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!

This is How It’s Done

For over a decade, I’ve been reading about transplant patients worried that their transplants weren’t making urine yet, or that the new [to them] kidneys started making urine right away. Making urine is important to kidney patients. I never really thought about that until it occurred to me that I didn’t know how the kidneys made urine. I find it amazing that something so basic hadn’t been on my horizon before. 

To understand this, we need to back up a bit and discover how blood goes through the kidneys. Hang on, it’ll make sense in just a bit. The National Insititute of Diabetes and Digestive and Kidney Diseases [NIDDK] tells us:  

“Each of your kidneys is made up of about a million filtering units called nephrons. Each nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process: the glomerulus filters your blood, and the tubule returns needed substances to your blood and removes wastes.”  

Side note: I just learned what the makeup of a glomerulus is! You will, too. Read on. 

Quick reminder: a tubule is [surprise!] a small tube.  

It’s the “removes wastes” in the information from the NIDDK that interests us today. Let’s start with what these wastes are. I turned to The University of Rochester Medical Center for more information: 

“The body takes nutrients from food and converts them to energy. After the body has used all the food components that it needs, waste products are left behind in the bowel and in the blood…. 

The kidneys remove waste products called urea from the blood through tiny filtering units called nephrons. There are about one million nephrons in each kidney. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Blood enters the glomerulus and is filtered there. This filtered fluid then passes through the tubule where substances and water are added or removed. The fluid that remains is urine.” 

It’s starting to make sense. Johns Hopkins Medicine offers more information: 

“The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep chemicals, such as potassium and sodium, and water in balance. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys, where it is removed along with water and other wastes in the form of urine.” 

Urinary system? The National Institutes of Health’s National Cancer Institute’s SEER Training Modules helped us out here: 

“The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys form the urine and account for the other functions attributed to the urinary system. The ureters carry the urine away from kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to the outside.” 

Sometimes, our urine is not the usual color. That also tells us something about our kidney function in a round-about way. Don’t forget your kidneys need water to function properly. That’s why you keep seeing reminders to hydrate. I’ve taken salient points from Healthline to explain: 

“The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys form the urine and account for the other functions attributed to the urinary system. The ureters carry the urine away from kidneys to the urinary bladder, which is a temporary reservoir for the urine. The urethra is a tubular structure that carries the urine from the urinary bladder to the outside.” 

“While being hydrated is a good thing, drinking too much water can rob your body of electrolytes. Urine that occasionally looks clear is no reason to panic, but urine that’s always clear could indicate that you need to cut back on how much water you’re drinking…. 

The color of ‘typical’ urine falls on the spectrum of light yellow to a deeper amber color. The urochrome pigment that’s naturally in your urine becomes more diluted as you drink water. 

Urochrome is produced by your body breaking down hemoglobin, the protein that carries oxygen in your red blood cells. In most situations, the color of your urine will depend on how diluted this pigment is…. 

Dehydration. If your urine appears orange, it could be a symptom of dehydration…. 

In general, blue urine is rare and most likely connected to something in your diet…. [Gail here, same with green urine.] 

In most cases, urine that’s dark brown indicates dehydration…. 

Cloudy urine with foam or bubbles is called pneumaturia. This can be a symptom of serious health conditions, including Crohn’s disease or diverticulitis.” 

Wait, there’s more. The smell of your urine can also tell you something about how your kidneys are functioning. MedlinePlus explains succinctly: 

“Kidney disease causes chemicals in urine to become concentrated and to cause a smell resembling ammonia. Kidney dysfunction can also cause high bacteria and protein levels in the urine, which will contribute to a foul ammonia smell.” 

Another MedlinePlus page elucidated other ways in which the odor of your urine indicates an illness: 

“Most changes in urine odor are not a sign of disease and go away in time. Some foods and medicines, including vitamins, may affect your urine’s odor. For example, eating asparagus causes a distinct urine odor. 

Foul-smelling urine may be due to bacteria. Sweet-smelling urine may be a sign of uncontrolled diabetes or a rare disease of metabolism. Liver disease and certain metabolic disorders may cause musty-smelling urine.” 

We’ve covered a lot today, from how the kidneys form urine to how to use urine’s color and/or odor to diagnose illness. Mostly, we’ve discovered that the kidneys can’t do their work without adequate water. Consider that a big hint. 

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!