Ratio: Is That Like Rationing?

urine containerA friend called me Friday night wondering what her creatinine/albumin ratio meant since that reading was high on her last blood draw. Actually, she wanted to know if this was something to worry about. After extracting a promise that she would call her doctor with her questions today when her physician’s office opened for business again, I gave her some explanations. Of course, then I wanted to give you the same explanations.

Although the Online Etymology Dictionary tells us both ratio and rationing are derived from the same Latin root – ratio – which means “reckoning, calculation; business affair, procedure,” also “reason, reasoning, judgment, understanding,” they aren’t exactly the same. My old favorite, The Merriam-Webster Dictionary defines ratio at dictionaryhttps://www.merriam-webster.com/dictionary/ratio in the following way: the relationship in quantity, amount, or size between two or more things, as in that of your creatinine and albumin.

As for rationing, if you’re old enough to remember World War II, you know what it means. If you’re not, the same dictionary can help us out again. At https://www.merriam-webster.com/dictionary/rationing, we’re told it’s “a share especially as determined by supply.” Nope, doesn’t work here since we’re not sharing our creatinine or albumin with anyone else. We each have our own supply in our own ratios, albeit sometimes too high or sometimes too low.

What are creatinine and albumin anyway? Let’s see what we can find about creatinine in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.

“Additional important jobs of the kidneys are removing liquid waste from your body and balancing the minerals in the body. The two liquid waste products are urea which has been broken down from protein by the digestive system and creatinine which is a byproduct of muscle activity.”

Well, what about albumin? This can get a bit complicated. Remember, the UACR (Hang on, explanation of this coming soon.) deals with urine albumin. There’s an explanation in SlowItDownCKD  2016 about what it’s not: serum albumin.

“Maybe we should take a look at serum albumin level. Serum means it’s the clear part of your blood, the part without red or white blood cells. This much is fairly common knowledge. Albumin is not. Medlineplus, part of The National Institutes of Health’s U.S. National Library of Medicine at https://medlineplus.gov/ency/article/003480.htm tells us, ‘Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood.’ Uh-oh, this is also not good: a high level of serum albumin indicates progression of your kidney disease. Conversely, kidney disease can cause a high level of serum albumin.”

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This is from SlowItDownCKD 2015 and explains what the UACR is and why your albumin-to-creatinine ratio (UAC R) is important:

In recent years, researchers have found that a single urine sample can provide the needed information. In the newer technique, the amount of albumin in the urine sample is compared with the amount of creatinine, a waste product of normal muscle breakdown. The measurement is called a urine albumin-to-creatinine ratio (UACR). A urine sample containing more than 30 milligrams of albumin for each gram of creatinine (30 mg/g) is a warning that there may be a problem. If the laboratory test exceeds 30 mg/g, another UACR test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria, a sign of declining kidney function, and should have additional tests to evaluate kidney function.

Thank you to the National Kidney and Urologic Diseases Information Clearinghouse , a service of the NIH, at http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/#tests for that information.”

Basically, that means if you have a high UACR once, get your urine retested a week or two later before you even think about worrying, which is what my friend’s doctor confirmed. But do make sure to get that second test so you can be certain your kidney function is not being compromised.

I was thrilled that both my paper and notes from the field about Chronic Kidney Disease Awareness were accepted for Landmark’s Journal for the  Conference for Global Transformation AND then be able to Journal for the Conference for Global Transformationpresent a poster about it during the conference this past weekend. In addition I was lucky enough to have lunch with one of the keynote speakers. Who, you ask? Amy D. Waterman, Ph.D.

This is one important person to us. She has changed the face of pre dialysis and transplant education globally by starting “an educational nonprofit corporation and has been awarded more than $20 million in grants…she has reached tens of thousands of people to date, educating them in the miracle of live organ donation. Last year, Dr. Waterman was invited to the White House to share about the possibility of ending the organ donor shortage.” This material is from the Journal of the 2017 Conference for Global Transformation, Volume 17, No. 1.

This is exactly what we need to do for early and moderate stage CKD. This is what the social media presence, the blogs, and the books are about. And you know what? That’s just.plain.not.enough. Last I heard, I have 107,000 readers in 106 countries. And you know what? That’s just.plain.not.enough. Am I greedy? Absolutely when it comes to sharing awareness of CKD. Do I know how to expand my coverage? Nope…not yet, that is. I am so very open to suggestions? Let me hear them!

K.E.E.P.Lest we forget, this year’s first Path of Wellness Screening will be Saturday, June 17th at the Indo American Cultural Center’s community hall, 2809 W. Maryland Ave., Phoenix, AZ 85017. As they’ve stated, “The free screening events can process up to 200 people.  Their use of point-of-care testing devices provides blood and urine test results in a matter of minutes, which are reviewed onsite by volunteer physicians.  All screening participants are offered free enrollment in chronic disease self-management workshops.  Help is also given to connect participants with primary care resources.  The goals of PTW are to improve early identification of at-risk people, facilitate their connection to health care resources, and slow the progression of chronic diseases in order to reduce heart failure, kidney failure and the need for dialysis.”

Until next week,

Keep living your life!

 

On the Sea, On the Sea, On the Beautiful Sea

What a week!  All the aspects of the Phoenix Kidney Walk have been completed, although you can still donate to Team SlowItDownCKD at kidneywalk.kintera.org until May 31st.  No, this is not a solicitation, but rather information for those of you who had asked for it. 2015-04-18 22.02.52

I thought you might like to see some of the pictures so here they are sprinkled throughout today’s blog – with thanks to Keith Harris for being our impromptu (and talented) photographer. Most of the members of our team were too busy walking to stay still for photos, but they were there. That’s Keith Harris, Patti DuBois & me in the photo above.

This allowed me to slow it down a bit myself.  So much so that I started finalizing the plans for the cruise to Vancouver, B.C. and Alaska that’s my gift to Bear for our second anniversary. (Finally, our long awaited honeymoon!) One of the things my very-experienced-at-cruising sister-in-law, Judy Peck, told me about is anti-motion sickness medication.  And, of course, my first reaction was, “I’ll have to research that for Chronic Kidney Disease.”  The banner picture is of my daughter, Abby Wegerski, on the left and me on the right.

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First I went to the UK site ‘Patient’ at http://www.patient.co.uk/medicine/cyclizine-for-sickness for the definition of what is commonly known as sea sickness or, as the English call it, travel sickness. This site has the some of the most reader friendly explanations for medical issues.

Nerves situated inside your ear send messages to your brain with information about your movement. Along with messages from your eyes and muscles, these nerves help your body to maintain a good sense of balance. If the nerves in one of your ears send too many, too few, or wrong messages to your brain, it conflicts with the messages sent from your other ear, your eyes, or your body. Your brain then gets confused and this can cause dizziness and vertigo (a spinning sensation), and can make you feel sick.

Travel sickness is caused by repeated unusual movements during travelling. These repeated movements, such as going over bumps or around in a 2015-04-18 21.41.32  circle, send lots of messages to your brain. The balance mechanism in your ear sends different signals to those from your eyes, which  results in your brain receiving mixed and confusing messages. This is what causes you to feel sick.

That’s a picture of my young friend and pooper scooper/dog sitter, Willie Vlasity and Mr. Taco Bell.

Makes sense.  Now, what can we do about it? According to MedicineNet at     http://www.medicinenet.com/motion_sickness_sea_sickness_car_sickness/page3.htm,

Over-the-counter medications, and occasionally prescription medications, are used to relieve and in some cases prevent motion sickness. Some of the more common medications that can be used for motion sickness include:

Scopolamine (transdermal patches, Transderm-Scop)2015-04-18 21.08.28

dimenhydrinate (Dramamine)

meclizine (Antivert, Bonine, Meni-D, Antrizine)

promethazine (Phenergan, Phenadoz, Promethegan)

diphenhydramine (Benadryl)

cyclizine (Marezine)

Notice Patti made a new friend, too.

Wonderful, except that when I researched each of these on different sites, this is what I found. By the way, the bolding and italicizing are mine.

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Lara Garwood, my step-daughter, helped me show off our team t-shirts.

At MedlinePlus, A service of the U.S. National Library of Medicine from the National Institutes of Health National Institutes of Health (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682509.html),

Before using scopolamine patches… tell your doctor if you have or have ever had glaucoma; heart, liver, or kidney disease; stomach or intestinal obstruction; or difficulty urinating.

From Drugs.com at http://www.drugs.com/disease-interactions/dimenhydrinate,dramamine.html about dimenhydrinate, better known as Dramamine (including less drowsy),

Limited pharmacokinetic data are available for the older, first-generation antihistamines. Many appear to be primarily metabolized by the liver, and both parent drugs and metabolites are excreted in the urine. Patients with renal and/or liver disease may be at greater risk for adverse effects from antihistamines due to drug and metabolite accumulation. Therapy with antihistamines should be administered cautiously in such patients. Lower initial dosages may be appropriate.

On the contrary, MedicineNet.com at http://www.medicinenet.com/meclizine/index.htm does not list kidney disease at all for meclizine.  Although, there is a warning against alcohol use while using this medication.

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Isn’t that a wonderful entry to the National Kidney Foundation of Arizona Phoenix Kidney Walk?

Trying to use as many varied sources as possible, I went to WebMD at http://www.webmd.com/drugs/2/drug-8895/promethazine-oral/details for information on promethazine.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: breathing problems (such as asthma, chronic obstructive pulmonary disease-COPD, sleep apnea), blood/immune system problems (such as bone marrow depression), high pressure in the eye (glaucoma), heart disease (such as irregular heartbeat), high blood pressure, liver disease, certain brain disorders (such as neuroleptic malignant syndrome, Reye’s syndrome, seizures), stomach/intestine problems (such as blockage, ulcer), overactive thyroid (hyperthyroidism), difficulty urinating (for example, due to enlarged prostate).

True, there is no warning against using promethazine if you have CKD, but how many of us who do also have sleep apnea and/or high blood pressure – the second most common cause of CKD.

Back to Medicinenet.com for the following about diphenhydramine at http://www.medicinenet.com/diphenhydramine/article.htm.

Diphenhydramine should be used with caution (if at all) in persons with narrow-angle glaucoma, prostatic hypertrophy (enlarged prostate gland), hyperthyroidism, cardiovascular disease, high blood pressure (hypertension), and asthma.

motion sickness

And what about cyclizine?  Everydayhealth.com at http://www.everydayhealth.com/drugs/cyclizine has no warnings about taking this if you have kidney disease.  There was one line in the how to take it section that just, plain cracked me up.  See if you get a good laugh out of this, too.

The chewable tablet must be chewed before you swallow it.

Let’s look into the two without any CKD warnings a bit more. Uh-oh, the British version of WebMD at http://drugs.webmd.boots.com/drugs/drug-137-Cyclizine.aspx tells us something different about cyclizine than the U.S. version of the same website.

Cyclizine should be used with caution in:

People with glaucoma (increased pressure in the eye)

People with obstructive disease of the stomach

People with liver disease

People with epilepsy (fits)

Males with prostatic hypertrophy (enlargement of prostate gland)

People with severe heart failure

People with decreased kidney functionncl

Pregnant women

Women breastfeeding

The elderly

As for meclizine, even the U.S. version of WebMD says emphatically “Consult your doctor.”

In all honesty, I wouldn’t take any medication without consulting my doctor – specifically my nephrologist.  I urge you to do the same.

Let’s say I was sufficiently spooked by today’s blog to not even want to try medication.  Is there something I could use to prevent sea sickness that’s not medication?  Of course, there is. Many people swear by these remedies, but that’s next week’s blog, folks.

Thank you so much for participating in the prize giveaways for each of the books.  As I saw each prize claimed, all I could think was, “Look how many people are going to share their awareness of Chronic Kidney Disease.”

Book Cover

Until next week,Part 2Digital Cover Part 1

Keep living your life!

It Is Not All In Your Mind; It’s In Your Organs, Too.

It’s National Kidney Month and National Kidney Day on March 13th is coming up fast, so – naturally – the Southwest Nephrology Conference was this past weekend.  It was the usual   Az. Kid Walk pleasure to see Dr. James Ivie, Director of Patient Services at The National Kidney Foundation of Arizona.  The man is wonderfully generous and will be distributing business cards for the book and blog at the Arizona Kidney Walk on April 7th at Chase Field as he allowed Dr. Jamal Atalla from Arizona Kidney Disease and Hypertension Center (AKDHC) to do at the last KEEP (Kidney Early Evaluation Program) event here.

I am up to my elbows in wedding preparations and had to push to make the time to attend the conference and, other than the non-renal diet food (geared to nephrology related practitioners, not patients), I was glad I did.

So much of the material was right up my alley, even though I’m what’s called ‘Allied Health’ rather than medical practitioner. True, I couldn’t quite understand the very technical medical issues, but what I did understand is worth sharing here.

There’s so much to share that I wasn’t sure what to concentrate on this week… until I spoke with Nima. We went from discussing my great-niece’s first birthday party to Nima’s god-mother’s youngest granddaughter’s Bat Mitzvah to lithium. That part of that family has a number of male members who have taken lithium for extended periods for bipolar disorder years ago.

According to Wikipedia, “Trace amounts of lithium are present in all organisms. The element serves no apparent vital biological function, since animals and plants survive in good health without it. Nonvital functions have not been ruled out. The lithium ion Li+ administered as any of several lithium salts has proved to be useful as a mood-stabilizing drug in the treatment of bipolar disorder, due to neurological effects of the ion in the human body.” The operant word in this definition is SALTS.  You can read more about lithium at:   http://en.wikipedia.org/wiki/Lithium.

There were two Plenary Sessions.  It was at the second one, “Psychiatric issues in kidney patients” presented by Dr. Christian Cornelius from Phoenix’s own Banner Good Samaritan Medical Center (where two of Cheryl’s grandchildren were born and also where she was diagnosed with the colorectal cancer that ended her life) that I suddenly sprang into attention again.

Hey, it had been a long morning and lunch was coming up soon.  I hadn’t been able to eat the mid-morning snack of cookies, soda, or coffee. I was tired from getting up at 5:30 to get to the conference down in Chandler in time. Tired and hungry – not the greatest combination.

cookiesWhat was this man saying?  Something about lithium doubling the risk for Chronic Kidney Disease?  And I was off… how many psychiatric patients knew that fact?  How many of their caretakers knew that just in case the patient was not responsible at the time of treatment?  What about children?  Did their parents know?  Was a screening for CKD performed BEFORE lithium was prescribed?

26 million Americans have kidney disease that is not yet diagnosed.  What if one of these psychiatric patients belongs to that group?  What if they all do?  Currently, kidney disease is the ninth leading cause of death in the United States.  Ninth!!!  Are these undiagnosed psychiatric patients moving it to the eighth?  And what about the 73 million at risk for kidney disease due to high blood pressure, diabetes, or family history?  Are they being given lithium without screening?  (You can read more facts about kidney disease at: http://www.kidney.org/news/newsroom/factsheets/FastFacts.cfm.)

I decided to dig deeper, as I often do.  Again and again on different sites about side effects of different psychiatric drugs, I found warnings that patients need to have a complete medical exam before starting the drug and then periodical exams to check whether or not the patient has developed some damage from taking the drug.  Here’s my question: do these exams include kidney screening?lithum

First I looked at my Twitter feed and found this at: http://www.winnipegfreepress.com/local/screening-for-kidney-disease-on-first-nations-193767521.html

“The $1.6-million federally funded project — First Nations Community Based Screening to Improve Kidney Health and Dialysis — will launch in March.

The project, co-led by Manitoba First Nations’ Diabetes Integration Project and Manitoba Health’s Manitoba Renal Program, provides early detection and treatment to several First Nations communities.

Detection of the disease in people as young as eight can take less than 15 minutes.”

The article deals with a KEEP type program for some Canadian First Nations and is included here to demonstrate the growing awareness of the need to screen for kidney disease, not to infer that First Nations have psychiatric disorders.

Other than that article, there is nothing about screening for kidney disease.  If medical practitioners aren’t aware of the prevalence of CKD – and, obviously, I am not referring to the entire medical professions – how can psychiatric practitioners be expected to know to do this?

I am not a psychiatric patient, not even for minor psychiatric issues, so I don’t know what the screening process is first hand.  However, I do know people who have confided in me (no names for privacy’s sake) that they are taking drugs for some psychiatric condition.  Big mouth here always asks what effect that drug might have on their kidneys… or liver for that matter since such drugs may hit the liver negatively.

That is not enough.  We need a lot more big mouths to ask the right question about drugs: How will this affect my kidneys?

I’m asking for one, no two, wedding presents from each and every one of you.

  1. Have yourself tested for kidney disease
  2.  Before you take any drug for any reason, ask how it will affect your kidneys.

Wow!  You have it in your power to make me a happy bride.  Please do it for your sake and mine.  wedding dress

Until next week,

Keep living your life!