WEBVTT 1 00:00:00.160 --> 00:00:05.080 Virgin Media broadband is smooth. How smooth you ask? Well, 2 00:00:05.240 --> 00:00:08.640 Imagine you're a big old Walruss and rather than lumbering 3 00:00:08.679 --> 00:00:12.119 around a glacier avoiding polar bears, you're on a lake, 4 00:00:12.880 --> 00:00:18.320 driving a speedboat three thousand kilos of mollusk, munching magnificence, 5 00:00:18.800 --> 00:00:21.559 feeling the wind in your whiskers and the sun. 6 00:00:21.440 --> 00:00:26.039 On your big blubbery face. That's the kind of smoothness 7 00:00:26.039 --> 00:00:29.760 you feel. With ninety nine point nine percent broadband reliability 8 00:00:30.120 --> 00:00:35.600 available nationwide Virgin Media, It's playtime subject. 9 00:00:35.240 --> 00:00:38.280 To acatal availability. Taccy s apply for broadband reliability. See 10 00:00:38.320 --> 00:00:40.039 Virgin Media, dot I E Forward slash Proof. 11 00:00:40.399 --> 00:00:43.159 Do you know what real power is? It's knowing you're 12 00:00:43.200 --> 00:00:45.920 on the same rate for energy all day, every day 13 00:00:45.960 --> 00:00:48.840 with a smart all day plan from board Gosh Energy. 14 00:00:49.039 --> 00:00:51.240 Save up to eight hundred and eighty euro on dual 15 00:00:51.320 --> 00:00:53.719 fuel plus get a two hundred and thirty five You're 16 00:00:53.759 --> 00:00:57.079 a welcome bonus switch today at board gash Energy, dot 17 00:00:57.119 --> 00:00:58.880 I E Board Gosh Energy. 18 00:00:59.119 --> 00:01:02.399 Know your estimation on your bill of twenty six and 19 00:01:02.399 --> 00:01:04.719 twenty one your new customer zone thirsty percent is Gento 20 00:01:04.840 --> 00:01:07.079 smart all day electricity unit rates in twenty nine percent 21 00:01:07.120 --> 00:01:09.680 of gassa unitrates. See Porcosha Energy Dotti for full seas 22 00:01:09.719 --> 00:01:10.040 and seas. 23 00:01:10.959 --> 00:01:12.920 Oh hey, it's that piece of gum that you managed 24 00:01:12.920 --> 00:01:15.959 to gnaw on through an entire movie. Ali Ward, I'm 25 00:01:16.000 --> 00:01:19.000 back with a very special episode celebrating March. It is 26 00:01:19.040 --> 00:01:21.359 the month of the kidney. Did you know that? Or 27 00:01:21.359 --> 00:01:24.159 maybe it's the two fortnights of each kidney? Depending on 28 00:01:24.200 --> 00:01:26.680 how many you have, how many should you have? How 29 00:01:26.680 --> 00:01:29.439 many do you really need? Is the question? Who has 30 00:01:29.560 --> 00:01:32.359 the most kidneys? We're gonna get there, my little beans. 31 00:01:32.680 --> 00:01:36.000 But nephrology. You have not heard this one before. This 32 00:01:36.079 --> 00:01:40.519 is not about clouds. That was nephology. But this topic, 33 00:01:40.959 --> 00:01:43.480 this topic might be a little foggy for a lot 34 00:01:43.480 --> 00:01:46.480 of us, because how does a kidney even work? And 35 00:01:46.560 --> 00:01:48.799 why can we take them out of our bodies and 36 00:01:48.840 --> 00:01:51.519 pretty much be fine? And why does your piece not 37 00:01:51.640 --> 00:01:56.159 like coffee? A nephrologist ways in, So nephrology comes from 38 00:01:56.159 --> 00:01:59.560 the Greek for nephro and this ologist and I met 39 00:01:59.599 --> 00:02:03.239 over a year ago via science Twitter. She was like, really, 40 00:02:03.400 --> 00:02:06.799 no nephrology episodes and I was like, well, welcome to 41 00:02:06.840 --> 00:02:09.439 my spreadsheet of people I want to interview and she 42 00:02:09.599 --> 00:02:12.639 tweeted back a jiff of ready when you are so 43 00:02:12.759 --> 00:02:15.120 here we are. It's a year later at the start 44 00:02:15.159 --> 00:02:18.680 of World Kidney Month, the week of World Kidney Day. 45 00:02:18.800 --> 00:02:21.240 We're doing it. We could not do it without you. 46 00:02:21.479 --> 00:02:23.840 So a quick thanks to everyone at patriot dot com 47 00:02:23.840 --> 00:02:26.599 slash Ologies who supports the show. It costs a dollar 48 00:02:26.639 --> 00:02:28.960 a month to join, and you can submit your questions 49 00:02:28.960 --> 00:02:32.159 to theologists. And thank you to everyone who shares this episode, 50 00:02:32.240 --> 00:02:35.000 especially to folks needing kidney info or maybe who are 51 00:02:35.000 --> 00:02:38.560 interested in donating. Perhaps no pressure, maybe you're like I 52 00:02:38.560 --> 00:02:41.080 could donate a kidney and coast on that for the 53 00:02:41.120 --> 00:02:43.879 rest of my life. I'm honestly fine with that. Thank 54 00:02:43.919 --> 00:02:46.879 you to everyone reviewing and rating the show. I read 55 00:02:46.919 --> 00:02:49.080 every single review and I bust out a new one 56 00:02:49.120 --> 00:02:52.159 is proof each week, such as this one from bkt 57 00:02:52.360 --> 00:02:55.080 co who says thanks Dad. I decided to go back 58 00:02:55.080 --> 00:02:58.680 to graduate school for forensic anthropologies solely because I started 59 00:02:58.680 --> 00:03:01.840 listening to ologies during a global pandemic that made me 60 00:03:01.879 --> 00:03:04.800 slow down for the first time in my adult life. 61 00:03:05.080 --> 00:03:07.719 Feed your brain cells with the soothing sounds of old 62 00:03:07.800 --> 00:03:11.800 dad word. They say, Oh, I'm so proud of you. 63 00:03:11.800 --> 00:03:14.599 Your brain cells and your p organs, all of us. 64 00:03:14.840 --> 00:03:17.560 They're in for a treat. Okay, So just in the 65 00:03:17.719 --> 00:03:21.919 US just learned this. Fifteen percent of adults have chronic 66 00:03:22.000 --> 00:03:26.639 kidney disease. What that's thirty seven million people and a 67 00:03:26.680 --> 00:03:29.199 lot of them don't even know. Miologist is going to 68 00:03:29.240 --> 00:03:31.159 tell you all about it. So she did her undergrad 69 00:03:31.199 --> 00:03:35.000 at Princeton University, got her MD from Rudgers University from 70 00:03:35.000 --> 00:03:38.000 the Robert Wood Johnson Medical School, where she graduated with 71 00:03:38.080 --> 00:03:40.960 a distinction, thank you very much in research. And she 72 00:03:41.120 --> 00:03:45.240 is an assistant professor of nephrology and Medical Education and 73 00:03:45.599 --> 00:03:49.560 the assistant director of the Nephrology Fellowship Program at Mount Sinai. 74 00:03:49.800 --> 00:03:52.439 She is also one of the organizers of something called 75 00:03:52.639 --> 00:03:56.719 nef Madness, which is like March Madness, but with different 76 00:03:56.800 --> 00:04:01.479 disciplines in kidney medicine. As the brackets nef madness hashtag. 77 00:04:01.639 --> 00:04:04.759 Check that out. So she lives and breathes the means. 78 00:04:04.800 --> 00:04:09.439 And while this podcast is obviously not qualified or intended 79 00:04:09.520 --> 00:04:12.759 to treat or diagnose any medical condition, it is not 80 00:04:12.879 --> 00:04:16.360 medical advice for so many legal reasons. It does offer 81 00:04:16.879 --> 00:04:19.920 a wealth of info such as where are the kidneys? 82 00:04:20.360 --> 00:04:23.920 Why shouldn't you punch them? How much should I pee? 83 00:04:24.040 --> 00:04:26.720 How much should you pee? Shouldn't you ever drink pea? 84 00:04:27.079 --> 00:04:30.319 What's worse childbirth? Are kidney stones? How hard is it 85 00:04:30.319 --> 00:04:32.519 to get a kidney donation? Do people really wake up 86 00:04:32.519 --> 00:04:36.480 in ice baths with stolen organs? What's the most altruistic 87 00:04:36.560 --> 00:04:39.879 way to get a free tattoo? What bad habits do 88 00:04:39.920 --> 00:04:44.879 your kidneys hate? And should you invest in a motivational thermis? 89 00:04:44.879 --> 00:04:45.360 And more? 90 00:04:45.639 --> 00:05:08.720 With transplant nephrologist doctor Samira Ferouk, I like to keep 91 00:05:08.759 --> 00:05:12.680 all the awkward bits in. Sometimes if you end up 92 00:05:12.720 --> 00:05:15.720 confessing to something, we can cut it out. Don't worry. 93 00:05:15.959 --> 00:05:16.680 I appreciate it. 94 00:05:17.480 --> 00:05:20.120 I'm so excited to talk to you. First thing I 95 00:05:20.120 --> 00:05:23.000 always have people do is if you could say your 96 00:05:23.000 --> 00:05:24.959 first and last name and also your pronouns. 97 00:05:25.519 --> 00:05:28.399 Sure. My name is Samira Ferruth. My pronouns are she, her. 98 00:05:28.680 --> 00:05:31.920 Awesome, and you are a nephrologist. 99 00:05:32.480 --> 00:05:35.839 I am a nephrologist at Mount Sinai Hospital in New 100 00:05:35.920 --> 00:05:36.439 York City. 101 00:05:36.959 --> 00:05:42.079 Heard of it, heard of it very exciting. A lot 102 00:05:42.079 --> 00:05:45.040 of listeners were all very hyped about this because a 103 00:05:45.079 --> 00:05:48.000 lot of us have kidneys, which is crazy. 104 00:05:48.279 --> 00:05:51.199 Yeah, I love to talk about the kidneys. I will 105 00:05:51.199 --> 00:05:54.279 do it anywhere. I like to get into arguments with 106 00:05:54.319 --> 00:05:57.959 people about which organ is the best and specifically why 107 00:05:58.000 --> 00:06:00.240 the kidney's better than the brain and the heart. So 108 00:06:00.279 --> 00:06:02.040 if you want to hear those arguments, like we can 109 00:06:02.040 --> 00:06:02.560 get into that. 110 00:06:04.240 --> 00:06:07.519 I love like a Lincoln Douglas style debate, the brain 111 00:06:07.639 --> 00:06:10.519 versus the kidneys. I mean, the brain wouldn't work without 112 00:06:10.519 --> 00:06:12.040 the kidneys properly working. 113 00:06:12.279 --> 00:06:14.519 I mean, really really nothing would work without the kidneys. 114 00:06:14.519 --> 00:06:16.959 And they're just kind of like behind the scenes doing 115 00:06:17.000 --> 00:06:19.600 all the work quietly. They're also kind of the martyrs 116 00:06:19.639 --> 00:06:24.120 sot a lot happening that no one appreciates. We don't 117 00:06:24.120 --> 00:06:26.879 even have an emoji. There's a whole movement on social 118 00:06:26.920 --> 00:06:30.399 media to try to get a kidney emoji, and so 119 00:06:30.439 --> 00:06:33.680 we were very upset that recently a lung emoji was added. 120 00:06:33.800 --> 00:06:38.720 So you'd think, I mean, at least it would double duty. 121 00:06:38.720 --> 00:06:40.680 Would they put it in the food area, would they 122 00:06:40.680 --> 00:06:43.480 put it in the organ area? Could be used for both? 123 00:06:43.759 --> 00:06:45.600 Yeah, it could definitely be used for both. And there's 124 00:06:45.600 --> 00:06:50.480 actually a petition that's been circulating so serious stuff. 125 00:06:50.519 --> 00:06:54.000 I'm signing it PS. This petition is on change dot 126 00:06:54.120 --> 00:06:58.439 org and it currently has three and seventy one signatures 127 00:06:58.800 --> 00:07:02.480 can counting. I will link that on my website. So 128 00:07:02.560 --> 00:07:06.839 it's one small graphic for phones, one big emotion for 129 00:07:07.000 --> 00:07:11.800 kidney doctors and donors and very patient patients. I've always wondered, 130 00:07:12.160 --> 00:07:14.240 do kidneys look like the kidney beans? Are they the 131 00:07:14.279 --> 00:07:16.439 same color? Are they completely different color palette? 132 00:07:17.000 --> 00:07:20.560 So they are like pinkish, light pinkish. So I'm a 133 00:07:20.600 --> 00:07:23.800 transplant nefrologist, so I see patients with beef before and 134 00:07:23.800 --> 00:07:26.000 after kidney transplant. And so if you're in the oar 135 00:07:26.160 --> 00:07:30.240 with a kidney transplant surgeon pre and post the kidney 136 00:07:30.279 --> 00:07:33.040 being hooked up, it's kind of like a whitish grayish 137 00:07:33.040 --> 00:07:35.519 color and then once it gets blood going into it 138 00:07:35.519 --> 00:07:37.959 starts making urin it. Pinks up is the term that 139 00:07:38.120 --> 00:07:38.519 we use. 140 00:07:38.920 --> 00:07:42.560 And was there something that attracted you to this field 141 00:07:42.560 --> 00:07:45.920 in particular? Did you have any brushes with transplants when 142 00:07:46.040 --> 00:07:48.519 you were younger? Do you have kidney disease? How did 143 00:07:48.560 --> 00:07:53.040 you end up doing this very necessary in specialized field. 144 00:07:53.639 --> 00:07:55.560 Yeah, I'm just going to go back to minor Prology 145 00:07:55.600 --> 00:07:58.839 Fellowship interviews when I got asked this question. So I 146 00:07:58.839 --> 00:08:01.399 actually wanted to be a cardiologist when I was in 147 00:08:01.639 --> 00:08:04.319 medical school, and before that I had done some research 148 00:08:04.360 --> 00:08:07.199 in cardiology and that's kind of like the cool internal 149 00:08:07.199 --> 00:08:09.639 medicine specialty, and so I had done a little bit 150 00:08:09.680 --> 00:08:12.399 of research, and when I was in residency, that was 151 00:08:12.439 --> 00:08:16.639 the plan. I'd always loved nephrology because the disease processes 152 00:08:16.639 --> 00:08:19.720 were very complex, and all the nephrologists that I met 153 00:08:19.759 --> 00:08:24.120 were seemed like very smart people that were really great educators, 154 00:08:24.199 --> 00:08:27.360 and they just made their very complicated topic feel easy 155 00:08:27.360 --> 00:08:31.680 to understand. But my first interactions with dialysis in medical school, 156 00:08:31.680 --> 00:08:34.919 I just was not that interested. I thought it was 157 00:08:35.200 --> 00:08:36.639 it was not the right field for me. 158 00:08:37.000 --> 00:08:38.039 Yeah, I'm not into it either. 159 00:08:38.759 --> 00:08:41.519 But then in residency training, I had some more experiences 160 00:08:41.519 --> 00:08:43.559 with patients with kidney disease and kind of fell in 161 00:08:43.559 --> 00:08:45.639 love with it and realized that it was a topic 162 00:08:45.679 --> 00:08:47.919 that I loved to teach about myself when I had 163 00:08:48.559 --> 00:08:51.320 opportunities to do that. And then, I think, like anyone 164 00:08:51.320 --> 00:08:53.240 in medicine, mentorship was really huge for me, and I 165 00:08:53.279 --> 00:08:56.080 got lucky to be paired up with some nephrologists at 166 00:08:56.080 --> 00:08:58.679 Mount Sinai that became mentors for me. And kind of 167 00:08:58.960 --> 00:09:01.720 inducted me into their nerd club. And so I made 168 00:09:01.759 --> 00:09:04.879 a pretty dramatic switch from like the cool cardiologist to 169 00:09:04.919 --> 00:09:06.240 the nerd nephrologists. 170 00:09:06.720 --> 00:09:09.799 Oh I love that it's different tables in the cafeteria 171 00:09:10.200 --> 00:09:12.480 talking about medical processing. 172 00:09:12.679 --> 00:09:14.720 Oh yeah, we definitely have our own table. 173 00:09:15.919 --> 00:09:20.120 Can you explain to me what is a kidney? What 174 00:09:20.240 --> 00:09:24.879 is it doing? Like what's happening in these big beans 175 00:09:24.919 --> 00:09:25.519 in our back? 176 00:09:25.919 --> 00:09:26.159 Yeah? 177 00:09:26.159 --> 00:09:30.200 I was waiting for that question. So what do they do? 178 00:09:30.399 --> 00:09:32.799 So one of the words that we use when we 179 00:09:32.879 --> 00:09:35.519 try to describe what the kidneys do is maintain. A 180 00:09:35.559 --> 00:09:39.240 word called homeostasis, and so kind of what that word 181 00:09:39.320 --> 00:09:42.879 means simply is it kind of keeps everything the way 182 00:09:42.879 --> 00:09:45.639 it needs to be. So those are things like your 183 00:09:46.120 --> 00:09:49.559 blood levels of different things like potassium and sodium, and 184 00:09:49.600 --> 00:09:51.600 what is the balance of water that you should have 185 00:09:51.679 --> 00:09:54.360 and so you know, everyone drinks different amounts of fluids, 186 00:09:54.360 --> 00:09:56.240 and so how does your body know like what to 187 00:09:56.240 --> 00:09:58.240 get rid of and what to hold on to. There 188 00:09:58.240 --> 00:10:00.960 are other things like like pa each like how acidic 189 00:10:01.039 --> 00:10:03.200 is your blood. The kidney plays a really important role 190 00:10:03.240 --> 00:10:06.159 in making sure that our blood isn't the pH isn't 191 00:10:06.200 --> 00:10:08.120 too low or isn't too high when we're talking about 192 00:10:08.120 --> 00:10:10.720 balance of fluids. And then the other category that we 193 00:10:10.720 --> 00:10:13.080 think about is electrolytes. And so the main ones that 194 00:10:13.120 --> 00:10:16.039 we talk about or things that can go wrong, and 195 00:10:16.120 --> 00:10:19.200 patients that develop kidney disease would be problems with their 196 00:10:19.240 --> 00:10:22.279 sodium or their potassium levels are too high, or their 197 00:10:22.320 --> 00:10:24.759 blood becomes a little bit too acidic, and so a 198 00:10:24.759 --> 00:10:26.960 lot of that work is done by the small units 199 00:10:26.960 --> 00:10:29.799 of the kidney that are called nephrons. And so what 200 00:10:29.919 --> 00:10:32.279 happens is that the blood comes into the kidney through 201 00:10:32.320 --> 00:10:35.320 the artery that's called the renal artery, and that artery 202 00:10:35.360 --> 00:10:39.039 basically sends the blood into these smaller filtering units, and 203 00:10:39.080 --> 00:10:41.279 then within each of those filtering units, that's kind of 204 00:10:41.279 --> 00:10:44.759 where all this magic happens. And so these little units 205 00:10:44.799 --> 00:10:46.879 decide kind of what needs to stay in the body 206 00:10:46.960 --> 00:10:50.080 and what needs to leave, and so what leaves comes 207 00:10:50.120 --> 00:10:53.000 out as urine you're in love, and then what stays 208 00:10:53.039 --> 00:10:55.440 goes back into our circulation and so we hold onto 209 00:10:55.440 --> 00:10:58.240 those things. So that's why we don't, you know, hemorrhage 210 00:10:58.240 --> 00:11:00.720 out fluid or blood, and that's that's why we can 211 00:11:01.000 --> 00:11:04.080 kind of maintain our blood pressure and keep everything in 212 00:11:04.120 --> 00:11:07.279 a normal range. And so that's why you don't develop 213 00:11:07.360 --> 00:11:09.960 lots of fluid in your legs and other parts of 214 00:11:10.000 --> 00:11:12.320 your body. And if your kidneys are not working well, 215 00:11:12.360 --> 00:11:14.559 that's one of the signs that the kidney may not 216 00:11:14.639 --> 00:11:16.799 be doing what it's supposed to do. And so on 217 00:11:16.840 --> 00:11:19.240 top of all that, which is incredibly you know, time consuming, 218 00:11:19.399 --> 00:11:22.679 I imagine, there's also hormones that the kidneys make that 219 00:11:23.159 --> 00:11:25.600 manage a couple other important things. So one of those 220 00:11:25.639 --> 00:11:29.600 things are your blood counts and so specifically the hemoglobin levels. 221 00:11:29.960 --> 00:11:35.039 So the kidney actually produces a hormone called erythropoetin, which 222 00:11:35.120 --> 00:11:37.840 tells your body to make red blood cells. And so 223 00:11:37.879 --> 00:11:40.799 when the kidneys are injured or damage, that hormone does 224 00:11:40.840 --> 00:11:44.440 not get produced as well. And so another presentation of 225 00:11:44.480 --> 00:11:48.000 kidney disease would be low blood counts or anemia. And 226 00:11:48.039 --> 00:11:52.120 then another hormone or hormone path that the kidneys are 227 00:11:52.120 --> 00:11:55.320 involved with is regulation of vitamin D and calcium and 228 00:11:55.360 --> 00:11:58.320 phosphorus pathways. And those are our three things that are 229 00:11:58.320 --> 00:12:00.639 really important for us maintaining our bone health. 230 00:12:00.879 --> 00:12:04.440 So to recap your renal artery brings your dirty, dirty 231 00:12:04.440 --> 00:12:07.759 blood into your kidney, which has an outer skin like 232 00:12:07.840 --> 00:12:10.799 thing called a cortex and an inner layer called the medulla, 233 00:12:10.840 --> 00:12:14.000 and it filters the blood through a million or more 234 00:12:14.200 --> 00:12:19.519 microscopic nephrons and have structures inside to further filter it. 235 00:12:19.919 --> 00:12:22.360 And then that area where the kidney kind of bunches 236 00:12:22.440 --> 00:12:25.480 up in the center, that's called a renal pelvis, and 237 00:12:25.519 --> 00:12:27.639 your two p tubes if you have both of them, 238 00:12:27.919 --> 00:12:30.679 are your eurydors, which are kind of like p filled 239 00:12:30.919 --> 00:12:34.559 water slides that lead to the splash pool of your bladder. 240 00:12:34.840 --> 00:12:37.679 So right now, if they're healthy, your kidneys are making 241 00:12:37.759 --> 00:12:41.600 sure that your electrolytes or salts like sodium and potassium 242 00:12:41.639 --> 00:12:44.440 or al in check. It's also making hormones to help 243 00:12:44.519 --> 00:12:47.919 keep your blood counts healthy, your bone strong. And if 244 00:12:47.960 --> 00:12:51.519 they're not healthy, they're probably still working their hardest to 245 00:12:51.559 --> 00:12:54.799 take care of you. Have you even thanked them, You 246 00:12:54.840 --> 00:12:59.440 should do that. How many symptoms do people have that 247 00:12:59.480 --> 00:13:04.039 they don't relate to kidney function? Is that part of 248 00:13:04.080 --> 00:13:06.120 what you have to do in terms of diagnosis, Like 249 00:13:06.159 --> 00:13:08.440 do people not realize like, oh, swollen feet has something 250 00:13:08.480 --> 00:13:10.200 to do with my back beans. 251 00:13:10.279 --> 00:13:13.360 So one of the challenges that we face as nephrologists 252 00:13:13.639 --> 00:13:15.679 in trying to treat patients with chronic kidney disease is 253 00:13:15.720 --> 00:13:18.559 that it's actually a silent disease until the very very 254 00:13:18.679 --> 00:13:22.480 very end. And so there's different stages of chronic kidney disease, 255 00:13:22.679 --> 00:13:25.559 and so their stage is one through five, and generally 256 00:13:25.600 --> 00:13:28.240 patients probably will not have any symptoms until they're at 257 00:13:28.240 --> 00:13:33.639 stage five. Unfortunately, once they've reached stage five, the opportunities 258 00:13:33.679 --> 00:13:37.080 for treatment become much more limited because what happens with 259 00:13:37.600 --> 00:13:39.759 kidney injury is that it's kind of like the skin 260 00:13:39.840 --> 00:13:41.279 in some ways, and that you know, if you get 261 00:13:41.279 --> 00:13:43.039 a cut in your skin, it turns into a scar. 262 00:13:43.480 --> 00:13:46.279 So when the kidney's damaged, it's going to scar, and 263 00:13:46.799 --> 00:13:48.919 right now, we don't really have anything to kind of 264 00:13:48.960 --> 00:13:52.840 reverse that scar process, and so what we really try 265 00:13:52.879 --> 00:13:54.919 to do is to try to have patients come and 266 00:13:54.960 --> 00:13:57.519 see us when they're a bit earlier in their disease process, 267 00:13:57.639 --> 00:14:00.519 because if they come and see us stay at stage three, 268 00:14:00.559 --> 00:14:03.559 for example, then we may have some room to do 269 00:14:03.600 --> 00:14:07.080 some treatment options that may actually slow down their progression 270 00:14:07.240 --> 00:14:09.679 of the disease and maybe even keep them away from 271 00:14:09.679 --> 00:14:11.120 that more advanced stage. 272 00:14:12.200 --> 00:14:14.840 Inside note, if you're like me, and you love to 273 00:14:14.879 --> 00:14:17.519 worry and just thought to yourself, what if I have 274 00:14:17.600 --> 00:14:20.279 stage four kidney disease and I don't even know it. 275 00:14:20.399 --> 00:14:22.080 I'm going to run it down for you. So the 276 00:14:22.120 --> 00:14:26.440 stages are based on something called an estimated glomerular filtration rate, 277 00:14:26.559 --> 00:14:30.080 I think, and that's how good your kidneys clean your 278 00:14:30.120 --> 00:14:32.159 PA and your water out of your blood. Okay, So 279 00:14:32.200 --> 00:14:35.320 stage one in two, you might have high blood pressure, 280 00:14:35.559 --> 00:14:40.799 swelling in the legs, urinary tract infections, or wonky urine tests. 281 00:14:41.120 --> 00:14:44.360 Stage three, you might have changes in how you pee, 282 00:14:44.559 --> 00:14:47.039 swelling in your hands or feet. You might be tired. 283 00:14:47.320 --> 00:14:51.120 You might have dry, itchy skin, back pain, some muscle cramps. 284 00:14:51.320 --> 00:14:57.519 Stage four anemia, decreased appetite, abnormal levels of phosphorus or calcium, 285 00:14:57.600 --> 00:15:01.159 or rhytamin d. In stage five, you might expect fatigue, 286 00:15:01.200 --> 00:15:04.919 shortness of breath, nausea, vomiting. Your thyroid might be wonky, 287 00:15:05.039 --> 00:15:07.720 and swelling in your hands or legs or lower back. 288 00:15:07.840 --> 00:15:11.039 And that EGFR rate is based on the levels of 289 00:15:11.159 --> 00:15:14.080 creatinine in your blood, which is not to be confused 290 00:15:14.120 --> 00:15:17.240 with creatine, which is an organic compound in protein that's 291 00:15:17.320 --> 00:15:19.519 used as a supplement that can bulk up your muscles, 292 00:15:19.720 --> 00:15:23.039 maybe enhance cognitive performance. And also I just thought maybe 293 00:15:23.080 --> 00:15:24.960 I should get someone and put some in coffee. Anyway, 294 00:15:25.039 --> 00:15:27.320 that's neither here nor there. Your P is not a 295 00:15:27.360 --> 00:15:31.480 pre workout elixir. I think either way, are your kidneys 296 00:15:31.519 --> 00:15:33.799 taking out the stuff they need to take out? Can 297 00:15:33.840 --> 00:15:38.200 you run through some of the things that end up 298 00:15:38.240 --> 00:15:41.360 in P I know that the notion that if you're 299 00:15:41.399 --> 00:15:43.840 stranded and you have nothing to drink, you can drink 300 00:15:43.879 --> 00:15:46.759 your pea. Other people say you can't. Some people say 301 00:15:46.759 --> 00:15:51.279 it's teryl what exactly is in p SO? 302 00:15:51.720 --> 00:15:53.600 There's actually an article about this, I think a couple 303 00:15:53.639 --> 00:15:56.480 of years ago or someone somewhere in the UK was 304 00:15:57.600 --> 00:15:59.639 drinking their PA and it turned into an article. So 305 00:15:59.720 --> 00:16:01.639 I I guess it's safe to do that, And we 306 00:16:01.679 --> 00:16:05.799 don't definitely don't recommend that what is in p SO 307 00:16:05.960 --> 00:16:09.600 water a lot of water, and that water content will 308 00:16:09.799 --> 00:16:12.120 depend on how much water you drink, And so if 309 00:16:12.159 --> 00:16:14.120 you're drinking a lot of water, your urine might be 310 00:16:14.240 --> 00:16:16.720 lighter colored or even clear. And if you're in a 311 00:16:16.759 --> 00:16:19.559 more kind of dehydrated state or not drinking water all day, 312 00:16:19.840 --> 00:16:21.360 your pea' is gonna be a little bit darker. There 313 00:16:21.360 --> 00:16:23.519 are some electrolytes that are in there. There might not 314 00:16:23.600 --> 00:16:25.399 be that much, but there might be some. And so 315 00:16:25.639 --> 00:16:31.559 some of those would be you know, sodium or salt, sodium, chloride, potassium. 316 00:16:32.039 --> 00:16:35.519 One of the quote waste products would be called urea. 317 00:16:36.000 --> 00:16:41.759 Okay, quick aside. So. Urea is a colorless, odorless nitrogenous metabolite. 318 00:16:41.840 --> 00:16:45.440 It's also called carbamide, and it's in p as the 319 00:16:45.519 --> 00:16:48.360 result of breaking down amino acids that make up proteins. 320 00:16:48.519 --> 00:16:53.759 But urea also breaks down into ammonia, hence fresh versus 321 00:16:54.000 --> 00:16:59.159 stale p odors, and urea is still used in a 322 00:16:59.360 --> 00:17:06.720 just ball array of industrial applications. It's in moisturizers, tooth whiteners, 323 00:17:07.079 --> 00:17:10.440 it's used as a cloud seating agent to make rain, 324 00:17:10.960 --> 00:17:14.920 and as the main hair removal chemical in the air. Now 325 00:17:15.079 --> 00:17:17.559 romans were hipp to p they knew what was up. 326 00:17:17.680 --> 00:17:19.960 They used to collect pea and public urinals on the 327 00:17:19.960 --> 00:17:22.519 street and be like thanks for the money, folks, and 328 00:17:22.559 --> 00:17:25.839 then they'd sell it to launder toegus and they'd also 329 00:17:25.920 --> 00:17:28.519 use it as mouthwash. But don't worry, we can synthesize 330 00:17:28.519 --> 00:17:29.839 it these days if you really want. 331 00:17:30.480 --> 00:17:33.480 That's something that actually increases in the blood of patients 332 00:17:33.480 --> 00:17:35.839 that have kidney disease because they're not really able to 333 00:17:35.880 --> 00:17:38.720 get rid of that, but really not else much. That's 334 00:17:38.720 --> 00:17:39.920 really worth mentioning. 335 00:17:40.200 --> 00:17:42.240 If you are stranded, can you drink your pea or 336 00:17:42.240 --> 00:17:44.599 will that just double toxify you? 337 00:17:47.200 --> 00:17:49.799 Ummm, I'm gonna say, don't drink your pea. 338 00:17:50.039 --> 00:17:55.519 Okay, most doctors agree, do not drink your pea. You're 339 00:17:55.559 --> 00:17:58.480 just adding more salt to your blood that could dehydrate 340 00:17:58.480 --> 00:18:02.640 you faster. Also, a clip of TV survivalists bear grills 341 00:18:02.680 --> 00:18:05.160 making people sip their own we wei out of Nalgene 342 00:18:05.160 --> 00:18:07.480 bottles and one chick was just throwing it back up 343 00:18:07.559 --> 00:18:09.799 and I noped out of that video so hard. I 344 00:18:09.799 --> 00:18:11.960 didn't need to do that to myself. Neither do you 345 00:18:12.000 --> 00:18:14.519 in real life or on the internet. So if you're like, 346 00:18:14.839 --> 00:18:17.759 by the way, why is pe yellow? That is a 347 00:18:17.799 --> 00:18:20.960 remnant of breaking down your older red blood cells. So 348 00:18:21.039 --> 00:18:24.079 think about that next time you're watching yourself pee. And 349 00:18:24.279 --> 00:18:27.440 if your smells like coffee, doctor say you're drinking too 350 00:18:27.519 --> 00:18:30.480 much coffee or just not enough water. Now, if you've 351 00:18:30.960 --> 00:18:34.440 never gotten the jokes about asparagus pa, you may be 352 00:18:34.640 --> 00:18:37.079 in the fifty percent of people who genetically are not 353 00:18:37.279 --> 00:18:41.799 able to smell asparagusic acid, which is broken down from asparagus. 354 00:18:42.119 --> 00:18:45.400 If you do have musky asparagus PA and it's driving 355 00:18:45.440 --> 00:18:48.720 you away from this delicious vegetable, just try skip in 356 00:18:48.759 --> 00:18:51.559 the tips where most of the smelly compound lies and 357 00:18:51.759 --> 00:18:56.079 just enjoy the slimy, woody stalks of asparagus, I guess, 358 00:18:56.240 --> 00:18:58.440 Or just get some air freshener and move on. Where 359 00:18:58.480 --> 00:19:02.559 does nephrology and and urology begin? Is there a pois 360 00:19:02.640 --> 00:19:04.960 or a juncture the bladder? Where does it stop? 361 00:19:05.200 --> 00:19:08.920 Yes? I love that question. So we often incorrectly have 362 00:19:09.039 --> 00:19:11.440 patients that come into our offices and they would benefit 363 00:19:11.480 --> 00:19:13.279 a lot more from seeing a urologist. And so the 364 00:19:13.279 --> 00:19:15.359 way that we describe it to our patients is that 365 00:19:15.960 --> 00:19:19.000 we deal with the problems that are happening within the kidney. 366 00:19:19.240 --> 00:19:21.319 Another way to think about it is that the urologists 367 00:19:21.319 --> 00:19:23.920 are more kind of thinking about the plumbing, and we're 368 00:19:23.960 --> 00:19:26.359 thinking about kind of all the really cool stuff that's 369 00:19:26.359 --> 00:19:27.240 happening in the kidney. 370 00:19:27.880 --> 00:19:33.119 Well, and now what about bathtubs and black market organs? 371 00:19:33.559 --> 00:19:36.119 No no, no, no, no, no, doesn't happen. 372 00:19:37.400 --> 00:19:40.119 So unfortunately it happens not as much in the in 373 00:19:40.160 --> 00:19:42.559 the US, but definitely in other countries. And the kind 374 00:19:42.559 --> 00:19:47.000 official term for that is transplant tourism. So definitely something 375 00:19:47.039 --> 00:19:48.960 that we try to try to limit, and there are 376 00:19:48.960 --> 00:19:50.920 efforts in other countries that are trying to limit that 377 00:19:50.960 --> 00:19:53.440 as well, but unfortunately we know that it happens that 378 00:19:53.480 --> 00:19:56.480 people are you know, buying and selling organs, and aside 379 00:19:56.480 --> 00:19:59.079 from ethical problems with that, another kind of medical issue 380 00:19:59.119 --> 00:20:02.240 is that those organs are not you know, screened for 381 00:20:02.319 --> 00:20:06.480 infections and other things that may potentially transmit to the 382 00:20:06.599 --> 00:20:10.000 person who's receiving that kidney. And so it's possible that 383 00:20:10.079 --> 00:20:12.880 you know, someone that buys a kidney is now going 384 00:20:12.920 --> 00:20:16.559 to end up with hepatitis C, for example, because we 385 00:20:16.599 --> 00:20:19.240 didn't know that that was present before. So I do 386 00:20:19.319 --> 00:20:21.480 want to say that we are very excited to be 387 00:20:21.720 --> 00:20:23.759 in the last year or so, we've started to be 388 00:20:23.799 --> 00:20:26.799 able to actually transplant kidneys that do have hepatitis C 389 00:20:26.960 --> 00:20:29.960 virus into individuals that don't have it because we have 390 00:20:30.000 --> 00:20:33.119 a cure now for heps So that has really been 391 00:20:33.720 --> 00:20:36.400 very cool to expand our donor pool significantly. 392 00:20:37.119 --> 00:20:39.960 So while the widespread threat of waking up in a 393 00:20:40.000 --> 00:20:43.359 bath of ice missing a kidney was a late nineteen 394 00:20:43.440 --> 00:20:48.960 nineties email chain urban legend. There are plenty, plenty of 395 00:20:49.000 --> 00:20:54.119 suspected Oregon harvestings on the black market, reportedly a lot 396 00:20:54.160 --> 00:20:58.880 from political prisoners in some countries and impoverished folks who 397 00:20:58.920 --> 00:21:02.200 are just learned into it for money. And in China, 398 00:21:02.359 --> 00:21:05.680 where living organ donors are rare, wait time for a 399 00:21:05.720 --> 00:21:08.160 liver or a kidney in the early two thousands at 400 00:21:08.240 --> 00:21:11.559 least was just a few weeks or a month, as 401 00:21:11.559 --> 00:21:14.559