormones that reduce your sensitivity to insulin. In addition, these events may be happening while your diabetes medication doses taken the day before are wearing off.” 

I found myself intrigued by this explanation but still wasn’t satisfied so I figured the American Diabetes Association would probably have something more detailed but still understandable. They did: 

“In the early hours of the morning, hormones, including cortisol and growth hormone, signal the liver to boost the production of glucose, which provides energy that helps you wake up. This triggers beta cells in the pancreas to release insulin in order to keep blood glucose levels in check. But if you have diabetes, you may not make enough insulin or may be too insulin resistant to counter the increase in blood sugar. As a result, your levels may be elevated when you wake up. The dawn phenomenon does not discriminate between types of diabetes. Approximately half of those with either type 1 or type 2 experience it.” 

Now, we’re talking. When I had pancreatic cancer, two thirds of my pancreas had to be removed. How much insulin can the remaining one third of a pancreas produce? I thought I was satisfied with what I’d read. 

Photo by Ron Lach on Pexels.com

Well, I was until I discovered the rare and controversial Somogyi effect in my researching. That threw a monkey wrench into my thinking. Healthline cleared my confusion: 

“According to the theory of the Somogyi effect, when insulin lowers your blood sugar too much, it can trigger a release of hormones that send your blood sugar levels into a rebound high. It’s thought to be more common in people with type 1 diabetes than type 2 diabetes.” 

Take a look at the list of symptoms provided by MedicalNewsToday. Luckily for me, I don’t have any of them. 

“Symptoms of the Somogyi effect start with high blood glucose levels upon waking that do not respond to increased insulin doses. 

The symptoms also include low blood glucose levels at 2:00 a.m. or 3:00 a.m. as well as the following, which are symptoms of low blood sugar: 

night sweats 

a rapid heart rate 

waking up with a headache 

blurred vision 

confusion 

dizziness 

dry mouth 

fatigue 

increased appetite 

thirst” 

Photo by Liza Summer on Pexels.com

Let’s move away from the discoverer named Somogyi effect and go back to the dawn effect. That must have symptoms, too. And there they are, right on MedicalNewsToday again. 

“faintness 

nausea 

vomiting 

blurry vision 

weakness 

disorientation 

feeling tired 

extreme thirst” 

Wait a minute. I’ve been nauseous for the last two days as well as feeling tired and having extreme thirst. There must be something I can do about this situation. Watch me run to the Mayo Clinic. Sure enough, they have the advice I was looking for: 

• Avoid carbohydrates at bedtime. 
• Adjust your dose of medication or insulin. 
• Switch to a different medication. 
• Change the time when you take your medication or insulin from dinnertime to bedtime. 
• Use an insulin pump to administer extra insulin during early-morning hours. 

You know, the only thing I can do by myself is the first suggestion. It’s a good thing I have an appointment with my endocrinologist coming up very soon. 

Of course, there are other causes of occasional high blood glucose when you awaken. Stress, anxiety, having high carbohydrate snacks before bedtime, illness, and lack of exercise also play their role in high blood glucose. 

Let’s talk about anxiety. In these CoVid times, we can get pretty anxious. You don’t want it contributing to the dawn effect [should you incur that].  

• “Any type of physical activity, even if it’s just a quick walk around the block during your lunch break. 
• Meditation or yoga 
• Speaking to a supportive friend, coworker or clergy. 
• Being gentle with yourself—give yourself a break and don’t be so hard on yourself. 
• Doing something fun, like engaging in a hobby or reading. 
• Eating healthy foods. 
• Reducing or eliminating your alcohol and caffeine consumption 
• Getting enough sleep 

If your anxiety continues for more than two weeks or if you’re finding it difficult to complete everyday activities, you should consider talking to a counselor or psychologist who can provide help and direction.” 

Thank you to Raleigh Medical Group for these suggestions. 

Until next week, 

Keep living your life! 

Not Polycystic Kidney Disease

My sister-in-law and I were discussing my brother’s health the other day. For the first time, she told me a cyst had been noticed on his left kidney. Wait a minute, I have a cyst on my left kidney. Was this something familial? 

Let’s start at the beginning with the definition of a kidney cyst. This one is from the Mayo Clinic. 

“Kidney cysts are round pouches of fluid that form on or in the kidneys. Kidney cysts can be associated with serious disorders that may impair kidney function. But more commonly, kidney cysts are a type called simple kidney cysts — noncancerous cysts that rarely cause complications.” 

That’s not much different from the definition of cysts, except that these form on or in the kidneys. 

Front view of kidney with simple cyst.

You’ve probably read about a kidney disease that causes multiple cysts on the kidneys: polycystic kidney disease or PDK. According to The National Kidney Foundation, 

“Polycystic kidney disease (also called PKD) causes numerous cysts to grow in the kidneys. These cysts are filled with fluid. If too many cysts grow or if they get too big, the kidneys can become damaged. PKD cysts can slowly replace much of the kidneys, reducing kidney function and leading to kidney failure.” 

It’s also an inherited disease, but that’s not what we’re looking at today. We’re dealing with one or two isolated cysts. Naturally, our next question should be why do some of us develop these. The Cleveland Clinic sort of has the answer: 

“Kidney cysts occur when the tube of a nephron begins to get bigger and fill with fluid. Researchers don’t know what causes this to occur, but they do know that simple cysts aren’t inherited. It is believed that injury or microscopic blockages in the tubules may lead to the development of some simple kidney cysts.” 

We have the theory, but no proof. One thing is certain, this type of kidney cyst is not inherited as those in PKD are.  

A definition of nephrons might be in order here… just in case you forgot what they are. This is how I defined them in my first book What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. 

“Nephrons: The part of the kidney that actually purifies and filters the blood.” 

That book was written so long ago that my name was still Gail Rae, but some things don’t change – like the definition of nephrons. 

Back to the question about the fact that my brother – my sibling – and I both have simple kidney cysts. I could not find any definitive evidence that our being related had anything to do with us both having simple kidney [or renal] cysts. I did learn that age has a lot to do with it and that males are more likely to develop renal cysts. I also learned that they are not uncommon. 

I know mine was picked up in routine scans, as was my brother’s. I became curious as to whether there was another way of discovering simple renal cysts. WebMD explained that you may have symptoms: 

“Simple kidney cysts usually don’t cause symptoms. In most cases, a doctor finds them during an ultrasound or computerized tomography (CT) scan done for another reason. If you do have symptoms, they may include: 

Pain in your side, back, or upper abdomen if they enlarge and press on other organs 

Fever, chills, or other signs of infection 

Blood in your urine 

Blocked blood or urine flow through your kidneys (rare) 

Impaired kidney function (rare) 

Simple kidney cysts have been associated with high blood pressure, but it is unclear what the relationship is between the two.” 

Okay, so you know you have a renal cyst. What do you do now? Usually nothing as MedicalNewsToday makes clear: 

“Most simple kidney cysts do not need any treatment beyond periodic monitoring. 

Kidney cysts that cause symptoms may require treatment, particularly if they block the flow of urine or blood through the kidneys. In these cases, a doctor may recommend draining the cyst, using a procedure called sclerotherapy. 

During sclerotherapy, a doctor uses ultrasound to guide a needle to the cyst. The sac of fluid is then punctured with the needle and drained. 

Next, the doctor will inject a saline solution into the area to harden the surrounding tissue and prevent another cyst from forming. The procedure is done using local anesthesia and on an outpatient basis. 

In rare cases of a very large cyst, surgery may be required to drain or remove the growth. Normally, this is done with a small tool that has a light and camera on one end that allows the surgeon to keep the incision small. 

Kidney cyst removal is usually performed in a hospital under general anesthesia. 

In the case of an infected cyst, antibiotic therapy may be started prior to any other treatment.” 

Cedars-Sinai explicates two other methods of renal cyst removal.

“Retrograde Intrarenal Surgery (RIRS) 

RIRS is the treatment of choice when the cyst can be reached from the draining portion of the kidney basin. A small telescope goes through the natural opening of the body, into the ureter and up into the kidney. A cut is made with a laser, and the cyst is opened into the draining system. A small tube (stent) is left in the ureter for about two weeks to allow proper healing. RIRS is an outpatient procedure. The stent is removed in the office. 

Percutaneous Kidney Surgery 

Percutaneous kidney surgery is done for large cysts in the back of the kidney. This is a minimally invasive method that allows the surgeon to do endoscopic surgery within the kidney using a small tract. A tract is an opening created by a small incision through the skin and tissues directly into the kidney. A sleeve is placed into the kidney, bridging the distance from the skin. The doctor performs the surgery by guiding endoscopic instruments through the sleeve into the kidney. Under X-ray control, the cyst is opened and a large portion of the wall is removed. This procedure usually requires an overnight stay in the hospital.” 

Who knew that a simple kidney cyst could be so complicated? 

Until next week,

Keep living your life!

Uh, What’s That?

 Finally, a bunch of help for slowing down chronic kidney disease! The latest one that caught my eye was Kerendia. It was the spelling that grabbed me. [Remember: I am a former English teacher.] This is the announcement from diaTribe: 

“On July 9, the FDA approved the drug KERENDIA (finerenone) which has been shown to slow the progression of chronic kidney disease (CKD) that is associated with type 2 diabetes. This new medication is indicated to reduce the risk of eGFR decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure – which are all associated with CKD as a result of having type 2 diabetes.” 

DiaTribe is new to me and you, so here’s what they have to say about themselves: 

“At The diaTribe Foundation, we believe that the millions of people living with diabetes, prediabetes, and obesity today deserve education and support to help them manage their health. 

Through our publication, diaTribe, we provide readers with cutting-edge diabetes insights and actionable tips that empower them to manage their diabetes. In doing so, we hope to help people become happier and healthier.” 

To say the least, this is ‘cutting-edge’ news. But why the two different names? The drug company that developed the drug – Bayer – uses Kerendia as its brand name, a common practice for drugs. For example, you’re probably familiar with aspirin [which is a NSAID, so don’t take it if you have CKD.]. That’s a brand name. The actual name for aspirin is acetylsalicylic acid. Just so, Kerendia is the brand name for finerenone. 

I have to admit I simply had no clue as to what finerenone is. So, I did what I always do. I looked it up.  It turns out that finerenon is a non-steroidal mineralocorticoid receptor antagonist. Wonderful. That didn’t help me in the least. 

Let’s go bit by bit. We do know that non-steroidal isn’t good for CKD patients. Time to hit the dictionaries. The Freedictionary’s Medical Dictionary tells us it means: 

“Not containing steroids or cortisone. Usually refers to a class of drugs called Non Steroidal Anti-Inflammatory Drugs” 

Do you remember why we can’t take NSAIDS? I enjoyed the easily understood answer to this question from Ochsner Health. They are one of the top hospitals in the USA. 

“NSAIDs can affect kidneys by several different mechanisms. They can cause high blood pressure and can also interact with some blood pressure drugs in a way that prevents them from working correctly such as diuretics, ACE inhibitors, and ARBs which are a group of drugs that are designed to relax blood vessels. NSAIDs may increase your fluid retention and can lead to decreased blood flow to kidneys. This is because NSAIDs block prostaglandins, which are the natural chemicals that dilate blood vessels and allow oxygen to reach the kidneys to keep them alive and healthy.” 

Got it. On to mineralocorticoid. The same dictionary as previously used tells us that it means: 

“Hormones from the outer layer (cortex) of the adrenal gland that promote retention of sodium and excretion of potassium in the urine.” 

And here we are trying our darnedest to avoid sodium and potassium. I think we can figure out both receptor and antagonist by ourselves. Add all this together and we find that non- steroidal mineralocorticoid receptor antagonist is not a NSAID but does prevent the introduction of certain hormones that make our sodium and potassium levels worse. I think. That wasn’t so hard, was it? [She asked tongue in cheek.] 

Now that we know what it is… sort of, let’s find out if there are side effects. Most drugs have them. I turned to my trusty old pal, RxList: 

Photo by Lisa A on Pexels.com

“Side effects of Kerendia include: 

high blood potassium (hyperkalemia),  

low blood pressure (hypotension), and  

low blood sodium (hyponatremia).” 

This is important to know because, as WebMD explains: 

“The body needs a delicate balance of potassium to help the heart and other muscles work properly. But too much potassium in your blood can lead to dangerous, and possibly deadly, changes in heart rhythm.”  

As for hypotension, The MayoClinic has that one covered: 

“Even moderate forms of low blood pressure can cause dizziness, weakness, fainting and a risk of injury from falls. And severely low blood pressure can deprive your body of enough oxygen to carry out its functions, leading to damage to your heart and brain.” 

And, finally, hyponatremia. Healthline, that wonderful company that awarded this blog not one, but two, awards tells us: 

“Sodium is an essential electrolyte that helps maintain the balance of water in and around your cells. It’s important for proper muscle and nerve function. It also helps maintain stable blood pressure levels.” 

I also noticed on a few sites that grapefruit or grapefruit juice can make the occurrence of side effects more frequent. There are other, less common side effects of kerendia. 

Keep in mind that this drug is only for those who have Chronic Kidney Disease and type 2 Diabetes. I think that calls for a little refresher. Type 1 Diabetes is when you don’t produce insulin. Type 2 is when you produce insulin, but your body is resistant to using the insulin you produce. Insulin is: 

“a protein pancreatic hormone secreted by the beta cells of the islets of Langerhans that is essential especially for the metabolism of carbohydrates and the regulation of glucose levels in the blood and that when insufficiently produced results in diabetes mellitus” 

Great! I got to use my favorite dictionary, The Merriam-Webster, for that definition.  

Personally, I am no longer pre-diabetic since two thirds of my pancreas have been removed due to cancer. Unfortunately, it’s because I am now a Type 2 Diabetic. You can’t have all the pancreatic hormone you need if you only have one third of your pancreas. 

Some blogs come easy; some don’t. This one didn’t. I hope it helps you understand this new drug so you don’t have to research it yourself. 

Until next week, 

Keep living your life! 

What It’s Like To Be A Kidney Donor

Last week I’d mentioned that I don’t have any first hand experience as a kidney donor, but knew someone who did. Although I know she’s pretty busy with her business, I took a chance and asked her if she’d like to guest blog about her experience as a kidney donor. Amy Donohue responded practically before I hit send. She was ready, much more than willing, and able to do just that. I had her guest blog in my hands within a day. As Amy says, “I love spreading the gospel of live organ donation.”

Ladies and gentlemen, this was Amy’s experience.

“I’ll do it. I’ll donate my kidney. What do I have to do?

Amy and TinyMom

That was a Friday night tweet from me in January, 2011, to a Twitter follower whose mother finally agreed to be put on the transplant list at Mayo Clinic. I saw a conversation between two people I had been following for a few years and responded.

I started testing as soon as I learned the process, and it started with a blood test to see if our blood types matched closely enough for me to be able to donate. My recipient, TinyMom, emigrated to the States in the 70s. Her kidney failure had been caused by high amounts of ibuprofen for a migraine. I lost my father to cancer, and couldn’t help in any way at all, which prompted me to help her.

My testing had to be spread out over a couple months because I’m a single woman, living alone, and I had had, at the time, a fairly new job. I kept track of all appointments to give to my bosses and maintain transparency about my testing and donating. I tried to do as many tests at once as possible, and spent Valentine’s Day 2011 at the Mayo Clinic in North Phoenix. 

The first test that day was a pregnancy test. When someone wants to donate, tests have to be thorough because there can be no harm to the donor, and they need to make sure we are healthy enough to not only donate, but make it through a 90-minute surgery. Next, I had to give several vials of blood. The third appointment that day was with an advocate. For donors, transplant centers want to be sure donors are advocated for and taken care of. I also had to see a social worker and psychiatrist, to make sure my intentions were pure. I had a mammogram, CT scan, and gave more blood and urine during the testing process.

I wanted nothing out of this but to help a woman have a better quality of life. Due to the whole process starting because of a tweet, though, I also had to do media interviews. I wanted to do them to educate others who may be interested in donating. The more open I was about testing, the more I hoped others would follow suit and do what I was doing. The interviews were exhausting for me, because not only was donating a kidney on my mind 24/7, but it also invited a lot of negativity. Thankfully, I had a ton of community support to get through it. I still hadn’t even met TinyMom, until we had our local FOX affiliate interview all of us together.

Two weeks before the scheduled surgery, I was fired from my job for missing my sales goal due to testing. Thankfully, the following morning, a Twitter follower hired me, and I started working immediately. I couldn’t be unemployed for the couple of weeks leading up to the surgery, because then I would have nothing to do but think about what was coming. I was tired of thinking.

The Today Show came out twice to interview us, and were there as we were being wheeled into the operating room. My last words: “Get that f**king camera out of my face!” (Sorry for the language!) All I wanted was to get this kidney out of me and into her, so she could be there for her family, and here I was, in a hospital gown all doped-up but still having a camera in my face. At this point, I wanted that anesthesia so I could have a break for a couple hours. I was exhausted mentally and emotionally. It was April 19th, 2011.

As I was being prepped for surgery, the surgeon noticed a potential problem. When they had given me a CT scan to decide which kidney to take, they had to make sure TinyMom had the same number of veins and arteries going to and from the kidney. They decided on my right kidney, which is rare, because it seemed like the best match.

When they cut me open, though, they realized I had had an extra renal vein that didn’t show up on the CT scan. My team of surgeons immediately spoke with TinyMom’s team, explaining there could be a potential problem. They had just finished prepping her for surgery.

Their response: “You’re not gonna believe this, but SHE has the SAME renal vein that didn’t show up on her CT scan!” 

This was meant to be. 

When I heard about it after waking up in my room, I cried. It was finally over, and we had a connection that was even deeper than I had thought. 

I was up and walking around within an hour or two of getting to my room. The more we walk after surgery, the quicker we heal and can go home. My stay was about 48 hours. I was walking around the nurses station by the evening of my donation. I was feeling great! 

I was out of the hospital in 48 hours, and got home on a Thursday. I was at my desk working the next day. The worst part of the recovery was the constipation from the anesthesia. I was hiking within 3 weeks of surgery, and could have sex around that time, too. Since they removed my kidney where women have a C-section, I just had to wait for the swelling of my abdominal muscles to ease before resuming normal physical activities. 

It’s been ten years now, and I am healthier than I have ever been. I haven’t seen TinyMom for awhile, due to the pandemic, but we will get together soon. We talk on the phone a lot and really miss each other. We have a deep connection, made deeper by a 3-ounce organ.”

Thank you, Amy. Now we know. 

Until next week,

Keep living your life!

 

There is Help

You may have noticed that I ‘steal’ most of my Facebook transplant posts from Jim Myers, better known in the kidney community as Uncle Jim. As kidney disease advocates, we are a very sharing bunch. You may have figured this out yourself when you read all the guest blogs while I was dealing with pancreatic cancer. Jim’s guest blog was on March 23, 2020. Use the archives dropdown to the right of the blog if you’d like to re-read the guest blogs mentioned today. 

I used to write in the foreword to the SlowItDownCKD book series that I didn’t deal with transplant because I didn’t know much about it. I think it was really because the thought any major surgery scared me. After two of my own during the cancer dance, I’m not afraid to write about transplants. Again, you’ve probably figured that out yourself by the number of transplant blogs in the last few years. 

While I’ve explained what a transplant is , why it’s needed, what kinds of kidneys can be used [4/19/21’s blog], and how the operation is executed [4/26/21’s blog], I have not written anything yet about help in finding a kidney. That’s where today’s blog comes in. Now keep in mind that this is not the only way to obtain a kidney, but it is a big help. 

The Resources & Services Administration’s Data Warehouse, a part of the Department of Health and Human Services, offered some numbers for us. Last year in the U.S. alone, there were 92,036 patients [about the seating capacity of the Los Angeles Memorial Coliseum] waiting for a kidney transplant. Only 21,656 received one. I decided to include kidney/pancreas transplants, too. 1,579 patients needed this double transplant, but only 674 received it. I am not a numbers person, but even I found this astounding. Look at the disparity between those people needing a kidney transplant and those receiving one. 

The American Kidney Fund offered quite a bit of information about getting on the national organ waiting list: 

“The process of getting listed for a kidney transplant often begins when your doctor refers you for the transplant surgery. But, you do not have to be referred by a doctor. You are free to visit a transplant center to be evaluated if you are interested in transplant. 

You can only be ready for a kidney transplant after you have passed the required evaluation at a transplant center that looks at your physical health, mental health, and finances. If you pass this evaluation and the transplant team decides you are ready for transplant, you will be added to the national waiting list. 

The national organ waiting list is managed by an organization called the United Network for Organ Sharing (UNOS), a private, nonprofit agency that works with the federal government. UNOS keeps track of all the people in the United States who need kidney transplants, and matches them with donors. 

The national waiting list is not an ordered list that gives priority to the person who has been listed the longest. The UNOS waiting list uses complex ways to calculate where and when the best kidney match becomes ready for you. 

The United States is divided into 11 regions and 58 local Organ Procurement Organizations (OPO)s, which are areas used to find matches for transplant. For example, if a kidney becomes available, UNOS will first try to find a match in the OPO where the kidney is being donated. If no match is found there, UNOS will search within the larger region. If no match is found within the OPO or region, the kidney will then be available to someone who lives outside the region. 

When deciding who gets an available kidney, UNOS considers things about the donor and the person who is getting a kidney (the recipient): 

The age of the recipient 

Blood type of the donor and recipient 

The size of the donor kidney compared to the body of the recipient 

How urgent it is for the recipient to get a kidney 

How long the recipient has been waiting for a kidney 

The distance of the recipient from the donor kidney” 

 
There’s also something called a kidney exchange or swap. UCLA Health explains what this is: 

“What is a Kidney Swap? 

If a donor and recipient have a different blood type, they can exchange their kidneys with another donor and recipient pair in a similar situation. 

This can also be done among three pairs.” 

I turned to the Mayo Clinic to find out if there are people who would not be eligible for a kidney transplant: 

“But for certain people with kidney failure, a kidney transplant may be more risky than dialysis. Conditions that may prevent you from being eligible for a kidney transplant include: 

Advanced age 

Severe heart disease 

Active or recently treated cancer 

Dementia or poorly controlled mental illness 

Alcohol or drug abuse” 

Uh-oh, is 74 considered advanced age? Is a year and a half ago recently treated cancer? I am so glad I’ve been able to keep my GFR in the low 50s. 

There is another kind of kidney transplant. That is preemptive. As Uncle Jim [Hi again, Jim!] wrote on the National Kidney Foundation’s website: 

“A preemptive kidney transplant is a transplant that takes place for a kidney patient, before starting dialysis. It usually takes place before your kidney function deteriorates to the point where you need dialysis. In the U.S., only 2.5% of all kidney transplants are preemptive. Preemptive transplants are considered to be the preferred method of transplants when compared to post-dialysis transplants.” 

Kevin Fowles guest blogged about his preemptive kidney transplant in March 16, 2020’s blog. There’s much, much more information you’ll need to know about kidney transplants if you need one or even if you’re just interested. I think to cover all the information I’d have to blog about them for several weeks.

I wanted to give you a gentle introduction to the different kinds of kidney transplants there are and how to start obtaining one. There is a wait… a long wait. So be prepared. Speak with your nephrologist to start the process or for questions particular to your kidney disease. You can always ask me general questions about transplants, and I’ll try to answer them for you. Keep in mind that I’m not only NOT your doctor, I’m not a doctor at all. 

Until next week, 

Keep living your life! 

It’s All Connected

With Mother’s Day last month and Father’s Day this month, I’ve been thinking about family a lot. Basically, I’ve been wondering if there are any oblique links to chronic kidney disease for any members of my family. As I ruminated, one link popped up. One of my daughters has PCOS… and has recently been diagnosed with diabetes… which we know is the primary cause of CKD. Uh-oh. 

Photo by Klaus Nielsen on Pexels.com

Let’s see how this all works. We know that CKD is the progressive decline of your kidney function for at least three months. We know that diabetes is either not producing insulin, which is type 1, or being unable to make use of the insulin you do produce, which is type 2. By the way, I’m type 2 but that was diagnosed many years after the ckd was diagnosed for me. CKD is also a prime cause of diabetes. It works both ways: CKD can cause diabetes and diabetes can cause CKD.  

And PCOS? Each time, my daughter tells me about it I have to ask, “Uh, what is that again?” PCOS is polycystic ovary syndrome. Big help, huh? Thank goodness for a more thorough answer from my old buddy TheMayoClinic: 

“Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. 

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.” 

I wondered if my daughter knew something was amiss or if her doctor picked this up, so I did the usual – looked up the symptoms. I found John Hopkins Medicine the most helpful source for this information: 

“The symptoms of PCOS may include: 

Missed periods, irregular periods, or very light periods 

Ovaries that are large or have many cysts 

Excess body hair, including the chest, stomach, and back (hirsutism) 

Weight gain, especially around the belly (abdomen) 

Acne or oily skin 

Male-pattern baldness or thinning hair 

Infertility  

Small pieces of excess skin on the neck or armpits (skin tags) 

Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts” 

Wait a minute. This is not that clear. Where does the insulin part of PCOS come in? That’s what is responsible for diabetes and diabetes is the foremost cause of CKD. Webmd explains: 

“Your body makes hormones to make different things happen. Some affect your menstrual cycle and are tied to your ability to have a baby. The hormones that play a role in PCOS include: 

Androgens. They’re often called male hormones, but women have them, too. Women with PCOS tend to have higher levels. 

Insulin. This hormone manages your blood sugar. If you have PCOS, your body might not react to insulin the way it should. 

Progesterone. With PCOS, your body may not have enough of this hormone. You might miss your periods for a long time or have trouble predicting when they’ll come.” 

Aha! So PCOS interferes with your insulin… which is practically the definition of insulin. MedicalNewsToday confirms this in describing the three major types of diabetes: 

“Type I diabetes: Also known as juvenile diabetes, this type occurs when the body fails to produce insulin. People with type I diabetes are insulin-dependent, which means they must take artificial insulin daily to stay alive. 

Type 2 diabetes: Type 2 diabetes affects the way the body uses insulin. While the body still makes insulin, unlike in type I, the cells in the body do not respond to it as effectively as they once did. This is the most common type of diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases, and it has strong links with obesity. 

Gestational diabetes: This type occurs in women during pregnancy when the body can become less sensitive to insulin. Gestational diabetes does not occur in all women and usually resolves after giving birth.” 

Let’s move on to how diabetes can cause CKD, just in case you’ve forgotten. The National Institutes of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health, which is part of the U.S. Department of Health and Human Services is of service here: 

“High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys….” 

Remember, it’s your insulin that controls the amount of blood glucose you have. Without producing insulin or if your body doesn’t respond well to insulin, you have diabetes. If you have diabetes your kidneys’ blood vessels may be damaged and you may ‘develop high blood pressure,’ which is a major cause of CKD. 

High blood pressure is actually the second most likely cause of CKD. So, it seems that PCOS can lead to diabetes which may lead to high blood pressure, the latter two both major causes of CKD. It seems to me that I noticed cardiovascular risk can also be associated with PCOS. VeryWellHealth makes it clear how this happens: 

“Having PCOS increases a woman’s chances of getting heart-related complications. 

This is due to the higher levels of insulin that have been associated with PCOS and are known to increase one’s risk for elevated triglycerides, low levels of high-density lipoprotein (HDL), high cholesterol, blood pressure, and atherosclerosis. These conditions can increase your risk for a heart attack and stroke.” 

I wonder if you’ve realized that CKD can also cause heart problems. The Kidney Fund clarifies: 

“The heart and the kidneys work closely together. When there is a problem with one, things can go wrong in the other. Heart disease can cause CKD, and CKD can also cause heart disease. 

When you have heart disease, your heart may not pump blood in the right way. Your heart may become too full of blood. This causes pressure to build in the main vein connected to your kidneys, which may lead to a blockage and a reduced supply of oxygen rich blood to the kidneys. This can lead to kidney disease. 

When the kidneys are not working well, your hormone system, which regulates blood pressure, has to work harder to increase blood supply to the kidneys. When this happens, your heart has to pump harder, which can lead to heart disease.”  

It is all connected. PCOS to diabetes to CKD to heart problems. Before you start to worry, it doesn’t have to be like that. Take care of yourself and prevent the diseases if you can. 

Until next week, 

Keep living your life! 

To Biopsy or Not to Biopsy

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

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

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

For those who don’t recognize the term: 

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

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

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

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

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

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

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

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

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

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

“A kidney biopsy may be done to: 

Diagnose a kidney problem that can’t otherwise be identified 

Help develop treatment plans based on the kidney’s condition 

Determine how quickly kidney disease is progressing 

Determine the extent of damage from kidney disease or another disease 

Evaluate how well treatment for kidney disease is working 

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

Well, that all makes sense to me so why didn’t my nephrologist order one for me? [I’m starting to sound like the one kid in the class who wasn’t invited to the birthday party.] The paper Patient education: Kidney (renal) biopsy (Beyond the Basics) written by William L Whittier, MD, FASN and Stephen M Korbet, MD, MACP published on UpToDate clarified for me: 

“The following are the most common reasons for kidney biopsy. You may have one or more of these problems, but not everyone with these problems needs a kidney biopsy: 

●Blood in the urine (called hematuria). … 

●Protein in the urine (called proteinuria) – This occurs in many people with kidney problems. A kidney biopsy may be recommended if you have high or increasing levels of protein in the urine or if you have proteinuria along with other signs of kidney disease…. 

●Problems with kidney function – If your kidneys suddenly or slowly stop functioning normally, a kidney biopsy may be recommended, especially if the cause of your kidney problem is unclear.” 

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

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

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

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

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

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

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

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

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

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

Now I know… and so do you. 

Until next week, 

Keep living your life! 

I’ve Had Cancer, But Not This Kind

Several days ago, I received a call from a cousin who I haven’t seen nor heard from since my brother’s funeral almost three years ago. You know that can’t be good… and it wasn’t. It seems she might have kidney cancer. We are a cancer prone family, but this is the first possible diagnose of this kind. She wanted to know what I knew about it and I had nothing to tell her. But I will after this blog and you’ll know a lot more about it, too.  

Having no knowledge of this kind of cancer except that it starts in the kidneys, I decided my usual go-to the Mayo Clinic might be the best place for a general overview. 

“In adults, renal cell carcinoma is the most common type of kidney cancer. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms’ tumor. 

The incidence of kidney cancer seems to be increasing. One reason for this may be the fact that imaging techniques such as computerized tomography (CT) scans are being used more often. These tests may lead to the accidental discovery of more kidney cancers. Kidney cancer is often discovered at an early stage, when the cancer is small and confined to the kidney.” 

Let’s not forget that the kidneys are buried deep in the body where a physical examination may not reach for signs of tumors. 

My cousin said she had no symptoms. Was that usual with this type of cancer? I know from my own experience that sometimes those with Chronic Kidney Disease have no symptoms, but this was cancer. The Cancer Treatment Centers of America laid out the possible symptoms for us: 

“The most common sign of kidney cancer is blood in the urine (hematuria), which may make the urine look rusty or dark red. Other signs of kidney cancer may include:  

Low back pain or pressure on one side that doesn’t go away 

A mass or lump on the side or lower back 

Fatigue 

Loss of appetite or unexplained weight loss 

A persistent fever not caused by infection 

Anemia (low red blood cell count) 

Swelling of the ankles and legs 

In men, a cluster of enlarged veins, called a varicocele, around a testicle, typically, the right testicle 

Although these symptoms may indicate a kidney tumor, they also may be caused by other, less serious health issues. Some kidney cancer patients experience none of these signs, and others experience different symptoms entirely.” 

I was curious as to how my cousin knew what her primary physician suspected since she’d told me she hadn’t had a biopsy yet. WebMD explained the other tests she may have undergone. 

“Urine tests check for blood in your urine or other signs of problems. 

Blood tests show how well your kidneys are working. 

Intravenous pyelogram (IVP) involves X-raying your kidneys after the doctor injects a dye that travels to your urinary tract, highlighting any tumors. 

Ultrasound uses sound waves to create a picture of your kidneys. It can help tell if a tumor is solid or fluid-filled. 

A CT scan uses X-rays and a computer to create a series of detailed pictures of your kidneys. This may also require an injection of dye. CT scans have virtually replaced pyelogram and ultrasound as a tool for diagnosing kidney cancer. 

Magnetic resonance imaging (MRI) uses strong magnets and radio waves to create detailed images of soft tissues in your body. You may need an injection of a contrast agent to create better pictures. 

Renal arteriogram. This test is used to evaluate the blood supply to the tumor. It is not given often but may help diagnose small tumors. It has other uses, as well.” 

While blood and urine tests can also confirm CKD and are familiar to us, renal arteriogram was something that was new to me. So, it sounds like she may go straight to CT since both the pyelogram and ultrasound are not as effective in diagnosing kidney cancer. 

Picture this. My cousin has been diagnosed and is going slightly berserk. Cancer is not an easy diagnosis. She goes to her primary doctor and (s)he refers her to one of these specialists who will bring in the rest of the team: 

“In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For kidney cancer, the health care team usually includes these individuals: 

Urologist. A doctor who specializes in the genitourinary tract, which includes the kidneys, bladder, genitals, prostate, and testicles. 

Urologic oncologist. A urologist who specializes in treating cancers of the urinary tract. 

Medical oncologist. A doctor trained to treat cancer with systemic treatments using medications. 

Radiation oncologist. A doctor trained to treat cancer with radiation therapy. This doctor will be part of the team if radiation therapy is recommended. 

Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.” 

Cancer.net, which is doctor approved patient information from the American Society of Clinical Oncologists, was my source for this information. 

Wait a minute. “What’s the role of the nephrologist in all this? After all, that’s the kidney specialist,” my cousin may ask. According to UCLA Health’s Core-Kidney: 

“Nephrologists screen and identify kidney cancer patients that are at high risk of developing CKD after surgery. Nephrologists team with urologists for ‘before and after surgery’ care of patients. Nephrologists are routinely consulted for optimization of blood pressure of kidney cancer patients, correction of anemia, avoidance of drugs that are potentially toxic to kidneys and adequate hydration of kidneys during contrast use with computer tomography or during surgery.” 

I know, I know. What’s important to her right now is how this kidney cancer may be treated. I went straight to the horse’s mouth (so to speak) for help with this one. The National Kidney Foundation offers a multitude of options. To paraphrase, they are: 

Open, laparoscopic surgery, or robotic surgery to remove part or all of the kidney 

Thermal ablation 

Active Surveillance 

Chemotherapy and Radiation 

There are more options for advanced kidney cancer. 

For the first time in a decade, I don’t know how to end this blog. Let’s put it this way; I’ve had cancer, even though it wasn’t kidney cancer and I just plain hope cancer is not something you’ll have to deal with. 

Until next week, 

Keep living your life! 

How Do You Know?

Often, people will ask me how I knew I had Chronic Kidney Disease. I didn’t have any symptoms although I did suffer from high blood pressure, which is the second most common cause of CKD. Well, how did I know then?

When I changed doctors to one closer to my home, she had her own set of thorough tests completed for me as a new patient. One of them was the eGFR [estimated Glomerular Filtration Rate]. She saw that 39% and had me in a nephrologist’s office the next day. The National Kidney Foundation explains why:  

“When your kidneys are working well, they filter out wastes and excess fluid that become part of the urine your body makes each day. When kidneys aren’t working well, you do not remove enough wastes and fluids to keep you healthy. You also cannot make important hormones for your blood and bones. Your GFR number is an estimate of how well your kidneys are working and keeping you healthy. If your GFR number is low, your kidneys are not working as well as they should. Early detection will allow for early treatment. Early treatment may keep kidney disease from getting worse.” 

Remember those old television commercials that announced, “But wait! There’s more.” That applies here, too. In addition to the blood test for eGFR, I needed a urine test. Thank you to The American Kidney Fund for revealing the necessity of this: 

“When your kidneys are damaged, they may let protein leak into your urine. This can be one of the earliest signs of kidney disease. To check for protein in your urine (called proteinuria), your doctor may suggest a urine test. There are two types of urine tests your doctor may use. 

Dipstick urine test 

A dipstick urine test tells your doctor if there is protein in your urine. Your doctor may test your urine in the office or ask you to bring a sample from home. If your first dipstick urine test shows protein in your urine, ask your doctor when you should be tested again. Also ask if a urine albumin-to-creatinine (UACR) test is right for you. 

Urine albumin-to-creatinine ratio (UACR) 

A UACR test tells your doctor how much albumin is in your urine. Your doctor will test your urine to see how much albumin (a type of protein) and creatinine (a kind of waste) are in it. Your doctor will compare these results to figure out your UACR. A normal UACR is less than 30mg/g. If your UACR is more than 30 mg/g, ask your doctor when you should be tested again. Also ask your doctor if you should have an eGFR test.” 

These two tests, the former gold standard for assessing CKD, seem to be falling out of favor. You see, the blood test relies on race as one of its elements. I was taught that was because Afro-Americans have a denser muscle mass. Okay, that seemed acceptable. It also seems that this is no longer acceptable. I understand that racism must be combatted, but what about the science of denser muscle mass? If I’m correct, that’s one of the reasons Cystatin-C is slowly becoming the norm in CKD testing, but certainly not the only one.  

What is Cystatin-C? Let’s find out together. The most easily understood explanation I found was. The Medical Center of the University of Rochester’s. 

“Your body makes cystatin C constantly, and the protein is found in different fluids, including blood, spinal fluid, and breast milk. When your kidneys are healthy, they filter cystatin C out of the blood so it can be excreted in your urine. 

This is a fairly sensitive blood test to look at your kidney health. Cystatin C can be used to calculate your glomerular filtration rate (GFR). Your healthcare provider can use this to see how well your kidneys are working and if there is a problem. It can also be used to check the progress of your disease, if you have kidney problems.” 

I wasn’t sure enough about this being the best test for CKD, so I turned to Lab Tests Online to see what they had to say. 

“Because cystatin C levels fluctuate with changes in GFR, there has been interest in the cystatin C test as one method of evaluating kidney function. Tests currently used include creatinine, a byproduct of muscle metabolism that is measured in the blood and urine, blood urea nitrogen (BUN), and eGFR (an estimate of the GFR usually calculated from the blood creatinine level). Unlike creatinine, cystatin C is not significantly affected by muscle mass (hence, sex or age), race, or diet, which has led to the idea that it could be a more reliable marker of kidney function and potentially used to generate a more precise estimate of GFR. 

While there are growing data and literature supporting the use of cystatin C, there is still a degree of uncertainty about when and how it should be used. However, testing is becoming increasingly more available and steps are being taken toward standardizing the calibration of cystatin C results.” 

Ah, I see, race need not be taken into account. Hmmm, neither does sex, age, or diet. This almost sounds too good to be true. 

Whoops! I haven’t reminded you what the BUN [blood urea nitrogen] test mentioned above is. My longtime standby, The Mayo Clinic clarifies: 

“A common blood test, the blood urea nitrogen (BUN) test reveals important information about how well your kidneys and liver are working. A BUN test measures the amount of urea nitrogen that’s in your blood. 

Here’s how your body typically forms and gets rid of urea nitrogen: 

Your liver produces ammonia — which contains nitrogen — after it breaks down proteins used by your body’s cells. 

The nitrogen combines with other elements, such as carbon, hydrogen and oxygen, to form urea, which is a chemical waste product. 

The urea travels from your liver to your kidneys through your bloodstream. 

Healthy kidneys filter urea and remove other waste products from your blood. 

The filtered waste products leave your body through urine. 

A BUN test can reveal whether your urea nitrogen levels are higher than normal, suggesting that your kidneys or liver may not be working properly.” 

Considering the information uncovered in today’s blog, I don’t think I’d mind at all if my nephrologist started to use the Cystatin-C method to test my eGFR. How about you? 

Until next week, 

Keep living your life! 

How Is It Done?

A slightly belated welcome to the last week of National Donate Life Month to you. I have learned so much about kidney donation via my research for the blog this month, and hope you have, too. What makes more sense than to take a look at the donation process this week? 

Ready? I suppose the physical donation is the first part of the process so let’s look at that first. This is what Jefferson Heath, the home of Home of Sidney Kimmel Medical College, had to say about deceased donors: 

“It isn’t necessary to match the donor and recipient for age, sex or race. All donors are screened for hepatitis viruses and the HIV virus. What’s more, all deceased donor organs are tested extensively to help ensure that they don’t pose a health threat to the recipient. Also, many studies – such as ABO blood type and HLA matching – are performed to ensure that the organs are functioning properly. 

As soon as a deceased donor is declared brain-dead, the kidneys are removed and placed in sterile fluid similar to fluid in body cells. They are then stored in the refrigerator. The harvested kidneys need to be transplanted within 24 hours of recovery – which is why recipients are often called to the hospital in the middle of the night or at short notice.” 

I wondered if the process were different for a living donation. The Mayo Clinic tells us: 

“Both you and your living kidney donor will be evaluated to determine if the donor’s organ is a good match for you. In general, your blood and tissue types need to be compatible with the donor. 

However, even if your donor isn’t a match, in some cases a successful transplant may still be possible with additional medical treatment before and after transplant to desensitize your immune system and reduce the risk of rejection.” 

Now to the actual process. Johns Hopkins offered this very clear explanation of the process: 

“Generally, a kidney transplant follows this process: 

You will remove your clothing and put on a hospital gown. 

An intravenous (IV) line will be started in your arm or hand. More catheters may be put in your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples. Other sites for catheters include under the collarbone area and the groin blood vessels. 

If there is too much hair at the surgical site, it may be shaved off. 

A urinary catheter will be inserted into your bladder. 

• 

• 

You will be positioned on the operating table, lying on your back. 

Kidney transplant surgery will be done while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure. 

The anesthesiologist will closely watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. 

The skin over the surgical site will be cleansed with an antiseptic solution. 

The healthcare provider will make a long incision into the lower abdomen on one side. The healthcare provider will visually inspect the donor kidney before implanting it. 

The donor kidney will be placed into the belly. A left donor kidney will be implanted on your right side; a right donor kidney will be implanted on your left side. This allows the ureter to be accessed easily for connection to your bladder. 

The renal artery and vein of the donor kidney will be sewn to the external iliac artery and vein. 

After the artery and vein are attached, the blood flow through these vessels will be checked for bleeding at the suture lines. 

The donor ureter (the tube that drains urine from the kidney) will be connected to your bladder. 

The incision will be closed with stitches or surgical staples. 

A drain may be placed in the incision site to reduce swelling. 

A sterile bandage or dressing will be applied.” 

I wanted to know if there might be side effects or something else I should worry about as a kidney transplant recipient. The United Kingdom’s National Health Service was detailed in their response: 

“Short-term complications 

Infection 

Blood clots 

Narrowing of an artery 

Arterial stenosis can cause a rise in blood pressure.  

Blocked ureter 

Urine leakage 

Acute rejection 

Long-term complications 

Immunosuppressant side effects: 

an increased risk of infections 

an increased risk of diabetes 

high blood pressure 

weight gain 

abdominal pain 

diarrhoea 

extra hair growth or hair loss 

swollen gums 

bruising or bleeding more easily 

thinning of the bones 

acne 

mood swings 

an increased risk of certain types of cancer, particularly skin cancer” 

Not everyone experiences these complications, nor are they insurmountable as far as I can tell. 

But what about the donor? Could he experience any ill effects? According to the trusted and respected National Kidney Foundation: 

“You will also have a scar from the donor operation- the size and location of the scar will depend on the type of operation you have. 

Some donors have reported long-term problems with pain, nerve damage, hernia or intestinal obstruction. These risks seem to be rare, but there are currently no national statistics on the frequency of these problems. 

In addition, people with one kidney may be at a greater risk of: 

high blood pressure 

Proteinuria 

Reduced kidney function” 

Naturally, as a donor, you’ll also be concerned about the financial aspects of donating. UNOS has information about this: 

“Medical bills 

The transplant patients’ health insurance, Medicaid, or Medicare may cover these costs: 

Testing 

Surgery 

Hospital stay 

Follow-up care related to donation 

Personal bills 

Paid vacation and sick leave… 

Tax deductions and credits… 

Time off… 

Tax deductions or credits for travel costs and time away from work… 

Short-term disability insurance… 

FMLA (Family and Medical Leave Act) … 

NLDAC (National Living Donor Assistance Center) … 

AST (American Society of Transplantation) … 

Other 

Your private insurance or a charity may also cover costs you get during donation related to: 

Travel 

Housing 

Childcare” 

Not everyone is entitled to these financial aids. It depends on your employer, your length of time at that job, your state, and previous financial standing. 

• 

You’ve probably noticed how little Gail there is in today’s blog and how much research there is. Remember, I knew extraordinarily little about transplant before writing this month’s blogs. 

Until next week, 

Keep living your life! 

What’s That Sound I Hear?

Ever since I had the surgery that removed part of my pancreas, my gall bladder, and my spleen while saving my life, I’ve had a superabundance of flatulence and belching. Remaining delighted that I’m alive, I’m still, well, embarrassed by this. I called the surgeon to see if this were normal. He hadn’t prescribed any long-term medication, so I think he was a bit surprised at my question. His answer was no. 

Hmmm, maybe it was another medication since medication can be the source of both belching and flatulence. I called all my other doctors (and there were plenty). Nope, no one had prescribed a medication that would cause this. I’m fairly careful with my diet, so what could be the cause? 

Ah, there I am starting in the middle again. Let’s go back to what each of these terms is. 

Scotland’s National Health Service Inform explains what flatulence is: 

“Flatulence is passing gas from the digestive system out of the back passage. [Gail here: I love how delicately that’s phrased.] It’s more commonly known as ‘passing wind,’ or ‘farting’. 

Farting is often laughed about, but excessive flatulence can be embarrassing and make you feel uncomfortable around others. However, it can usually be controlled with changes to your diet and lifestyle. 

Flatulence is a normal biological process and is something everyone experiences regularly. Some people pass wind only a few times a day, others a lot more, but the average is said to be about 5 to 15 times a day.” 

While I like how easily I understood the definition, I wanted a little bit more and to find out about belching, too. Fortis Memorial Research Institute helped here and even threw in a bit about bloating – which seems to go along with belching and flatulence. It also explained what the pain you might experience with these three is: 

“Belching is a normal process and results from swallowed air accumulating in the stomach. The [sic] can be subsequently passed as rectal gas (flatus) also. 

Bloating is the subjective feeling that the abdomen is full but does not necessarily mean that the abdomen is enlarged. 

Flatulence refers to the passage of rectal gas. The gas is generally a combination of swallowed air and gas produced by the action of colon bacteria on undigested food. 

Gas accumulation can lead to pain which could seem like gallbladder pain or pain that can radiate up to the chest and seem like cardiac pain.” 

This was more informative, but I still wanted to find out more about this subject. (I guess I’m just never satisfied!). The MayoClinic provided me with that: 

“Flatulence: Gas buildup in the intestines 

Gas in the small intestine or colon is typically caused by the digestion or fermentation of undigested food by bacteria found in the bowel. Gas can also form when your digestive system doesn’t completely break down certain components in foods, such as gluten, found in most grains, or the sugar in dairy products and fruit. 

Other sources of intestinal gas may include: 

Food residue in your colon 

A change in the bacteria in the small intestine 

Poor absorption of carbohydrates, which can upset the balance of helpful bacteria in your digestive system 

Constipation, since the longer food waste remains in your colon, the more time it has to ferment 

A digestive disorder, such as lactose or fructose intolerance or celiac disease” 

There must be a way to cut down on belching and flatulence, I thought. Even if it’s normal, maybe it doesn’t have to happen so very often. So, I turned to my old buddy, Everyday Health to see if I could find some of the causative behaviors: 

“Eating high-fiber foods like beans, legumes, fruits, vegetables, and whole grains 

Drinking carbonated beverages 

Chewing gum 

Eating too quickly or talking while chewing, which results in swallowing more air 

Drinking through a straw 

Consuming artificial sweeteners 

Chronic intestinal diseases like diverticulitis or inflammatory bowel disease 

Food intolerances like celiac disease or lactose intolerance 

Bacterial overgrowth in the small bowel” 

That sounds easy enough. Yet, something was missing for me. I’d had cancer and still have chronic kidney disease. Is there some kind of connection? I found none with cancer, but Kidney Health Australia did make the connection between chronic kidney disease, and belching, bloating, and flatulence. 

“Reduced kidney function can lead to bowel problems such as constipation and diarrhoea. This can cause stomach discomfort including pain, bloating, gas and nausea. A renal dietitian or renal nurse may be able to suggest how to safely increase the fibre in your diet. Gentle exercise such as walking can also help relieve discomfort. Medications can also provide relief.” 

It’s the gas you produce that causes bloating (sometimes), belching, and flatulence. Remember that the Mayo Clinic cited constipation can contribute to these. Now we find that “reduced kidney function” can lead to constipation. 

That’s what ckd is: a progression in the decline of your kidney function for at least three months. 

Your flatulence, bloating, and/or belching may also be a complication of another problem. Check in with your medical team. You have to remember that I am not a doctor and have never claimed to be one.  

Healthline suggests the following conditions may be the cause: 

“If your diet doesn’t contain a large amount of carbohydrates or sugars, and you don’t swallow excessive air, your excessive flatulence may be due to a medical condition. 

Potential conditions underlying flatulence range from temporary conditions to digestive problems. Some of these conditions include: 

constipation 

gastroenteritis 

food intolerances, such as lactose intolerance 

irritable bowel syndrome (IBS) 

Crohn’s disease 

celiac disease 

diabetes 

eating disorders 

ulcerative colitis 

dumping syndrome 

gastroesophageal reflux disease (GERD) 

autoimmune pancreatitis 

peptic ulcers” 

Uh-oh, did you notice “diabetes” in the list above? That’s the second most prevalent cause of CKD and vice-versa. 

Hopefully, today’s blog has told you everything you always wanted to know about ckd & flatulence, belching, and bloating, but were afraid to ask (with apologies to Woody Allen). 

Until next week, 

Keep living your life! 

It’s Not Just Scaly Patches

Did I ever mention that I have latent psoriasis? Or that it has something to do with Chronic Kidney Disease? Hmmm, well maybe it’s time… not that most people ever want to admit they have unsightly psoriasis. 

I realize not everyone knows what that is, so we’ll start with a definition from the Mayo Clinic: 

“Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp. 

Psoriasis is a common, long-term (chronic) disease with no cure. It tends to go through cycles, flaring for a few weeks or months, then subsiding for a while or going into remission. Treatments are available to help you manage symptoms. And you can incorporate lifestyle habits and coping strategies to help you live better with psoriasis.” 

Now you can see why people might be lax to mention they have psoriasis. It almost appears as if you hadn’t been taking care of your personal hygiene, and no one enjoys looking at those sores. My father had it in large, constant patches, but I grew up seeing it on him and never questioned what it was or how he got it. Maybe that’s why I’m so open about having it myself. 

Oh, yes, latent. That just means it’s there, but it hasn’t made itself known yet. 

I went to WebMD for an explanation of the symptoms of psoriasis. 

“Plaques of red skin, often covered with silver-colored scales. These plaques may be itchy and painful, and they sometimes crack and bleed. In severe cases, the plaques will grow and merge, covering large areas. 

Disorders of the fingernails and toenails, including discoloration and pitting of the nails. The nails may also crumble or detach from the nail bed. 

Plaques of scales or crust on the scalp.” 

I remember a dermatologist telling me a long time ago that this skin disorder causes skin cells to produce 10 times faster than usual and asking me if I had psoriatic arthritis. I looked at him blankly. That resulted in a trip to the rheumatologist.  

Yes, that’s what I had. Arthritis.org was extremely clear about just what psoriatic arthritis [abbreviation: PsA] is: 

“Causes 

PsA (like psoriasis) is an autoimmune disease, which means the body’s immune system mistakenly attacks healthy tissue, causing inflammation and pain and resulting in damage. Researchers aren’t sure why some people develop PsA. They think it’s a combination of having certain genes, which makes them more likely to develop the disease, and being triggered by something in the environment, like an infection, stress, physical trauma or another factor.  

Symptoms: 

Skin: 

Itchy, painful red patches or a silvery white buildup of dead skin cells; most commonly on the knees, elbows and scalp, although a rash can occur anywhere on the body. It is not contagious. [Gail here: same symptoms as psoriasis] 

Joints/Spine: 

Mainly occurs in the fingers (in the joints closest to the nail), wrists, ankles and knees. Symptoms such as pain, tenderness, warmth and swelling, may affect different sides of the body (right hand and left knee). This may be referred to as peripheral arthritis. Sometimes one entire, individual finger or toe will swell up, making it painful and hard to bend. This is referred to as dactylitis. Pain and stiffness in the low back, buttock can also occur. Sometimes the neck and hips are affected and this may be referred to as spondylitis or axial arthritis.  

Nails: 

Cracking, pitting, white spots and lifting from the nail bed can occur. This may be referred to as nail disease. 

Enthesis (plural, entheses): 

Inflammation and swelling of one or more entheses, which are the places in the body where a tendon or ligament connects with a bone. Common spots include at the back of the heel and the bottom of the foot. This is called enthesitis.  
 
Many people with psoriatic arthritis get very tired (fatigue) and some may have a low-grade fever. Symptoms may come and go. A period of increased inflammation and worsening of other symptoms is called a flare. A flare can last for days or months.”   

And now for the biggie- What does any of this have to do with CKD? 

“’Psoriasis is an autoimmune disease of the skin that causes inflammation throughout the entire body,’ says Dr. Aamir Memon, nephrologist on staff at Advocate Sherman Hospital in Elgin, Ill. ‘When you have an autoimmune disease, you have antibodies in your blood, which can deposit anywhere in the body, such as your heart and kidneys. The increased inflammation increases the risk of atherosclerosis (hardening of the arteries) and organ damage.’ 

According to Dr. Memon, many patients with moderate to severe psoriasis take medications like Cyclosporine or Methotrexate as treatment. However, side effects from these medications include kidney problems. 

‘Since psoriasis has effects on the kidneys, it would intuitively make sense to control the inflammation to prevent further worsening of the kidneys,’ Dr Memon says. ‘Further studies are needed to evaluate if that is the case and as to what medications are best to decrease inflammation and prevent or halt kidney disease.’” 

Thank you to health enews at Advocate Aurora Health for the above information. This is a new site for me, so allow me to introduce you to them via their website: 

“health enews is the Midwest’s go-to source for timely, patient-centered and credible health news and information. Our goal is to provide readers with relevant and engaging articles and stories as part of our commitment to building healthy and informed communities across Illinois, Wisconsin and beyond. 

health enews is produced by a team of seasoned journalists and public affairs professionals from across Advocate Aurora Health.” 

From my 11 years of blogging about CKD, I’m beginning to accept that it is all connected. What happens to one part of the body does, indeed, affect the other parts of the body. Now you know how CKD and psoriasis are related, in case you’d ever wondered. 

You may have noticed there are no URLs in the blogs lately. Press control and click on the name of the organization instead. They are linked to the articles mentioned.

Until next week, 

Keep living your life!  

A New Year, New Kidney Disease Information

Happy New Year! Or, at least, that’s what I’m hoping for. I fervently believe the more you know, the better you can handle whatever’s happening in your world. That’s why, today, I’m exploring yet another term pertaining to kidney disease that I hadn’t been aware of. Oh my, how many, many types of kidney disease am I (and possibly you) unaware of?  

This one is membranous glomerulonephritis. I sort of-maybe-suspected what it might be, but I wanted to know for sure so I turned to Healthline – who bestowed a couple of awards on this blog a few years ago – at https://www.healthline.com/health/membranous-nephropathy for something more in the way of a definition. 

“Your kidneys are made up of a number of different structures that aid in the removal of wastes from your blood and the formation of urine. Glomerulonephritis (GN) is a condition in which changes in the structures of your kidney can cause swelling and inflammation. 

Membranous glomerulonephritis (MGN) is a specific type of GN. MGN develops when inflammation of your kidney structures causes problems with the functioning of your kidney. MGN is known by other names, including extramembranous glomerulonephritis, membranous nephropathy, and nephritis.” 

It’s hard to know where to start in exploring this disease. Let’s take the easy way and start with a definition of nephritis from… ta da, you guessed it – my all-time favorite dictionary, the Merriam Webster at https://www.merriam-webster.com/dictionary/nephritis.  

“acute or chronic inflammation of the kidney caused by infection, degenerative process, or vascular disease” 

I’m going back to the beginning of my blog journey to What Is It and How Did I Get It? Early Stage Chronic Kidney Disease for the following definitions. 

“Acute: Extremely painful, severe or serious, quick onset, of short duration; the opposite of chronic. 

 Chronic: Long term; the opposite of acute.” 

By the way, you can click on the title of the book if you’re interested in purchasing it from Amazon. 

So, basically, nephritis means a kidney problem. But membranous glomerulonephritis is something more specific in that it is a kind of GN or glomerulonephritis. Back to the dictionary for the definition of glomerulonephritis: 

“acute or chronic nephritis that involves inflammation of the capillaries of the renal glomeruli, has various causes (such as streptococcal infection, lupus, or vasculitis) or may be of unknown cause, and is marked especially by blood or protein in the urine and by edema, and if untreated may lead to kidney failure” 

Ah, so now we know what part of the kidneys are involved. Do you remember what the glomeruli are? Just in case you don’t, here’s how ‘s Lexicon at https://www.lexico.com/en/definition/glomerulus  defines this plural noun: 

“a cluster of nerve endings, spores, or small blood vessels, in particular a cluster of capillaries around the end of a kidney tubule, where waste products are filtered from the blood.” 

Now we’re getting somewhere. Let’s keep digging. Membranous glomerulonephritis is a specific GN. I went directly to MedlinePlus, which is part of the National Institutes of Health, which in turn is part of The U.S. National Library of Medicine at https://medlineplus.gov/ency/article/000472.htm. 

“Membranous nephropathy is caused by the thickening of a part of the glomerular basement membrane. The glomerular basement membrane is a part of the kidneys that helps filter waste and extra fluid from the blood. The exact reason for this thickening is not known. 

The thickened glomerular membrane does not work normally. As a result, large amounts of protein are lost in the urine. 

This condition is one of the most common causes of nephrotic syndrome. This is a group of symptoms that include protein in the urine, low blood protein level, high cholesterol levels, high triglyceride levels, and swelling. Membranous nephropathy may be a primary kidney disease, or it may be associated with other conditions. 

The following increase your risk for this condition: 

Cancers, especially lung and colon cancer 

Exposure to toxins, including gold and mercury 

Infections, including hepatitis B, malaria, syphilis, and endocarditis 

Medicines, including penicillamine, trimethadione, and skin-lightening creams 

Systemic lupus erythematosus, rheumatoid arthritis, Graves disease, and other autoimmune disorders 

The disorder occurs at any age, but is more common after age 40.” 

Being only a bit more than a year out from cancer, I was getting nervous so I went to the National Kidney Foundation at https://www.kidney.org/atoz/content/membranous-nephropathy-mn for a list of symptoms. 

“Swelling in body parts like your legs, ankles and around your eyes (called edema) 

Weight gain 

Fatigue 

Foaming of the urine caused by high protein levels in the urine (called proteinuria) 

High fat levels in the blood (high cholesterol) 

Low levels of protein in the blood” 

These symptoms struck me as so common that I wanted to know just how usual membranous glomerulonephritis was. After checking numerous sites, the consensus I found was that this is not a common disease. Thank goodness! 

Even though it’s not common, we still might want to know what to do if we were diagnosed with membranous glomerulonephritis, especially since I discovered that this may be considered an autoimmune disease. This is how the Mayo Clinic suggested the disease be treated: 

“Treatment of membranous nephropathy [Gail here: That’s a synonym for membranous glomerulonephritis.] focuses on addressing the cause of your disease and relieving your symptoms. There is no certain cure. 

However, up to three out of 10 people with membranous nephropathy have their symptoms completely disappear (remission) after five years without any treatment. About 25 to 40 percent have a partial remission. 

In cases where membranous nephropathy is caused by a medication or another disease — such as cancer — stopping the medication or controlling the other disease usually improves the condition.” 

There is much more detailed treatment information on their website at mayoclinic.in/354QFPU.    

That is a bit more reassuring. Thank you to all the readers who use terms I hadn’t heard of before and/or ask questions about topics that are new to me. May this year be kinder to us than the last one. 

Until next week, 

Keep living your life! 

Baby, It’s Cold Outside. I Mean Inside.

As a diabetic, I have my feet checked and my toenails cut every nine weeks. When I was at my podiatrist’s recently, we both made mention of my slightly blue skin at the same time. I thought it was just thin skin showing the veins underneath. That’s when she mentioned a syndrome I’d heard of many times, but had never explored: Raynaud’s Syndrome, named after the Frenchman who discovered it. 

Hmmm, I wondered. Could this be related to Chronic Kidney Disease? So, of course, I looked for answers to my questions. Let’s get the basics down first… like what is it? 

Circulation Foundation at http://bit.ly/37yxSy4 answers that question.  

“Raynaud’s is a common condition where the blood supply to the extremities is interrupted or reduced. This usually affects the fingers and toes, but occasionally the nose or ears. 

Attacks are usually provoked by cold or a sudden change in temperature. During an attack the affected body part first becomes white, then turns blue as the tissues use up the oxygen and finally bright red as the arteries relax and fresh blood rushes in. 

Raynaud’s can vary in form, from very mild to severe cases – which can require treatment. 

Anyone of any age can suffer from Raynaud’s, but younger women are affected more commonly. It seems to be a change in temperature, rather than just exposure to cold that precipitates an attack, so although worse in winter, it can occur in summer too. 

Stress or anxiety can also provoke a Raynaud’s attack. Some cases of Raynaud’s are associated with some other diseases (called secondary Raynaud’s).” 

Uh, secondary Raynaud’s? What’s that? Back to the drawing board or, in this case, the researching mode. Let’s try WebMD. Bingo! 

“Secondary Raynaud’s (Raynaud’s syndrome, Raynaud’s phenomenon) happens as a result of another illness. It’s often a condition that attacks your body’s connective tissues, like lupus or rheumatoid arthritis. It’s less common, but it’s more likely to cause serious health problems. This can include things like skin sores and gangrene. These happen when cells and tissue in your extremities die from lack of blood.” 

Then, according to WebMD at http://wb.md/3h3fznI, IF I have Raynaud’s, it’s probably secondary Raynaud’s. But what about the terms Raynaud’s syndrome and Raynaud’s phenomenon in the quote above? Are they interchangeable? 

Hello, my favorite dictionary. The Merriam-Webster Medical Dictionary at http://wb.md/3h3fznI tells us that Raynaud’s phenomenon is the same as Raynaud’s syndrome: 

“the symptoms associated with Raynaud’s disease 

— called also Raynaud’s syndrome” 

Of course, that brings up another question. Symptoms are mentioned in the definition. What are the symptoms of Secondary Raynaud’s? I’ll bet the Mayo Clinic at http://mayocl.in/3pn9fur can help us out here. 

“Cold fingers or toes 

Color changes in your skin in response to cold or stress 

Numb, prickly feeling or stinging pain upon warming or stress relief 

During an attack of Raynaud’s, affected areas of your skin usually first turn white. Then, they often turn blue and feel cold and numb. As you warm and your circulation improves, the affected areas may turn red, throb, tingle or swell. 

Although Raynaud’s most commonly affects your fingers and toes, it can also affect other areas of your body, such as your nose, lips, ears and even nipples. After you warm up, the return of normal blood flow to the area can take 15 minutes.” 

I should mention here that severe cases of Secondary Raynaud’s are rare. Also, I can honestly say that I have each of these symptoms at times. As far as the cold, I figured it was just anemia. Wrong. 

We know what Secondary Raynaud’s is, what the symptoms are, and that it need not be serious, but how do you treat it? 

Wait, wait, wait. I just found this from the Merck Manual, Consumer Edition at http://bit.ly/38oZwwr: 

“Raynaud syndrome, a functional peripheral arterial disease, is a condition in which small arteries (arterioles), usually in the fingers or toes, narrow (constrict) more tightly than normal in response to exposure to cold.” 

It’s a PAD? Oh, excuse me, that means “peripheral arterial disease,” as mentioned above. Let’s get a definition. Back to the Merriam Webster Medical Dictionary. This time at http://bit.ly/37CdR9P:  

“damage to or dysfunction of the arteries outside the heart resulting in reduced blood flow” 

Hmmm, the podiatrist did mention spasms in the arteries at the extreme ends of my body, meaning my fingers and toes. This is all starting to make sense now. 

But we were going to see what we could find out about treatment before I made the PAD discovery. Let’s go back to that.  MedicalNewsToday at https://www.medicalnewstoday.com/articles/176713 had quite a bit of information: 

“There is no cure for Raynaud’s disease, but there are ways to manage symptoms. 

For mild forms of Raynaud’s disease, covering exposed skin before leaving the house can help. If an attack occurs, soaking the affected parts in warm, not hot, water can alleviate symptoms and prevent them from worsening. 

If stress is a factor, learning to manage stress can help. 

For moderate to severe cases, medication may be necessary. 

Alpha-1 blockers can counter the effect of norepinephrine, which constricts blood vessels. Examples include doxazosin and prazosin. 

Dihydropyridine calcium channel blockers relax the smaller blood vessels of the hands and feet. Examples include amlodipine, nifedipine, and felodipine. 

Topical nitroglycerin ointment applied to the affected area appears to relieve the symptoms by improving blood flow and cardiac output and decreasing blood pressure. 

Other vasodilators dilate the veins, easing symptoms. Examples include losartan, sildenafil (Viagra), fluoxetine (Prozac), and prostaglandin.” 

They also talk about surgery and/or chemical injections for severe cases. 

The funny thing is I live in Arizona. We have winter… sort of, but nothing drastic like snow and ice. I also take losartan for high blood pressure and to protect my kidneys. As for stress, that is present now with me just recovered from the double hernia surgery, my bother in a health care facility for Parkinson’s dementia, my husband’s Alzheimer’s and someone extremely close to my children in ICU with Covid-19 and other illnesses. (Reading this, I wonder why I’m not depressed!) 

Until next week, 

Keep living your life! 

D&C Now has Another Meaning

We usually think of a D&C as a women’s issue:  

“Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.” 

Thank you to MayoClinic at https://mayocl.in/3oOzkC2 for the above explanation. 

But that’s not what I’ll be writing about today. The ‘D’ in the title stands for Dialysis and the ‘C‘ for Covid-19. Yes, Covid-19 has struck close to home for us. Someone my grown children are very close to has tested positive. He also started dialysis so recently that he hasn’t yet accepted that this is what is keeping him alive. 

Let’s get some definitions out of the way first. Take it away, Merriam-Webster Dictionary. 

Dialysis:  1. the separation of substances in solution by means of their unequal diffusion through semipermeable membranes 

                 2. the process of removing blood from an artery (as of a patient affected with kidney failure), purifying it by dialysis, adding vital substances, and returning it to a vein 

Covid-19: a mild to severe respiratory illness that is caused by a coronavirus (Severe acute respiratory syndrome coronavirus 2 of the genus Betacoronavirus), is transmitted chiefly by contact with infectious material (such as respiratory droplets) or with objects or surfaces contaminated by the causative virus, and is characterized especially by fever, cough, and shortness of breath and may progress to pneumonia and respiratory failure 

NOTE: While fever, cough, and shortness of breath are common symptoms of COVID-19, other symptoms may include fatigue, chills, body aches, headache, loss of taste or smell, sore throat, runny nose, nausea, vomiting, or diarrhea. 

 Here are an additional couple of definitions you may need. They’re from the glossary of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease. 

Arteries: Vessels that carry blood from the heart. 

Veins: Vessels that carry blood toward the heart. 

Now what? Let’s see if we can find out how Covid-19 affects dialysis patients. The Clinical Journal of the American Society of Nephrology (CJASN) at https://cjasn.asnjournals.org/content/15/8/1087 reports the following in an August study: 

“The patients with kidney disease who appear most at risk for COVID-19 are those with a kidney transplant, due to immunosuppression, and those who undergo in-center hemodialysis treatments thrice weekly, due to inability to self-isolate. Patients with kidney disease also have other comorbidities, including hypertension, diabetes mellitus, and cardiovascular disease, that are risk factors for poor outcomes in COVID-19.” 

On December 1 of this year, the Centers for Disease Control and Prevention (CDC) cautioned those of us with chronic kidney disease, including those on dialysis: 

“Having chronic kidney disease of any stage increases your risk for severe illness from COVID-19. 

Actions to take 

Continue your medicines and your diet as directed by your healthcare provider. 

Make sure that you have at least a 30-day supply of your medicines. 

Stay in contact with your healthcare team as often as possible, especially if you have any new signs or symptoms of illness. Also reach out to them if you can’t get the medicines or foods you need. 

If you don’t have a healthcare provider, contact your nearest community health or health department. 

Have shelf-stable food choices to help you follow your kidney diet. 

If you are on dialysis: 

Contact your dialysis clinic and your healthcare provider if you feel sick or have concerns. 

Do NOT miss your treatments. 

Plan to have enough food on hand to follow the KCER 3-Day Emergency Diet for dialysis patients in case you are unable to maintain your normal treatment schedule. 

Learn more about kidney disease. 

Learn how to take care of your kidneys.” 

The KCER 3-Day Emergency Diet is not that intricate, but it is a long explanation. Click on the link to go right to the diet itself. 

We know the best way to deal with Covid-19 is prevention. I’m sure you’re tired of hearing it, but here are the ways you can hopefully do just that. This information was posted on the World Health Organization’s (WHO) website at bit.ly/3nfeMCB on December 8^th of this year. 

“Maintain at least a 1-metre [Gail here: that’s 3.28 ft, so I’d be more comfortable with 2-metres.] distance between yourself and others to reduce your risk of infection when they cough, sneeze or speak. Maintain an even greater distance between yourself and others when indoors. The further away, the better. 

Make wearing a mask a normal part of being around other people. The appropriate use, storage and cleaning or disposal are essential to make masks as effective as possible. 

Here are the basics of how to wear a mask: 

Clean your hands before you put your mask on, as well as before and after you take it off, and after you touch it at any time. 

Make sure it covers both your nose, mouth and chin. 

When you take off a mask, store it in a clean plastic bag, and every day either wash it if it’s a fabric mask, or dispose of a medical mask in a trash bin. 

Don’t use masks with valves….  

How to make your environment safer 

Avoid the 3Cs: spaces that are closed, crowded or involve close contact. 

Outbreaks have been reported in restaurants, choir practices, fitness classes, nightclubs, offices and places of worship where people have gathered, often in crowded indoor settings where they talk loudly, shout, breathe heavily or sing. 

The risks of getting COVID-19 are higher in crowded and inadequately ventilated spaces where infected people spend long periods of time together in close proximity. These environments are where the virus appears to spreads by respiratory droplets or aerosols more efficiently, so taking precautions is even more important. 

Meet people outside. Outdoor gatherings are safer than indoor ones, particularly if indoor spaces are small and without outdoor air coming in…. 

Avoid crowded or indoor settings but if you can’t, then take precautions: 

Open a window. Increase the amount of ‘natural ventilation’ when indoors…. 

Wear a mask (see above for more details).  

Don’t forget the basics of good hygiene 

Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water. This eliminates germs including viruses that may be on your hands. 

Avoid touching your eyes, nose and mouth. Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and infect you. 

Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately into a closed bin and wash your hands. By following good ‘respiratory hygiene’, you protect the people around you from viruses, which cause colds, flu and COVID-19. 

Clean and disinfect surfaces frequently especially those which are regularly touched, such as door handles, faucets and phone screens.” 

This is a long, but necessary, blog. Just a bit more now. 

I’d wondered why dialysis patients are so much more at risk of Covid-19 and was surprised at how simple and common sense the reasons are. These are gathered from multiple sites that agree that shared rides, the inability to quarantine (since hemodialysis patients usually need to go to a dialysis center), and closer than six feet distancing at the centers (if that’s the case) all contribute to the susceptibility of dialysis patients to Covid-19. 

Please be safe. 

Until next week, 

Keep living your life! 

Oh, S**T!

Cute, huh? Especially since I’ll be writing about feces or, as it’s commonly called these days, poo. Defecation (or pooing, if you’d rather) is an important topic for those of us with Chronic Kidney Disease. Did you know CKD can lead to constipation? 

Photo by Pixabay on Pexels.com

Well, how do you know if you have constipation? The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253 explains: 

• “Passing fewer than three stools a week 
• Having lumpy or hard stools 
• Straining to have bowel movements 
• Feeling as though there’s a blockage in your rectum that prevents bowel movements 
• Feeling as though you can’t completely empty the stool from your rectum 
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum” 

Sometimes, medication can be the cause of constipation. According to the International Foundation of Gastrointestinal Disorders at https://www.iffgd.org/diet-treatments/medications/medications-that-can-affect-colonic-function.html, 

“Constipation can be caused by a variety of medications. These medications affect the nerve and muscle activity in the large intestine (colon) and may also bind intestinal liquid. This may result in slowed colonic action (slow and/or difficult passing of stool).” 

Maybe we need to know what happens in your body during constipation? This is what the Cleveland Clinic at https://my.clevelandclinic.org/health/diseases/4059-constipation has to say: 

“Constipation happens because your colon absorbs too much water from waste (stool/poop), which dries out the stool making it hard in consistency and difficult to push out of the body. 

To back up a bit, as food normally moves through the digestive tract, nutrients are absorbed. The partially digested food (waste) that remains moves from the small intestine to the large intestine, also called the colon. The colon absorbs water from this waste, which creates a solid matter called stool. If you have constipation, food may move too slowly through the digestive tract. This gives the colon more time – too much time – to absorb water from the waste. The stool becomes dry, hard, and difficult to push out.” 

Photo by August de Richelieu on Pexels.com

We’re Chronic Kidney Disease patients. That means some of the foods recommended to alleviate constipation may not be allowed on our renal diets. For instance, dried raisin, apricots, and prunes are too high in potassium for CKD patients, although they are helpful if you’re experiencing constipation. You need to speak with your renal dietitian before changing your diet. 

I turned to a new site, BMC at https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-019-0246-3 for information about constipation that is particular to CKD patients. BMC has “an evolving portfolio of some 300 peer-reviewed journals, sharing discoveries from research communities in science, technology, engineering and medicine,” as stated on their website.   

“Accumulating evidence has revealed a relationship between constipation and cardiovascular disease and CKD. The pathogenesis of constipation in CKD patients is multifactorial: decreased physical activity, comorbidities affecting bowel movement, such as diabetes mellitus, cerebrovascular disease, and hyperparathyroidism, a restricted dietary intake of plant-based fiber-rich foods, and multiple medications, including phosphate binders and potassium-binding resins, have all been implicated. CKD is associated with alterations in the composition and function of the gut microbiota, so-called gut dysbiosis.” 

Oh goody, a term I don’t know. Remember VeryWell Health? This is their definition of gut dysbiosis at https://www.verywellhealth.com/what-is-intestinal-dysbiosis-1945045#:~:text=Overview,the%20microorganisms%20within%20our%20intestines. 

“Gut microbiota dysbiosis, also known as intestinal or gastrointestinal dysbiosis, refers to a condition in which there is an imbalance of the microorganisms within our intestines. These microorganisms, collectively known as gut flora, consist predominantly of various strains of bacteria, and to a lesser extent include fungi and protozoa. The gut flora are essential for digestion and immune functioning….  A state of dysbiosis, therefore, will result in digestive and other systemic symptoms.” 

Photo by Anna Shvets on Pexels.com

Aha, so that’s why I take probiotics. I not only have CKD, but Diabetes Type 2, and have had chemotherapy which is known to cause this problem. I always wondered what the probiotics did for me. We’ll find out right now. WebMD at https://www.webmd.com/digestive-disorders/what-are-probiotics was helpful here: 

“Researchers are trying to figure out exactly how probiotics work. Some of the ways they may keep you healthy: 

• When you lose ‘good’ bacteria in your body, for example after you take antibiotics, probiotics can help replace them. 
• They can help balance your ‘good’ and ‘bad’ bacteria to keep your body working the way it should.” 

Prebiotics are also recommended. I get it that ‘pre’ is a suffix (group of letters added before a word to change its meaning) indicating ‘before,’ but still, what do they do for us?  Here’s what the Mayo Clinic at https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058 has to say about prebiotics, 

“Prebiotics are specialized plant fibers. They act like fertilizers that stimulate the growth of healthy bacteria in the gut. 

Prebiotics are found in many fruits and vegetables, especially those that contain complex carbohydrates, such as fiber and resistant starch. These carbs aren’t digestible by your body, so they pass through the digestive system to become food for the bacteria and other microbes.” 

To sum it all up: 

“Constipation is one of the most common gastrointestinal disorders among patients with chronic kidney disease (CKD) partly because of their sedentary lifestyle, low fiber and fluid intake, concomitant medications (e.g., phosphate binders), and multiple comorbidities (e.g., diabetes). Although constipation is usually perceived as a benign, often self-limited condition, recent evidence has challenged this most common perception of constipation. The chronic symptoms of constipation negatively affect patients’ quality of life and impose a considerable social and economic burden. Furthermore, recent epidemiological studies have revealed that constipation is independently associated with adverse clinical outcomes, such as end-stage renal disease (ESRD), cardiovascular (CV) disease, and mortality, potentially mediated by the alteration of gut microbiota and the increased production of fecal metabolites. Given the importance of the gut in the disposal of uremic toxins and in acid-base and mineral homeostasis with declining kidney function, the presence of constipation in CKD may limit or even preclude these ancillary gastrointestinal roles, potentially contributing to excess morbidity and mortality….” 

Thank you to the National Institutes of Health’s U.S. Library of Medicine’s National Center for Biotechnology Information at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000799/ for their summary of the problem. Before I end this blog, I ask you to make sure you notice the mention of “the disposal of uremic toxins” above. 

Until next week, 

Keep living your life! 

Baby, It’s Hot Outside.

As a person with arthritis among other maladies, I regularly see my rheumatologist. “A rheumatologist is a board certified internist or pediatrician who is qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles, and bones,” according to HSS at https://www.hss.edu/rheumatology-rheumatologist.asp. During my appointment, she mentioned that my GFR (Glomerular Filtration Rate) was 46.

Panic! It’s almost always in the low 50s. She calmed me down by telling me that GFR is usually lower during the Arizona heat (I know, I know: but it’s a dry heat.) of the summer. I don’t know why I was surprised. It made sense.

Think about it. Let me re-enforce this with a statement taken from study on PubMed at https://pubmed.ncbi.nlm.nih.gov/21617334/.

“However, the percent change in eGFR from spring to summer was greater in hypertensive patients with CKD… than in those without CKD …. “

PubMed is part of the National Institutes of Health’s National Library of Medicine’s National Center for Biotechnology Information.

I know hypertension (high blood pressure) is included in this statement, but the fact that GFR is lowered t than it’s lowered in those without hypertension leads us to the realization that those without hypertension DO have lower GFRs during the summer heat.

Another study from EuropePMC at https://europepmc.org/article/med/28946962 tells us:

“Recurrent dehydration in people regularly exposed to high temperatures seems to be resulting in an unrecognised cause of proteinuric chronic kidney disease, the underlying pathophysiological mechanism of which is becoming better understood. However, beyond heat waves and extreme temperatures, there is a seasonal variation in glomerular filtration rate that may contribute to the onset of renal failure and electrolyte disorders during extremely hot periods.”

Here are a couple of definitions you may need to understand the above statement. The first is from The Mayo Clinic at https://www.mayoclinic.org/symptoms/protein-in-urine/basics/definition/sym-20050656.

“Protein in urine — known as proteinuria (pro-tee-NU-ree-uh) — is excess protein found in a urine sample. Protein is one of the substances identified during a test to analyze the content of your urine (urinalysis).

Low levels of protein in urine are normal. Temporarily high levels of protein in urine aren’t unusual either, particularly in younger people after exercise or during an illness.

Persistently high levels of protein in urine may be a sign of kidney disease.”

The following definition is from MedicineNet at https://www.medicinenet.com/script/main/art.asp?articlekey=10691.

“Pathophysiology: Deranged function in an individual or an organ due to a disease.”

So, it looks like dehydration is a key factor in lowering the GFR during the summer heat. We know that dialysis patients need to limit their liquid intake, but what about those of us who are not on dialysis but do have CKD (Chronic Kidney Disease)?

I went to MedicalNewsToday at https://www.medicalnewstoday.com/articles/153363#symptoms for some facts about dehydration:

“Around three-quarters of the human body is water.

The causes of dehydration include diarrhea, vomiting, and sweating.

Individuals more at risk of dehydration include athletes, people at higher altitudes, and older adults.

Early symptoms of dehydration include dry mouth, lethargy, and dizziness.”

Did you notice “sweating” and for those of a certain age like me “older adults”?

So, I gather I’m sweating out more liquids than I’m taking in. But how does that work exactly? I thought I was drinking sufficient amounts of fluid.

Biology Online at https://www.biologyonline.com/dictionary/sweating was a bit of an eye opener.

“Sweating is a way of our body to regulate body temperature. It is commonly used as a synonym for perspiration but in stricter sense perspiration pertains to the water loss as a cooling mechanism of the body and therefore It (sic) includes both the release of watery, salty fluid through the pores of the skin from the sweat glands and the evaporation of water from the skin (trans-epithelial) and respiratory tract. Thus, there exist two forms of perspiration, the sensible and the insensible water loss. In sweating, the process always entails the loss of both water and solutes…. The salty fluid is secreted as droplets or moist on the skin and is called as sweat. Environmental cues that could stimulate the body to produce sweat are high temperature and humidity of the surroundings.”

Oh, solutes. Those include the electrolytes that are so important to us as CKD patients. Orthology at https://orthology.com/myth-debunked-need-electrolytes-work/ offers us a simple explanation:

“The warmer the weather and the more you sweat, the more likely you’ll need electrolyte replacement. Again, this is just a general guideline and will differ by individual, activity and other factors. Pay attention to signs that your electrolyte levels are too low, such as muscle cramps, fatigue, dizziness, nausea or mental confusion.”

Aha, it’s excessively hot out. We drink more, but more sweat is being produced the higher the temperature is. When we sweat or perspire (since the two words are often used interchangeably), we are also exuding electrolytes. Now it all makes sense. An imbalance of electrolytes could lower your GFR. I turned to Tampa Cardio at https://tampacardio.com/causes-electrolyte-imbalance-body/ for confirmation.

“Electrolyte imbalances can cause a wide range of symptoms, some mild and some potentially life threatening. Electrolyte imbalances are commonly caused by loss of fluids through prolonged diarrhea, vomiting, sweating or high fever.”

But we’re already having problems with our electrolytes. No wonder excessive heat affects our GFR. As the University of Michigan’s Michigan Medical at https://www.uofmhealth.org/conditions-treatments/kidney/fluid-and-electrolyte-disorders states:

“Changes in the body’s levels of minerals including potassium, magnesium, calcium and sodium—and the corresponding impact these have on the body’s function, muscle strength and heart rhythm can be associated with disorders of kidney or endocrine glands.

Got it. Let’s all just stay in the air conditioning so we don’t lower our GFRs even more than the excessive heat does. In Arizonia, that probably means until November this year. That was a joke (I hope).

Until next week,

Keep living your life!

The Dye is Cast

Bet you think I made a spelling error in the title. If you’re thinking of the original phrase, you’re right. In that one, it’s spelled ‘die’. Here’s where it came from according to Wikipedia at https://en.wikipedia.org/wiki/Alea_iacta_est:

“Alea iacta est (‘The die has been cast’) is a variation of a Latin phrase (iacta alea est [ˈjakta ˈaːlɛ.a ˈɛst]) attributed by Suetonius to Julius Caesar on January 10, 49 BCE, as he led his army across the Rubicon river in Northern Italy…. The phrase, either in the original Latin or in translation, is used in many languages to indicate that events have passed a point of no return. It is now most commonly cited with the word order changed (‘Alea iacta est’) rather than in the original phrasing….”

Uh-oh, there is in existence a phrase just like the title of today’s blog. It means the tint has been applied and can’t be changed or something like that.That this phrase with this spelling exists was a bit surprising. What I meant in the title is the dye used in contrast CTs.

Let’s back up just a bit so we can explain what a CT is. The Mayo Clinic at https://mayocl.in/3jujqdk tells us:

A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information than plain X-rays do.”

I’ll be having one with contrast this afternoon. You know we, as CKD patients, have been warned not to allow that contrast into our bodies. Let’s find out why and then I’ll tell you why I am allowing it. The contrast is the dye in the title of today’s blog.

“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.

After the CT scan, you’ll need to drink plenty of fluids to help your kidneys remove the contrast material from your body.”Thank you, WebMD at https://www.webmd.com/cancer/what-is-a-ct-scan#2 for the above information.

Of course, now we need to know why we shouldn’t be having this contrast material. Radiology Affiliates Imagining at https://4rai.com/blog/can-contrast-hurt-my-kidneys, a new site for me but one that seems very thorough, explains that we just don’t know for sure:

“…. Unhealthy kidneys, though, may be slower and less efficient when it comes to clearing the contrast from the blood. While the medical community has not yet determined exactly how contrast dye causes kidney problems, they think it has to do with this slow clearance of the dyes from the body.”

Well, what problems can contrast dye cause for our kidneys? I went right to the National Kidney Foundation at https://bit.ly/2YL7RXv  for an answer to this question

“What is Contrast Induced Nephropathy (CIN)?

CIN is a rare disorder and occurs when kidney problems are caused by the use of certain contrast dyes. In most cases contrast dyes used in tests, such as CT (computerized tomography) and angiograms, have no reported problems. About 2 percent of people receiving dyes can develop CIN. However, the risk for CIN can increase for people with diabetes, a history of heart and blood diseases, and chronic kidney disease (CKD)….The risk of CIN in people with both CKD and diabetes is 20 to 50 percent.

CIN is associated with a sharp decrease in kidney function over a period of 48-72 hours. The symptoms can be similar to those of kidney disease, which include feeling more tired, poor appetite, swelling in the feet and ankles, puffiness around the eyes, or dry and itchy skin. In many cases, CIN is reversible and people can recover. However, in some cases, CIN can lead to more serious kidney problems and possible heart and blood vessel problems

What is Nephrogenic Systemic Fibrosis (NSF)?

NSF is a rare but serious disease affecting skin and other organs that has been found in some patients with advanced CKD after exposure to gadolinium-containing contrast dyes that are used in magnetic resonance imaging (MRI). NSF appears to affect about 4 percent of patients with advanced CKD. People with acute kidney injury (AKI) are also at higher risk. NSF has not been reported in people with mild kidney damage or normal kidney function.

NSF can be painful, debilitating, or even fatal. Symptoms and signs of NSF can include burning and itching of the skin, red or dark patches on the skin, joint stiffness, or muscle weakness. The disease can develop within 24 hours up to around 3 months….  delay in excretion [of this drug] is thought to be one the main reasons why NSF may happen.”

Notice that both possible effects of using contrast dye with kidney disease are rare.

So why am I having the contrast dye when I’ve been advised not to? My oncology team needs to see if the cancer has returned and, if it has, how badly. I told them at the beginning of my treatment to spare my kidneys as much as possible. But, in this case, I don’t want them to spare my kidneys so much that I end up dead of cancer.

There are two kinds of dye used, one less harmful to the kidneys than the other. I believe that’s the one that is used on me. It is also reduced in order to save me from any possible further kidney damage. Most importantly, my creatinine level is measured before administering the contrast dye. After a year and a half of this, my kidneys are doing just as well as they were doing before I started allowing contrast dye.

This is my story; remember, everyone is different and talk this over with your nephrologist before you agree to contrast dye. My nephrologist and I agreed that I needed to be alive more than I needed to save my kidneys.

Until next week,

Keep living your life!

I Can’t Eat That

Now that I’m cancer free, I’ve resumed visits to all the other specialists (Isn’t growing older wonderful?) I had been seeing before the cancer diagnosis. One of these specialists was my immunologist, who had suggested I stop taking my allergy injections while I was doing chemotherapy since the chemo would change many of the conditions in my body. She was right. I no longer need the monthly injections for seasonal allergies, but there are certain foods I can no longer eat.

Why not, you may be asking yourself. Easy answer? I’m allergic to them. Wait just a minute here. What exactly does allergic mean and how will this affect your Chronic Kidney Disease?

The Merriam-Webster dictionary at https://www.merriam-webster.com/dictionary/allergy tells us that allergy means,

“1: altered bodily reactivity (such as hypersensitivity) to an antigen in response to a first exposure….

2: exaggerated or pathological immunological reaction (as by sneezing, difficult breathing, itching, or skin rashes) to substances, situations, or physical states that are without comparable effect on the average individual

3: medical practice concerned with allergies

4: a feeling of antipathy or aversion”

It’s definition number two for us. Maybe an explanation of those monthly allergy injections would be helpful here, too. The Mayo Clinic at https://www.mayoclinic.org/tests-procedures/allergy-shots/about/pac-20392876#:~:text=If%20you%20get%20weekly%20or,reaction%2C%20particularly%20a%20local%20reaction had the explanation we needed:

“Allergy shots are regular injections over a period of time — generally around three to five years — to stop or reduce allergy attacks. Allergy shots are a form of treatment called immunotherapy. [Gail here: Hence, the specialist who treats allergies is called an immunologist.] Each allergy shot contains a tiny amount of the specific substance or substances that trigger your allergic reactions. These are called allergens. Allergy shots contain just enough allergens to stimulate your immune system — but not enough to cause a full-blown allergic reaction.

Over time, your doctor increases the dose of allergens in each of your allergy shots. This helps get your body used to the allergens (desensitization). Your immune system builds up a tolerance to the allergens, causing your allergy symptoms to diminish over time.”

Lucky me: no more seasonal allergies. Let’s get back to those food allergies and CKD now… or not. While I found quite a bit of information about drug allergies, I found very little about food allergies. It’s nice to know my allergies to shellfish and vanilla will not harm my kidneys. Come to think of it, I don’t eat these foods because I’m allergic to them, so they’re not in my system anyway.

Hmmm, is it any different with food sensitivities? How’s about a definition first. It’s so nice to have a favorite dictionary. This is what The Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/sensitivity?utm_campaign=sd&utm_medium=serp&utm_source=jsonld has to say:

“the quality or state of being sensitive: such as

a: the capacity of an organism or sense organ to respond to stimulation: IRRITABILITY

b: the quality or state of being hypersensitive

c: the degree to which a radio receiving set responds to incoming waves

d: the capacity of being easily hurt

e: awareness of the needs and emotions of others”

Definition a is the one we need.

Again, I did not find enough validation that food sensitivities could damage our kidneys to write about it.

Maybe I’m looking at this backwards. Maybe it’s not do food sensitivities and allergies damage our kidneys that I should be dealing with, but rather can they cause kidney damage. Back to the internet. Will you look at that? Again, there was much more information about drug allergies damaging your kidneys and very little about food allergies or sensitivities.

I’ve satisfied myself that, just as with my food allergies, my sensitivity to lactose, wheat, fructose syrup, and acidic foods will not harm my kidneys. Although, they may cause me to read more food labels than I usually do. Hopefully, you’re satisfied that your food allergies and sensitivities will not harm your kidneys. If you’re still concerned, speak with your nephrologist or renal dietitian.

Of course, none of this means we can ignore the kidney diet. That is, not if you want to slow down the progression of the decline of your kidney function. Eat according to your labs. Keep watching your potassium, phosphorous, protein, and sodium restrictions. This is highly individualized, so again: speak with your nephrologist or renal dietitian should you have questions.

While we’re on the subject of food, do you remember when I wrote about Flavis? That’s the low sodium, low phosphorus, low potassium food company. Bear made a beef stew which we decided to eat upon a layer of pasta. We chose Flavis’s fusilli. That’s a kind of short, spiral pasta. I have got to say it was delicious. I like that it tastes so light, especially since I usually find pasta so heavy.   

News! I’ve gotten so many emails asking where readers can buy my books that I’ve made each title clickable. Click on the title and you go directly to the book’s page on Amazon.com. The titles are to the right of the blog itself on the blog roll.

I know, especially now in the time of Covid-19, that money can be an issue and even the $2.99 for the digital version of each of the books can be $2.99 too much. In that case, I suggest you request your library order the book and then you can borrow it for free. Even libraries that have shut down have virtual sites now. I do humbly request reviews from those of you who read the books. You can leave them on the Amazon.com page for each book. Thank you in advance.

Until next week,

Keep living your life!

We Know They Do, But How?

• “aluminum- and calcium-containing antacids
• anticonvulsants
• calcium channel blockers
• diuretics
• iron supplements
• narcotic pain medications
• medicines used to treat Parkinson’s disease”

I ask you what do these drugs have in common. Healthline at https://www.healthline.com/health/what-does-constipation-feel-like#takeaway tells us they all may cause constipation.

This is one of those topics we don’t like to talk about, but have probably each experienced at one time or another. There are other causes of constipation, but today, we’ll stick with that caused by drugs. Mind you, we’re not talking about party drugs. Rather, it’s the drugs that are prescribed for you that may cause constipation which I’m writing about.

Well, how do you know if you have constipation? The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253 explains:

• “Passing fewer than three stools a week
• Having lumpy or hard stools
• Straining to have bowel movements
• Feeling as though there’s a blockage in your rectum that prevents bowel movements
• Feeling as though you can’t completely empty the stool from your rectum
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum”

According to the International Foundation of Gastrointestinal Disorders at https://www.iffgd.org/diet-treatments/medications/medications-that-can-affect-colonic-function.html,

“Constipation can be caused by a variety of medications. These medications affect the nerve and muscle activity in the large intestine (colon) and may also bind intestinal liquid. This may result in slowed colonic action (slow and/or difficult passing of stool).”

Let’s see if we can get more specific information on how constipation works. I went to Medscape at https://emedicine.medscape.com/article/184704-overview#a4 and discovered there are quite a few different kinds of constipation:

“The etiology [Gail here. That means the cause of the disease.] of constipation is usually multifactorial, but it can be broadly divided into two main groups …: primary constipation and secondary constipation.

Primary constipation

Primary (idiopathic, functional) constipation can generally be subdivided into the following three types:

Normal-transit constipation (NTC)

Slow-transit constipation (STC)

Pelvic floor dysfunction (ie, pelvic floor dyssynergia)

NTC is the most common subtype of primary constipation. Although the stool passes through the colon at a normal rate, patients find it difficult to evacuate their bowels. Patients in this category sometimes meet the criteria for IBS with constipation (IBS-C). The primary difference between chronic constipation and IBS-C is the prominence of abdominal pain or discomfort in IBS. Patients with NTC usually have a normal physical examination.

STC is characterized by infrequent bowel movements, decreased urgency, or straining to defecate. It occurs more commonly in female patients. Patients with STC have impaired phasic colonic motor activity. They may demonstrate mild abdominal distention or palpable stool in the sigmoid colon.

Pelvic floor dysfunction is characterized by dysfunction of the pelvic floor or anal sphincter. Patients often report prolonged or excessive straining, a feeling of incomplete evacuation, or the use of perineal or vaginal pressure during defecation to allow the passage of stool, or they may report digital evacuation of stool.”

We won’t be dealing with secondary constipation today since that doesn’t include drugs in its etiology.

What does happen in your body during constipation? This is what the Cleveland Clinic at https://my.clevelandclinic.org/health/diseases/4059-constipation has to say:

“Constipation happens because your colon absorbs too much water from waste (stool/poop), which dries out the stool making it hard in consistency and difficult to push out of the body.

To back up a bit, as food normally moves through the digestive tract, nutrients are absorbed. The partially digested food (waste) that remains moves from the small intestine to the large intestine, also called the colon. The colon absorbs water from this waste, which creates a solid matter called stool. If you have constipation, food may move too slowly through the digestive tract. This gives the colon more time – too much time – to absorb water from the waste. The stool becomes dry, hard, and difficult to push out.”

Imagine, drugs to improve your health taxing your health. Luckily, since you need to take the prescribed drugs to alleviate whatever your medical diagnosis is, there are methods to relieve your constipation. Here’s WebMD’s (https://www.webmd.com/digestive-disorders/constipation-relief-tips) advice:

“One way to keep things moving is by getting enough fiber in your diet, which makes stool bulkier and softer so it’s easier to pass. Gradually increase the amount of fiber in your diet until you’re getting at least 20 to 35 grams of fiber daily.

Good fiber sources include:

• Bran and other whole grains found in cereals, breads, and brown rice
• Vegetables such as Brussels sprouts, carrots, and asparagus
• Fresh fruits, or dried fruits such as raisins, apricots, and prunes”
• Beans

While you’re having an issue with constipation, limit foods that are high in fat and low in fiber, like cheese and other dairy products, processed foods, and meat. They can make constipation worse.

And on the subject of diet, water is important for preventing constipation, too. Try to drink at least 8 glasses of water a day.

Also, exercise regularly. Moving your body will keep your bowels moving, too.”

Wait a minute. We’re Chronic Kidney Disease patients. That’s means some of the foods listed above may not be allowed on our renal diets. For instance, dried raisin, apricots, and prunes are too high in potassium for CKD patients. You need to speak with your renal dietitian before changing your diet.

As Benjamin Franklin stated, “an ounce of prevention is worth a pound of cure.” Let’s see what we can find on prevention.

• “Increasing your fiber intake: Fiber-rich foods, such as fruits, vegetables and whole grains, all help improve gut function. If you have bowel sensitivity, you’ll want to avoid high-fructose fruits, such as apples, pears and watermelon, which can cause gas.
• Getting more exercise: Regular exercise can help keep stool moving through the colon.
• Drinking more water: Aim for eight glasses daily, and avoid caffeine, as it can be dehydrating.
• Go when you feel like it: When you feel the urge to go, don’t wait.”

Thank you to Johns Hopkins Medicine at https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipation-causes-and-prevention-tips for this information. Will you look at that? Prevention methods for constipation are almost the same as how to treat constipation. Better get started, folks.

Until next week,

Keep living your life!

Good Oils or Bad Oils?

 Here’s hoping those of you in the U.S.A. had a safe and thoughtful July 4^th. This is a peculiar year with different kinds of celebration or none at all.

I’m going to jump right in to a reader’s question since it is the source of today’s blog. Melita wanted to know if it was a good idea for Chronic Kidney Disease patients to take fish oil, flaxseed oil, or virgin coconut oil. As my children used to say when they were little and we were doing a home experiment to find out if something was true or not, “Let’s find out.”

Before we start, I want to make it clear to Melita and everyone else that it is important you ask your nephrologist the questions you have. I am not a doctor, have never claimed to be one, and can only do some superficial researching for you while you wait to speak with your nephrologist. Another thought to keep in mind is that every patient is different. Usually, you eat according to your labs… unless your nephrologist has something else to say.

Let’s start with fish oil. Back at the end of 2016, the National Center for Biotechnology Information, which is part of the National library of Medicine, which is itself part of the National Institutes of Health, conducted a literature review concerning Omega 3 (part of fish oil). I found it at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241408/.

“At least until more clear recommendations are available, the omega-3 PUFA intake guidelines released by American Heart Association (AHA) suggest rational intake goals (approximately 1g EPA + DHA per day) in advanced CKD. Fortunately, safety profile of omega-3 doses recommended by AHA is excellent. Aside from minimal gastrointestinal side effects (e.g., nausea, stomach upset, eructation, fishy aftertaste), omega-3 consumption at these doses do not cause other serious adverse effects and thus can be considered safe in advanced CKD patients.”

I needed some help with the initials. Maybe you do, too.

PUFA means polyunsaturated fatty acid.

EPA means eicosapentaenoic acid, an omega-3 fatty acid.

DHA means docosahexaenoic acid, an omega-3 fatty acid.

The definitions above were hobbled together from numerous sources.

One thing to keep in mind is that the above literature review was from the point of using omega-3 for the pruritus (itching) that may accompany more advanced CKD. However, it does show us that omega-3 is safe for CKD patients.

On to flaxseed oil. The Mayo Clinic at https://advancingthescience.mayo.edu/2019/09/30/people-with-kidney-disease-should-be-cautious-with-supplementspeople-with-kidney-disease-should-be-cautious-with-supplements/#:~:text=Flaxseed%20oil%2C%20the%20most%20commonly,which%20translates%20to%20167%2C500%20Americans says no to flaxseed oil. According to a recent study published in the American Journal of Kidney Diseases that they cited:

“Flaxseed oil, the most commonly used high risk supplement that contains phosphorus, was taken by 16 percent of patients with normal or mildly reduced kidney function. In addition, 1.3 percent of patients who were unaware they had moderate kidney impairment took flaxseed oil, which translates to 167,500 Americans. And while phosphorus is not listed on the flaxseed oil nutrition information label, a tablespoon (about 10 grams) of whole flaxseeds has about 62 milligrams of phosphorus, or about 7% of the daily value for a person without chronic kidney disease. In addition, flaxseed and flaxseed oil may interact with blood-thinning and blood pressure drugs, and may decrease absorption for any oral drug, according to Mayo Clinic.”

Now, if you remember, we as CKD patients need to limit phosphorous, as well as potassium, protein, and sodium. As the University of Wisconsin-Madison’s School of Medicine and Public Health at https://www.uwhealth.org/healthfacts/nutrition/320.pdf tells us,

“You may also need to control your phosphorus intake through diet and medicines. If phosphorus builds up in the blood it can cause weak and brittle bones and skin itching. Over time, your heart and blood vessels can become damaged. To control phosphorus levels, phosphorus binding medicines must be taken at the proper time.… “

Years ago, I wrote a blog about why flaxseed and products containing flaxseed are not good choices for us as CKD patients. It seems the same is true of flaxseed oil.

Well, what about virgin coconut oil? I have a vague memory of coconut being a no-no, but I think we need more than that. I’d often wondered about the use of the term ‘virgin,’ so I tackled that first. Medical News Today at https://www.medicalnewstoday.com/articles/282857#types defined the term for us:

“Extra virgin coconut oil comes from the fruit of fresh, mature coconuts. Processing does not involve high temperatures or added chemicals.”

Got it. While I could not find anything specifically related to the use of virgin coconut oil by CKD patients, I did find many articles mentioning that the oil could be related to cardiovascular detriment. We know that the kidneys and the heart interact closely with each other and that by protecting your heart, you are also protecting your kidneys. WebMD at https://www.webmd.com/diet/features/coconut-oil-and-health#1 simplifies this issue a bit:

“The American Heart Association says to limit saturated fat to no more than 13 grams a day. That’s the amount found in about one tablespoon of coconut oil.

Fans of coconut oil point to studies that suggest the MCT-saturated fat in coconut could boost your HDL or ‘good’ cholesterol. This, they claim, makes it less bad for your heart health than the saturated fat in animal-based foods like cheese and steak or products containing trans fats.

But it also raises your LDL ‘bad’ cholesterol.

A quick cholesterol lesson:

• LDL — helps form plaque that blocks your arteries
• HDL — helps remove LDL

‘But just because coconut oil can raise HDL cholesterol doesn’t mean that it’s great for your heart,’ Young says. ‘It’s not known if the rise in beneficial cholesterol outweighs any rise in harmful cholesterol.’

At best, she says, coconut oil could have a neutral impact on heart health, but she doesn’t consider it ‘heart-healthy.’ ”

Anyone of these three oils could be a separate blog by itself. If you’d like to see a blog about one of them, just let me know.

Before I forget, remember Flavis the low protein medical food products? We tried their Fette Tostate, a cracker toast and found it very pleasing. When I was having stomach issues associated with chemotherapy, I tossed a few of them into chicken noodle soup – the only food I could tolerate at the time. They absorbed the broth and were just plain delicious.

Until next week,

Keep living your life!

 

How Sweet It Isn’t

Hello again. Last week when I was writing about Bipolar Disorder and Chronic Kidney Disease, I mentioned nephrogenic diabetes insipidus. During the week I realized how little I know about that.

Let’s start by going back and reviewing what I wrote last week:

“What is nephrogenic diabetes insipidus?
The most common problem from taking lithium is a form of diabetes due to kidney damage called nephrogenic diabetes insipidus. This type of diabetes is different than diabetes mellitus caused by high blood sugar. In nephrogenic diabetes insipidus, the kidneys cannot respond to anti-diuretic hormone (ADH), a chemical messenger that controls fluid balance. This results in greater than normal urine out-put and excessive thirst. It can be hard to treat nephrogenic diabetes insipidus.”

Frankly, that’s not enough information for me, although it’s pretty clear. Former English teacher here. Let’s take a look at the words themselves. Keep in mind, this is what I learned along the years.

Nephro = kidneys

Genic = Beginning in

So we know this disease begins in the kidneys. And diabetes? According to Michigan State University at https://www.canr.msu.edu/news/how_diabetes_got_its_name,

“The ancient Greek word for diabetes means, ‘passing though; a large discharge of urine.’ The meaning is associated with frequent urination, which is a symptom of diabetes.”

And finally insipidus. I found myself turning to Wikipedia at https://en.wikipedia.org/wiki/Diabetes_insipidus#:~:text=”Insipidus”%20comes%20from%20Latin%20language,or%20zest%3B%20not%20tasty for help with this.

” ‘Insipidus’ comes from Latin language insipidus (tasteless), from Latin: in- ‘not’ + sapidus ‘tasty’ from sapere ‘have a taste’ — the full meaning is ‘lacking flavor or zest; not tasty’.”

This one I didn’t quite get. Back to the above link to figure out what tasteless has to do with this disease.

“Application of this name to DI arose from the fact that diabetes insipidus does not cause glycosuria (excretion of glucose into the urine).”

Ah, so the urine is not sweet. Reminder: Diabetes can be diagnosed by the doctor tasting the urine. While this was more common in the 1600s, I have read about doctors tasting urine for diabetes more recently and even currently. If the urine is sweet, diabetes is present.

This is interesting. I’d never considered a form of diabetes that didn’t deal with blood glucose, which may also be called blood sugar, so sweet. Of course, I then began to wonder if taking lithium was the only way to develop this disease. The Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/symptoms-causes/syc-20351269#:~:text=Nephrogenic%20diabetes%20insipidus%20occurs%20when,or%20a%20chronic%20kidney%20disorder was quite a bit of help here:

“Nephrogenic diabetes insipidus occurs when there’s a defect in the kidney tubules — the structures in your kidneys that cause water to be excreted or reabsorbed. This defect makes your kidneys unable to properly respond to ADH.

The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium or antiviral medications such as foscarnet (Foscavir), also can cause nephrogenic diabetes insipidus.”

This is a lot of new information to understand unless we get more help. Let’s take a look at kidney tubules now. I turned to my old favorite Healthline at https://www.healthline.com/health/human-body-maps/kidney#nephrons and found the following:

“Each tubule has several parts:

• Proximal convoluted tubule. This section absorbs water, sodium, and glucose back into the blood.
• Loop of Henle. This section further absorbs potassium, chloride, and sodium into the blood.
• Distal convoluted tubule. This section absorbs more sodium into the blood and takes in potassium and acid.

By the time fluid reaches the end of the tubule, it’s diluted and filled with urea. Urea is byproduct of protein metabolism that’s released in urine.”

That makes sense, but what about this ADH? What is that?  My Health Alberta Ca at https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=hw211268 tells us:

“Antidiuretic hormone (ADH) is a chemical produced in the brain that causes the kidneys to release less water, decreasing the amount of urine produced. A high ADH level causes the body to produce less urine. A low level results in greater urine production.

Normally, the amount of ADH in the body is higher during the night. This helps prevent urination while you are sleeping. But if the levels of ADH remain low during the night, the body will produce large amounts of urine, so urination during the night is more likely.”

We know how you can develop nephrogenic diabetes insipidus, but how do you treat it once you’ve been diagnosed? WebMD at https://www.webmd.com/diabetes/guide/nephrogenic-diabetes-insipidus-symptoms-causes-and-treatments offers us the following:

“If a drug like lithium is responsible, switching medicines might improve nephrogenic diabetes insipidus.

Most adults with nephrogenic diabetes insipidus are able to keep up with fluid losses by drinking water. For some people, though, the symptoms of near-constant thirst and urination can become intolerable. Some treatments can reduce the symptoms of nephrogenic diabetes insipidus, at least somewhat:

• Diet. A low-salt, low-protein diet reduces urine output.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin), indomethacin (Indocin), and naproxen (Naprosyn) also can reduce urination. [Gail here: but as CKD patients, we can’t take NSAIDS.]
• Diuretics. It might seem paradoxical, but “water pills” like hydrochlorothiazide and amiloride can ease excessive urination from nephrogenic diabetes insipidus.

All adults and children with nephrogenic diabetes insipidus should take frequent bathroom breaks. This helps to avoid over-distending the bladder, which can cause long-term problems, though rarely.

The most important treatment for nephrogenic diabetes insipidus is to ensure constant access to lots of water. Not keeping up with fluid losses can lead to dehydration or electrolyte imbalances, which can sometimes be severe. Seek medical help if symptoms don’t improve after rehydrating, eating fresh fruit, and taking a multivitamin.”

Now, the biggie…. Is this rare disease curable? Unfortunately it isn’t, although,

“For individuals with acquired NDI treating the underlying cause (e.g., correcting metabolic imbalances or discontinuing drug use) can reverse the kidneys resistance to vasopressin. [Gail here again: Vasopressin is another name for ADH as far as I can tell.] However, this reversal may take weeks. In some cases caused by the use of drugs such as lithium, it may take years for the kidneys to respond to vasopressin again or it can become irreversible.”

Thank you to National Organization for Rare Diseases (NORD) at https://rarediseases.org/rare-diseases/nephrogenic-diabetes-insipidus/ for the above information.

I feel like I’ve been down the rabbit hole with Alice with all this new information about a rare disease that your already existing kidney disease may cause. Hopefully, you won’t be one of its victims.

Until next week,

Keep living your life!