This blog aims to make evidence based medicine understandable to the lay person. Readers are encouraged to comment on posts, share them, or ask questions. Your feedback is always appreciated!

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".

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.


HOW DO PAIN MEDICATIONS DAMAGE THE KIDNEYS: EFFECTS ON KIDNEY FUNCTION

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".

Tuesday, August 12, 2014

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 18, 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?

Friday, June 13, 2014

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! 




Veeraish "VC" Chauhan, MD, FACP, FASN
Nephrology
Bradenton, Lakewood Ranch, Sarasota, FL

Sunday, April 27, 2014

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"?

Sunday, April 13, 2014

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.

Friday, March 28, 2014

Managing pain in patients with kidney disease

(It is hard to imagine this blog is one year old! When I started this an year ago, I thought I was going to play it by ear and see how it goes. I am overwhelmed by the support and readership it has achieved. A big thank you to the readers!)

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?

Monday, March 17, 2014

How do you treat excess protein in the urine (proteinuria)?

I had covered why excess protein in the urine needs to be treated in my earlier post. Lets talk briefly about how we go about achieving that.

Friday, February 28, 2014

What is a good target blood pressure for someone with kidney disease?

Besides being a huge risk factor for heart disease, strokes, etc, high blood pressure can also lead to kidney disease. People with high blood pressure are at risk of developing changes that lead to scarring inside the kidneys, that could ultimately cause the kidneys to "burn out". Patients with existing chronic kidney disease (CKD), are at a higher risk of progression to end stage kidney disease when they would need either dialysis or a kidney transplant, should their blood pressure stay high/uncontrolled. In fact, after diabetes, high blood pressure is the commonest reason that people develop kidney failure. So what is the target blood pressure for someone with underlying CKD to minimize their risk of progression to end stage kidney disease?

Friday, February 14, 2014

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?

Saturday, February 1, 2014

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. 

Friday, January 3, 2014

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?

Friday, December 20, 2013

High uric acid levels/gout: the effects on the kidneys, and do you need to treat it?


Uric acid is a substance found in the blood. It gets there when "purines" which are one of the building blocks of your DNA, are broken down. This is normal cell metabolism, and hence it is ok to see some amount of uric acid in the blood. However certain disease conditions, foods, and medications can also raise blood uric acid levels to abnormal levels. High uric acid levels, or "hyperuricemia", may lead to "gout/gouty arthritis", but these terms are not interchangeable. 

Friday, December 6, 2013

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.  

Friday, November 22, 2013

Higher infection risk in CKD: Vaccinations that every kidney disease patient should receive

Patients with chronic kidney disease (CKD) are at a higher risk of infections since kidney disease does compromise the body's immune system. The extent to which the body's immunity gets weakened is usually directly proportional to the extent to which the kidney function has declined. The important point to realize is that even moderate decline in kidney function can be associated with a significantly higher risk of serious life threatening infections.  These include infections from any agent: bacteria, virus, and fungi, etc. Specific studies have looked at the association of kidney disease with serious infections like pneumonia and herpes zoster. In fact, infectious diseases are the second leading cause of death in people with advanced kidney disease who are on dialysis!


Once you realize that CKD really is a de facto immunocompromised state, it becomes easy to understand the importance of preventive vaccination. Vaccinations should hence be an integral part of a comprehensive care plan for the CKD patient. Specific vaccines are recommended based on the stage of CKD, and in fact, both the Center for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), and international bodies like Kidney Disease: Improving Global Outcomes (KDIGO) have now come up with specific guidelines regarding adult immunizations in patients with kidney disease.

Sunday, November 10, 2013

When do you really need to start seeing a nephrologist (a kidney doctor)?


I often call kidney disease the "Rodney Dangerfield of Medicine". It gets no respect! Well, outside of the medical community, the same could be said for nephrologists (to a certain extent)! No one is quite sure what they do, or why does anybody need to see one anyway.  For some, we are just another version of urologists. Nephrologists, as the readers of this blog know are physicians who specialize in the diagnosis and treatment of kidney disease, electrolytes, high blood pressure, dialysis, kidney stones, etc. 

Friday, October 25, 2013

Does obesity cause kidney disease?

It is a fact we are all too well aware of. The world, as we know it, continues to grow fat. The popular press has done an excellent job of educating the lay person about the link between obesity and heart disease, high blood pressure, diabetes, etc. However, despite scientific evidence to the contrary, the effect of obesity on the kidneys’ function is less widely known. 

Friday, October 11, 2013

Why do people with kidney disease develop low blood count (anemia)? How do you treat it?

For many of my patients, it is hard to see the connection between chronic kidney disease (CKD) and low red blood count, or anemia. The two entities just seem so disconnected that one wonders, what would one have to do with the other? The key to appreciating this link is recognizing two fundamental principles; one, that the function of the kidneys extends to beyond just "making urine", and two, kidney disease has numerous repercussions that affect multiple organ systems. Well, one of these organ systems happens to be your body's machinery that makes red blood cells, known as the hematopoietic system. And the reason this machinery gets affected in kidney disease is because of the kidneys' function in producing a hormone called, erythropoietin.

Friday, October 4, 2013

Does kidney disease cause bone disease: how does it happen, and what can you do about it?

One of the relatively less recognized complications of chronic kidney disease (CKD), is bone disease. While medical science has made great strides in understanding this link, most patients have a tough time making sense of how/why a disease of the kidneys could create problems for their bones? 


Before we begin to understand this complication, lets briefly recount an important function that the kidney serves in the body. Like I always say, "it's not just about making urine"! 

Friday, September 27, 2013

Treatment of kidney disease: why acid levels in the blood matter?

Sometime ago, I had posted a brief overview of treatment of chronic kidney disease. However, one factor that does determine the progression of chronic kidney disease that I did not touch upon was the amount of "acid" in your blood, and its consequent effect on the kidneys.

Friday, September 20, 2013

Is it possible to lower high blood pressure without pills or dieting? Alternative therapies for blood pressure control

Sometime ago, I had written a post exploring the role of alternative herbal medications in the treatment of chronic kidney disease. That post had evoked strong reactions, both for and against, from the readers! Which set me thinking...is there a role of alternative therapies in the treatment of high blood pressure? If yes, is it based on hearsay, or solid medical evidence? 


Luckily, to make my job easier, the American Heart Association came out with an official statement addressing this issue early this year. This was published in the journal Hypertension. I will try to summarize this statement's conclusion's addressing the efficacy of approaches like acupuncture, yoga, meditation, etc in treating high blood pressure. Please note that these conclusions apply only to treatment of high blood pressure, and not to other health/psychological benefits that may be derived from doing these activities.   

Friday, September 13, 2013

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.

Saturday, September 7, 2013

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

THE FUTURE IS HERE.....WELL, ALMOST!

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.

Saturday, August 31, 2013

Is it safe for me to donate a kidney? What kind of problems can I expect?

This is one the commonest questions that I get as a nephrologist. The typical situation is a patient with advanced kidney disease that I see in the office. The patient is accompanied by a family member who is eager to donate their kidney to the patient, but is concerned about any potential health pitfalls. 

Assuming you have a donor who is willing to donate you their kidney and is fit to do so (I covered the steps involved in kidney transplantation and the prerequisites for a potential donor here), the donor as well as you would need to be aware of what donation entails, and what, if any, future health consequences can they expect. So assuming the potential donor has no major contraindications to kidney donation (these will include impaired kidney function, active infections, cancers, chronic lung/heart/liver/autoimmune disease, substance abuse, pregnancy, etc.), this is what they could expect:

Wednesday, August 21, 2013

The step-by-step guide to kidney transplantation for patients with kidney failure

No treatment option for kidney failure comes remotely close to kidney transplantation in terms of superiority of health outcomes and quality of life. Patients who get a kidney transplant often report that they feel like they "got their life back". The high phosphorus or potassium levels that they were used to seeing during their dialysis days become a thing of the past, blood pressure suddenly becomes so much easier to control, and often, the best part for a lot of patients is that they don't have to subject themselves to the strict dietary restrictions that are imposed on patients on dialysis. All of this points to but one simple fact. No matter how much dialysis technology progresses, no matter how many hours of dialysis we realistically prescribe to our patients, dialysis any day is a poor copy of the kidney's function. Man just hasn't yet made a dialysis machine that can outdo what nature's fantastic creation can. 

Saturday, August 10, 2013

What is dialysis? How does a dialysis machine work?

When patients develop advanced kidney disease, medically called stage 5 CKD, they could begin to develop symptoms or signs of kidney failure, called uremia. Up to a certain point, your nephrologist will try and treat these complications medically as much as possible. However, as kidney disease progresses, the symptoms may no longer be amenable to medical treatment. At this point, you will need either dialysis or a kidney transplant.

Image courtesy NIDDK

Saturday, August 3, 2013

What are "kidney cysts"? Should I be worried? How do you treat them?

Cysts, or abnormal pockets of fluid filled sacs, are a common finding on imaging studies like ultrasounds that are done on the kidney. I often see concerned patients in consultation about this finding. The question in that situation is...should you be worried if you discovered that you have cyst/s in your kidney?


HOW COMMON ARE KIDNEY CYSTS?

Cysts in the kidney are a pretty common occurrence. They tend to get more prevalent in the older age groups. For instance, 11.5% of individuals aged 50-70, and 22.1% of all individuals aged over 70 yrs will have at least one cyst in the kidney. However, the challenge is to identify whether it is a benign age related finding or something as serious as cancer (which can present as cysts). Cysts often will have no symptoms, and will usually be discovered incidentally as part of imaging of the kidneys for unrelated reasons.

Saturday, July 27, 2013

Pregnancy in women with kidney disease

Pregnancy is a physiologic stressor on a woman's body. The cardiac output has to increase to keep up with the increased metabolic demands of the woman and the developing fetus. The blood flow to the kidneys increases. Changes in blood electrolyte and acid levels occur. These changes, among others, have implications for both the kidney's function, as well the state of the pregnancy. Hence, nephrologists typically try to answer two questions when assessing these issues:

1) How does kidney disease affect the chances of getting pregnant, and kidney disease's effect on pregnancy?

2) What effects does pregnancy have on the status of your underlying kidney disease? 


Continuing on my last discussion about sexual and reproductive issues in people with kidney disease, lets carry this forward.

Saturday, July 20, 2013

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, July 14, 2013

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.

Friday, July 5, 2013

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, June 23, 2013

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.

Thursday, June 13, 2013

Does smoking cause kidney disease?

The damaging  effects of smoking on lung and cardiovascular function are well known. Does smoking have similar effects on the kidney function as well? If yes, what is the evidence to support that conclusion?

Most recently, this question was addressed by two different studies, both of which were published in the Journal of the American Society of Nephrology. The first study I want to discuss came out from the Johns Hopkins University School of Medicine. Unlike a lot of its predecessor studies, this study was a prospective study (rather than a retrospective analysis of patients' charts), following about 23,000 patients over a span of 20 years. The results of this study clearly established that current cigarette smoking was a significant risk factor for development of chronic kidney disease (CKD). However, what was even more profound was that the attributable risk (difference in CKD rates between people who smoke and those who don't)  of CKD for smokers was 31%, which was even higher than hypertension as an isolated risk factor! It thus seemed to suggest that the damaging effect of smoking on kidney disease might have been related to factors beyond smoking's transient effect of increase in blood pressure alone. These conclusions applied both to women, and men.

Image courtesy of photostock/FreeDigitalPhotos.net


One year later, another study came out in the same journal, this time from Sweden.

Tuesday, May 28, 2013

Is it possible to reverse and "cure" chronic kidney disease? How do you treat chronic kidney disease?

BACKGROUND

It is estimated that more than 20 million Americans may have chronic kidney disease (CKD). That means roughly 1 in 15 Americans. Subjectively speaking, and for some reason, the rate seems to be even higher where I practice (Bradenton / Sarasota, Florida), but that could be related to the older aged population here.

Whether you could "cure" CKD would depend on the cause of kidney disease. Quite often, the cause happens to be a chronic disease that can only be "controlled" (like diabetes or hypertension), but not technically cured. And so is the case with CKD. That is, you can usually not cure and get rid of CKD, but you should be able to control the worsening of your CKD and prevent the fall in your GFR. 

I have discussed in my previous posts about how physicians measure your kidneys' function and the concept of GFR. You may want to take a look at the picture of the "GFR meter" again wherein I had mentioned that the needle on this meter usually swings only one-way. In other words, you cannot increase your GFR once it is chronically low, BUT you can try to keep it from getting worse.

Monday, May 27, 2013

Who needs to be tested for kidney disease? What are the causes of kidney disease?

I often get the question, "hey doc, do I need to be tested for kidney disease"? The answer would depend on whether you have the risk factors to develop serious kidney disease. Kidney disease is often called a "silent killer", because all too often, patients do not have any symptoms, period. A common misconception is that if you "make urine", your kidneys are healthy. This is not true. As you might have noticed in my previous post, the amount of urine you make is not necessarily considered a valid test of your kidneys' function. In fact, I personally have a lot of patients who are on dialysis due to kidney failure; yet they continue to pee out a liter of urine daily! I will talk about the symptoms of kidney disease later, but for now let's focus on who needs testing; knowing that you may or may not have the relevant symptoms.

Saturday, May 25, 2013

Does alcohol consumption cause kidney disease?

Nephrologists typically would question you about your alcohol intake as part of a routine office visit.  Let's see why is that so? Humanity's association with alcohol dates back to antiquity, as evidenced by the now-famous discovery of the Stone Age Beer Jugs! So for millenia, we have been using alcohol variously as a medication, an antidote, a source of inspiration for treatment of writer's block, a medium to make friends and political connections, etc. "I have taken more out of alcohol than alcohol has taken out of me", claimed Winston Churchill. I am not sure if that included kidney disease or not, but I do intend to explore that question today. 

Does alcohol cause kidney disease?
Image courtesy of arztsamui/FreeDigitalPhotos.net

You would think that 9000 years of binge drinking would lead to some solid evidence about the association between alcohol use and kidney disease. Surprisingly, there are not a lot many good studies out there that have addressed this question.

Tuesday, May 21, 2013

Does cranberry juice really prevent or treat urinary tract infections (UTIs)?

The short answer is, "probably not". So is this another one of those medical myths, then? I had a patient's relative ask me this question recently. They had driven up from Sarasota to see me for some other nephrological issue, when we got talking about the role of recurrent kidney infections in causing chronic kidney disease (CKD). Recurrent kidney infections (called pyelonephritis, which is a type of a UTI) are known to cause renal scarring. They might also be associated with genetic or developmental abnormalities that could be lead to CKD.  That is a separate discussion in itself, but for the time being, I wanted to delve a little bit in to whether cranberry juice is worth your money. This is another one of those "top ten" questions that nephrologists get all the time!

Do cranberries prevent UTIs?
Image courtesy of James Barker/FreeDigitalPhotos.net

Jokes about cranberry juice aside, there do seem to be plausible biological mechanisms to suggest that it should prevent recurrent UTIs, and we do have basic scientific studies that support that.