Archive for kidney problems
Environmental Lead Exposure and Progressive Renal Insufficiency
We are seeing a common theme here regarding the damaging effects that heavy metals have on our health. Cognitive function, kidney problems, hypertension. I’m sure the list will continue to grow. And, considering that vitamin C has a tendency to reduce the absorption of lead, the lowered intake of fruits and vegetables in the US population may lead to higher and higher intakes of lead. Not a good combination.
Kidney stones may be linked with sleep posture
I thought this was an interesting article and gives us yet another tool to aid in the avoidance of renal calculi. Other ways to avoid stones: copious amounts of water, no caffeinated beverages, calcium citrate supplements and more of a plant based diet.
bmj.com Josefson 322 (7293): 1015b
Two Diets for the Prevention of Recurrent Stones
It is still surprising to me that the idea that patients with recurrent kidney stones are given the recommendation to lower intake of calcium, despite the finding that calcium intake is just not associated with stones. Stones have more to do with a animal based over a plant based diet. Avoid caffeine, drinks copious amounts of water and choose predominately plant foods. Actually, calcium supplementation with calcium citrate many actually lower the risk of stones…
NEJM — Abstracts: Borghi et al. 346 (2): 77.
Dietary Factors and the Risk of Incident Kidney Stones in Younger Women
It is funny how, for many years, patients who have had kidney stones were told to avoid calcium intake (both in food and supplemental). This has never really matched what we would assume from knowledge of physiology. Rather, an environment in the kidney that supports stone growth would be more important than the presence or absence of calcium. So, dietary calcium protects and supplements have no effect. Interestingly, sucrose definitely increased the risk of kidney stones.
Arch Intern Med — Abstracts: Curhan et al. 164 (8): 885 -
Gradient Between Long-Term Arsenic Exposure & Atherosclerosis
Too many times heavy metals are overlooked as a potential contributor to human disease, and yet many, many times they may play a large factor. A few years back I ran a hair analysis on an elderly patient for some paresthesias that I was not convinced were coming from carpal tunnel syndrome. Her cadmium levels came back markedly elevated (which also matched her hypertension–cadmium is damaging to the kidneys). Despite that large volumes on the negative impact of cadmium on human health, her nurse convinced her that the idea that cadmium being harmful was ridiculous.
Unfortunately, this story is not uncommon as ignorant medical personnel give advice on things that they don’t know anything about.
Circulation — Abstracts: Wang et al. 105 (15): 1804 -
Adverse renal effects of anti-inflammatory agents: evaluation of selective and nonselective cyclooxygenase inhibitors.
With the sharp increase in COX-2 use such as Celebrex and Vioxx (most of this use being inappropriate for its indications), we really need to evaluate the selective COX-2 inhibitors against other known damages from NSAIDs. Here we see that the COX-2 inhibitors are just as dangerous to the kidneys as traditional NSAIDs. And much more expensive. Hey–just use the cheaper NSAIDs and save the extra money for that kidney transplant!!
Sodium intake affects urinary albumin excretion especially in overweight subjects
I have to admit, that I have usually told patients that sodium intake is really not as important as most believe it is (with the exception of processed foods–which are generally higher in sodium). There seems to be only a small percentage of the population that is salt sensitive. The rest don’t experience much effect from salt intake.
However, this article suggest an alternative opinion, that salt intake in overweight patients adversely effects the kidney’s excretion of albumin. Remember that the kidney should not lose any proteins–protein in the urine can be a sign of renal problems. Microalbuminuria has shown to be related to the degree of insulin resistance. So, might the salt in this study be affecting insulin resistance in a negative way somehow?
Sodium intake affects urinary albumin excretion especially in overweight subjects – Journal of Internal Medicine, Vol 256, Issue 4, Pages 324-330, October 2004 -
Has mortality from acute renal failure decreased?
We generally think of medical research as a good thing. Billions of dollars go into new approaches, new treatment, new methods of detection. But do they really change things? In many cases, the answer is no. How many untold billions have gone into AIDS research without anything even resembling a cure? Many cancers still have high mortality rates.
This study reviews 50 years of technological advances in renal treatment, but finds no overall change in mortality rates. I’ve said it a thousand times before and I will continue to say it–prevention is infinitely better than a cure. Lets spend even a mere 10% of the large organizations’ budget (Amer Heart, Amer Cancer, Amer Diabetes) for prevention and we would see a huge return on investment in just a few short years. Does everyone know that Tylenol and ibuprofen damage the kidneys? Or that a large chunk of patients on dialysis got there because they took too much Tylenol? Probably not.
Comparative effects of hydroxocobalamin and cyanocobalamin on plasma homocysteine concentrations in end-stage renal disease
This issue of cyanocobalamin has come up once before a few years back, but it was enough to give me cause for concern.
The study suggested that cyanocobalamin actually inhibited one of the enzymes it was supposed to be helping.
This study did not look at this enzyme affect, but it did find a much stronger effect of raising cobablamin levels in the bloodstream with hydroxy vs cyano (40 fold increase vs 10 fold increase).
N-Acetylcysteine for the Prevention of Contrast-induced Nephropathy
Remember that NAC exerts one of its main actions by increasing the amount of available glutathione, and that glutathione is one of the body’s more potent antioxidant molecules as well as a major participant in detoxification.
This was a review and meta-analysis of several studies, with the consensus being that NAC helps to predict the kidneys in the event of a bad reaction to dyes used in diagnostic imaging. The problem is that it needs to be administered 12 hours prior to the testing. It would be nice to see if oral dosages would be as effective as IV.
In the meantime, probably a good idea to pop some NAC if you’re having any imaging done that requires contrast medium.