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!

 

Peeking At Transplantation

ringLadies and Gentlemen: welcome to the first blog by Gail Rae-Garwood (Mrs. Paul A. Garwood), formerly Gail Rae.  Thank you for all your congratulations and good wishes! I have more former names than I’d like to admit, but I’m sticking with this one, just as I’m hoping to stick with my own two kidneys for the rest of my life… or as I say to Bear “whatever time we have left.”

I am not morbid but I’m also not the blushing bride my dear cousin Steve Bernard caricatured me as.  I’m just plain realistic. And that’s why we’ll take a little peek at transplantation today.  Remember that I’m not a doctor and I didn’t want to know anything about this ever.  But it is a fact in some lives.  Sure I don’t want to have one of those lives and I’m doing everything I can to avoid it, yet….

Do you know about the TransplantCommunityOutreach page on Facebook?  They asked me to be their kidney ‘expert’ right after What Is It And How Did I Get It? Early Stage Chronic Kidney Disease                         was published.  I balked since I certainly didn’t feel like an expert and knew nothing about transplantation.  Linda and Rex Maus went back and forth with me until I understood they didn’t expect me to know everything, just to remind the transplantees what it had been like in the early stages and keep them informed about what new discoveries have been made since their own time in the early stages of chronic kidney disease.  I was comfortable doing that.

You already know that when your kidney function decreases to 10 or 15%, depending upon your nephrologist’s views, you need outside help.  By this I mean, from outside your body.  We timidly explored dialysis last week.  A word about that.  There is so much more that I’ve learned about dialysis while I was researching for that blog. If you’d also like to learn more – whether you’re at the point of needing it or not – I urge you to do more research on your own.The Table

Or, if you’re not comfortable researching, go to one of the national kidney organizations.  They will give you clear, simply stated explanations with diagrams and will list other sources. I would start with Medlineplus, a service of The National Institute of Diabetes and Digestive and Kidney Diseases at http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=renal+dialysis .

I went to Medline at http://www.nlm.nih.gov/medlineplus/kidneytransplantation.html for a definition of renal (or kidney) transplant:

“A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, so you no longer need dialysis.

During a transplant, the surgeon places the new kidney in your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Often, the new kidney will start making urine as soon as your blood starts flowing through it. But sometimes it takes a few weeks to start working.

Many transplanted kidneys come from donors who have died. Some come from a living family member. The wait for a new kidney can be long.

If you have a transplant, you must take drugs for the rest of your life, to keep your body from rejecting the new kidney.”

I find people cringe at the thought of taking drugs for that long, but think of the alternative… or lack of one.  There is quite a bit of information packed into that concise definition.

Diagrams always help me understand when the words don’t.  You’d think that wouldn’t be the case for a writer, but I like to think of myself as the exception to the rule. (It saves face when I don’t remember what some of the terms in the definition mean.)  This is the clearest, simplest diagram I could find.faq_kidney_transplantation

A couple of reminders (taken from the glossary of What Is It And How Did I Get It? Early Stage Chronic Kidney Disease):

  1. Arteries are the vessels that carry blood from the heart.
  2. Veins are the vessels that carry blood toward the heart.

In the last decade, there has been experimentation with taking the donor kidney laparoscopically. That means using extremely small instructions which require extremely small incisions into the abdomen of the donor. I haven’t seen any articles that are negative about this and it cuts down on the recovery time for the live donor.  Since we each have two kidneys and it is possible to live with one, someone who matches may donate a kidney to you.  Otherwise, you will receive something called a cadaver kidney, meaning one which comes from someone who has just died.

Recently, according to ScienceBlog at http://scienceblog.com/56571/donors-like-giving-up-kidney-through-belly-button/ , this marvelous procedure of removing donor kidneys laparoscopically has been further improved by using only one incision in the belly button which is lost within the navel folds once it is healed. The idea is to make it more comfortable for the living donor so that more living donors can be found.

As for the person receiving the kidney, you will be on anti-rejection drugs for the rest of your life.  Your body is designed to reject foreign bodies – including organs.  You’ll also need to pay attention to exercise, diet, sleep, and stress sort of like with ckd, only this is not a life or death matter…  not a keeping your GFR up matter.

Some people choose not to take on that challenge.  It was only through Cheryl’s death that I came to realize not everyone wants to prolong their life if it means doing what they don’t feel they can.

I know, I know, here I am a newlywed (one day now, folks) and I haven’t told you a thing about the wedding or the reception.  I simply felt that, logically, a blog on transportation had to follow the one on dialysis.  Again, I haven’t told you much more than the basics so if you want more, research.  Or comment and I’ll help you find more information.

Expect to cry and laugh with me next week as I weave highlights of the wedding into kidney information.  To my European readers, thank you so much for the volume of sales there!  To my US readers, don’t forget this Kidney Walk season.  Contact your local kidney organization for info on the walk in your area.Az. Kid Walk

Until next week,

Keep living your life!