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Showing posts from May, 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.

Does alcohol consumption cause kidney disease?

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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. 

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.

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

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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!

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 th…

Does drinking a lot of water reduce the chance of developing kidney disease?

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For all these years, I have considered the good old recommendation of drinking "8 glasses of water daily" another one of those medical myths; an unsubstantiated idea that for some reason has come to be accepted as the gospel truth by all. Till date, not a single high quality scientific study has looked at whether this is indeed the appropriate amount of water to drink. Yes, dehydration is obviously harmful to the kidneys' function, and you should still drink according to the thirst/weather. Yes, drinking a good amount of water will prevent kidney stones. But, how do we know if the magic number is 6 glasses, or 8, or 10? Should the recommendation be a higher intake for my patients here in Bradenton, Florida, than for instance, someone living in Upstate New York? 

Even nephrologists and other physicians have been guilty of doling out this advice to their patients for the longest time.

Diagnosis, treatment, and diet for people with kidney stones

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Since we have been discussing kidney stones over the last few weeks, I wanted to highlight a few points about the diagnosis and treatment of kidney stones, as it pertains to patients. I am not going to get in to the technical details of what a nephrologist or a urologist would do. My idea is to emphasize what you can do to complement your physician's treatment plan.
One of the perks of practicing nephrology in Bradenton, Florida, is that you get a pretty good experience seeing patients with kidney stones. Maybe it is the weather! Most patients that I see have already received a diagnosis of kidney stones (nephrolithiasis or urolithiasis) via imaging studies by the time I see them in my clinic. Imaging studies used to diagnose kidney stones include CT scans, X-rays, or ultrasounds. The latter two modalities can often miss certain types of stones (like uric acid), which is why CT scans are considered the "gold standard".

Why do people develop kidney stones? What the risk factors for forming a kidney stone?

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I had previously emphasized that the treatment of a kidney stone does not end with its passage or removal. Let's talk about why is that the case? Kidney stones could be of different kinds (the predominant types are made of calcium and oxalate). Why you form a stone, as well as what type of stone you form, depends on a number of lifestyle, dietary, and genetic factors. It could also depend on other disease conditions that have a bearing on the way stones form in the first place. Some of these factors might be treatable or modifiable, and hence prevention of future stone formation is possible if you can tailor treatment to those risk factors.



Before we talk about why kidney stones form, lets talk briefly about how stone formation occurs.