Posts Tagged ‘kidney disease’

When Our Kidneys Go South

October 26, 2013

Andrew Siegel MD Blog #125

Our kidneys are paired, bean-shaped, fist-sized organs that work diligently and silently behind the scenes 24/7/365, filtering our blood free of toxins and waste products so that we can maintain a healthy existence. When they are working well, they are often taken for granted.  The renal arteries bring blood to the kidneys, the kidneys do their magic, and the cleansed and purified blood is returned into the renal veins, with the liquid waste—urine—excreted into the ureters that drain into the urinary bladder.

If the kidneys stop working properly, excessive fluid and toxic wastes build up rapidly, resulting in death within a matter of days to weeks. Death by kidney failure is described as “euphoric” because of the very abnormal blood chemistries and electrolyte disturbances that occur…not that death is something to be “giddy” about, but kidney failure just happens to be an easier, more peaceful way to exit the planet than many others.

Because of their critical importance to our healthy existence, it behooves us to take great care of these prized possessions, which nature gave us in duplicate. This “spare tire” is capable of sustaining life in the event of trauma, cancer requiring surgical removal, donating a kidney or other issues resulting in loss of one kidney.

The kidneys are multifunctional, not only filtering our blood to remove waste products, but also responsible for regulating fluid, electrolyte, acid-base balance and blood pressure.  They are in charge of maintaining the proper fluid volume within our blood stream. They regulate the levels of our electrolytes including sodium, potassium, chloride, etc. They keep our blood pH (indicator of acidity) at a precise level to maintain optimal function. They are key players in the regulation of blood pressure.  Furthermore—and unbeknownst to many—they are responsible for the production of several important hormones: calcitrol (calcium regulation), erythropoietin (red blood cell production), and renin (blood pressure regulation).

Kidney disease is a very common cause of serious illness with a prevalence of more than 25 million Americans. Each year approximately 110,000 new patients start dialysis treatments in the USA.  Kidney disease is responsible for nearly 100,000 American deaths annually. When the kidneys fail (end stage renal disease), the options are peritoneal dialysis, hemodialysis, kidney transplantation, or death. Peritoneal dialysis uses the peritoneal membrane that lines the abdomen as a filter to clear wastes and extra fluid from the body. Hemodialysis involves being hooked up to a machine that mimics the function of the kidneys; it requires three sessions weekly that take about 3-4 hours per session.

The unfortunate thing about kidney disease is that it typically causes few symptoms until it is advanced; however, simple tests are capable of detecting it.   Symptoms of kidney disease are non-specific and may include the following: fatigue; decreased energy; poor appetite; difficulty concentrating; insomnia; swollen ankles and feet; nighttime muscle cramping; puffiness around one’s eyes; dry and itchy skin; and the need for frequent urination, particularly at night

A definitive sign of kidney disease is the presence of protein in the urine, which is easily detectable on a urinalysis. Additionally, uncontrolled high blood pressure is highly suggestive of kidney disease, as is an elevated serum creatinine, detectable by a simple blood test.  Early detection is critical as it can help prevent kidney disease from progressing to kidney failure. The bottom line is that three simple tests can detect kidney disease:  blood pressure; serum creatinine; urine albumin (protein).

Under normal circumstances, the kidneys filter the blood, removing waste products and excessive fluid, returning into circulation the body’s important chemicals and constituents. When the filtration system is not working properly, one’s system is not cleared of the bad (waste products), resulting in electrolyte disturbances and proteinuria, a condition in which what is good for the body (protein) ends up being filtered out into the urine.

Risk factors for kidney disease are the following: African-American race; diabetes; high blood pressure; and family history of kidney disease.  The two leading causes of chronic kidney disease are hypertension and diabetes, responsible for about two thirds of cases.

Urologists are the specialists who deal with surgical kidney issues whereas nephrologists are the specialists who deal with medical kidney tissues including hypertension and impaired kidney function. If kidney disease is diagnosed, one will typically be referred to a nephrologist for further evaluation and management.  Nephrologists will typically measure the serum creatinine, and do blood and urine tests to assess the glomerular filtration rate, a quantitative test of kidney function.  Often a renal ultrasound is performed and in some cases it is necessary to do a renal biopsy to find the root cause of the kidney dysfunction

Treatment for progressive kidney disease includes interventions such as blood pressure control, often with the use of ACE inhibitors and angiotensin receptor blockers, and control of diabetes.   Nutritional interventions include dietary protein restriction that may slow the progression of chronic kidney disease.   High-protein intake can worsen the proteinuria and result in the accumulation of various protein breakdown products as a result of decreasing kidney function, which can cause toxic effects.

A truly unfortunate fact of life is that many of us are not responsible caretakers of our kidneys (or any of our other “precious physical valuables”); many seem to take better care of their automobiles than they do of their own health.  How many of us change our oil every 3000 miles, bring our cars in for regular service and proudly maintain shiny exteriors while at the same time neglecting our own health by living a harmful lifestyle.  This includes a sedentary existence, excessive stress, insufficient sleep and substance abuse—of alcohol, tobacco and food—with diets high in red and processed meats, sodium and fat laden concoctions, sugar-sweetened drinks, etc., and low in fruits, vegetables, legumes, nuts, whole grains, and low-fat dairy.  The result: obesity, high blood pressure, and elevated cholesterol, which oftentimes leads to diabetes, heart attack, stroke, cancer, and premature death. Sadly, the diabetic situation in our nation—often referred to as “diabesity”—has become epidemic and, as mentioned, is one of the leading causes of chronic kidney disease in the United States.

So how do we care for our kidneys?  The prescription for healthy kidneys is to maintain a healthy lifestyle and, if you have been neglectful in this department, to do a lifestyle remake through the following: good eating habits; maintaining a healthy weight; engaging in exercise; obtaining adequate sleep; consuming alcohol in moderation; avoiding tobacco; and stress reduction.  Additionally, being proactive by seeing a physician on a regular basis for “scheduled maintenance” is of paramount importance in order to detect kidney disease—or any other malady—as early as possible, no matter what the ivory tower pundits say about the ineffectiveness of annual physicals.

Bottom Line: Kidney disease is a debilitating—oftentimes deadly—condition, the risk for which can be greatly reduced by adopting a healthy lifestyle. Never neglect your health, for it is your greatest wealth. 

Andrew Siegel, M.D.

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Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in January 2014.

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My Blood Pressure Ordeal

July 6, 2013

Andrew Siegel, MD  Blog #111

I consider myself to be a very fit person—for the most part, I eat a very healthy diet with abundant fruits and vegetable and avoid processed, fast and junk foods, don’t smoke, drink alcohol very moderately, and exercise religiously and aggressively.  I’m 5’9” tall and weigh 155 lbs., so I’m not carrying around much body fat.  Nonetheless, in spite of my healthy lifestyle, I was diagnosed with hypertension this year.  I am a strong believer in the mind-body connection and initially attributed my blood pressure issue to the incorporation of electronic medical records into my urology practice, a frustrating and tedious experience that has added hours of time to my workday and much grief and hassle to my life.  That stated, it is difficult to hide from one’s genetics—I have a bunch of family members with high blood pressure, including my younger sister who is a vegetarian and avid cyclist and runner who truly could not be any leaner or in any better physical shape.  But it really irks me that I know many obese and sedentary individuals who do not have blood pressure iss

Earlier this year, I was in Florida with my brother, cousin, and brother’s friend for an extended weekend golf and tennis excursion. We went to the Publix supermarket where we chanced upon one of those free blood pressure machines that you stick your arm in and presto, in a few moments you have a blood pressure reading.   Suffice it to say that among the four of us, I lost the blood pressure contest!   I wrote it off to the stressful week that I had had, but at a visit to my dentist several weeks later, the elevated blood pressure was confirmed.  Suffice it to say that I was not pleased with this news.

You are probably aware that high pressure within the arterial walls (hypertension) contributes to many serious ailments including the following: coronary artery disease; aneurysms; stroke; congestive heart failure; and kidney disease.  These cardiovascular diseases are the leading causes of death in the USA. So it behooves anyone with high blood pressure to get it treated, pronto.

I saw my internist and was prescribed medication called Diovan, which I started immediately.  It controlled my blood pressure nicely, but I experienced some side effects, so I returned to my doctor and I recommended to him a trial of a different class of medication called a beta-blocker.   This is typically not a first-line drug for hypertension and is often used for people with cardiac problems.   It works by decreasing the heart rate and contractility (the ability of the heart muscle to squeeze out blood).   This class of medication generally has a calming effect and I thought that because of my rather “energetic” style and persona, it might have a beneficial effect beyond managing the high blood pressure. Beta-blockers are sometimes used by people before public speaking, work on tremors of the hand, and have a general blunting/“take off the edge” effect.  I have some early morning insomnia and thought that this might help with that as well.

The medication was effective in normalizing my blood pressure.   However, it did “knock” me down a few notches.  I experienced fatigue in the late afternoon that was new to me.  More disturbing was that it was more difficult for me to exercise when it required major exertion.   When working out, I became short of breath and tired much more readily than previously. I’m a recreational cyclist and have always enjoyed bike riding since my earliest days of childhood.  I observed that I was having trouble keeping up with my cycling buddies and that hills—previously one of my strengths—were suddenly particularly difficult.  Understand that I’m going to be 58 years old on my next birthday, so I thought that my age might have finally caught up with me a bit, but I also questioned what role the beta blocker was playing.

My old heart rate monitor that I typically use when I cycle was not working properly so I headed out to Campmor and picked up a new one.  It is basically a chest strap that detects one’s heart rate that is displayed on a wristwatch. It is a very helpful device when cycling that helps one stay in the proper zone of heart rates to assure the appropriate level of exertion.   For example, I know that my maximum heart rate is 160 and a level of 125–140 is a comfortable heart rate for an endurance ride. When I start heading above 145, I begin experiencing shortness of breath and need to tamp down the exertion if I want to maintain the endurance.  I learned all of this when I attended Chris Carmichael hill cycling camp, located in Asheville North Carolina where I went a number of years ago with my cycling buddies to learn the proper techniques of attacking hills.

So I put on my new heart monitor and went out on a hilly ride.  Much to my surprise, my maximum heart rate was now 125, being 160 under normal circumstances.   At 115, I started experiencing shortness of breath; 110 was a comfortable rate.  I was astonished by the profound effect the beta-blocker had my heart rate.

Understand that beta-blockers do not just work on heart rate but also on contractility.  The term “stroke volume” refers to the amount of blood that the heart pumps out with one beat. Beta-blockers reduce both heart rate and stroke volume.   The ability to succeed in aerobic sports such as cycling and running is contingent upon satisfactory cardiac output to provide oxygen and nutrients to our cells. Cardiac output is the product of heart rate and stroke volume. So, cardiac output goes way down on a beta-blocker and clearly explains my sub-normal performance with highly exertion physical sports.

I saw my internist yet again, stopped the beta-blocker, and started an alternative medication—the same one that my sister is on—that has no cardiac effects. I went on a bike ride in Fort Lee Park and Route 9W with my sister and friends and noticed a dramatic subjective improvement in my cycling performance, more in line with my typical cycling functioning of previous years.  This was just one day after getting the beta-blocker out of my system. Objectively, my maximum heart rate was 140, much improved over the 125 on the beta-blocker, but still not up to the 160 that was typical for me.  On my next ride, my maximum heart rate was back to normal and my cycling performance was fully back to days of old.  I was back!  I’m very happy to say that age is not catching up with me—yet.

Bottom Line: The morals of the story are several: 

1.    High blood pressure usually causes no symptoms whatsoever and must be sought after, so get your blood pressure checked periodically even if you’re feeling great

2.    Do not assume that because you are in great physical shape, exercise regularly, are not overweight, are a non-smoker and have a healthy diet, that you are immune from high blood pressure, which is often genetic despite a very healthy lifestyle

3.    Be wary of beta-blockers if you are an endurance exercise enthusiast.   Apparently what I experienced does not happen to everybody, but it was quite profound with me.  

4.    Don’t tell your doctor what to prescribe you even if you are a doctor!  Physician—do not treat thyself; let your internist provide their sage input regarding management of medical problems.

 

 

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

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Liquid Gold

February 23, 2013

Liquid Gold

Andrew Siegel, MD  Blog # 95

 

Urine is as valuable as gold is—at least when it comes to its potential for revealing our underlying health or infirmity.  Our kidneys work 24/7/365 filtering and removing from our bloodstream toxic wastes.  These include nitrogen-rich soluble products generated from cellular metabolism, numerous other organic and inorganic chemicals, salts and metabolites, as well as excessive water.  Urine—the end product appearing in our bladders—can provide amazing insight into our overall health.

With every pulsation of our heart, arterial blood flows into the kidney via the renal arteries; after the blood is filtered, the cleansed blood is returned via the renal veins.  In essence, the artery brings “dirty” blood to the kidneys for filtering, with the renal veins providing transport back of cleansed blood. Urine is a sterile by-product of this filtering process.  For this reason, when operating on the urinary tract (for example when the bladder is opened and urine enters the abdominal cavity), it is of no concern from an infectious point of view.

Using a simple and inexpensive dipstick, in a matter of moments, diabetes, kidney disease, urinary tract infection and the presence of blood in the urine can be diagnosed.  Although there are many benign causes of blood in the urine, the worrisome possibilities are kidney and bladder cancer.  The dipstick also reveals specific gravity, a test that can indicate dehydration, over-hydration, and other potential health issues. Not only can the dipstick disclose the presence of diabetes mellitus (sugar diabetes), but it can also reveal a condition known as diabetes insipidus, in which the kidneys lose their ability to concentrate urine. As a result, massive amounts of dilute urine are produced, which can have dire consequences.  Urine testing can also reveal substance and performance-enhancing drug abuse. Who knew that a waste product could be so revealing?  Of all the waste products that humans produce, urine uniquely provides the best “tell” regarding our health.

Urine odor can provide information as well. A sweet smell is consistent with diabetes mellitus; a foul odor may indicate a urinary infection or the intake of certain foods such as asparagus.  Vitamin intake can also cause the urine to have an unpleasant odor. Vitamins B and C are water soluble and therefore not stored in the body.  Any excess above what is necessary for the body’s use is immediately excreted in the urine.  Malodorous urine that has a feculent scent may indicate an abnormal connection between the colon and the bladder that is known as a colo-vesical fistula. This happens most commonly on the basis of diverticular disease of the colon.  When it occurs, there is often air in the urine, designated by the term pneumaturia.

Color is a “tell” with respect to hydration status.  When well hydrated, our urine will look clear or very pale yellow, like a light American beer.  When dehydrated, our urine becomes very concentrated, appearing dark amber, like a strong German beer.  Excessive B vitamins can result in light orange urine. Red urine is most often blood in the urine, which may indicate a potentially serious underlying condition, although overconsumption of beets, blackberries, and rhubarb may sometimes impart a red color to urine.  “Iced tea” or “cola” colored urine is often indicative of old blood, as opposed to the bright red color of urine indicative of fresh and active bleeding. Dark brown urine may indicate jaundice.  Pyridium, prescribed for the discomfort of urinary infections, turns the urine a neon orange color.  Other urinary analgesics that contain methylene blue can turn the urine blue or green.  Cloudy urine may be indicative of a urinary tract infection, but can also occur when phosphate salts crystallize in the urine on the basis of dietary intake of foods high in phophates.

When our urine is occasionally foamy or sudsy, it is considered to be normal. When it occurs consistently, it can be a sign of protein in the urine, indicative of kidney disease.

Bottom Line:  Urine is an invaluable waste product and offers many clues as to our overall health or presence of illness.

 

What a dipstick can reveal:

specific gravity…status of our hydration

pH…acidity of urine

leukocytes…urinary infection

blood…many urological disorders including kidney and bladder cancer

nitrite…urinary infection

ketones…in the absence of carbohydrate intake, fat is used as fuel and ketones are by-products of fat metabolism; may also indicate a very serious condition known as diabetic ketoacidosis

bilirubin…a yellow pigment found in bile, a substance made by the liver; its presence may be indicative of jaundice

urobilinogen…a byproduct of bilirubin breakdown formed in the intestines by bacteria—when elevated may indicate: impaired liver function; hepatitis; cirrhosis; excessive breakdown of red blood cells—when low may indicate bile obstruction or failure of bile production

protein…kidney disease

glucose…diabetes

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Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

The Skinny On Salt

October 26, 2012

 

Andrew Siegel, M.D.   Blog # 81

Most of us adore our saltshakers and put them to frequent use.  Salting our foods enhances taste—imagine how bland French fries, scrambled eggs or popcorn would be without salt (aka sodium).  Salt also serves a function as a food preservative and played an important role as such in the days before refrigeration was widely available.  Historically, salt has been a valuable commodity. Think for a moment of all of the salt idioms used in our English language, many of which that convey the value of this essential mineral: “Salt of the earth”; “Worth one’s salt”; “Back to the salt mines”; “Rub salt in a wound”; “To salt away.”

Sodium is an important mineral, a critical electrolyte in terms of regulating fluid exchange within the body compartments, including membrane permeability in cells, nerve conduction, and muscle cell contraction of skeletal, smooth and cardiac muscles. However, when consumed in excess, it can wreak havoc on our bodies. Unfortunately, the majority of Americans consume more than twice the recommended upper limit of sodium, with most of us eating/drinking about 3400 mg sodium daily.

Excessive sodium intake increases our blood volume, which causes increased pressure within the arterial walls, known as hypertension.  Hypertension within the arterial walls contributes to the following serious ailments: coronary artery disease; aneurysms; stroke; congestive heart failure; and kidney disease.  These cardiovascular diseases are the leading causes of death in the USA.  So clearly, excess sodium intake contributes to the hypertension present in at least one of three Americans; this hypertension in turn is linked to cardiovascular disease and death.  Excess dietary sodium also promotes fluid retention and edema.

Although the recommended daily allowance of sodium is 2300 mg (one teaspoon), our bodies actually only require 500 mg of sodium daily, and most Americans would do well to consume no more than 1500 mg daily.

Sources of sodium include table salt, pickles, olives, canned soups, luncheon meats and deli products, cheeses in general and cottage cheese in particular, and bread.  Pizza is very high in sodium.  Snack foods such as chips, pretzels, and popcorn pack a load of sodium.  Condiments and salad dressings are major culprits as are processed, prepared foods, fast foods and many sauces including tomato, soy, Worcestershire and Tabasco. Chinese food and Mexican food are often bathed in salt.  Flavor enhancers such as Accent, for example, are mono-sodium glutamate and are thus very high in sodium.  Restaurant meals are a major source of sodium.  That gyro that I consumed for dinner the other evening was so salt-laden that I was thirsty all evening and the following morning I had trouble getting my wedding ring on!

Generally speaking, roughly 80% of our sodium comes from processed foods and restaurant dining, 10% occurs naturally, 5% is added at the table and 5% is added during cooking.

What To Do:

Lowering salt intake is an inexpensive and practical way to make a major impact on our overall cardiovascular health and avoid morbidity and mortality:

  • Increase potassium intake by eating more potassium-rich foods including root vegetables; sweet potatoes; green, leafy vegetables; grapes; yogurt; and tuna. (Increasing our potassium intake helps to lower blood pressure by blunting the effects of sodium.)
  • Use salt substitutes such as potassium chloride.
  • Read food labels carefully and compare brands—you might be shocked at how many foods that you would not expect have very high levels of sodium.
  • The less processed the better in terms of sodium content—in general, the more highly processed foods have more ingredients, are touched by more hands, and are usually located in the central area of supermarkets.
  • Avoid “instant” foods that are often high in sodium, e.g., Ramen noodles and Rice-a-Roni.
  • Use alternative flavors: think spicy (like chili or red peppers) instead of salty.
  • Eat fresh foods including fresh fruits and vegetables, which are extremely low in sodium.
  • Any animal product will have some degree of sodium as sodium it is a vital chemical to biological existence. Even a glass of milk will have over 100 mg of sodium.
  • Rinse off canned vegetables, tuna, etc.
  • The DASH diet (Dietary Approaches to Stop Hypertension) can be a very effective approach to lowering sodium consumption.

Take everything you read with a grain of salt, but trust me on this one—take your salt in moderation and your body will thank you!

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts by email. Please avail yourself of these educational materials and share them with your friends and family.