August 10, 2011

As I have come to find out over the last several years, your kidneys, play a huge role in how the rest of your body functions, not just as it relates to Diabetes and Kidney Disease, but in everyday life of every person.  Everybody knows that the heart pumps oxygenated blood though out your body constantly throughout the day…in a sense, it is your main engine that makes you go.

I say your main engine, because the body also has smaller, but no less important, engines that help the body go.  And one of the critical smaller engines is the function of your kidneys.  The kidneys are essential in the urinary system and also serve functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure (by maintaining salt and water balance). They also serve the body as a natural filter of the blood, and remove the junk that build up in our blood and are diverted to the bladder to be expelled from the body. In producing urine, the kidneys excrete this junk, such as urea and ammonium; the kidneys also are responsible for the reabsorping water, glucose, and amino acids; and they produce hormones like calcitriol, erythropoietin, and the enzyme renin.

So it is a big deal when this engine begins to shut down.  Think of the engine in your own car…we change the oil and replace the oil filter on a regular basis, every 3000 to 5000 miles.  Ok, so we are suppose to do that every 3000 miles or so, but there are few of us who do that.  Come on, admit it, unless you have a reminder from the OnStar® system in your car, or a little sticker in the top corner of your windshield from either the dealer where you bought your car from, or from the last time you went to Jiffy Lube®, you can’t remember the last time you had the oil changed in your car.

As I have gotten older, those reminders are more and more helpful.  But that is not to say that when I was in my 20’s (you know that time – the time of your life when no one can tell you anything because you feel like you already know everything!, or so you would like to think) it wasn’t unusual for me to look at one of those stickers and see that I have about 1000 miles to go before I need to have the oil changed and then forget about it altogether until I see the red “CHECK ENGINE” light come on, on the dashboard.

“Oh, Crap!”, or something like that would come from my mouth, as I now realized that I was now about 4000 miles over from when I needed to have the oil changed.

This didn’t just happen once or twice…no, no, this happened multiple times.  To the point that when I was out on a date we were driving along to whatever restaurant we were going to, and all of a sudden the car sputters…and then sputters again.  I look to see if I have enough gas – yep, plenty of gas.  The car jerks again, and now I start to see a little bit of smoke coming from under the hood of the car…and then one last jerk and the car sputters to a slow painful stop – I had seized the engine!!!

The same thing happens when our kidneys are not working properly…they begin to slow down filtering all of the junk that needs to be eliminated from our bodies, and eventually they seize up…also known as End Stage Renal Disease.

One of the cogs in the kidney engine is the function of the Parathyroid Glands.  There are four of them and they all perform the same function  - regulating calcium levels in our bodies.  When one of your parathyroid glands go bad and makes too much hormone, the excess hormone goes to the bones and takes calcium out of the bones and puts it in your blood. It's the high calcium in the blood that makes you feel bad.

This according to Wikipedia, the Parathyroid hormone (PTH) is a small protein that takes part in the control of calcium and phosphate homeostasis, as well as bone physiology. Parathyroid hormone has effects antagonistic to those of calcitonin. PTH increases blood calcium levels by stimulating osteoclasts to break down bone and release calcium. PTH also increases gastrointestinal calcium absorption by activating vitamin D, and promotes calcium conservation (reabsorption) by the kidneys. PTH affects the perception of well being and absence of PTH can be associated with feeling of fatigue and anxiety.

Hence, feeling tired and feeling like crap when you have kidney disease.  However, generally, I am told, that when the kidneys are working normally, the PTH also runs pretty normal.  When I was at the doctor last week, Dr. P. went over some test results from the previous week.  One was the PTH and the other was a Bone Density test.

With the PTH, she told me that my blood test came back as 138, and normal range is 20 – 50.  She could see the shock that probably came across my face.  She told me not to worry because this was all due in part to the kidney disease and as the new kidney continues working well over the next year or so, she expect that number to drop significantly.  She told me that she has had patients with a PTH of 900 or 1000, or even higher, and said that those patients typically will have much more difficult time getting into the normal range.

According to the Beth Israel Deaconess Hospital Transplant Patient Handbook, Phosphorus is also a mineral found in your bones that is involved in this whole mix.  Think of phosphorus as another cog in the kidney engine.  In conjunction with calcium, phosphorus helps to keep your bones strong.  When kidneys fail, the kidneys lose the ability to get rid of phosphorus and the blood levels of phosphorus can get too high.  This will then pull calcium out of your bones and make your bones weak, increasing the risk of bone disease and fractures.  When my phosphorus level skyrocketed, I was put on a phosphate binder to help my body eliminate the extra phosphorus.  I have to tell you, I have never seen such a huge pill – it was enormous!  I actually asked to be switched to the pediatric version, which was a powder that you added to water, because I had gagged big time on the original pill – it was literally big enough to choke a horse, as the saying goes.

The handbook goes onto say, that if levels of calcium and phosphorus get too high in the blood, you can get calcium deposits in your blood vessels or heart that cause ‘hardening’ and can restrict blood flow. 

Post transplant, the blood phosphorus levels can go very low because the new kidney is doing its job and getting rid of all of the excess phosphorus.

As for the bone density test…well, I originally had a bone density test done back in 2002, but for the life of me I cannot remember the reason why.  Despite my apparent memory loss, it turns out that it was good that I did have that initial test because there was now something Dr. P. could compare to.  So, in explaining it to me, she said that my original test showed that I was on the high side of the normal range, and this test showed that I am now on the low end of normal. Much of this could be attributed to the kidney disease advancing over the years.

This is from Dr. P.’s doctor’s notes:

“Although Michael’s bone mass is within the expected range for age, it has decreased significantly (by 5.1% in total PA spine between 5/20/2002 and 7/21/2011 and by 25.5%  in the total left hip between 5/20/2002 and 7/21/2011).  His calcium and Phosphorus (levels) are normal currently.  PTH is 138 and Vitamin D is low at 20.”

Dr. P. said that it is quite possible that, as mentioned, the PTH could return to normal which means that, with a normally functioning kidney, the Parathyroid Gland will pull less and less calcium from the bones…and if that happens we will hopefully see an improvement in the next bone density test.

I would suggest that any Diabetic, or certainly anyone at risk of kidney disease, have a baseline bone density test done.  I would also make sure that your doctor, either your Nephrologist, Endocrinologist, or at the very least, your Primary Care Physician, is checking your Vitamin D levels, your PTH levels, your phosphorus levels, and your calcium levels.

I have seen several different statistics, but in general Diabetics account for about 40% of all kidney disease patients.  With that being said, being a Diabetic myself, I would urge any an all Diabetics to keep a check on all of their engines in your bodies...you want to get as many miles out of the engines you have before your engine starts sputtering or seizing, and you have to trade in your engine for a newer model.

If you, or someone you know is interested in organ donation, please contact: www.neod.org; www.donatelifenewengland.org, www.organdonor.gov; www.unos.org; www.donatelife.net; www.organtransplants.org; or  www.thewaitinglist.org, or, by all means, speak to your own physician, or feel free to send me an email.