Save The Earth, Check Your Kidneys
For those who don't know, my mom was only recently diagnosed with RAS - Renal Artery Stenosis. Fancy term for a plugging kidney artery.
I'll try not to get too opinionated here, however, it should be known that this doesn't happen overnight, it doesn't happen in a vacuum, and isn't nearly as rare as the doctors continue to state.
History
40 years ago, folks on dialysis were only those with known true kidney disorders. Not diabetes, not RAS. (check kidney.org, kidneyfund.org, niddk.nih.gov/for history of kidney disorders). Now, fully 1/3 of all dialysis patients are diabetics, and 29% (nearly a third) are RAS patients.
275,000 people are on dialysis throughout the US alone. The number of patients needing dialysis has increased 3-fold in 40 years.
To me, that's an epidemic.
And you know what?
29% are fully preventable. FULLY But because doctors are hiding their heads in the sand, quoting 40 year old statistics, these people aren't being treated appropriately, aren't being tested in a timely fashion, and are losing their lives needlessly to RAS. Sounds a bit like malpractice, huh?
So, how do you know if you have RAS?
Generally, people don't know they have it until at least 1 kidney has failed completely, and the other has only partial function. By then, the ability to treat RAS is limited at best, and the person's quality of life has been great affected, along with their positive long-term outcome.
You have to look at your health history and know a bit about your family's to get a firm handle on being your own patient advocate. This is one case that no one else is going to fight for you.
Blood Pressure
Do you have high blood pressure?
If so, do you take 3 or more medications in an attempt to control it?
Did you get high blood pressure when you were young?
The second question is the real sign. If you take 3 or more medications to control your blood pressure, you most likely have RAS. Whether the RAS or the hypertension came first is a moot point. You need to have your doctor order the tests.
Artery Disease
Have you had bypass surgery?
Has your doctor stated your carotids are filling up?
Do you have other artery disease (peripheral artery disease)?
This is the second key indicator you might have RAS. Couple this and the hypertension together, and you need to demand the testing.
Valve Problems
Many of us have a slightly prolapsed valve in our heart. The doctors can hear it when they listen, and is often caught at birth or after a major heart infection.
While this is not a key indicator directly, prolapsed valves increase the likelyhood of arteries calcifying, which can lead to RAS.
Miscellaneous
Have you ever had an episode of your lungs filling up for no reason? In other words - have you had a "heart attack", but never been diagnosed with congestive heart failure, or general heart failure?
Having an acute episode of severe pulmonary edema (sudden lungs filling up) with no history is being shown as a key indicator of RAS. Couple it with the hypertension and you've got an almost certain diagnosis.
Are you a boy or a girl? - Males tend to get RAS more often than females, but as the population ages, this is starting to even out.
How old are you? The older you get, the higher the chances of having RAS
Did you/Do you smoke? While there are no direct causal links between smoking and RAS, the majority of people who suffer from it have an extensive smoking history.
Do you have high cholesterol? Again, this isn't a key indicator, but is a risk factor.
Tests
So, how does a doc find out if you have RAS?
There are a number of ways to discover it. I'll try to list them from cheapest and least invasive to most invasive (but also most accurate).
Listening - The doctor can listen to your kidneys through your back just like he'll listen to your carotids. If he hears turbulence (bruit - brew ee), you have RAS. But this is not definitive. If he doesn't hear bruits, it does not mean you don't have RAS. It just means it isn't extensive enough for him to hear.
Blood work - there are indicators - such as very low potassium (hypokalemia), higher creatinine, higher sodium, higher phosphorous that indicate problems with the kidneys. If these items show up in your blood at bad levels, it means you already have kidney damage.
Urine analysis - protein in your urine, low or no levels of normal wastes. Your urine should always be pale and clear - not dark and/or cloudy. Pale yellow is best. But if it is completely clear, it means your kidneys are moving water, but no wastes. This is bad. If you have protein in your urine, you may have other kidney issues, but you have kidney issues.
Ultrasound with Doppler Survey - You know how pregnant women have ultrasounds? Same idea, but through your back. It can show if a kidney is smaller than the other - if so, this is a good indication that RAS has caused the smaller to atrophy. The doppler survey finds the pulse of the artery. If the pulse is weak or non-existant, you have RAS or another kidney disease affecting the artery.
MRA - an MRI but with a contrast that shows just the arteries. This contrast is not toxic to the kidneys, so is a lower risk imaging test.
CT and MRI with contrast - know up front the contrast that is used is toxic to the kidneys. This is why they make you drink a great deal of water after the CT/MRI is performed. These 2 imaging tests can show the arteries and the kidneys with great clarity and can diagnose very affectively whether you have RAS or not.
Angiogram - these aren't generally done until it is time to do angioplasty. It's invasive, moderately risky, and the dye used is, again, toxic to the kidneys. But it is what the doctors consider the golden standard for diagnosing RAS. Generally, if you're at this point, it's already been diagnosed by at least one of the above tests.
Why It Matters
The sooner you are diagnosed, the sooner treatment can begin. This includes changes in lifestyle - diet, smoking, exercise, medication. Medications may be changed. Some blood pressure meds have been found to actually slow the RAS process. And, controlling the blood pressure itself assists in slowing the process. Some medications can speed the process, so changing these meds is very important (and wasn't done with my mom).
When treatment is delayed, or ignored entirely, the possibility of angioplasty - placing a stent in the renal arteries, becomes minimal. At this point, you have 2 options - renal artery bypass or dialysis.
Bypass is highly complex, considering all of the blood vessels needed are IN the kidney, rather than outside like with the heart. Also, because RAS is a calcification problem, it usually means the bypass cannot be hooked directly into the aorta and must be placed in another artery - the one to the iliac crest, the liver or the spleen. Very few surgeons are capable of this surgery, which makes the outcome less than assured.
RAS patients on dialysis have a life expectancy of 27 months. That's it. Most dialysis patients live past 5 years, so 27 months is not at all positive, not to mention the quality of life during that time.
If you do have the angioplasty or the bypass, you can generally cut your blood pressure meds in half, your kidneys are far more likely to continue functioning until you die a natural death, and your quality of life is far higher than without.
It also means you don't have the burden or the cost of dialysis - which is an extremely harsh treatement.
Now - How does this save the earth?
You're not needing countless medications to maintain health - which means fewer need to be produced. You're not excreting byproducts from these medications into the water and thus into nature (earthworms have PROZAC in their systems!). You're not needing transport to and from dialysis, and no waste produced from the dialysis.
Multiply that by the 29% of all dialysis patients, and you have 79,750 people in the US alone helping save the earth.
That's a number to talk about.
Please - do you and your family a favor - get tested! The ultrasound is cheap, non-invasive and an incredibly accurate test for this. You do not want to go through what my mother and the rest of the family is going through trying to play catch up and not run out of time - for no reason other than every physician and surgeon she has been to is living in the past.
Her indicators are (And were for the last 6 years):
Family history of artery disease
High blood pressure with 3 meds unable to control it
Prolapsed aortic valve
Carotid artery stenosis
Smoking history
Dangerously low potassium virtually unhelped by megadosing potassium (hypokalemia)
I'll try not to get too opinionated here, however, it should be known that this doesn't happen overnight, it doesn't happen in a vacuum, and isn't nearly as rare as the doctors continue to state.
History
40 years ago, folks on dialysis were only those with known true kidney disorders. Not diabetes, not RAS. (check kidney.org, kidneyfund.org, niddk.nih.gov/for history of kidney disorders). Now, fully 1/3 of all dialysis patients are diabetics, and 29% (nearly a third) are RAS patients.
275,000 people are on dialysis throughout the US alone. The number of patients needing dialysis has increased 3-fold in 40 years.
To me, that's an epidemic.
And you know what?
29% are fully preventable. FULLY But because doctors are hiding their heads in the sand, quoting 40 year old statistics, these people aren't being treated appropriately, aren't being tested in a timely fashion, and are losing their lives needlessly to RAS. Sounds a bit like malpractice, huh?
So, how do you know if you have RAS?
Generally, people don't know they have it until at least 1 kidney has failed completely, and the other has only partial function. By then, the ability to treat RAS is limited at best, and the person's quality of life has been great affected, along with their positive long-term outcome.
You have to look at your health history and know a bit about your family's to get a firm handle on being your own patient advocate. This is one case that no one else is going to fight for you.
Blood Pressure
Do you have high blood pressure?
If so, do you take 3 or more medications in an attempt to control it?
Did you get high blood pressure when you were young?
The second question is the real sign. If you take 3 or more medications to control your blood pressure, you most likely have RAS. Whether the RAS or the hypertension came first is a moot point. You need to have your doctor order the tests.
Artery Disease
Have you had bypass surgery?
Has your doctor stated your carotids are filling up?
Do you have other artery disease (peripheral artery disease)?
This is the second key indicator you might have RAS. Couple this and the hypertension together, and you need to demand the testing.
Valve Problems
Many of us have a slightly prolapsed valve in our heart. The doctors can hear it when they listen, and is often caught at birth or after a major heart infection.
While this is not a key indicator directly, prolapsed valves increase the likelyhood of arteries calcifying, which can lead to RAS.
Miscellaneous
Have you ever had an episode of your lungs filling up for no reason? In other words - have you had a "heart attack", but never been diagnosed with congestive heart failure, or general heart failure?
Having an acute episode of severe pulmonary edema (sudden lungs filling up) with no history is being shown as a key indicator of RAS. Couple it with the hypertension and you've got an almost certain diagnosis.
Are you a boy or a girl? - Males tend to get RAS more often than females, but as the population ages, this is starting to even out.
How old are you? The older you get, the higher the chances of having RAS
Did you/Do you smoke? While there are no direct causal links between smoking and RAS, the majority of people who suffer from it have an extensive smoking history.
Do you have high cholesterol? Again, this isn't a key indicator, but is a risk factor.
Tests
So, how does a doc find out if you have RAS?
There are a number of ways to discover it. I'll try to list them from cheapest and least invasive to most invasive (but also most accurate).
Listening - The doctor can listen to your kidneys through your back just like he'll listen to your carotids. If he hears turbulence (bruit - brew ee), you have RAS. But this is not definitive. If he doesn't hear bruits, it does not mean you don't have RAS. It just means it isn't extensive enough for him to hear.
Blood work - there are indicators - such as very low potassium (hypokalemia), higher creatinine, higher sodium, higher phosphorous that indicate problems with the kidneys. If these items show up in your blood at bad levels, it means you already have kidney damage.
Urine analysis - protein in your urine, low or no levels of normal wastes. Your urine should always be pale and clear - not dark and/or cloudy. Pale yellow is best. But if it is completely clear, it means your kidneys are moving water, but no wastes. This is bad. If you have protein in your urine, you may have other kidney issues, but you have kidney issues.
Ultrasound with Doppler Survey - You know how pregnant women have ultrasounds? Same idea, but through your back. It can show if a kidney is smaller than the other - if so, this is a good indication that RAS has caused the smaller to atrophy. The doppler survey finds the pulse of the artery. If the pulse is weak or non-existant, you have RAS or another kidney disease affecting the artery.
MRA - an MRI but with a contrast that shows just the arteries. This contrast is not toxic to the kidneys, so is a lower risk imaging test.
CT and MRI with contrast - know up front the contrast that is used is toxic to the kidneys. This is why they make you drink a great deal of water after the CT/MRI is performed. These 2 imaging tests can show the arteries and the kidneys with great clarity and can diagnose very affectively whether you have RAS or not.
Angiogram - these aren't generally done until it is time to do angioplasty. It's invasive, moderately risky, and the dye used is, again, toxic to the kidneys. But it is what the doctors consider the golden standard for diagnosing RAS. Generally, if you're at this point, it's already been diagnosed by at least one of the above tests.
Why It Matters
The sooner you are diagnosed, the sooner treatment can begin. This includes changes in lifestyle - diet, smoking, exercise, medication. Medications may be changed. Some blood pressure meds have been found to actually slow the RAS process. And, controlling the blood pressure itself assists in slowing the process. Some medications can speed the process, so changing these meds is very important (and wasn't done with my mom).
When treatment is delayed, or ignored entirely, the possibility of angioplasty - placing a stent in the renal arteries, becomes minimal. At this point, you have 2 options - renal artery bypass or dialysis.
Bypass is highly complex, considering all of the blood vessels needed are IN the kidney, rather than outside like with the heart. Also, because RAS is a calcification problem, it usually means the bypass cannot be hooked directly into the aorta and must be placed in another artery - the one to the iliac crest, the liver or the spleen. Very few surgeons are capable of this surgery, which makes the outcome less than assured.
RAS patients on dialysis have a life expectancy of 27 months. That's it. Most dialysis patients live past 5 years, so 27 months is not at all positive, not to mention the quality of life during that time.
If you do have the angioplasty or the bypass, you can generally cut your blood pressure meds in half, your kidneys are far more likely to continue functioning until you die a natural death, and your quality of life is far higher than without.
It also means you don't have the burden or the cost of dialysis - which is an extremely harsh treatement.
Now - How does this save the earth?
You're not needing countless medications to maintain health - which means fewer need to be produced. You're not excreting byproducts from these medications into the water and thus into nature (earthworms have PROZAC in their systems!). You're not needing transport to and from dialysis, and no waste produced from the dialysis.
Multiply that by the 29% of all dialysis patients, and you have 79,750 people in the US alone helping save the earth.
That's a number to talk about.
Please - do you and your family a favor - get tested! The ultrasound is cheap, non-invasive and an incredibly accurate test for this. You do not want to go through what my mother and the rest of the family is going through trying to play catch up and not run out of time - for no reason other than every physician and surgeon she has been to is living in the past.
Her indicators are (And were for the last 6 years):
Family history of artery disease
High blood pressure with 3 meds unable to control it
Prolapsed aortic valve
Carotid artery stenosis
Smoking history
Dangerously low potassium virtually unhelped by megadosing potassium (hypokalemia)
Labels: medication, renal artery stenosis, save the earth
posted by Leslie at
10:14 PM
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