Posts Tagged ‘kidney transplantation’

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

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Organ Donation: America Can Do Better

November 30, 2012

Andrew Siegel, MD    Blog #84

photo (3) copy 2

This past Monday marked the death of Dr. Joseph E Murray at the age 93, the surgeon who performed the first successful human organ transplant.  In 1954, he removed a healthy kidney from a 23-year-old man and implanted it into the man’s identical twin.  This heralded the beginning of the transplant era that has saved the lives of thousands of patients who have received new kidneys, heart, lungs, livers and other organs after their own had failed.  In 1990, Dr. Murray was awarded the Nobel Prize in medicine.

Currently, there are over 100,000 Americans on the waiting list for organ transplantation, 75% of whom are awaiting a kidney.  The situation is literally at a crisis level insofar as there are only about 30,000 transplants performed annually. Twenty or so Americans die EVERY day for want of an organ donor. The bottom line is that people are literally dying while on the wait list for organs; this is a huge public health issue that becomes a very private one if it becomes you, a family member or friend who is the one in need of that organ. What makes this particularly tragic is that this is a readily remediable problem!

I am signed up to be an organ donor.  This was a decision that I opted in for when I received my New Jersey driver’s license.  I figured that this is the least I can do for my fellow man.  If I get hit by a bus or suffer an injury that renders me in a permanent vegetative state, why not recycle my organs for the benefit of the living? I will happily donate my corneas, kidneys, heart, liver, lungs, pancreas or any other organ that will help improve the quality and quantity of the life of my fellow man or woman, particularly as these organs will do me no good at all where I am going.
Charitable acts that are of benefit to another living human being are essential, particularly insofar as in the USA we have a tremendous shortage of available organs, as demand far exceeds supply. With advances in dialysis, patients with kidney disease are surviving longer than ever. This, coupled with the rise in prevalence of kidney failure due to greater longevity, as well as an increase in the prevalence of hypertension and diabetes related primarily to the growing obesity epidemic, has resulted in a major demand for kidneys.

In the USA, consent for organ donation is an opt-in system, usually authorized by the person designated as medical power of attorney.  So those persons who give explicit consent become potential donors. However, alternatively, a number of European countries, including Spain, Austria and Belgium, have laws that provide an opt-out system.  In these countries, one must petition to be excluded from being an organ donor after death, presumptive consent existing in the absence of specifying a preference.

In general, the opt-out system will dramatically increase consent rates for organ donation. For example, Germany, a country that utilizes an opt-in system, has an organ donation consent rate of 12%; this is as opposed to Austria, a nation that utilizes an opt-out system, which has a consent rate nearing 100%.   It would seem that in general, people do not like having to make a decision and check off a box, and if a system is set up such that the default mode results in an action, then meaningful change can result.

Israel has developed an interesting alternative to the aforementioned opt in or opt out approaches.  They have enacted a system that prioritizes organ allocation based upon willingness to be a donor.  A donor card is issued to willing donors and a registry of donors is maintained.  Highest priority (3.5 points) for organ allocation goes to donors and first-degree relatives of those individuals who are non-directed donors (those not donating to a specific individual).   Whereas a donor of a live, non-directed organ gets 3.5 points, a directed living donor (those donating to a specific individual) gets no prioritized organ allocation.  Anybody with a donor card gets 2 points.  If a family member has a donor card, 1 point is given to any first-degree relative of that individual.  Even though this approach seems somewhat arbitrary, consent rates for donation have increased, resulting in a significant increase in the number of organ transplants since this system was enacted.

In the late 1980s, Iran adopted a system of paying kidney donors and within a decade or so became the only country in the world to have no waitlists for transplants.  Now, by no means am I suggesting that people “sell” their organs for transplantation; however, how sad that monetary incentive compels individuals to act to save lives.

Thanksgiving, the day that we give thanks for the bounty of fortune that we have, has recently passed. The holiday season fast approaches, the time of giving gifts to our loved ones.  I’m not certain if the United States will ever develop an opt-out system for organ donors, but in the meantime, the simple act of opting in can provide the ultimate gift to a person in dire need.  The DMV has made opting in extremely easy: one need not wait to renew one’s license to check the little opt-in box—simply log onto www.dmv.org to learn how to acquire a form to change your donor status to “yes.” Many states have downloadable forms that, once completed, are mailed or faxed in.  And some more progressive states, like California and Pennsylvania, actually allow you to register as a donor on-line.

It was less than 60 years ago that Dr. Murray performed the first transplant—a courageous and heroic moment that many at the time deemed ludicrous—ushering in an era such that transplants have become commonplace.  Let us celebrate the holiday season and commemorate the death of Dr. Murray by trying to increase the ranks of organ donors by simply checking the little opt-in box, a painless and altruistic act that, instead of wasting valuable organs, will recycle them, and in so doing, recycle someone’s life.  That someone, some day, might just be you, your loved one or your friend.

 

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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