This blog aims to make "evidence-based medicine" understandable to the lay person
An updated version of this blog now runs on www.KidneyDisease.About.com . Please check the link for the most updated posts. Thanks!

Wednesday, August 31, 2016

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:

Friday, July 22, 2016

Protein in the urine: what's the big deal and why it needs to be treated?

Protein in the urine is medically referred to as "proteinuria". As we had discussed earlier, abnormally high amount of protein in the urine is one of the hallmarks of Chronic Kidney Disease (CKD). We also talked about the role of moderate protein diet in preventing CKD progression. But if protein in the urine is just another downstream effect of kidney disease, then why do we nephrologists make so much fuss about treating it?

Wednesday, April 13, 2016

Kidney disease and heart disease: five questions to unravel the link

A frequent conundrum that I see patients run into almost everyday, is understanding the link between chronic kidney disease (CKD) and coronary heart disease (CHD). They are surprised when I tell them that most CKD patients are more likely to die from heart disease, than from kidney disease (or require renal replacement therapy/dialysis).

Why is that so, and is there a link between kidney and heart disease? Lets explore.

Sunday, January 3, 2016

What is the right amount of daily protein that a patient with kidney disease needs to eat?

Earlier, I had talked about the recommended dietary guidelines for patients who have kidney disease. I want to tackle the issue of protein intake in patients with chronic kidney disease (CKD) in a little more detail today because this is an issue that patients seem to be the most confused about. The question is not just limited to how much protein you need to eat to for your kidneys' health and your overall health. What also needs to be realized is that not all sources of protein are created equal, even if they have the same amount of protein. Quality hence matters as much as quantity. 

Thursday, December 3, 2015

How does kidney disease affect your sexual health and reproductive function? What are your treatment options?

Kidney disease has a profound effect on sexual health, fertility, the ability to conceive, etc. I will cover the issues related to chronic kidney disease (CKD) and pregnancy in my next post. For today, lets try and understand how and why a reduction in your kidney function could affect your sexual health. Sexual dysfunction does tend to worsen as kidney disease progresses, and is part of the constellation of various signs and symptoms of advanced kidney disease.

Sunday, November 1, 2015

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 human kidney, not a chimera of materials from man and machine. It always seemed to be the stuff of science fiction.

Wednesday, September 30, 2015

Can we create an artificial/mechanical kidney to treat kidney failure?


It has been a while since researchers started working on developing prototypes of artificial kidneys that could literally be implanted in to a human suffering from kidney failure. Theoretically, this kind of artificial kidney would replace the functions of a normal human kidney. It would flush the blood of all metabolic toxins, maintain all body electrolytes in the narrow range necessary for all life processes, produce hormones like erythropoietin (that drives the bone marrow to produce red blood cells), activate vitamin D, regulate blood pressure, etc etc. Yes, these are all some of the functions that those miracles of nature sitting in your flanks, your kidneys, are doing right now.

Tuesday, September 1, 2015

Saturday, August 8, 2015

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 situation are:

  • How would I feel if I refuse dialysis?
  • Would my life span be shortened if I refuse dialysis?

Saturday, August 1, 2015

Managing pain in patients with kidney disease

Pain, both acute and chronic, is commonly prevalent in patients with chronic kidney disease (CKD). This is due to the myriad diseases that often coexist in kidney disease patients (like arthritis, diabetes, obesity, etc). I had earlier written a post on how certain painkillers adversely affect the function of the kidneys. So we know that many pain medications are bad for your kidneys. We also know that even if some pain medications are not directly toxic to your kidneys, they can still accumulate in your body and affect other organs in patients who have kidney disease. It saddens me when patients with pain come to my office after being told that they can't take a particular pain medication because "their kidney numbers have worsened". Granted that could certainly happen; but not coming up with an alternative and leaving patients "marooned" is also a disservice to them. What then could be some viable options for patients with kidney disease to deal with their pain conditions?

Sunday, June 21, 2015

Polycystic kidney disease, and future drugs that might treat it

Earlier, we had talked about kidney cysts, and how they could be present in different disease conditions of varying severity. Lets talk a little about one specific entity characterized by multiple cysts in the kidney, called Polycystic Kidney Disease (PKD), and some potential treatment options that might pan out in the future.  

Saturday, May 23, 2015

Treatment Options for Kidney Failure: From Transplantation to Dialysis to Conservative Management...in 10 minutes!

After I wrote my last post on the treatment options that patients with advanced kidney disease and kidney failure have when it comes to managing their disease, I came across a really nice 10 minute long video on YouTube that pretty much summarizes everything that I wrote in that article. The video goes into options that patients with kidney disease will typically have- dialysis being the most common one, transplantation, and finally not doing anything aggressive and treating it conservatively (I have written on conservative management and what happens when patients refuse dialysis here).  The video also covers questions like when to start dialysis, and the decision making that goes in to deciding who would make a good candidate for home dialysis. All in all, it is a great way in which kidney disease patients and their loved ones can educate themselves. The format is engaging and you won't have to read pages of text that many patients find boring! 

The video has been produced by Dr. Mike Evans, who is the founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital. Although certain references to Canadian statistics have been made in the video, it is still relevant to patients worldwide.

And now ladies and gentleman, I present to you...this awesome video! 

Bradenton, Lakewood Ranch, Sarasota, FL

Saturday, March 21, 2015

Sugar Consumption and Chronic Disease: A Brief History of the CardioRenal Epidemic

One-third of adults in the US are obese. One-third of adults in the US have hypertension. A little under 10% have diabetes.

It wasn't always like this. Not till the very recent past. And I am talking about the early 1900s. What happened to you America?

Sugar may be a big part of the answer to the above question (if not the complete answer). In huge amounts. Cheap and omnipresent. To understand the effects of sugar consumption on health and kidney disease, lets take an interesting detour in to the history of sugar consumption. Once one understands  how sugar's (over)use has grown in parallel with the increasing incidences of heart and kidney disease, diabetes, etc since the eighteenth century, the link between sugar consumption and adverse health consequences becomes clearer.

Saturday, February 7, 2015

What Kind of Dialysis is the "Best"? Which Dialysis Modality should I chose if I have Impending Kidney Failure?

We are years, if not decades away from creating an artificial kidney. Until then, in an ideal world, every patient with advanced stage-5 kidney disease who needs kidney replacement therapy would get a kidney transplant. Unfortunately, kidneys are a scarce and limited resource. The number of people with kidney failure who could use a transplant far outweighs the number of transplants that actually occur every year. As per the latest USRDS Annual Data Report (2013), 17,671 kidney transplants were performed in the United States in 2011 (111 fewer than in 2010). Meanwhile, the waiting list had 90,474 patients in line, as of December 31st of the same year. As you can see, the active waiting list is more than three times larger than the actual supply of donor kidneys. In the light of this stark mismatch, desperate patients have to make a decision about the next best option, dialysis. And the question that any proactive patient will ask, and should ask, is what kind of dialysis is the "best"?

Friday, December 26, 2014

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.

Sunday, November 30, 2014

Diet for patients with kidney disease: A little sweet, a little salty, and what to eat more/less of?

You are what you eat. Your kidneys are no different. Diet and lifestyle have a huge influence on the development of kidney disease, as well its rate of progression once it develops. Hence, in my practice, and especially in patients with early stage chronic kidney disease (CKD)  or stage 3/early stage 4,  I place a strong focus on diet (in addition to treating the cause of CKD) which may sometimes go a long way in preventing disease progression. This does not mean that the right diet is not important in advanced stages of CKD. It very well is; however, you will probably need more aggressive medical management in those stages. I have emphasized before that, like many other things in life, prevention is not only better than cure, it is much much easier too. Once GFR (glomerular filtration rate, a measure of your kidney function) permanently declines, it is unlikely that it will increase. Hence GFR decline is often a "one way highway".

Wednesday, November 19, 2014

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?

Saturday, November 1, 2014

Is drinking coffee/caffeine bad for your kidneys?

This is a question that often comes up when I see patients in my office for treatment of chronic kidney disease (CKD). As always, I tend to emphasize the huge role that diet plays in the management of CKD. I noticed that my recent posts might be becoming too wordy, so I am going to keep myself very brief today!

Tuesday, October 7, 2014

The effect of artificially sweetened soft drinks/colas on kidney and cardiovascular function: Are diet sodas as harmless as they appear?

Most of us, even the fitness freaks, feel good about consuming diet soda...that harmless, calorie-free, sugar-free indulgence. What could ever be wrong about a can of zero calorie, carbonated, flavored water?!

Possibly a lot, it seems. The potential for harm stems from the various ingredients that go in to conjuring your favorite diet soft drink. Lets break down a typical artificially sweetened beverage (diet soda) in to its bare ingredients that are pertinent for this discussion : artificial sweeteners, caffeine, caramel color, and phosphoric acid.

Friday, September 12, 2014

How do some over-the-counter pain medications cause/worsen kidney disease? How can patients with kidney disease treat their pain?

The fact that a number of painkillers are available freely over-the-counter (OTC) often gives a lot of people a false sense of security about the safety of these medications. A statement that I here from some of my patients is, "it was available without a prescription, so I thought it wasn't too strong". So very often, patients assume that if a medicine is not too potent, it probably does not have serious side effects either. Sadly, a medication's potency is not necessarily proportional to its side effect profile.


Pain medications can have different renal effects. These can range from reversible, short term reductions in kidney function due to a decrease in the blood supply to the kidneys (called Acute Renal Failure, or Acute Kidney Injury), to a more chronic disease where the kidneys shrink in size, develop a rough and bumpy surface, and demonstrate tissue breakdown called "papillary necrosis".