Creating a human kidney in the lab to treat kidney failure: Reality or Star Trek?

I look at the artificial kidney that I talked about in my last post as a sort-of futuristic automaton. It can work (in principle) on the body's internal power (the blood pressure) and does not require the frequent tweaks (again, in principle) that are required with conventional dialysis; thus giving patients more freedom with their lives.

However, the technology that really has the trans-humanist in me jumping up and down with excitement is the promise of regenerating a "natural" human kidney in the lab. In Greek mythology, Prometheus' liver would regenerate even after an eagle nibbled on it every day, all while the poor fellow lay chained to a rock (he was lucky the eagle didn't mess with his kidneys, which don't quite possess the same regenerative capacity!). My fantasy is not quite the same, but what I had always conceptualized is that with the advances in regenerative medicine, we might be able to just play God, and "make a kidney", a real huma…

Is a vegan or vegetarian diet better for patients with kidney disease?

Over the last few decades, we have seen the accumulation of evidence that supports the health benefits of plant-based diets. Vegetarian diets have been shown to be associated with a lower incidence of obesity, hypertensiondiabetes, and coronary artery disease. Since all these entities are risk factors for chronic kidney disease (CKD), it might be reasonable to assume that these diets might actively reduce the risk of CKD development and progression. However, at the very outset, let me emphasize that any diet, vegetarian or not, comes with the same restrictions that are advised for patients with CKD. For instance, potassium intake might need to be restricted in advanced CKD. Fruits, a significant portion of the vegetarian diet, are an important source of potassium, and will need to be appropriately restricted. So you have to watch what you eat regardless. More importantly, you owe it to yourself to know what exactly is there in the food that you eat.

Environmental Toxins That Cause Kidney Disease and Failure

Toxins present in the environment are a common but under-appreciated cause of kidney disease and kidney failure. Environmental causes typically include chemical agents (eg. heavy metals), physical agents (eg. high temperature/heat, dehydration), and biological/infectious agents (eg. malaria, HIV etc). Here is an overview of some exposures and their sources that you should be aware of:

Can certain herbal medications treat chronic kidney disease (CKD)? Is alternative medicine the cure for CKD?

I set off to try and answer this question after one of my patients whom I saw at my Bradenton clinic brought along an article that claimed that "nettle leaf lowers creatinine level in the blood". This by extension would mean that it could perhaps cure CKD? I was quick to admit that not once during my typical "western medicine" training had I heard of that claim. To me, CKD had always been this inexorable malady that can be, at best, controlled or slowed down from progressing further. "Cure" is not a word that gets thrown around a lot when you talk about CKD. As I had discussed earlier, once kidney function declines chronically, it can typically not be regained.   
But I do try to have an open mind, the good old scientific temper and all that. So rather than dousing disdain over my patient's excitement, I tried to look for evidence to see if the article's claim was indeed true.

How do physicians check your kidneys' function?

Most people know that getting a stress test is a way to test your heart's function. But how do you test your kidney function? You might have heard doctors mention words like "creatinine", or "GFR" when checking how good or bad your kidneys are doing. Although there are a lot of methods by which the kidneys' performance can be measured, I will explain the ones that are used most often in clinical setting

How does contrast/dye given during a CT scan harm your kidneys? What can you do to prevent and minimize the damage?

Certain types of CT scans will often require that the patient get intravenous (iv) "dye" or contrast to make the organs stand out and delineate them better. This usually would lead to better images with greater sensitivity that help the radiologist in picking up features that would otherwise get missed. The downside however is that this very contrast could sometimes cause damage to the kidneys. The medical term for this is "contrast induced nephropathy" (CIN). What do you then do in a situation where iv contrast is necessarily required? Lets try and understand a few nuances about contrast-mediated kidney damage, and what you can do about it?

I do not want dialysis: how long can I expect to live, and how would I feel?

I often see patients in my office who refuse dialysis (should it become necessary) for their advancing kidney disease. I divide these patients in to two categories. The more common category is patients who refuse it because of the "fear of dialysis". They could have trouble understanding dialysis and what potential benefits they could derive from it. They would often make good dialysis candidates who have more to lose than gain by refusing dialysis therapies.

The other category is the patient who rightfully refuses dialysis because she or he would not make a good candidate for such treatment. There could be multiple reasons for that. It could be advanced age and frailty, presence of other severe disease conditions like heart failure or metastatic cancer, etc. In such cases, it is hard to always predict if dialysis would add anything to the quality/quantity of life. And often, patients are simply looking at the "big picture". So the questions that come up in this s…