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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?

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

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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 usua…

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

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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.

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

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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…

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

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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.

What is "Chronic Kidney Disease", or CKD?

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In my previous post, I had talked about how physicians check your kidney function, as well as the concept of glomerular filtration rate (a measure of your kidneys' function, or more accurately, its filtration capacity), or GFR. I want to talk today about an entity that you might have heard before: chronic kidney disease, or CKD. 
CKD is a generic, umbrella term. Nephrologists define it as "kidney damage or reduction in kidney function that persists for 3 or more months". The definition does not include the cause of kidney disease. In other words, whether you have reduction in kidney function from diabetes, or high blood pressure, or a genetic cause, you could still carry a common diagnosis of CKD. This diagnosis is then further subdivided in to stages 1 thru 5, depending on the disease severity. This is where the concept of GFR that I talked about before becomes useful. 

Take a look at the above picture (courtesy of The National Kidney Disease Education Program). Now th…