Kidney Health

Video Transcription

00:00 oh we're we're done huh I didn't know 00:04 you'd given your spiel okay well the 00:08 subject tonight is kidneys and which 00:12 I've sort of decided from a lot of 00:13 reading is perhaps our most 00:15 underappreciated organ we just sort of 00:17 assume they're going to do great things 00:18 for us and you're gonna find that 00:23 probably about half of everybody we know 00:26 is in the very initial stages of kidney 00:29 failure 00:30 however there's so much reserve it 00:33 doesn't much matter as long as it 00:35 doesn't progress so I'm gonna turn you 00:39 all into nephrologists now that's a 00:45 knowledge estava nephron and the nephron 00:48 is a little microscopic unit in the 00:50 kidneys which we will see that each 00:52 kidney has about a million of them and 00:54 so they do microscopic filtration and 00:57 all add up to be functional kidneys so 01:03 let's okay ah okay now a lot of us don't 01:11 have excellent kidney function anymore 01:13 but it isn't necessary because there's 01:15 so much reserve but that leads to some 01:18 questions about where are our kidneys on 01:21 the scale of good to bad and how can we 01:23 tell that and what are likely problems 01:25 and what causes those and what can we do 01:27 about them and how do they work in the 01:29 first place and more grimly what got me 01:35 into this was having done this for the 01:39 last four years all the doctors here 01:41 giving a series of talks during the year 01:43 I was trying to figure out after three 01:46 years of giving them what I was going to 01:48 do this year and I came to the 01:49 conclusion that I would do something 01:51 that sounded kind of grim and talked 01:53 about the things that are most likely to 01:54 get us well I've done that through the 01:58 year and now we're down to kidneys which 02:00 is the eighth the most likely thing to 02:02 get us and it's it's pretty low down the 02:05 scale because the first to account for 02:07 55% of things that might get us and so 02:10 it doesn't sound like a very big 02:13 figure and it's not unless you've got it 02:17 so let's see well I do okay 02:22 now let's just talk about some 02:23 housekeeping questions waste products 02:26 from cells enter the bloodstream the 02:29 liver does a lot of cleansing and drains 02:31 into the gut for exit from there the 02:34 liver also prepares materials to exit 02:36 via the kidney and with kidney 02:39 filtration large protein molecules 02:42 aren't lost they're kept and neither are 02:47 the small ones it's the middle sized 02:50 ones that are the waste product so the 02:52 kidneys have to be rather sophisticated 02:54 as to how to get rid of the middle sized 02:56 ones without getting rid of the big ones 02:58 of the blue ones so here's some basics 03:02 and you know some of this they're 03:04 they're sort of in the back of the 03:06 abdomen each one is about four to five 03:08 inches long about fist size and the 03:11 blood filtration passes through the 03:13 kidneys several times a day not not 03:16 instantly because the kidneys aren't 03:17 filtering all the blood that's going 03:19 that way it filters some of it it's like 03:21 an air cleaner in a room it doesn't 03:23 suddenly clean all the air in the room 03:25 it just keeps cleaning a little bit at a 03:27 time so with the filtration the urine is 03:30 created it collects in the kidney pelvis 03:32 you'll see what that is it's a funnel 03:35 safe structure it drains down the tubes 03:37 called ureters and in the bladder and 03:39 each kidney as I said contains about a 03:41 million units called nephrons and as 03:45 much as 90% of kidney function can be 03:48 lost without experiencing any symptoms 03:49 or problems but by the time you get that 03:52 far down you're in pretty much trouble 03:59 and see okay now this is just for 04:04 general circulation you're looking in 04:07 the body and the red lines are the 04:10 arteries and the blue ones are the veins 04:12 returning the blood from the body back 04:14 and into the general circulation to get 04:17 oxygenated in the lungs and pumped out 04:19 by the heart and you see the kidneys are 04:22 located right about down here and you 04:25 get the idea that this 04:26 big red line is the aorta the biggest 04:28 one coming down from the heart and their 04:31 branches off of that to all the organs 04:33 and we can see the little branch of the 04:35 renal artery going into the kidney there 04:37 and for some reason they just show the 04:40 the renal vein returning it over here 04:42 but each one has an artery in each one 04:44 has a vein okay thank you I'll try to be 04:48 careful what do I point at oh we're okay 05:09 I got it now another view is just 05:14 showing you where everything inside 05:16 lungs the diaphragm is underneath it the 05:20 liver is sitting there and we'll see 05:22 that the liver is more right on top of 05:24 the right kidney and it's going to turn 05:27 out to be lower just because it's pushed 05:29 down by the liver and there are the 05:30 intestines and here the ureter is coming 05:32 down to the bladder now a close-up so we 05:38 see the diaphragm muscle and there's a 05:40 little split in it where the aorta comes 05:41 down and here it branches off the renal 05:45 artery going into the kidney and you see 05:48 the return of the blood into the 05:52 circulation there and in the kidney you 05:54 see that the urine would gather into the 05:57 pelvis and go on the renal pelvis and go 05:59 on down in the ureter up on top you see 06:03 something here that's not very clear 06:05 it's more clear over here the kidneys 06:08 are called the renals 06:09 and so this is added to it so they're 06:12 called the adrenals and you know about 06:15 those and they're always described as 06:18 having a roughly pyramid shape but it 06:20 wouldn't go over in Egypt very well and 06:23 of course there's a characteristic well 06:27 we said that the right one is a little 06:29 lower than the left one because the 06:31 deliverer is above it up there the 06:33 characteristic shape of course is what 06:37 the bean was named for and not the other 06:39 way around 06:40 now if we're looking at this again and 06:43 we're saying well okay so the blood is 06:45 going out here and some action is taking 06:48 place that causes filtration and let's 06:51 take a look at what that actually is now 06:55 this looks like a complete mess I'll 06:57 sort it out for you and then it will 06:59 shift to a diagram that is much simpler 07:01 but this is actually how it might look 07:03 under the microscope if you could get 07:05 down real fine and look at it so here's 07:08 the blood coming in from the renal 07:11 artery and it goes down to a smaller 07:14 artery called an arteriole it comes up 07:17 here and it goes into something rather 07:20 special called the glomerulus that's 07:23 what actually does the filtration and we 07:26 see built around this as some kind of 07:29 little capsule and science teams to be 07:33 crazy about heroes and named things 07:35 after people who found them first so 07:37 it's called Bowman's capsule and I guess 07:39 he found it from now not that it wasn't 07:42 there already now we see that the blood 07:47 goes on from this filtration on out 07:50 through here and eventually becomes 07:53 venules and then larger and back into 07:56 the veins well meanwhile the filtration 08:00 from this is going out through here very 08:04 complicated lee and finally can the the 08:09 flow from this can get dumped in along 08:12 with a lot of other units like this into 08:14 a channel going down to the renal pelvis 08:18 now as I said that's that's kind of 08:21 complicated looking but the reason for 08:23 showing you that thing is we're going to 08:25 show you some very specific things about 08:27 about this part right here it turns out 08:31 that this is a much simpler diagram we 08:34 see the glomerulus right there and so 08:37 the filtration of small and medium-sized 08:40 molecules takes place saving the larger 08:45 molecules like proteins into the blood 08:47 and so now you've got to get those small 08:52 ones back 08:52 we'll see how that's done but it happens 08:56 the filtration occurs here the small 08:58 ones and the large ones are look like 09:02 they're being filtered out here but 09:04 actually what's going to happen is the 09:07 small ones get back in and the 09:08 medium-sized ones did I say that right 09:10 the medium-sized ones and the small ones 09:11 get filtered out the small ones like 09:13 sodium ions chloride ions and so on get 09:16 back in and waste products are going to 09:17 end up going out and so this whole thing 09:21 is a nephron and that's the glomerulus 09:25 that does the little first trick and 09:27 there's another nephron now this is just 09:32 a diagram of Bowman's capsule to show 09:35 you a fine little batch of capillaries 09:37 there which together with the capsule 09:40 performs this very talented thing two 09:42 million times for you now this diagram 09:48 is showing you the fact that you can 09:51 secrete into this channel leaving all 09:55 these things that you might want to get 09:57 rid of you can recover water you can 10:00 recover sodium potassium chloride ions 10:03 and stuff like that you can recover up 10:06 here some more so actually this whole 10:09 nephron is doing this whole very 10:11 specialized batch of things amazingly to 10:15 keep us going keep us cleansed not 10:18 urinate away all our sodium which would 10:20 make us feel very terrible and this is 10:25 even a simpler schematic diagram just 10:28 showing the glomerulus and the Bowman's 10:30 capsule and shifting from the artery 10:33 through the veins and secreting into 10:36 urine elimination and recovery back in 10:39 okay as at this point you're now all 10:42 nephrologists okay ologists of the 10:45 nephron a kidney doctor now let's talk 10:49 about some things that can trouble us 10:51 and one simple one is kidney stones and 10:55 it's not really exactly a kidney problem 10:59 but it happens there because see if you 11:04 have something in 11:06 urine that's so concentrated it doesn't 11:08 stay dissolved it tends to precipitate 11:11 out well it's slow enough that it 11:13 actually precipitates out sometimes it's 11:15 crystals sometimes it's just little 11:17 lumps and they can be made of various 11:19 things like calcium oxalate is pretty 11:22 insoluble stuff so if some calcium meets 11:25 some oxalate it's gonna precipitate 11:28 probably but if there's a lot of uric 11:31 acid that can do it two small ones pass 11:34 down the ureter fairly unnoticed so 11:36 we're probably making a few of these all 11:38 the time and so long as they're small we 11:41 don't even know about them they're just 11:42 silent and they happen and they go away 11:45 some may be large enough to actually 11:48 block your inflow either in the kidney 11:50 itself or in the ureter they're also 11:53 rather sharp their crystals and they 11:56 might produce kidney pain if they're in 11:58 the kidney and they might even cause 12:01 some damage to tissue and therefore 12:03 cause bleeding so as we said this tiny 12:06 ones are silent but if it's too big to 12:09 pass easily this causes what's called 12:11 flank pain meaning over here and it can 12:15 feel like a large rock trying to pass 12:17 through a small tube it is considered 12:20 one of the most painful conditions you 12:22 can ask anybody about that who's had one 12:27 fortunately the tube stretches and it 12:29 usually passes in a few days usually 12:31 seeming about three years to the person 12:33 who's got it but there are various 12:35 things that can be done to help relax 12:37 the ureters and so on like that so you 12:43 start forming a stone up in here and if 12:46 everything goes okay it goes in and 12:48 flops into the renal pelvis and then 12:51 goes on down unless it gets stuck and 12:54 then you begin to feel pain if a stone 12:58 doesn't move through it can be helped to 13:00 pass if it doesn't pass from the kidney 13:03 and causes trouble one non-surgical 13:06 procedure known as lithotripsy the litho 13:09 is a term called stone and basically 13:15 they put the person down in a very high 13:17 class tank of water 13:19 aim ultrasound shockwaves at it and they 13:23 blow it apart into little pieces that 13:25 didn't pass and that technique hasn't 13:28 been around for very many years so there 13:31 used to be a lot more kidney operations 13:32 than there are now because they can just 13:34 blow into pieces and they go away there 13:39 is something that is very intriguing to 13:41 me there was a research publication in 13:45 2008 about a non surgical procedure that 13:49 is not in general use and sadly there 13:52 are no other reports of investigating 13:54 this other than the one paper in 2008 13:56 and I just thought I'd share this one 13:59 with you because if somebody turns up 14:02 with a kidney stone I may try this now 14:04 gallium is a mineral and it happens to 14:08 be a potent antibiotic for what are 14:10 called Nano bacteria they're very very 14:12 small compared to regular bacteria but 14:16 one of the things they do is cause 14:18 calcifications for instance most of the 14:22 calcifications you've ever heard of that 14:23 have happened in people's heart arteries 14:25 is something like that or due to now in 14:27 bacteria putting a calcified coating 14:30 around himself so there was the report 14:35 of a woman who had kidney stones and 14:37 pain and blood in the urine and some 14:40 enterprising physician made of a weak 14:42 solution for her of gallium nitrate and 14:45 had her drink this for three days and 14:47 all of a sudden she was urinating white 14:50 urine powdered calcium stones were being 14:54 released the pain ceased and the 14:57 bleeding ceased however she got the 15:00 stones again one year later and the 15:02 treatment was repeated so it wasn't an 15:04 accident however as I say there's no 15:08 other investigation of this just this 15:09 one thing seven years ago which I find 15:14 awfully curious now there are people 15:17 that are referred to as stone formers 15:19 simply because they seem to have the 15:21 talent for doing it more than once and 15:25 if it does happen to somebody we all 15:27 ought to start investigating what is 15:31 this stone 15:32 made of because that's going to make a 15:33 lot of difference what kind of chemistry 15:35 that we try to change in the person and 15:37 what chemistry involved and was it 15:39 simply that they weren't drinking enough 15:41 water because that of course would 15:43 concentrate the blood and make it more 15:45 likely so if somebody gets a kidney 15:48 stone it's supposed to be a warning that 15:50 they're supposed to be more generous 15:51 with their fluid intake than they were 15:53 before 15:54 there is another report that for people 15:59 who were classified as stone formers 16:01 meaning they did it more than once 16:03 extra b6 and magnesium seemed to greatly 16:07 reduce the likelihood of stones and I 16:11 think that's true now let's shift to 16:16 actually things that go wrong in the 16:18 kidney that is when we talk about kidney 16:21 failure we're talking about failure to 16:22 filter it very well and some medical 16:27 writers have claimed it to be a rather 16:29 silent epidemic involving 17% of the 16:32 population which is a fair sized amount 16:37 now you saw that there marvelously 16:39 intricate but the more intricate 16:43 something is the more ways of 16:44 interrupting the function so it's good 16:47 that we've got 90% spare but as I said 16:50 if you're down to 10% you can't afford 16:52 to lose any more and the problem can be 16:56 a bit like driving a car with a broken 16:58 gas gauge you don't know anything is 17:01 happening until the car sputters so we 17:04 don't want to be about that and we'll 17:05 talk about how we know how we can detect 17:08 this tendency early it's very simple its 17:11 most normal blood work would include it 17:13 but now you're going to be educated 17:15 about how to look at your own blood work 17:17 and see what your keys are doing so the 17:20 topics I want to cover our symptoms of 17:23 kidney failure and early lab detection 17:25 and the stages of chronic kidney disease 17:28 we're talking about getting worse than 17:30 the kidneys not performing very well and 17:33 progressively because it does tend to be 17:35 a sort of progressive condition now it's 17:38 possible that somebody can have reduced 17:40 function that is very stable due to 17:44 whatever and they're not in a particular 17:46 danger but when you see somebody here 17:48 the year before last and here last year 17:51 and here this year you know there's a 17:53 process that's ongoing and you'd better 17:56 do something to stop it or it's going to 17:57 be worse than that the year after next 17:59 so we'll talk about an assortment of 18:03 kidney problems and approaches to kidney 18:06 failure and some causes and some 18:07 treatments so it has such huge reserve 18:12 that there aren't any symptoms for a 18:16 long time and so at a low level of 18:19 failure nothing's noted however the 18:22 kidneys perform so many different 18:25 functions and so many body systems can 18:29 be affected that the symptoms can vary 18:31 and see we know that it eliminates waste 18:34 what we may not do is it actually 18:36 controls fluid balance in the body 18:38 because you saw in those diagrams that 18:42 the kidneys water was being absorbed and 18:44 so on like that and then electrolyte 18:46 balance we're talking about those little 18:49 ions sodium magnesium potassium chloride 18:52 and stuff like that so the balance of 18:54 those is controlled too so any of these 18:58 things that went wrong that was not 19:01 being done well you would get a 19:03 different set of symptoms from each one 19:06 of these so it's not the easiest thing 19:08 in the world to listen to somebody and 19:10 say you have a kidney problem and then 19:13 there's some other things that the 19:14 normal citizen doesn't necessarily know 19:16 about it says signaling for bone marrow 19:19 for red cell production oh you see if 19:23 you need to remind the bone marrow every 19:28 once in a while hey guys maybe it would 19:31 be good if you made a few more red cells 19:34 it turns out that the signaling device 19:37 for that is placed in the kidney well 19:40 that's a good idea because you've got 19:43 the blood going through there and the 19:44 state of oxygenation can be detected and 19:48 if the state of oxygenation is kind of 19:50 low the signal goes out from the kidney 19:53 into the blood that ends up circulating 19:55 back to the bone 19:56 that more or less says hey more red 19:58 cells please and then there's this one 20:04 maybe you know a lot of people I run 20:06 into don't understand that the control 20:08 of blood pressure is really in the hands 20:10 of the kidney there are materials that 20:14 can be released from there that will 20:16 tighten up the muscles in the blood 20:19 vessel walls and that's to tone them so 20:23 that they're not floppy and you don't 20:25 pass out every time you stand up but on 20:28 the other hand remember that everything 20:31 in the body is going through the kidney 20:33 and if you put things through there that 20:36 are highly disagreeable maybe it's going 20:39 to muck up the kidney somehow and that 20:41 may affect the blood pressure mechanism 20:43 and all of a sudden the blood pressure 20:46 mechanism is out of hand and we one of 20:48 gzp I was just doing fine and all of a 20:51 sudden I've got hypertension so kind of 20:56 surprising most persons with severe 20:59 kidney problems do not have any decrease 21:01 in urine output even in advanced kidney 21:04 disease so symptoms they aren't very 21:08 specific they can be frequent urination 21:11 especially at night but gee whiz is a 21:13 lot of things that can do that there can 21:15 be leg swelling and puffiness around the 21:17 eyes now we're not talking just about 21:19 the bags under but it's puffiness around 21:21 so we're talking fluid retention high 21:25 blood pressure we should think about the 21:27 kidney there can be other things fatigue 21:30 well geez that's the major reason people 21:32 go to physicians but this is from anemia 21:36 so we're going oh if the signal doesn't 21:41 go out from the kidney to the bone 21:44 marrow they're not enough red cells 21:45 they're not carrying oxygen from the 21:49 lungs around to cells in the body that 21:51 don't have lungs of their own the body 21:53 may feel kind of breathless when it's 21:56 sitting still much less exerting itself 21:58 and running out of air and fatigue is 22:00 one of the symptoms of that and 22:03 hitching yeah if people don't have good 22:07 function kidney sometimes stuff comes 22:09 out through the skin and itch is and 22:13 easy bruising it's for some reason there 22:17 is and I don't really understand it 22:19 fully there is a connection between 22:21 people having low vitamin K and not 22:25 clotting easily and bruising easily 22:28 shortness of breath if they get fluid 22:30 accumulation in the lungs again 22:31 controlled by the kidney headaches whole 22:36 lot of stuff but as I said this is 22:37 nonspecific they can be due to complete 22:40 other things now it turns out this one's 22:45 worth mentioning your vitamin K whether 22:50 it's the kind you get from sunlight on 22:52 your skin or the kind you get from the 22:54 health food store that's the start and 22:59 then that goes over to the liver and it 23:02 chemically operates on it a little bit 23:04 and then it goes down to the kidney and 23:06 it chemically operates on it a little 23:08 more and all of a sudden you have the 23:10 active form of vitamin P so that means 23:13 if you have severe kidney problems maybe 23:15 you're not activating your vitamin D 23:17 very well and you think about everything 23:19 that does allow you to absorb calcium 23:21 and it has a big effect on bones and a 23:24 whole lot of other stuff it has an 23:26 effect on muscles even so vitamin D is 23:28 is the effect of it is very pervasive 23:31 and if one has a severe kidney problem 23:33 maybe there's a problem with activating 23:36 vitamin D let's talk about laboratory 23:40 detection and as I said this information 23:43 is in routine lab health screens and one 23:46 of the numbers is referred to as bu in 23:49 the molecule is called urea and I'm 23:52 always wondered why in the world they 23:54 had to say this because they used to 23:56 just say you're real maybe they think 24:00 that's impolite or something the 24:02 molecule was named that for where it was 24:04 found it's a very small molecule so that 24:08 means it's easily filtered out by the 24:10 kidney it turns out it's a waste product 24:13 of partial use of amino 24:16 and when somebody realized oh this is a 24:20 molecule that's easy to test for in 24:22 blood and it's filtered out very well by 24:26 the kidney so if it goes high in the 24:28 blood might mean the kidneys not working 24:30 very well so that's really why it's 24:32 there now a little more sophisticated is 24:36 testing for this material which is a 24:39 waste product of muscle action and it's 24:41 a slightly larger molecule so that would 24:44 be considered if that one was elevated 24:47 that would be considered a little more 24:48 serious a little more than if urea was 24:51 elevated and then we come down to this 24:55 one ah we're back to the glomerulus the 24:58 thing that's really doing the first 25:00 filtration now the e stands for 25:03 estimated because it depends on the 25:06 creatine number and your age and a bunch 25:09 of other numbers and it's a calculated 25:11 number but it's pretty pretty helpful 25:14 and so this kind of tells you how it's 25:18 working now exellent is about a hundred 25:22 for some reason a lot of labs don't give 25:25 you an actual number the lab I use I had 25:31 to go fight with him and said I don't 25:33 want you to tell me whether it's above 25:36 or below sixty I need to know whether 25:39 it's eighty or 61 so they supply me with 25:44 a number because eighty is fine and 61 25:48 is scary 25:49 again 59 does not mean somebody's going 25:54 out from kidney problems but I need to 25:57 know where they are 25:58 so now another one is the protein is not 26:02 supposed to be filtered out so in a 26:04 urinalysis if there is protein in the 26:07 urine again this is one of these things 26:09 that everybody has a right to have a 26:11 little protein in the urine once in a 26:13 while but if if it's a big deal if 26:15 there's a lot of it and if it's 26:16 persistent that's telling you there's a 26:18 kidney problem so you now an expert on 26:22 your own lab work and how your kidneys 26:25 are doing so see not too many people are 26:29 of 26:30 here above 90 above 90 is considered 26:34 excellent just everything is peachy keen 26:37 and frankly probably eighty is too but 26:42 that's the beginning of a lowering that 26:45 one would be interested in where you're 26:47 going to be eighty the rest of your life 26:49 or where you're going to be seventy next 26:51 year now this is a table that shows the 26:57 so called stages of chronic kidney 26:59 disease and so they're saying well stage 27:01 one is above 90 and they shouldn't have 27:03 really done it that way they talked 27:05 about five stages this should be normal 27:08 kidneys and four stages but they do it 27:10 this way and I have no idea why but see 27:13 this is normal kidney function okay now 27:16 however eighty nine down to sixty 27:19 they're saying mildly reduced now I'll 27:22 take most of the population is in here 27:24 and we can say well gee why would most 27:29 of the population being here is this 27:31 human destiny no I think it's modern 27:36 life and various exposures we get is why 27:40 most of us are in there now if we get 27:43 below sixty things get a little more 27:46 exciting for unless people are down here 27:50 because they're talking about moderately 27:51 reduced now moderately duce doesn't mean 27:53 it even means moderately reduced and 27:57 then it goes down lower than that and 28:00 down in here somebody has to be on 28:02 dialysis so they're gonna be really 28:03 toxic now so just sort of a rehash in 28:11 words 28:12 Stage three you'd want careful 28:15 management and consultation at least 28:17 every six months to prove that it's not 28:20 getting any worse because stage three is 28:22 definitely lower than stage two stage 28:25 four is severely reduced Stage five is 28:28 very severely reduced and probably on 28:33 dialysis down here now I'll show you a 28:38 problem that's not the fault of the 28:40 kidney 28:42 can we touch this Thanks 28:54 it turns out that some heart problems 28:58 can call cause kidney problems and some 29:00 kidney problems can cause heart problems 29:02 so chicken and egg I want to tell you 29:06 about one of them now it's referred to 29:09 as pre renal kidney failure so it is 29:13 kidney failure but the fault is before 29:15 the kidney so remember back to where we 29:18 had the aorta from the heart pumping the 29:21 blood coming down and then sending the 29:24 blood to the kidney suppose the heart 29:26 doesn't pump very well okay so if it 29:29 fails to pump well as in what's term 29:32 congestive heart failure now see when 29:34 somebody first hears congestive heart 29:35 failure they go 29:36 good grief am I going to die right now 29:39 it really means failure to pump evenly 29:42 so you've got four chambers and what's 29:46 happening is the bottom right ventricle 29:50 is pumping harder into the lungs than 29:53 the top right atrium is pumping down 29:58 into the left ventricle so the lungs get 30:01 wet you know as you're pushing fluid out 30:03 through the the blood vessels in the 30:06 lungs and it's kind of hard to breathe 30:08 through water you've noticed probably 30:10 and that's what congestive heart failure 30:14 means it also means that you're probably 30:16 pushing fluid out into other places and 30:19 you may have swollen legs and so on like 30:20 that but at any rate what I'm trying to 30:23 get to is that if this is not pumping 30:27 from the heart very well you're not 30:30 pumping to the kidneys very well you're 30:32 not cleansing the blood very well and so 30:35 usual kidney failure symptoms can occur 30:37 the waste products may affect the brain 30:39 I'm going to tell you a story about that 30:41 other kidney functions may be done 30:43 poorly it's called pre reen or as the 30:46 causes before the kidney okay the small 30:48 story is this a few years ago I got 30:54 a telephone call from doctors in a 30:57 hospital in Asheville North Carolina 30:58 that said my mother was there and they 31:01 thought she was dying and that I might 31:03 want to know so I got up and ran to 31:05 Asheville now I got there and it turns 31:10 out that she had sort of what they 31:11 thought it was terminal kidney failure 31:13 and I said you do understand don't you 31:15 she has a long record of congestive 31:17 heart failure they said no we can do 31:20 this she travels a lot 31:24 meanwhile I go in and see my mom now see 31:28 she's toxic from not enough kidney 31:32 function and it has affected her brain 31:36 temporarily at least and she was totally 31:40 convinced in talking to me that we were 31:44 of the family of Timothy McVeigh and the 31:46 government was after us now he was the 31:49 Oklahoma bomber remember and so I'm 31:52 going yeah mom I gotta watch out for 31:55 those agents yeah mom and so at this 31:58 point see there I am in Asheville North 32:01 Carolina which is the biggest town in 32:02 Western North Carolina but it is in New 32:04 York City so I go to the telephone book 32:08 at the nurses desk and I look for the 32:12 few health food stores in there and I 32:14 find one that's about ten blocks away 32:15 and I walk there and what I'm looking 32:18 for is coenzyme q10 which is known to 32:23 jazz up the mitochondrial energy 32:25 generation in especially heart and a few 32:30 hundred milligrams and that will pull 32:31 people out of congestive heart failure 32:33 so the only signs they had was something 32:37 ridiculously small I don't remember what 32:39 it was 20 milligrams or something like 32:41 that so I bought them out you know about 32:45 a dozen bottles of it and I go back and 32:48 I start feeding the Eastern Bloc and by 32:52 morning I walk in and she looks at me 32:54 and says I was really far out wasn't I 32:58 it has said yes but I gotta go talk to 33:02 the doctor so I go out and talk to them 33:03 and said this is what's going on 33:07 and this is what I did and they said and 33:10 I said will you keep this going if I 33:13 have to leave and they said well is it 33:16 in the hospital dispensary and I said no 33:20 it isn't a prescription and they could 33:25 not guarantee me they would keep it 33:27 going and we you know I did come back 33:30 she was okay for a while and so on like 33:32 that but it was one of these very hairy 33:34 things and I was dealing with some 33:36 doctors that weren't very nutritionally 33:38 educated that is a polite term from what 33:41 I'd really like to say but anyway that's 33:44 the small story which is a really great 33:46 example of pre renal failure hopefully 33:50 if you meet anybody they won't be 33:51 Timothy McVeigh now recent related 33:56 research though there's a report in 2015 33:59 titled restoration of thyroid hormone 34:03 balance a game-changer in the treatment 34:05 of heart failure Wow 34:08 this is quotation the idea that thyroid 34:11 dysfunction contributes to diseases 34:13 leading to heart failure has been 34:15 discussed for over 50 years 34:17 discussed evidence from animal and human 34:21 studies suggests the thyroid hormone 34:23 treatment may improve clinical outcomes 34:25 and then also it says if a similar 34:29 positive information was available for a 34:32 newly developed heart drug there is 34:33 little doubt that a large-scale clinical 34:35 trial would be underway with 34:36 considerable excitement I thought that 34:39 was very revealing you've seen stuff 34:41 like that before like where are we it's 34:45 not that pharmaceutical companies 34:47 haven't made a great contribution in a 34:51 way but sometimes we just get too darned 34:53 dependent on them and avoid the obvious 34:56 that thyroid hormone controls the speed 35:01 of every single process in your body 35:03 it's basically like your life flame it's 35:06 turned down everybody with low thyroid 35:07 hormone is colder and tighter and slower 35:10 and you turn it up and everything runs a 35:14 little better here's another one from 35:18 2050 an evaluation of thyroid hormone 35:20 chronic kidney disease patients okay 35:22 that's right on a significant decrease 35:25 in the levels of thyroid hormones in 35:27 chronic kidney disease patients now 35:30 exactly that's sort of saying if the doc 35:36 is examining somebody with chronic 35:38 kidney disease and they happen to have a 35:40 temperature well below 98 6 35:42 somebody needs to order a real thyroid 35:45 profile not just TSH which is only going 35:48 to find 24 percent of the ones that are 35:51 below ok another favorite chronic kidney 35:54 disease and hypothalamic pituitary axis 35:56 dysfunction well they're talking about 35:58 the hypothalamus talking to the 36:00 pituitary which talks to the thyroid and 36:02 so they're saying well chicken or egg 36:04 whichever choice you like so a quotation 36:08 out of here recent evidence points 36:11 toward our monel disorders in the 36:12 genesis of chronic kidney disease 36:15 starting it off 2013 two years ago I 36:21 will practically guarantee that you 36:24 won't find one doctor in a thousand who 36:27 knows this it is amazing to me but 36:30 you're gonna see in here in a minute no 36:33 I was a little weird when I was writing 36:37 one of these slides there are somewhere 36:42 between 2,000 and 4,000 medical papers a 36:45 day added to the National Library of 36:49 Medicine nobody is up to date you can't 36:53 be if you had nothing else to do you 36:56 couldn't read 2,000 a day and know what 36:58 you'd read so more Thyroid Association 37:05 of renal failure with our own 37:07 dysfunction well so one moral is check 37:10 their thyroid function oh yeah this is 37:12 where I got weird another is that every 37:14 physician should have a split 37:15 personality want to read papers and one 37:17 to practice okay 37:20 additional kidney conditions of note 37:24 there is something called pyelonephritis 37:26 now that's where you actually have an 37:29 infection in the kidney pelvis it's 37:31 bacterial you 37:33 it causes back pain and fever by pain 37:38 without fever is probably not 37:40 pyelonephritis it's probably a strained 37:42 back but you can get fever from all 37:47 kinds of things so I don't want you to 37:48 think every but friend of yours with a 37:50 hurt back has a kidney problem 37:53 it usually rises up from a fairly 37:57 innocent bladder infection but that 38:00 doesn't happen very often at all thank 38:01 goodness we have a pretty good immune 38:03 system and the flow downward keeps it 38:05 from going backward then 38:08 glomerulonephritis okay so we're talking 38:11 about the glomerulus and nephritis nefra 38:15 the nephron inflammation of the nephron 38:18 particularly in the glomerulus okay 38:21 this is an immune system problem it's an 38:23 autoimmune problem attacking for some 38:27 strange reason and it can result in a 38:29 degree of kidney failure there is 38:31 something called nephrotic syndrome 38:33 where damage to the kidneys causes them 38:36 to spill large amounts of protein into 38:38 the urine that can be detected very 38:41 easily what happens one of the things 38:46 that keeps your fluid mostly into the 38:50 blood circulation and not out into your 38:54 tissue where you would go sloshing 38:56 around is the protein in the blood 38:59 sucking the fluid in to be less 39:02 concentrated see so down here if you're 39:05 losing the protein out of the blood 39:07 you're gonna get tissue swelling and 39:08 gravity being what it is it happens in 39:10 the legs first and you see that but yes 39:14 that can happen for other reasons too so 39:16 again leg swelling is not just kidding 39:19 it can be thyroid it can be a number of 39:21 it can be heart problems polycystic 39:26 kidney disease now this is one of these 39:28 things that can be genetically inherited 39:30 but there are a lot of things that can 39:32 be done about that these days papillary 39:37 necrosis so this is calling talking 39:39 about the papilla of the kidney 39:42 again the 39:44 is a weird thing that fortunately 39:47 doesn't happen much diabetic nephropathy 39:50 ah okay 39:52 an unknown diabetic has got very high 39:56 blood sugar that's being trying to be 39:59 filtered through the kidney it can 40:01 damage it so not only do they have high 40:06 blood sugar but they can damage all 40:08 kinds of things nerves and the eyes 40:10 kidneys and so on like that so it's a 40:12 good idea a few times in your life to 40:14 get your blood sugar checked kidney 40:16 cancer or well that's obviously a pretty 40:18 bad one but this may be something that 40:20 you don't know that smoking is the most 40:22 common cause of this see we think about 40:24 smoking as possibly giving us lung 40:27 cancer or if you smoke and you don't get 40:29 lung cancer you're destined to get into 40:31 Xena probably but if you think about the 40:35 fact that all the stuff that comes in 40:37 when you smoke gets into the body 40:39 circulation and has to exit so it gives 40:43 people a high who smoke a higher rate of 40:45 colon cancer a higher rate of bladder 40:48 cancer a higher rate of kidney cancer 40:50 all the exit ports same interstitial 40:55 nephritis now when you see the term 40:57 interstitial you're talking about in the 41:00 tissue and automatically that's an 41:03 autoimmune disease so connective tissue 41:06 that's the stuff that connects 41:08 everything else together it doesn't 41:11 function white liver cells or kidney 41:13 cells it just lose everything together 41:15 so an inflammation of connective tissue 41:17 that's a classic type of autoimmune 41:20 problem it can be manifest anywhere and 41:23 there's a lot of things to do about that 41:25 and autoimmunity can be triggered by all 41:29 kinds of things chemicals like drugs 41:33 other chemicals that are supposedly not 41:35 even helpful and so on there's something 41:38 rather strange called minimal change 41:39 disease meaning they've got a kidney 41:42 problem but when you look at it under 41:43 the microscope it looks pretty ordinary 41:44 so not much change so strange name 41:50 nephrogenic diabetes insipidus now this 41:53 term is not talking about blood sugar 41:57 dive 41:57 it's talking about extremely extremely 42:01 dilute urine and a lot of it and there 42:05 is this diabetic insipidus that can 42:07 occur when your pituitary gland goofs up 42:12 because one of the things that that is 42:13 supposed to make is something called ADH 42:16 that stands for an antidiuretic hormone 42:18 which means that you don't die urease 42:21 and get rid of all your fluid you keep 42:24 it so that's the common one but there 42:27 can be one that's due to a kidney 42:28 problem renal cysts well those are 42:32 hollowed out spaces in the kidney and 42:34 they're I wouldn't say normal but very 42:38 usual and not particularly threatened in 42:41 any way so definitions of this there is 42:46 what's called acute kidney failure 42:49 it is often reversible but severe and 42:52 sudden and it's most commonly happening 42:55 to people in very chronic condition in 42:57 hospitals and stuff like that and so it 42:59 has a lot of severe symptoms associated 43:04 with it 43:05 what it goes on most of the time that 43:08 I'm most concerned with is what we call 43:10 chronic kidney failure chronic meaning 43:12 it's continuing slowly it's not leaving 43:16 in this case it is less reversible some 43:20 people think not reversible I think it 43:23 is at least partially reversible if you 43:25 find out the cause of it it's also 43:29 referred to as chronic renal failure or 43:31 chronic renal insufficiency in case you 43:33 see those terms they're all the same it 43:36 can seem sudden in the sense that 43:38 somebody says wow you've got this and 43:40 you didn't have it last year or 43:43 something like this but it comes on very 43:46 gradually over years at some point the 43:50 remaining nephrons will not filter blood 43:52 enough to stay healthy and the big point 43:55 is to recognize it and stop recognize 43:58 the causes and stop the causes or the 44:00 kidney function will continue to decline 44:02 because whatever the cause is that's got 44:04 you down this far is still going in 44:06 where she stopped it I think this is 44:10 pretty poorly addressed in general 44:11 medicine because they they don't tend to 44:14 look for cause they tend to just monitor 44:16 the person and say yeah you're a little 44:18 worse than last year but don't worry 44:20 meaning we'll tell you when it's time 44:22 for dialysis it's you need to do 44:26 something about it but then that may 44:29 come from my education previously as a 44:31 chemist you want to do something about 44:33 things so chronic kidney failure we're 44:36 talking about low GFR or progressively 44:39 lowering dual mariel or filtration rate 44:42 look at the forces that can act on it 44:46 well high blood sugar hypertension too 44:49 much pressure on those little blood 44:50 vessels in the glomerulus allergic 44:54 reaction all that stuff has to be 44:55 filtered through there what is an 44:57 allergic reaction it's a situation where 45:00 the immune system has been temporarily 45:03 prompted to be somewhat violent but see 45:07 most allergic reactions when you no 45:09 longer have the exposure they go away in 45:11 a few days lutein intolerance is an 45:16 autoimmune condition of monumental 45:18 nature and can additionally attack you 45:22 absolutely anywhere between the head and 45:24 the toes and there's a 1975 paper that I 45:28 wish more physicians knew about where 45:31 they found out that people with celiac 45:34 disease have antibodies against their 45:38 connective tissue and if they stop 45:41 eating gluten they don't have the 45:42 antibodies and if they eat it again they 45:45 have the antibodies so it means 45:47 essentially that if you've got celiac 45:49 disease and eating gluten you are slowly 45:50 taking yourself apart fortunately we 45:53 have a few repair mechanisms so we don't 45:55 seem to fall apart too quickly drug 46:00 reactions well there some drugs that 46:03 seem to be relatively safe and others 46:05 that are not quite so safe and some that 46:07 set off some people and not others and 46:10 since everything is filtered through the 46:12 kidney sometimes they're bad news for 46:15 some people in the kiddin autoimmunity 46:18 well considering that it can hit you 46:20 anywhere one or two kidney and now we 46:23 get down to the 46:27 this is talking toxic organic is talking 46:31 about non metal materials that are 46:34 man-made that we have tossed out there 46:36 herbicides pesticides solvents and so on 46:38 like that they're made of carbon and 46:41 they usually have a few other kinds of 46:42 atoms with them hydrogen may be nitrogen 46:44 some oxygen and whatnot there are large 46:46 ish molecules they tend to be fat 46:48 soluble and they store themselves in air 46:51 fat and we carried them around for a 46:54 long time now metals are relatively 46:57 smaller and we have thrown away lead 46:59 cadmium mercury arsenic antimony dotted 47:01 it out of the DA and they're all out 47:03 there and coming back to us in the air 47:05 in the food in the water and I'll jump 47:09 ahead and say this strangely enough to 47:13 me it's strange the American Medical 47:15 Association only admits to two 47:20 conditions that can be caused by toxic 47:22 metals in spite of thousands of research 47:26 papers maybe next year they'll admit to 47:28 a third but those two happen to be 47:31 kidney problems and high blood pressure 47:33 particularly of cadmium because that is 47:37 a very very toxic material and but lead 47:42 mercury are pretty close behind and so 47:44 is all the rest of them see antimony is 47:46 a toxic metal did any of you happen to 47:49 remember that they used to fireproof 47:51 children's pajamas with antimony that's 47:54 a real cool on to admit the dumps are 47:56 now all full of exposome ah's and 47:59 leaching into the soil and so on like 48:02 that so and then of course if somebody 48:05 already has a known autoimmune condition 48:09 whether it's relatively instant 48:11 innocent-sounding like rheumatoid 48:12 arthritis or some of the worst ones that 48:16 essentially means that your immune 48:19 system has already gone a little bit 48:21 insane over some particular part of the 48:23 body and you don't know when it might do 48:25 that to some other part of the body so 48:27 you have to watch people who have known 48:29 autoimmune diagnosis now causes okay the 48:35 number one cause in the u.s. is claimed 48:37 to be high blood 48:38 undetected IBT diabetes in a second is 48:41 uncontrolled high blood pressure and the 48:43 accumulated toxic metals and other 48:45 chemistry can't be far behind because 48:47 that affects more persons and diabetes 48:49 and I told you about that already 48:53 and there can be family genetic 48:56 influences in kidney failure and there 48:59 can be autoimmune attack and we 49:03 mentioned this already that the high 49:05 blood pressure can damage the tiny 49:07 vessels in the glomerulus and then in 49:13 reverse abnormalities in the kidney can 49:15 cause hypertension so it can sort of go 49:18 either way suggested approaches assuming 49:24 that kidney failure has been identified 49:26 by lab testing well we want to pursue 49:29 causes because it's just going to get 49:31 worse so we try to locate every 49:34 influence on the kidneys like of course 49:36 we'd worry about how the glucose is and 49:38 how the blood pressure is and what 49:40 prescription drugs and whether or not 49:42 there's any family tendency and whether 49:44 or not their immune aspects like food 49:46 allergy or autoimmunity and checking 49:50 toxic metals and other chemicals so we 49:54 saw earlier that undetected 49:56 hyperthyroidism frequently accompanies 49:58 chronic kidney disease so that should 50:01 definitely be checked and there are many 50:05 many papers on this I just threw one of 50:08 them in here in 2012 it says we 50:11 currently recognize that environmental 50:13 toxins lead cadmium arsenic with the 50:16 only ones that covered in that 50:17 particular paper play a significant role 50:19 in the development of chronic renal 50:20 failure now see I didn't say this before 50:23 why does the American Medical 50:25 Association only had only admit to two 50:28 problems because there is so much 50:29 evidence for those two if they didn't 50:32 admit to those nobody would ever believe 50:34 them again so the metals cause what we'd 50:40 call oxidative damage they they actually 50:44 promote the formation of oxygen free 50:47 radicals which are very tissue damaging 50:50 and there's a lot of evidence that 50:52 drinking green tea reduces oxidative 50:54 damage there are many other things that 50:56 will do it but I thought I would 50:58 acquaint you with this simply because 51:00 having heard over the years the goodness 51:05 of green tea I started trying to drink 51:07 it many years ago so I must have tried 51:10 out 50 brands from various drugs to 51:12 grocery stores it all tasted green to me 51:16 so I had a postdoc a couple of years 51:22 back she was Japanese and when we were 51:28 on our weekends working together she had 51:34 her own tea and it turned out to be this 51:37 and I said where did you get this and 51:41 she told me and I said how did you know 51:43 about it she said my grandmother told me 51:45 to buy it from Costco so there's some 51:48 educated grandmother's so if you want to 51:50 try that I consider that kind very 51:52 drinkable it's good quality Japanese 51:56 green tea and the Japanese are very 51:59 peculiar very particular about their 52:00 green tea so this is pretty good stuff 52:04 I'm sorry 52:10 no see the the teeth doesn't get 52:14 irradiated and glow and do you anything 52:16 no I don't think you have to worry about 52:17 that at all no we lacked a lot of 52:22 answers about some of the exact 52:24 mechanisms of reduced kidney function 52:28 and we've already shown you that there's 52:30 a bit of chicken and egg stuff that 52:32 isn't sorted out completely yet but we 52:35 know the accumulation of toxic metals 52:37 from the environment that we all have 52:39 some and some of us have a lot more than 52:41 others and I'm glad I'm not in the 52:45 position of being in the government but 52:47 if I was I would Lobby to have every 52:50 fourteen year old check for toxic metals 52:52 and not wait until they're 45 years old 52:54 to find out their levels are high see 52:56 when children are growing they actually 53:00 accumulate them faster than we do so it 53:03 would be a good idea to identify them 53:05 early and years ago they did some 53:09 studies like examined the children and 53:12 the adults and family that live near the 53:14 freeways making allowance for how many 53:17 hours they were home and everything else 53:19 and they found out the children 53:20 accumulated a much much faster than the 53:23 adults did so again autoimmune attack 53:29 your immune system is your personal 53:33 version of Rambow the protector 53:35 it's an 800-pound gorilla on your side 53:38 you hope that the 800-pound gorilla does 53:41 not forget who its friends are because 53:43 otherwise you're locked in the room with 53:45 an 800-pound gorilla and that's not a 53:48 comfortable thing if it doesn't know who 53:50 you are so the summary here is the first 53:56 goal in chronic renal failure is stopped 53:59 a progressive decrease now that can take 54:02 time to see the measurement change but 54:04 when it's successful it can even be a 54:06 rise in the glomerular filtration rate 54:08 indicating that we're winning the game 54:10 to some degree in at least stabilizing 54:12 the situation if not being better off so 54:16 as explained the damage is believed 54:18 largely to be permanent but stopping the 54:21 progression 54:21 will mean a healthier life and no future 54:23 of dialysis so okay I'll be glad to show 54:28 my ignorance if you have any questions