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Speaker 5: Oh hey, it's that piece of gum that you managed
Speaker 5: to gnaw on through an entire movie. Ali Ward, I'm
Speaker 5: back with a very special episode celebrating March. It is
Speaker 5: the month of the kidney. Did you know that? Or
Speaker 5: maybe it's the two fortnights of each kidney? Depending on
Speaker 5: how many you have, how many should you have? How
Speaker 5: many do you really need? Is the question? Who has
Speaker 5: the most kidneys? We're gonna get there, my little beans.
Speaker 5: But nephrology. You have not heard this one before. This
Speaker 5: is not about clouds. That was nephology. But this topic,
Speaker 5: this topic might be a little foggy for a lot
Speaker 5: of us, because how does a kidney even work? And
Speaker 5: why can we take them out of our bodies and
Speaker 5: pretty much be fine? And why does your piece not
Speaker 5: like coffee? A nephrologist ways in, So nephrology comes from
Speaker 5: the Greek for nephro and this ologist and I met
Speaker 5: over a year ago via science Twitter. She was like, really,
Speaker 5: no nephrology episodes and I was like, well, welcome to
Speaker 5: my spreadsheet of people I want to interview and she
Speaker 5: tweeted back a jiff of ready when you are so
Speaker 5: here we are. It's a year later at the start
Speaker 5: of World Kidney Month, the week of World Kidney Day.
Speaker 5: We're doing it. We could not do it without you.
Speaker 5: So a quick thanks to everyone at patriot dot com
Speaker 5: slash Ologies who supports the show. It costs a dollar
Speaker 5: a month to join, and you can submit your questions
Speaker 5: to theologists. And thank you to everyone who shares this episode,
Speaker 5: especially to folks needing kidney info or maybe who are
Speaker 5: interested in donating. Perhaps no pressure, maybe you're like I
Speaker 5: could donate a kidney and coast on that for the
Speaker 5: rest of my life. I'm honestly fine with that. Thank
Speaker 5: you to everyone reviewing and rating the show. I read
Speaker 5: every single review and I bust out a new one
Speaker 5: is proof each week, such as this one from bkt
Speaker 5: co who says thanks Dad. I decided to go back
Speaker 5: to graduate school for forensic anthropologies solely because I started
Speaker 5: listening to ologies during a global pandemic that made me
Speaker 5: slow down for the first time in my adult life.
Speaker 5: Feed your brain cells with the soothing sounds of old
Speaker 5: dad word. They say, Oh, I'm so proud of you.
Speaker 5: Your brain cells and your p organs, all of us.
Speaker 5: They're in for a treat. Okay, So just in the
Speaker 5: US just learned this. Fifteen percent of adults have chronic
Speaker 5: kidney disease. What that's thirty seven million people and a
Speaker 5: lot of them don't even know. Miologist is going to
Speaker 5: tell you all about it. So she did her undergrad
Speaker 5: at Princeton University, got her MD from Rudgers University from
Speaker 5: the Robert Wood Johnson Medical School, where she graduated with
Speaker 5: a distinction, thank you very much in research. And she
Speaker 5: is an assistant professor of nephrology and Medical Education and
Speaker 5: the assistant director of the Nephrology Fellowship Program at Mount Sinai.
Speaker 5: She is also one of the organizers of something called
Speaker 5: nef Madness, which is like March Madness, but with different
Speaker 5: disciplines in kidney medicine. As the brackets nef madness hashtag.
Speaker 5: Check that out. So she lives and breathes the means.
Speaker 5: And while this podcast is obviously not qualified or intended
Speaker 5: to treat or diagnose any medical condition, it is not
Speaker 5: medical advice for so many legal reasons. It does offer
Speaker 5: a wealth of info such as where are the kidneys?
Speaker 5: Why shouldn't you punch them? How much should I pee?
Speaker 5: How much should you pee? Shouldn't you ever drink pea?
Speaker 5: What's worse childbirth? Are kidney stones? How hard is it
Speaker 5: to get a kidney donation? Do people really wake up
Speaker 5: in ice baths with stolen organs? What's the most altruistic
Speaker 5: way to get a free tattoo? What bad habits do
Speaker 5: your kidneys hate? And should you invest in a motivational thermis?
Speaker 1: And more?
Speaker 5: With transplant nephrologist doctor Samira Ferouk, I like to keep
Speaker 5: all the awkward bits in. Sometimes if you end up
Speaker 5: confessing to something, we can cut it out. Don't worry.
Speaker 6: I appreciate it.
Speaker 5: I'm so excited to talk to you. First thing I
Speaker 5: always have people do is if you could say your
Speaker 5: first and last name and also your pronouns.
Speaker 6: Sure. My name is Samira Ferruth. My pronouns are she, her.
Speaker 5: Awesome, and you are a nephrologist.
Speaker 6: I am a nephrologist at Mount Sinai Hospital in New
Speaker 6: York City.
Speaker 5: Heard of it, heard of it very exciting. A lot
Speaker 5: of listeners were all very hyped about this because a
Speaker 5: lot of us have kidneys, which is crazy.
Speaker 6: Yeah, I love to talk about the kidneys. I will
Speaker 6: do it anywhere. I like to get into arguments with
Speaker 6: people about which organ is the best and specifically why
Speaker 6: the kidney's better than the brain and the heart. So
Speaker 6: if you want to hear those arguments, like we can
Speaker 6: get into that.
Speaker 5: I love like a Lincoln Douglas style debate, the brain
Speaker 5: versus the kidneys. I mean, the brain wouldn't work without
Speaker 5: the kidneys properly working.
Speaker 6: I mean, really really nothing would work without the kidneys.
Speaker 6: And they're just kind of like behind the scenes doing
Speaker 6: all the work quietly. They're also kind of the martyrs
Speaker 6: sot a lot happening that no one appreciates. We don't
Speaker 6: even have an emoji. There's a whole movement on social
Speaker 6: media to try to get a kidney emoji, and so
Speaker 6: we were very upset that recently a lung emoji was added.
Speaker 5: So you'd think, I mean, at least it would double duty.
Speaker 5: Would they put it in the food area, would they
Speaker 5: put it in the organ area? Could be used for both?
Speaker 6: Yeah, it could definitely be used for both. And there's
Speaker 6: actually a petition that's been circulating so serious stuff.
Speaker 5: I'm signing it PS. This petition is on change dot
Speaker 5: org and it currently has three and seventy one signatures
Speaker 5: can counting. I will link that on my website. So
Speaker 5: it's one small graphic for phones, one big emotion for
Speaker 5: kidney doctors and donors and very patient patients. I've always wondered,
Speaker 5: do kidneys look like the kidney beans? Are they the
Speaker 5: same color? Are they completely different color palette?
Speaker 6: So they are like pinkish, light pinkish. So I'm a
Speaker 6: transplant nefrologist, so I see patients with beef before and
Speaker 6: after kidney transplant. And so if you're in the oar
Speaker 6: with a kidney transplant surgeon pre and post the kidney
Speaker 6: being hooked up, it's kind of like a whitish grayish
Speaker 6: color and then once it gets blood going into it
Speaker 6: starts making urin it. Pinks up is the term that
Speaker 6: we use.
Speaker 5: And was there something that attracted you to this field
Speaker 5: in particular? Did you have any brushes with transplants when
Speaker 5: you were younger? Do you have kidney disease? How did
Speaker 5: you end up doing this very necessary in specialized field.
Speaker 6: Yeah, I'm just going to go back to minor Prology
Speaker 6: Fellowship interviews when I got asked this question. So I
Speaker 6: actually wanted to be a cardiologist when I was in
Speaker 6: medical school, and before that I had done some research
Speaker 6: in cardiology and that's kind of like the cool internal
Speaker 6: medicine specialty, and so I had done a little bit
Speaker 6: of research, and when I was in residency, that was
Speaker 6: the plan. I'd always loved nephrology because the disease processes
Speaker 6: were very complex, and all the nephrologists that I met
Speaker 6: were seemed like very smart people that were really great educators,
Speaker 6: and they just made their very complicated topic feel easy
Speaker 6: to understand. But my first interactions with dialysis in medical school,
Speaker 6: I just was not that interested. I thought it was
Speaker 6: it was not the right field for me.
Speaker 5: Yeah, I'm not into it either.
Speaker 6: But then in residency training, I had some more experiences
Speaker 6: with patients with kidney disease and kind of fell in
Speaker 6: love with it and realized that it was a topic
Speaker 6: that I loved to teach about myself when I had
Speaker 6: opportunities to do that. And then, I think, like anyone
Speaker 6: in medicine, mentorship was really huge for me, and I
Speaker 6: got lucky to be paired up with some nephrologists at
Speaker 6: Mount Sinai that became mentors for me. And kind of
Speaker 6: inducted me into their nerd club. And so I made
Speaker 6: a pretty dramatic switch from like the cool cardiologist to
Speaker 6: the nerd nephrologists.
Speaker 5: Oh I love that it's different tables in the cafeteria
Speaker 5: talking about medical processing.
Speaker 6: Oh yeah, we definitely have our own table.
Speaker 5: Can you explain to me what is a kidney? What
Speaker 5: is it doing? Like what's happening in these big beans
Speaker 5: in our back?
Speaker 4: Yeah?
Speaker 6: I was waiting for that question. So what do they do?
Speaker 6: So one of the words that we use when we
Speaker 6: try to describe what the kidneys do is maintain. A
Speaker 6: word called homeostasis, and so kind of what that word
Speaker 6: means simply is it kind of keeps everything the way
Speaker 6: it needs to be. So those are things like your
Speaker 6: blood levels of different things like potassium and sodium, and
Speaker 6: what is the balance of water that you should have
Speaker 6: and so you know, everyone drinks different amounts of fluids,
Speaker 6: and so how does your body know like what to
Speaker 6: get rid of and what to hold on to. There
Speaker 6: are other things like like pa each like how acidic
Speaker 6: is your blood. The kidney plays a really important role
Speaker 6: in making sure that our blood isn't the pH isn't
Speaker 6: too low or isn't too high when we're talking about
Speaker 6: balance of fluids. And then the other category that we
Speaker 6: think about is electrolytes. And so the main ones that
Speaker 6: we talk about or things that can go wrong, and
Speaker 6: patients that develop kidney disease would be problems with their
Speaker 6: sodium or their potassium levels are too high, or their
Speaker 6: blood becomes a little bit too acidic, and so a
Speaker 6: lot of that work is done by the small units
Speaker 6: of the kidney that are called nephrons. And so what
Speaker 6: happens is that the blood comes into the kidney through
Speaker 6: the artery that's called the renal artery, and that artery
Speaker 6: basically sends the blood into these smaller filtering units, and
Speaker 6: then within each of those filtering units, that's kind of
Speaker 6: where all this magic happens. And so these little units
Speaker 6: decide kind of what needs to stay in the body
Speaker 6: and what needs to leave, and so what leaves comes
Speaker 6: out as urine you're in love, and then what stays
Speaker 6: goes back into our circulation and so we hold onto
Speaker 6: those things. So that's why we don't, you know, hemorrhage
Speaker 6: out fluid or blood, and that's that's why we can
Speaker 6: kind of maintain our blood pressure and keep everything in
Speaker 6: a normal range. And so that's why you don't develop
Speaker 6: lots of fluid in your legs and other parts of
Speaker 6: your body. And if your kidneys are not working well,
Speaker 6: that's one of the signs that the kidney may not
Speaker 6: be doing what it's supposed to do. And so on
Speaker 6: top of all that, which is incredibly you know, time consuming,
Speaker 6: I imagine, there's also hormones that the kidneys make that
Speaker 6: manage a couple other important things. So one of those
Speaker 6: things are your blood counts and so specifically the hemoglobin levels.
Speaker 6: So the kidney actually produces a hormone called erythropoetin, which
Speaker 6: tells your body to make red blood cells. And so
Speaker 6: when the kidneys are injured or damage, that hormone does
Speaker 6: not get produced as well. And so another presentation of
Speaker 6: kidney disease would be low blood counts or anemia. And
Speaker 6: then another hormone or hormone path that the kidneys are
Speaker 6: involved with is regulation of vitamin D and calcium and
Speaker 6: phosphorus pathways. And those are our three things that are
Speaker 6: really important for us maintaining our bone health.
Speaker 5: So to recap your renal artery brings your dirty, dirty
Speaker 5: blood into your kidney, which has an outer skin like
Speaker 5: thing called a cortex and an inner layer called the medulla,
Speaker 5: and it filters the blood through a million or more
Speaker 5: microscopic nephrons and have structures inside to further filter it.
Speaker 5: And then that area where the kidney kind of bunches
Speaker 5: up in the center, that's called a renal pelvis, and
Speaker 5: your two p tubes if you have both of them,
Speaker 5: are your eurydors, which are kind of like p filled
Speaker 5: water slides that lead to the splash pool of your bladder.
Speaker 5: So right now, if they're healthy, your kidneys are making
Speaker 5: sure that your electrolytes or salts like sodium and potassium
Speaker 5: or al in check. It's also making hormones to help
Speaker 5: keep your blood counts healthy, your bone strong. And if
Speaker 5: they're not healthy, they're probably still working their hardest to
Speaker 5: take care of you. Have you even thanked them, You
Speaker 5: should do that. How many symptoms do people have that
Speaker 5: they don't relate to kidney function? Is that part of
Speaker 5: what you have to do in terms of diagnosis, Like
Speaker 5: do people not realize like, oh, swollen feet has something
Speaker 5: to do with my back beans.
Speaker 6: So one of the challenges that we face as nephrologists
Speaker 6: in trying to treat patients with chronic kidney disease is
Speaker 6: that it's actually a silent disease until the very very
Speaker 6: very end. And so there's different stages of chronic kidney disease,
Speaker 6: and so their stage is one through five, and generally
Speaker 6: patients probably will not have any symptoms until they're at
Speaker 6: stage five. Unfortunately, once they've reached stage five, the opportunities
Speaker 6: for treatment become much more limited because what happens with
Speaker 6: kidney injury is that it's kind of like the skin
Speaker 6: in some ways, and that you know, if you get
Speaker 6: a cut in your skin, it turns into a scar.
Speaker 6: So when the kidney's damaged, it's going to scar, and
Speaker 6: right now, we don't really have anything to kind of
Speaker 6: reverse that scar process, and so what we really try
Speaker 6: to do is to try to have patients come and
Speaker 6: see us when they're a bit earlier in their disease process,
Speaker 6: because if they come and see us stay at stage three,
Speaker 6: for example, then we may have some room to do
Speaker 6: some treatment options that may actually slow down their progression
Speaker 6: of the disease and maybe even keep them away from
Speaker 6: that more advanced stage.
Speaker 5: Inside note, if you're like me, and you love to
Speaker 5: worry and just thought to yourself, what if I have
Speaker 5: stage four kidney disease and I don't even know it.
Speaker 5: I'm going to run it down for you. So the
Speaker 5: stages are based on something called an estimated glomerular filtration rate,
Speaker 5: I think, and that's how good your kidneys clean your
Speaker 5: PA and your water out of your blood. Okay, So
Speaker 5: stage one in two, you might have high blood pressure,
Speaker 5: swelling in the legs, urinary tract infections, or wonky urine tests.
Speaker 5: Stage three, you might have changes in how you pee,
Speaker 5: swelling in your hands or feet. You might be tired.
Speaker 5: You might have dry, itchy skin, back pain, some muscle cramps.
Speaker 5: Stage four anemia, decreased appetite, abnormal levels of phosphorus or calcium,
Speaker 5: or rhytamin d. In stage five, you might expect fatigue,
Speaker 5: shortness of breath, nausea, vomiting. Your thyroid might be wonky,
Speaker 5: and swelling in your hands or legs or lower back.
Speaker 5: And that EGFR rate is based on the levels of
Speaker 5: creatinine in your blood, which is not to be confused
Speaker 5: with creatine, which is an organic compound in protein that's
Speaker 5: used as a supplement that can bulk up your muscles,
Speaker 5: maybe enhance cognitive performance. And also I just thought maybe
Speaker 5: I should get someone and put some in coffee. Anyway,
Speaker 5: that's neither here nor there. Your P is not a
Speaker 5: pre workout elixir. I think either way, are your kidneys
Speaker 5: taking out the stuff they need to take out? Can
Speaker 5: you run through some of the things that end up
Speaker 5: in P I know that the notion that if you're
Speaker 5: stranded and you have nothing to drink, you can drink
Speaker 5: your pea. Other people say you can't. Some people say
Speaker 5: it's teryl what exactly is in p SO?
Speaker 6: There's actually an article about this, I think a couple
Speaker 6: of years ago or someone somewhere in the UK was
Speaker 6: drinking their PA and it turned into an article. So
Speaker 6: I I guess it's safe to do that, And we
Speaker 6: don't definitely don't recommend that what is in p SO
Speaker 6: water a lot of water, and that water content will
Speaker 6: depend on how much water you drink, And so if
Speaker 6: you're drinking a lot of water, your urine might be
Speaker 6: lighter colored or even clear. And if you're in a
Speaker 6: more kind of dehydrated state or not drinking water all day,
Speaker 6: your pea' is gonna be a little bit darker. There
Speaker 6: are some electrolytes that are in there. There might not
Speaker 6: be that much, but there might be some. And so
Speaker 6: some of those would be you know, sodium or salt, sodium, chloride, potassium.
Speaker 6: One of the quote waste products would be called urea.
Speaker 5: Okay, quick aside. So. Urea is a colorless, odorless nitrogenous metabolite.
Speaker 5: It's also called carbamide, and it's in p as the
Speaker 5: result of breaking down amino acids that make up proteins.
Speaker 5: But urea also breaks down into ammonia, hence fresh versus
Speaker 5: stale p odors, and urea is still used in a
Speaker 5: just ball array of industrial applications. It's in moisturizers, tooth whiteners,
Speaker 5: it's used as a cloud seating agent to make rain,
Speaker 5: and as the main hair removal chemical in the air. Now
Speaker 5: romans were hipp to p they knew what was up.
Speaker 5: They used to collect pea and public urinals on the
Speaker 5: street and be like thanks for the money, folks, and
Speaker 5: then they'd sell it to launder toegus and they'd also
Speaker 5: use it as mouthwash. But don't worry, we can synthesize
Speaker 5: it these days if you really want.
Speaker 6: That's something that actually increases in the blood of patients
Speaker 6: that have kidney disease because they're not really able to
Speaker 6: get rid of that, but really not else much. That's
Speaker 6: really worth mentioning.
Speaker 5: If you are stranded, can you drink your pea or
Speaker 5: will that just double toxify you?
Speaker 6: Ummm, I'm gonna say, don't drink your pea.
Speaker 5: Okay, most doctors agree, do not drink your pea. You're
Speaker 5: just adding more salt to your blood that could dehydrate
Speaker 5: you faster. Also, a clip of TV survivalists bear grills
Speaker 5: making people sip their own we wei out of Nalgene
Speaker 5: bottles and one chick was just throwing it back up
Speaker 5: and I noped out of that video so hard. I
Speaker 5: didn't need to do that to myself. Neither do you
Speaker 5: in real life or on the internet. So if you're like,
Speaker 5: by the way, why is pe yellow? That is a
Speaker 5: remnant of breaking down your older red blood cells. So
Speaker 5: think about that next time you're watching yourself pee. And
Speaker 5: if your smells like coffee, doctor say you're drinking too
Speaker 5: much coffee or just not enough water. Now, if you've
Speaker 5: never gotten the jokes about asparagus pa, you may be
Speaker 5: in the fifty percent of people who genetically are not
Speaker 5: able to smell asparagusic acid, which is broken down from asparagus.
Speaker 5: If you do have musky asparagus PA and it's driving
Speaker 5: you away from this delicious vegetable, just try skip in
Speaker 5: the tips where most of the smelly compound lies and
Speaker 5: just enjoy the slimy, woody stalks of asparagus, I guess,
Speaker 5: Or just get some air freshener and move on. Where
Speaker 5: does nephrology and and urology begin? Is there a pois
Speaker 5: or a juncture the bladder? Where does it stop?
Speaker 6: Yes? I love that question. So we often incorrectly have
Speaker 6: patients that come into our offices and they would benefit
Speaker 6: a lot more from seeing a urologist. And so the
Speaker 6: way that we describe it to our patients is that
Speaker 6: we deal with the problems that are happening within the kidney.
Speaker 6: Another way to think about it is that the urologists
Speaker 6: are more kind of thinking about the plumbing, and we're
Speaker 6: thinking about kind of all the really cool stuff that's
Speaker 6: happening in the kidney.
Speaker 5: Well, and now what about bathtubs and black market organs?
Speaker 5: No no, no, no, no, no, doesn't happen.
Speaker 6: So unfortunately it happens not as much in the in
Speaker 6: the US, but definitely in other countries. And the kind
Speaker 6: official term for that is transplant tourism. So definitely something
Speaker 6: that we try to try to limit, and there are
Speaker 6: efforts in other countries that are trying to limit that
Speaker 6: as well, but unfortunately we know that it happens that
Speaker 6: people are you know, buying and selling organs, and aside
Speaker 6: from ethical problems with that, another kind of medical issue
Speaker 6: is that those organs are not you know, screened for
Speaker 6: infections and other things that may potentially transmit to the
Speaker 6: person who's receiving that kidney. And so it's possible that
Speaker 6: you know, someone that buys a kidney is now going
Speaker 6: to end up with hepatitis C, for example, because we
Speaker 6: didn't know that that was present before. So I do
Speaker 6: want to say that we are very excited to be
Speaker 6: in the last year or so, we've started to be
Speaker 6: able to actually transplant kidneys that do have hepatitis C
Speaker 6: virus into individuals that don't have it because we have
Speaker 6: a cure now for heps So that has really been
Speaker 6: very cool to expand our donor pool significantly.
Speaker 5: So while the widespread threat of waking up in a
Speaker 5: bath of ice missing a kidney was a late nineteen
Speaker 5: nineties email chain urban legend. There are plenty, plenty of
Speaker 5: suspected Oregon harvestings on the black market, reportedly a lot
Speaker 5: from political prisoners in some countries and impoverished folks who
Speaker 5: are just learned into it for money. And in China,
Speaker 5: where living organ donors are rare, wait time for a
Speaker 5: liver or a kidney in the early two thousands at
Speaker 5: least was just a few weeks or a month, as
Speaker 5: opposed to the US, where around one hundred thousand patients
Speaker 5: at a time wait years hoping for a life saving match.
Speaker 5: Why the short weight times? Some reports accuse the government
Speaker 5: of harvesting from prisoners. Do we have enough kidneys from
Speaker 5: living donors to get everyone who's on dialysis or who
Speaker 5: has kidney disease kind of healthy? Again? Is it not
Speaker 5: a matter of maybe supply, but just reluctance.
Speaker 6: Yeah, that's an interesting question. We definitely the number of
Speaker 6: living donor kidney transplants that are performed or you know,
Speaker 6: varies by institution to institution, but at most centers, the
Speaker 6: majority of transplants that are done are going to come
Speaker 6: from diceased donors or people that have agreed to be
Speaker 6: organ donors and then their organs are donated after they
Speaker 6: pass away. And so there's a lot of reasons for
Speaker 6: why the numbers may be low for a living donation.
Speaker 6: A lot of it, I think, in my opinion, is
Speaker 6: that it really takes a really concerted effort to you know,
Speaker 6: communicate with the patient, their family, their potential individuals that
Speaker 6: may be potential living donors, to find potential donors, and
Speaker 6: then there's a whole process that has to happen after
Speaker 6: that where living donors have to be screened pretty rigorously
Speaker 6: similar to the person that's going to be receiving the kidney.
Speaker 6: And so a lot of times the conversation is hard
Speaker 6: because patients with kidney disease or any disease really may
Speaker 6: not be willing to share that with other people. And
Speaker 6: so we often see patients in our clinic that no
Speaker 6: one in their family or community knows about their kidney disease,
Speaker 6: and so it's really something that they're trying to manage
Speaker 6: on their own. And so if you're presented with that
Speaker 6: kind of situation, it can be challenging to find someone
Speaker 6: that's going to be a living donor.
Speaker 5: For you, and what types of things are you looking
Speaker 5: for when you're screening for a match. Is it just
Speaker 5: blood type or are there tissue types and sizes?
Speaker 6: Yeah, so there's two main things that we look at.
Speaker 6: And so the first thing is is a blood type match,
Speaker 6: and so the different types are ABO and AB blood type.
Speaker 6: But I think what's really most important as part of
Speaker 6: the living donor valuation process is that even if to say,
Speaker 6: you know, I'm I need a kidney transplant and I
Speaker 6: have someone that's willing to donate to me, but we're
Speaker 6: two different blood type matches, So that doesn't mean that
Speaker 6: you know, I'm all, I'm out of the system and
Speaker 6: now I have to just get a deceased donor kidney transplant.
Speaker 6: So there's a program called the swap program or something
Speaker 6: called paired kidney donation. And so the idea behind that
Speaker 6: is is that so say that there's another pair of
Speaker 6: people that are very similar to me, So someone else
Speaker 6: needs a kidney transplant, but they have a donor that's
Speaker 6: not a match for them, but that living donor is
Speaker 6: a match for me. And so what happens is that
Speaker 6: I get someone else's donor and then my donor donates
Speaker 6: to this other patient and now we've both ended up
Speaker 6: with a living kidney transplant on the other side.
Speaker 3: Ah.
Speaker 5: And is that called the chain?
Speaker 6: Yep, that's the chain. It's also called pair donation. It's
Speaker 6: part of the National Kidney Registry Program. And so sometimes
Speaker 6: we can have very very long chains of you know,
Speaker 6: eleven to twelve donor recipient pairs. And so our goal is,
Speaker 6: you know, how can we maximize patients getting that living
Speaker 6: donor kidney transplant. And that's another piece that really takes
Speaker 6: a lot of education from our end because oftentimes we
Speaker 6: see patients that you ask them in the visit, is
Speaker 6: there anyone that's the potential living donor for you? And
Speaker 6: they say no. And if we don't probe that a
Speaker 6: bit more, it could be that they do have a
Speaker 6: couple living donors, but they've excluded them in their mind
Speaker 6: because they know that they're not a blood type match.
Speaker 5: Got it. Have you ever seen those videos of hermit
Speaker 5: crabs exchanging shelves?
Speaker 6: I have seen them.
Speaker 5: Is that what's happening with?
Speaker 1: Yeah?
Speaker 7: Basically, yeah, after a close inspection, the big crab moves
Speaker 7: in this triggers a chain reaction. Each crab horridly moves
Speaker 7: into the shell vacated by the crab ahead of it
Speaker 7: in the line.
Speaker 5: It's one of the cutest things on the planet. Just
Speaker 5: the idea of like, well I got one lineup, got
Speaker 5: I gotta be negative, It's like so great.
Speaker 6: The other type of match you mentioned a tissue typing,
Speaker 6: and what we're looking for is something called HLA typing.
Speaker 6: That's human leucocyte antigen. And so the way that that
Speaker 6: works is that we each inherit two copies, so one
Speaker 6: from your biological mother, one from your biological father, and
Speaker 6: so we basically look for the degree of similarity between
Speaker 6: what yours is and what your potential donors would be.
Speaker 6: But the better the match, typically the the you know,
Speaker 6: the better that that pair may do.
Speaker 5: So they go buy blood type and human leukocyte antigen,
Speaker 5: which tells transplant coordinators about your immune system compatibility. Do
Speaker 5: you get to make the phone call? Like, hey, are
Speaker 5: you sitting? I have a key for you? Who gets
Speaker 5: to make that phone call?
Speaker 6: So explin institutes have very very massive care teams because
Speaker 6: it's a you know, pretty complicated process, and so we
Speaker 6: have transplant coordinators that are actually the ones that make
Speaker 6: that initial call and so once they start that process,
Speaker 6: then there are many other individuals, including the transplant surgeons,
Speaker 6: the transplant nefrologists, and we all kind of make a
Speaker 6: decision together. Unfortunately, I'm not the one that gets to
Speaker 6: make the call.
Speaker 5: I wonder what those phone calls are like. Do you
Speaker 5: ever hear like heartwarming stories?
Speaker 6: Oh? Yeah, yeah, especially for you know, some of our
Speaker 6: patients that have been on dialysis for for ten years
Speaker 6: and then and then we call them and say, hey,
Speaker 6: there's an organ for you. It's I mean, it's why
Speaker 6: I went into to transplant a prology. And you know,
Speaker 6: when we see the patients on the in the hospital.
Speaker 6: In addition to the patients that are admitted for their
Speaker 6: surgeries for a living donors, we also have their donors
Speaker 6: that are admitted for a day or so after their
Speaker 6: donation surgery. And its just every time it makes me
Speaker 6: pretty emotional to kind of interact with the donors as
Speaker 6: well as their recipients.
Speaker 5: Do they usually know, I guess each other or the
Speaker 5: part of a chain. Do they get to meet the
Speaker 5: person who is getting their kidney? Is there usually a
Speaker 5: bond there?
Speaker 6: So if it's a if they're not part of the pair, program.
Speaker 6: Then they they almost always have some sort of connection
Speaker 6: to that recipient. If they don't have a connection, then
Speaker 6: they're you know, you have to question a bit kind
Speaker 6: of what are the what are the motives for that
Speaker 6: Caney transplant donation. We do a lot of kind of
Speaker 6: background work to make sure that the donor recipient relationship,
Speaker 6: you know, makes sense to us, and that there's no coercion.
Speaker 6: Donor isn't being forced or being paid to do the donation.
Speaker 6: There are instances of altruistic donation, which basically means that
Speaker 6: you know, you say, I want to donate your kidney
Speaker 6: and I don't know the person that it's going to.
Speaker 6: That's a little bit less common. I haven't really been
Speaker 6: a part of that many cases like that.
Speaker 5: Oh wow.
Speaker 6: Dire actually is a really interesting podcast. I think I
Speaker 6: can't remember. I think it's called Two Strangers maybe, but
Speaker 6: it basically is a series of podcasts of the journey
Speaker 6: of someone that actually did do an altruistic donation, and
Speaker 6: it goes through her process kind of you know, before
Speaker 6: the transplant and then during and there were some interesting
Speaker 6: questions about how the altruistic donor wanted to select her recipient.
Speaker 6: And there's a lot of ethical questions there because there
Speaker 6: is already a wait list in place, and so she
Speaker 6: kind of wanted to make her own rules about who
Speaker 6: she thought was the best recipient. And so because of
Speaker 6: this was all happening on the podcast, there was actually
Speaker 6: a lot of interaction from the podcast listeners who kind
Speaker 6: of weighed in on what their opinions were.
Speaker 5: Okay, So I looked around for this, and I believe
Speaker 5: it's the podcast Strangers, and it's a three part series.
Speaker 5: Elizabeth and Mary also epidemiology guests. The Doctor's Aaron from
Speaker 5: this podcast Will Kill You recently did an organ donation
Speaker 5: episode in February, and doctor frug is a host on
Speaker 5: her own kidney podcast, a Pea Cast if you will.
Speaker 6: It's called Freely Filtered kN absolutely intended well. And so
Speaker 6: it's me and one, two, three, three other neprologists and
Speaker 6: we try to meet a couple times a month and
Speaker 6: sometimes we invite guests depending on the topic, and we
Speaker 6: have good time.
Speaker 5: Okay. This is something that made me definitely want to
Speaker 5: do nephrology. One thing I feel like people were talking
Speaker 5: about a few months ago that I did not know
Speaker 5: is when you put in a kidney, you don't take
Speaker 5: out the old one. Is this true?
Speaker 6: This is true? Yeah, so it's amazing.
Speaker 7: Yeah.
Speaker 6: So that the native kidneys, which is what we call them,
Speaker 6: they stay there. And so the kind of classic kidney
Speaker 6: transplant is that those stay and then the new kidney
Speaker 6: comes in. And there's three connections that need to be made,
Speaker 6: and so it's an artery, a vein, and the urder,
Speaker 6: which is how the urine's going to come out. And
Speaker 6: then that's it. And so there are there are some
Speaker 6: instances when someone's you know, own kidneys may need to
Speaker 6: come out, but generally those are because they are causing
Speaker 6: some sort of problem. Like for example, if someone has
Speaker 6: a disease called polycystic kidney disease, it's a disease in
Speaker 6: which the kidney basically becomes filled with these fluid filled
Speaker 6: sacks that are called and the kidneys can become very
Speaker 6: very large, and so that would be a potential reason
Speaker 6: to remove the kidneys if those are causing symptoms for
Speaker 6: the patients, If kidneys are becoming infected, that would be
Speaker 6: another reason to remove them. But generally those kidneys are
Speaker 6: left in because it just becomes a much more complicated surgery. Unfortunately,
Speaker 6: kidney transplants don't last forever. They probably last, you know,
Speaker 6: somewhere between ten to fifteen years, depending on the type
Speaker 6: of kidney and how you know, other factors related to
Speaker 6: the patient, the kidney transplant will stay. And so I
Speaker 6: think the most number of kidneys that I've seen in
Speaker 6: a patient are seven. Oh wow, Oh.
Speaker 5: My gosh, that's like a bunch of grapes.
Speaker 2: Wow.
Speaker 6: Yeah, And my surgical colleagues will say that, you know,
Speaker 6: as long as they can find a place to make
Speaker 6: those three connections, then it can happen.
Speaker 5: Oh so wait, okay, so the connections are they still
Speaker 5: going to the old kidneys or they must be hooked
Speaker 5: up to me receiving blood so that they're not just
Speaker 5: gangrenous in there? But can are you You're able to
Speaker 5: kind of splice is it like splicing cables?
Speaker 6: So the native kidneys and their blood supply, they're actually
Speaker 6: kind of left alone. And so the arteries in the
Speaker 6: veins are going to be connected, you know away from that. Wow,
Speaker 6: oh my gosh, you're exactly right. They just the artery
Speaker 6: just needs to be connected to another artery, and the
Speaker 6: vein just needs to be connected to another vein. It's
Speaker 6: a little bit more complicated that. I'm sure, but I'm
Speaker 6: not a surgeon. So that's how they explained it to me.
Speaker 6: So that's how I that's how I explain it.
Speaker 5: Wow, that's amazing. That's such good too. Truth and a
Speaker 5: lie fodder. If you wanted to say, like one truth
Speaker 5: is I have seven kidneys, no one would believe. Okay,
Speaker 5: I'm talking to you, Dutch school teacher. You aren't found
Speaker 5: an unpl who has received the Guinness Book of World
Speaker 5: Records highest number of kidney transplants at seven, the last
Speaker 5: of which was from his sister, a living donor. And
Speaker 5: I'm happy to report that with persistent googling, I discovered
Speaker 5: that Jorn is doing very well, forty one years old,
Speaker 5: now married to a wonderful woman who also had a
Speaker 5: kidney transplant as a child. They recently had a baby
Speaker 5: against a lot of odds, and he has written a
Speaker 5: heartwarming book about his experience called Sigh of Enlightenment. And yes,
Speaker 5: I will link the book on my website in case
Speaker 5: you want to purchase it for March twelfth, World Kidney Day,
Speaker 5: because there are so many people out there who need
Speaker 5: spare kidneys or who maybe are packing a few extra
Speaker 5: that is so fascinating and I've always wondered too, how
Speaker 5: does dialysis essentially work. Does it reroute your blood, clean
Speaker 5: your blood through machinery and then bring it back.
Speaker 6: Yeah, yeah, basically. So I think an important thing about
Speaker 6: dialysis that we try to emphasize is that the dialysis
Speaker 6: One it doesn't fix the kidneys, and two it only replaces,
Speaker 6: you know, a fraction of what the kidney's doing. And
Speaker 6: so again, the kidney does a ton of stuff, and
Speaker 6: dialysis is basically going to do two main things. One
Speaker 6: is to try to restore some of the balance of
Speaker 6: some of those electrolytes, and so it's going to get
Speaker 6: rid of the quote bad stuff that the kidney cannot
Speaker 6: get rid of on its own. And the second thing
Speaker 6: is to try to maintain your fluid balance, and so
Speaker 6: again to if you have kidney disease, you're not making
Speaker 6: an urine. If you don't have any way to remove
Speaker 6: that fluid, you're essentially going to kind of keep you know,
Speaker 6: becoming more and more swollen. And so what the dialysis
Speaker 6: treatments do is provide a way to kind of remove
Speaker 6: some of that fluid and to get rid of some
Speaker 6: of that bad stuff. And so you know, one of
Speaker 6: the important things that the dialysis removes is potassium. And
Speaker 6: why do we as nephrolo just care so much about potassium.
Speaker 6: If the potassium levels become too high, that can be
Speaker 6: very dangerous for the heart and cause abnormal and potentially
Speaker 6: life threatening arrhythmias. And so the dialysis importantly takes care
Speaker 6: of that and also removes a few other what we
Speaker 6: would call toxins. There's two different types of dialysis I
Speaker 6: should also mention. So one is done through the blood.
Speaker 6: That's probably the more common one in the United States,
Speaker 6: and that's called hemodialysis, and so that the blood is
Speaker 6: directly being removed and so the blood is removed, goes
Speaker 6: through the filter the bad things that remove some fluid
Speaker 6: is removed, and then the clean blood is returned and
Speaker 6: that goes on for about three three and a half hours,
Speaker 6: and the patients generally do that three times a week.
Speaker 6: And that can be done in like a clinic type setting,
Speaker 6: so that that would be called a dialysis unit, but
Speaker 6: that can actually also be done at home. It's something
Speaker 6: called home hemodialysis. And so patients that are able to
Speaker 6: kind of manage that can do the treatments at home.
Speaker 5: To be able to diy it at home seems like
Speaker 5: something that fifty years ago couldn't even be imagined.
Speaker 6: I feel like, yeah, it's really amazing what the patients
Speaker 6: can can do at home, and for many patients, I
Speaker 6: think that can really be changing for their quality of
Speaker 6: life as well.
Speaker 5: So I looked up a hemodialysis machine and they're about
Speaker 5: the size of a large night stand or maybe like
Speaker 5: a speaking podium or a slot machine, but I imagine
Speaker 5: less loud and blinky. And doctor Feruke says, the type
Speaker 5: of dialysis that's right really depends on the patient. Because
Speaker 5: there's hemodialysis, which goes straight for the blood, but then
Speaker 5: there's another flavor too.
Speaker 6: And the other type of dialysis is called peritoneal dialysis.
Speaker 6: It's a bit different because it doesn't require needles or
Speaker 6: accessing the blood. And so how that works is there's
Speaker 6: a plastic caf that are that's placed in the abdomen
Speaker 6: and it sits in the peritoneal space, so it's like
Speaker 6: between your organs and your abdominal wall. Basically that space
Speaker 6: between is used as the cleaning filter, and so for
Speaker 6: patients that are on peraitoneal dialysis. They are able to
Speaker 6: put fluid through the catheter into that space in the abdomen,
Speaker 6: and that fluid sits in there for you know, four
Speaker 6: to six hours, and that's when the dialysis is quote happening,
Speaker 6: and then they can drain that fluid and then they
Speaker 6: can put a new fluid again. And they're actually machines
Speaker 6: that can do this for them overnight while they're sleeping,
Speaker 6: and so that can be really awesome because in the
Speaker 6: dialycese happens at night when they're asleep, and then during
Speaker 6: the daytime there's nothing for them to worry about.
Speaker 5: That's got to be a quality of life upgrade too. Yeah. Oh,
Speaker 5: I have so many questions from listeners. Is it okay
Speaker 5: to rapid fire?
Speaker 3: Yeah?
Speaker 5: Yeah, I'll try my best, like a lightning ground, like
Speaker 5: lightning ground. Okay, But before we ZipZap through your very
Speaker 5: good questions, a quick word about word approved sponsors of
Speaker 5: the show who let us shower a charity and a
Speaker 5: golden donation, And this week doctor Fruke says a donation
Speaker 5: to AAKP would be awesome, and that is the American
Speaker 5: Association of Kidney Patients which since nineteen sixty nine is
Speaker 5: dedicated to improving the lives and long term outcomes of
Speaker 5: kidney patients through education, advocacy, patient engagement, and the fostering
Speaker 5: of patient communities. And they fight for early disease detection
Speaker 5: and diagnosis, increased kidney transplantation, patient dialysis choice, and more.
Speaker 5: And you can learn about them at AAKP dot org
Speaker 5: or on Twitter at kidney patients. And that donation was
Speaker 5: facilitated by sponsors of the show, who you may hear
Speaker 5: about now.
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Speaker 5: Okay, back to your questions, which I filtered through to
Speaker 5: the best of my ability. Will Pleiwo wanted to know
Speaker 5: camels and hopping mice, and I was like, what does
Speaker 5: that mean? Have you heard of how camels and hopping
Speaker 5: mice like what their kidney deal is? Like how can
Speaker 5: camels not drink water for a while.
Speaker 6: Yeah, so that's a really awesome question and something that
Speaker 6: I actually recently have spoken to about with my nephrology colleagues.
Speaker 6: Different animals have different abilities to what we call concentrate
Speaker 6: their urine. I think that's the easiest way to put it.
Speaker 6: And so depending on your version of the kidney, however
Speaker 6: concentrated that system can make the urine. That's kind of
Speaker 6: how much water you need to or do not need
Speaker 6: to drink, if that makes sense. So like, for example,
Speaker 6: as humans, like we have a certain capacity, so like
Speaker 6: we can only what's called kind of keep in a
Speaker 6: certain amount of water and be on that point like
Speaker 6: we just can't do it anymore. EI are gonna cry
Speaker 6: with my pants. And so if you're if you're an
Speaker 6: animal that's able to just hold on to all of
Speaker 6: your water and never get rid of it, then yeah,
Speaker 6: you can go longer period of time without drinking water.
Speaker 5: Ah, how do they do this? Okay, so they excrete
Speaker 5: less water in their wastes, solid and liquid. And if
Speaker 5: you're a camel, your humps hold fat and not water.
Speaker 5: But when you break down the fat, there's some water released. Also,
Speaker 5: you can drink up to thirty two gallons at a
Speaker 5: time camels. Now, should we as human beings drink one
Speaker 5: thirty second of that in a day? Patrons color to
Speaker 5: Ostwald and Charlotte are both good hydraters and TBH frequent peers,
Speaker 5: and they wanted to know if this is okay? Now,
Speaker 5: what about drinking a gallon a day? You know how
Speaker 5: people are like, it's so good for your skin.
Speaker 6: It actually was just talking to one of my really
Speaker 6: filtered field traits and I said, I'm worried she's gonna
Speaker 6: ask me how much water people should drink? So what
Speaker 6: do we tell patients that ask us this question? So
Speaker 6: we always get asked like, it makes sense that you
Speaker 6: should drink more water, right, because it's gonna flush out
Speaker 6: the kidney whatever that means. And so the kidney smarter
Speaker 6: than that, and so we can't just kind of flush
Speaker 6: it out. It's not like the heart where it's just
Speaker 6: like a pump. It's like more sophisticated, we say, drink
Speaker 6: to your thirst and the kidney will figure out the rest.
Speaker 6: And so drinking too much water is probably not gonna
Speaker 6: help or hurt anything. Drinking too little water is probably
Speaker 6: for some short period of time is okay, because again,
Speaker 6: if your kidneys are working appropriately, it's going to be
Speaker 6: able to respond and regulate to kind of keep everything
Speaker 6: where it needs to be.
Speaker 5: Does it ever happen to you where you are hydrated
Speaker 5: but you don't feel thirsty and then you start drinking
Speaker 5: water and then you're like, oh, I didn't realize that
Speaker 5: thirsty I was. Why does our brain do that? Uh?
Speaker 6: Personally, yes, yeah, that's happened to me.
Speaker 5: Sometimes I'll be like I didn't realize. Then I'm like, huh,
Speaker 5: water is so good? Why didn't I drink it for
Speaker 5: six hours?
Speaker 6: So another cool thing that's, you know, not directly related
Speaker 6: to the kidney, but kind of is that one of
Speaker 6: our mechanisms for thirst is actually your level of sodium
Speaker 6: in the blood. And so the reason we feel thirsty
Speaker 6: is that one of the reasons is that your sodium level,
Speaker 6: if it starts to go up, then that's kind of
Speaker 6: a signal to your brain that you know you need
Speaker 6: more water. And so for people that have what we
Speaker 6: call a normal thirst mechanism, even very small rises in
Speaker 6: your sodium will make you incredibly thirsty. And so another
Speaker 6: way that we maintain kind of what is the normal
Speaker 6: balance or our homeostasis, is by kind of responding to
Speaker 6: that thirst mechanism. Boy, these pretzels are making me thirsty.
Speaker 5: Now, if you have salt cravings that shock your friends
Speaker 5: and family, that can be one symptom of Addison's disease
Speaker 5: or adrenal insufficiency, alongside fatigue and skin pigment changes. The
Speaker 5: adrenal glands sit on top of your kidneys kind of
Speaker 5: like little hats or nipple tassels, and they deserve their
Speaker 5: own episode. We will get to that in the future. Now,
Speaker 5: what about if you're sick and you're supposed to drink
Speaker 5: a lot of fluids? Is this because the kidneys are
Speaker 5: also germ custodians and virus cleaners. Not really, It's because
Speaker 5: you can lose fluids sweating through a fever, and also
Speaker 5: dehydration makes your thick, disgusting mucus more thick and disgusting.
Speaker 5: No offense. But before you chug a gallon of water
Speaker 5: in the span of this episode. Just slow a down, champ.
Speaker 5: If your electrolytes get too diluted, it can lead to hyponetremia,
Speaker 5: which makes you feel drunkish and can cause a coma
Speaker 5: and even death. So if you need to get one
Speaker 5: of those water bottles with the time stamps and the
Speaker 5: motivational benchmarks on it every hour, I will not judge you.
Speaker 5: Me and your kidneys will be very pe roud of you.
Speaker 5: You're not flushing your money down the toilet. Let's see.
Speaker 5: Mariika asked who was Henley and how did he get
Speaker 5: the most memorable structure named after him? And I'm been
Speaker 5: guessing she's talking about the Loop of Henley.
Speaker 6: Oh no, I don't know a lot about Henley, but
Speaker 6: I do love the Loop of Henley. And I think
Speaker 6: in nephrology we like to kind of get very nerdy
Speaker 6: with how we name different things. And so I just
Speaker 6: started this nephrology mentorship program for medical students and residents
Speaker 6: that want to kind of learn a little bit more
Speaker 6: about nephrology. So it's a year long program and we've
Speaker 6: broken up the trainees into different groups and they're each
Speaker 6: named based on a different part of the kidney, and
Speaker 6: so we have actually two groups that are inspired by
Speaker 6: the Loop of Henley. And so there's the acending limb
Speaker 6: of the Loop of Henley and the descending limb of
Speaker 6: the Loop of Henley, and so they do different things.
Speaker 6: And so within our little mentorship program, we've had some
Speaker 6: nice kind of debate about whose group is better and
Speaker 6: who's part of the of the nephron is better.
Speaker 5: You know. Ethan Batana. A listener asked, why do several
Speaker 5: parts of the kidneys and pantcras have really weird names,
Speaker 5: like the isles of langer Hands and Bowman's Capsule. Is
Speaker 5: it just because nephrologists are cooler and more imaginative.
Speaker 6: Yeah, yeah, absolutely, and so that we kind of have
Speaker 6: our own little secret language, and so that when we
Speaker 6: have a mentorship program, we have options for how to
Speaker 6: name our groups.
Speaker 5: That's why that's the origin of it. Of course, Henley,
Speaker 5: by the bye is doctor Frederick Gustav Jacob Henley, a
Speaker 5: Bavarian born doctor from the eighteen hundreds. And you have
Speaker 5: all kinds of Henley thingamabobs in your body and face,
Speaker 5: including the crips of Henley. Those are in your eyeball area.
Speaker 5: And he was the founder of modern medicine and also
Speaker 5: a big proponent of germ theory. So a hero today,
Speaker 5: but I'm sure at least a few people back then
Speaker 5: were like, Yeah, that guy with the clean shaven face
Speaker 5: and the hairy neckbeard cuts up dead people all day
Speaker 5: and he thinks invisible animals are responsible for plagues. Okay,
Speaker 5: but he was right, and we're lucky that he was
Speaker 5: a little loopy. Melissa Whise, first time question asker, wanted
Speaker 5: to know what is it about trauma damage to the kidneys?
Speaker 5: It's so bad you get stabbed there and almost immediately die.
Speaker 5: Why And then we had another question. Julie Behar said,
Speaker 5: why are kidney strikes for boting in most boxing and
Speaker 5: martial arts? Kaitlin Powell said kidney punches are illegal in
Speaker 5: boxing and why is it more painful or dangerous? So
Speaker 5: what is it about kidneys where it's like, don't even
Speaker 5: think about punching me there?
Speaker 6: Huh. If you're thinking about anatomy, there's a lot of
Speaker 6: structures in that area and the kidney I think, is
Speaker 6: you know, relatively exposed in a sense, and so that's
Speaker 6: why if you do get trauma to that area. You
Speaker 6: can get you know, bruises of the kidney, just like
Speaker 6: you can of your skin. And so those are those
Speaker 6: are called contusions, and so those definitely not are not
Speaker 6: going to be good for the for the kidney moving forward.
Speaker 6: If you're causing trauma an area that has a big
Speaker 6: blood supply that can be be ruptured, that can definitely
Speaker 6: lead to some devastating effects moving forward.
Speaker 5: Harry Hudini, if you're wondering, didn't die of a kidney punch.
Speaker 5: But I did stumble upon a few newspaper articles with
Speaker 5: the titles like quote one punch killings, they happen more
Speaker 5: often than you might think, which suggests that I think
Speaker 5: about one punch killings a lot, if at all. And
Speaker 5: the moral is essentially just don't punch anyone. And if
Speaker 5: you live in Czechoslovakia and maybe you're having a flirty
Speaker 5: snowball fight with your husband, just be careful. In a
Speaker 5: twenty seventeen paper titled snowball fight an Unusual Cause of
Speaker 5: spleen Injury, doctors reported that a patient sought treatment for
Speaker 5: excruciating pain with no underlying cause, just a snowball fight
Speaker 5: with his wife five days ago, and with one leader
Speaker 5: of blood and clots in his abdomen quote spleen trauma.
Speaker 5: Suspicion was high. The patient added information about the possible trauma.
Speaker 5: It was not an ordinary snowball, the report says, but
Speaker 5: a piece of ice about forty centimeters or one point
Speaker 5: five feet long, quote, and he endured a spleen removal,
Speaker 5: but doctors did not note the prognosis of his relationship,
Speaker 5: so amateur or professional and just lay off the organs.
Speaker 5: I didn't know that in boxing, because I don't watch
Speaker 5: a lot of boxing, but like, it's just funny that
Speaker 5: it's like you can absolutely bust open each other's faces
Speaker 5: and eyes but leave the kidneys alone.
Speaker 6: The other cool thing, though, is that patients often will
Speaker 6: say that, you know, my kidney's hurt, which is really
Speaker 6: interesting because the kidneys are actually not innervated by any nerves,
Speaker 6: and so we actually should not really feel pain there.
Speaker 6: And so the only times in my clinical practice that
Speaker 6: I've had patients that have kidney pain are in the
Speaker 6: setting of kidney stones or if they have a severe
Speaker 6: kidney infection called pileonephritis. But otherwise chronic kidney disease is
Speaker 6: painless from you know, the standpoint of you know, talking
Speaker 6: about pain from the kidney itself.
Speaker 5: I had a kidney infection once. It sent me to
Speaker 5: the hospital and I ignored it for several days because
Speaker 5: I had taken my first ever yoga class and just
Speaker 5: thought I was sore. And then I was like, this
Speaker 5: is more sore than it should be. But I was like,
Speaker 5: I don't know how yoga works.
Speaker 6: It sounds sounds very bad.
Speaker 5: Yeah, it was not fun. So pain receptors in parts
Speaker 5: of your upper p tubes and where the kidney attaches
Speaker 5: to arteries can get inflamed and painful.
Speaker 6: Though.
Speaker 5: And also, no matter how many hours you're working in
Speaker 5: a week, never deal with a uti with just cranberry
Speaker 5: pills because you don't have time to go to the doctor.
Speaker 5: You will end up at the doctor and it might
Speaker 5: cost four thousand dollars because of your high deductible. In
Speaker 5: twenty eleven, Ali and what about an exotic disease affecting
Speaker 5: up to ten percent of unfortunate human souls. It's called
Speaker 5: nephro lithiasis, and it means there's rocks up in there.
Speaker 5: Christina Weaver says, we know soda is bad for your health,
Speaker 5: but does drinking a lot of soda increase your chance
Speaker 5: of getting kidney stones? And why are some people more
Speaker 5: susceptible to getting kidney stones and other people, And how
Speaker 5: do you prevent them from in the first place.
Speaker 6: Yeah, the kidney stones are incredibly interesting and also another
Speaker 6: area where we collaborate a lot with our urology colleagues.
Speaker 6: So there's different types of kidney stones, and so one
Speaker 6: of the first things that we try to do when
Speaker 6: someone has a kidney stone is to understand what is
Speaker 6: it made out of. And so there's different flavors that
Speaker 6: they come in, and so for example, they could be
Speaker 6: made out of something called calcium phosphate. They could be
Speaker 6: made out of calcium oxalate, They could be made out
Speaker 6: of uric acid. They could be made out of something
Speaker 6: called cysteine. And the reason that the composition is so
Speaker 6: important is that knowing what the kidney stone is made
Speaker 6: out of, that can give us a clue into why
Speaker 6: it might be forming, and then that can help us
Speaker 6: with what can we do next to prevent them. So
Speaker 6: across the board, regardless of the type of kidney stone,
Speaker 6: almost everybody would agree that more water in this situation
Speaker 6: actually is helpful. We recommend you know, at least producing
Speaker 6: two leaders of urine per day, which is a lot.
Speaker 6: And so we do actually give our patients urinals that
Speaker 6: allow them to measure the volume of urine that they're producing.
Speaker 6: And another thing that we do siphically for patients with
Speaker 6: kidney stones, particularly if they're having a lot of kidney stones,
Speaker 6: is that looking at what's in the urine can actually
Speaker 6: help us understand what is their particular risk factor for
Speaker 6: causing that stone. And so we can do a twenty
Speaker 6: four hour urine collection and then we send that to
Speaker 6: a special lab and we do certain tests and so
Speaker 6: we actually measure your in volume, We measure urine calcium,
Speaker 6: we can measure your oxalate, remember the calcium oxylate stone,
Speaker 6: and so depending on what the levels of those are, like,
Speaker 6: if a certain element is too high or too low,
Speaker 6: then we can make you know, give you their medications
Speaker 6: or dietary recommendations to try to kind of help lower
Speaker 6: or increase the level of that, because there are some
Speaker 6: things in the urine that if they're too low, that
Speaker 6: can actually increase your risk of forming stones. And so
Speaker 6: some of these are going to be genetic and so
Speaker 6: they may run in families and so that may also
Speaker 6: give us the clue, but sometimes they're not. And these
Speaker 6: urine studies can be really enlightening. But the first thing
Speaker 6: that we say is, you know, when we first see them,
Speaker 6: before we have any data, is needs to drink more water?
Speaker 5: Really?
Speaker 2: Yes?
Speaker 5: Oh so if you have a lot of kidney stones,
Speaker 5: like we have a listener named Sydney who's twenty six
Speaker 5: and has had seven kidney stones, and she's been told
Speaker 5: that they could be genetic, but they have more stones
Speaker 5: than the rest of their family combined. Should Sydney be
Speaker 5: drinking more water?
Speaker 6: Absolutely? I mean if first I would want to know
Speaker 6: how much urine is are they currently making and if
Speaker 6: it's below that two liter threshold, then we can try
Speaker 6: a little bit more. But the key really is knowing
Speaker 6: what is that stone made out of and what is
Speaker 6: happening in the.
Speaker 5: Urine Sydney, it's time to start peanut bucket two leaders
Speaker 5: my babies. Now, kidney stones are also called nephroliths. And
Speaker 5: what about the color of different stones? Is it like
Speaker 5: bird stones? Is it fun to celebrate? Well? According to
Speaker 5: nephrologist doctor Rajesh Shaw, a calcium oxalate stone looks single.
Speaker 5: It's small, hard, it's painful and it may cause bleeding.
Speaker 5: And then the phosphate stones are larger stones. I gather
Speaker 5: that they're smoother and that they hurt less. Uric acid
Speaker 5: stones those are multiple and small and yellowish. You can't
Speaker 5: see them an X rays, but you can feel them
Speaker 5: coming out of your p tube. So depending on what
Speaker 5: you pee out, it might look different. And if you're like, wow,
Speaker 5: such foamy p I have lately, call your doctor. That
Speaker 5: can be a sign of protein in your urine and
Speaker 5: is the signal of bigger health problems, maybe even cancer.
Speaker 5: Not to freak you out, and don't freak out if
Speaker 5: beats turn your pea pink, but also soak in blood.
Speaker 5: So just when in doubt, check it out. Oh, speaking
Speaker 5: of color.
Speaker 6: In nephrology, urine is gold and has all the answers,
Speaker 6: and so whenever we don't know what's going on, we
Speaker 6: need to look at the urine. And that's not just
Speaker 6: for kidney stones, it's really for any kind of kidney disease.
Speaker 6: And it's actually a pretty easy test that we can
Speaker 6: do routinely. But basically all you need is a urine
Speaker 6: sample and a microscope and then we can we can
Speaker 6: look for clues to tell us what's happening inside the kidney.
Speaker 5: Oh, Megan Walker wants to know what's the biggest kidney
Speaker 5: stone you've ever seen? Any whoppers?
Speaker 6: I would say anything like that's approaching the centimeter mark.
Speaker 6: That's pretty large.
Speaker 5: If you live in the US and you're like, oh
Speaker 5: big is a centimeter? It's about one third two half
Speaker 5: an inch, which is kind of like peeing out a
Speaker 5: ladybug or some rock candy the size of a ladybug?
Speaker 5: Can they be made smaller? Please? And zapping them? Can
Speaker 5: you are they zappable.
Speaker 6: So they can be zapped? And that would be so
Speaker 6: when we're talking about big kidney stones, that's when we're
Speaker 6: gonna start talking to our urologists about what can we
Speaker 6: do next? And so do they want to know zap
Speaker 6: them and make them into smaller kidney stones and maybe
Speaker 6: easier to pass or is it so big that the
Speaker 6: stone needs to be removed surgically?
Speaker 5: Oh my gosh. Patron Megan Walker said, my mom said
Speaker 5: her kidney stone was more painful than childbirth, and to
Speaker 5: be honest, y'all, that was a question on my mind. Also,
Speaker 5: do you have patients who have had kidney stones and
Speaker 5: have had children, and do they tell you which pain
Speaker 5: is worse.
Speaker 6: It's an interesting question. Now I've never asked that, and
Speaker 6: I have that information has not been shared with me.
Speaker 5: I feel like you always hear that it's on par
Speaker 5: with childbirth, or it's like the child birth of the penis,
Speaker 5: you know what I mean. Dudes who have kidney stones
Speaker 5: are like, it's supposed to hurt as much. I have
Speaker 5: never had a kidney stone or baby, so I'm just
Speaker 5: curious theame over here.
Speaker 6: Yeah, kidney stone and pregnancy naive.
Speaker 5: So yeah, maybe I'll take a Twitter pol if anyone's
Speaker 5: had both. Okay, I took a Twitter pole. So twelve
Speaker 5: thousand and seventy seven people responded. Three hundred and fourteen
Speaker 5: said that birthing hurt worse than kidney stones, but three
Speaker 5: hundred and ninety eight said the kidney stones hurt worse.
Speaker 5: Eleven three hundred and fifty two chose the third option,
Speaker 5: which was just show me the results of the people
Speaker 5: who chimed in. Holly said one hundred percent kidney stones
Speaker 5: hurt worse, and my firstborn was a no drug birth.
Speaker 5: I'd do that every day before dealing with kidney stone
Speaker 5: pain again. Hollywould have a baby every day before a
Speaker 5: kidney stone. Michelle Kelly CW says two rounds of kidney
Speaker 5: stones versus a forty hour labor with no drugs stones
Speaker 5: had worse pain. Turtle sixty three said, I had six
Speaker 5: kids and only one epidural. I would rather have all
Speaker 5: six in one day than to have another kidney stone. Well,
Speaker 5: Abayak says, the kidney stone hurts worse, for sure, but
Speaker 5: the pain has gone a lot faster. Doctor tigan Wall said,
Speaker 5: they don't give you an epidural for a kidney stone,
Speaker 5: but you also didn't have to save for the kidney
Speaker 5: stone to go to college. So Amanda Whitehead said, my
Speaker 5: mother said they were comparable, but only one had a
Speaker 5: good prize at the end. And she did not mean
Speaker 5: the stone. I mean I would keep it though you
Speaker 5: made it. It's yours, it's art.
Speaker 6: I have had patients bring me kidney stones and zip
Speaker 6: like bags, which is incredibly helpful and awesome.
Speaker 5: Do they get to keep them afterwards?
Speaker 3: Uh?
Speaker 6: Yeah, Well, we also asked them to, particularly for patients
Speaker 6: that are having you know, current episodes, to try to
Speaker 6: collect the stone at home and so we can give
Speaker 6: them some supplies to help them kind of strain them
Speaker 6: out because you know they're tiny.
Speaker 5: Yeah, ooh, relatively relatively relatively tiny. I'm sure it does
Speaker 5: not feel tiny when it's coming out of you.
Speaker 6: Definitely not. And you know, kidney and someone that has
Speaker 6: a history of kidney stones, that's an important question that
Speaker 6: we ask them as part of their pre kidney transplant
Speaker 6: evaluation because if they've had stones in the past, it's
Speaker 6: likely that they're going to form stones again. And so
Speaker 6: if I know that going in, then I want to
Speaker 6: do everything I can to try to prevent stones from
Speaker 6: forming in that transplant.
Speaker 5: So if you're like, I have a kidney to spare,
Speaker 5: I mean, it's hella stony baloney, but I kind of
Speaker 5: can't wait to get rid of this thing, to be honest,
Speaker 5: just tell the docs first and then they'll figure it out.
Speaker 5: How's that for fatherly advice? Lizzy C. First time question
Speaker 5: asker says, my dad donated a kidney to me almost
Speaker 5: twenty three years ago, and my quote new kidney is
Speaker 5: now eighty years old while I'm thirty nine. Have there
Speaker 5: been any studies on the biological age of a transplanted
Speaker 5: kidney and longevity?
Speaker 6: So I don't know about official studies that have been done,
Speaker 6: but it's definitely something that we take into consideration. And so,
Speaker 6: you know, we have to think about the donor kidney
Speaker 6: and the characteristics of that and how we're matching that
Speaker 6: with the recipient. And so if we have someone that's
Speaker 6: what we call it age mismatch, then that that kidney
Speaker 6: may may have some you know, natural wear and tear,
Speaker 6: because you know, our kidneys are not designed to last forever,
Speaker 6: and you know, over time, even patients without any clear
Speaker 6: cause of chronic kidney disease will lose some of their
Speaker 6: you know, kidney function that they were they were born with. Essentially,
Speaker 6: another important thing that we think about is there something
Speaker 6: called a size mismatch. And so you know, depending on
Speaker 6: your your ideal body weight and how tall you are,
Speaker 6: your kidney maybe maybe a different size than somebody else.
Speaker 6: And so if I'm transplanting you know, say, you know,
Speaker 6: a very tall person and they're getting a kidney from
Speaker 6: someone that's much smaller than that kidney, even though it's working,
Speaker 6: you know, the best that I can, it may not
Speaker 6: be reflected in that recipient because that recipient is just bigger.
Speaker 6: So it doesn't mean that we wouldn't do that transplant.
Speaker 6: But you know, when we're looking at measures of kidney
Speaker 6: function and that recipient and we're wondering, you know, we
Speaker 6: expect this kidney to be working a little bit better.
Speaker 6: That could be related to the size mismatch.
Speaker 5: Also, I had to google how big are kidneys, and
Speaker 5: in eaty bitty babies there are two to three inches
Speaker 5: and in adults they're about ten to eleven centimeters long
Speaker 5: or four to five inches. Also, your right kidney is
Speaker 5: usually longer than the left, So take a sip of water,
Speaker 5: give them a little pet. Good job, buddies. But before
Speaker 5: you assume that bigger is better, consider polycystic kidney disease
Speaker 5: or PKD. I did not know this until today a clock,
Speaker 5: but when cysts form in a kidney, they can get
Speaker 5: huge and be incredibly dangerous. Patron Nicole Wackery wrote in
Speaker 5: to say quote, I'm amazed at how huge some polycystic
Speaker 5: kidneys could be. I work in the or and have
Speaker 5: seen some removed that were the size of a human
Speaker 5: baby and so heavy, And I'm amazed that the person
Speaker 5: was just walking around with it inside them for so long.
Speaker 5: Now are their photos online?
Speaker 7: Yes?
Speaker 5: Did I find them?
Speaker 6: Of course?
Speaker 5: Do they look like football's bound in blood filled bubble wrap?
Speaker 5: They do? And if you have PKD and are listening,
Speaker 5: I hope your match comes along soon and you and
Speaker 5: a new kidney walk off into the sunset happily. Ever after,
Speaker 5: speaking of which we had a few people have had
Speaker 5: questions about mental health and kidneys. Chris Brewer asking kidney
Speaker 5: disease cause mental health problems and car and celestine. First
Speaker 5: time question asker says, why do some people get depression
Speaker 5: after donating a kidney? They say, I think it's called
Speaker 5: kidney depression. Have you ever heard about that?
Speaker 6: So, I've been heard about a depression after kidney donation.
Speaker 6: But you know, I'm sure it's been studied and maybe described.
Speaker 6: But there is a strong association between patients with not
Speaker 6: just chronic kidney disease or patients that are on dialysis,
Speaker 6: but anyone with chronic illness. There are significant links to
Speaker 6: depression and other mental health challenges. I'm not sure that
Speaker 6: there's been any you know, biological link between what the
Speaker 6: kidney is unable to do and the link to that,
Speaker 6: but it's it's definitely plausible.
Speaker 5: Okay, I'm looked into some studies, and one titled Depression
Speaker 5: and Kidney Transplantation in the Journal Transplantation said that end
Speaker 5: stage renal disease patients experience high levels of depression, with
Speaker 5: approximately twenty to thirty percent suffering from depressive symptoms, and
Speaker 5: post transplant can be tough because of all the physical
Speaker 5: realities of recovery and inflammation. But there are transplantation trained
Speaker 5: psychiatrists who are experts of this, and if you have
Speaker 5: any chronic illness, it's very understandable to have that affect
Speaker 5: your mental well being. So, as Raven Baxter said a
Speaker 5: few episodes ago, give yourself grace and give any sick
Speaker 5: pals some extra patients and support, and reach out to
Speaker 5: a doctor because you matter, you deserve it. This is
Speaker 5: a flim flam question. Ariel van Sant wants to know
Speaker 5: what is your reaction. When you hear talk of cleanses
Speaker 5: and detox te's, they immediately start defending the kidneys in
Speaker 5: the liver.
Speaker 6: My thought of that is, be careful. We don't always
Speaker 6: know what's in these things, and you know they're not
Speaker 6: you know, often approved by the FDA, and oftentimes it's
Speaker 6: hard to even know what's in them. We do try
Speaker 6: to tell our patients that if you are going to
Speaker 6: take something, if you can bring it into the office
Speaker 6: so we can at least see what might be on
Speaker 6: the label, even though that may not have all of
Speaker 6: the information. And just to just be very very cautious
Speaker 6: when you do those things, and if you start to
Speaker 6: not feel well, definitely stop and seek professional medical care.
Speaker 5: Good to know as long as we're talking about things
Speaker 5: to put in your mouth. A bunch of folks asked
Speaker 5: about diet and kidney function, such as Eve Ross, Juan Martin, Heineken,
Speaker 5: Chris Rosendale, first time question askers Cayugpa, Alexia Kaiger and
Speaker 5: Chris Berer asked about low carb diets, and first time
Speaker 5: question asker Jenny Peve Pellerin wrote in eating too much
Speaker 5: protein can cause kidney failure myth or reality.
Speaker 6: So with patients with normal kidney function, we don't generally
Speaker 6: think that there's any really dietary link. However, you know
Speaker 6: there are associations between other disease processes and kidney disease.
Speaker 6: So for example, if you have diabetes, particularly for a
Speaker 6: prolonged period of time that has not been controlled very well,
Speaker 6: that is definitely associated with higher incidents of kidney disease.
Speaker 6: For a low carb diet specifically, should not you know,
Speaker 6: hurt the kidneys. However, as kidney disease becomes more advanced,
Speaker 6: there is a debate about whether or not, you know,
Speaker 6: changing the protein intake could be harmful or helpful. And
Speaker 6: so again I think our best recommendation is generally everything
Speaker 6: is really kind of a patient by patient basis, and
Speaker 6: so if you are thinking about trying a diet that
Speaker 6: is going to you know, cut something out or have
Speaker 6: you take in a lot of you know, for example, protein,
Speaker 6: to discuss that with your physician.
Speaker 5: First, especially do that if you have a history of
Speaker 5: kidney stones and ps. I looked into global kidney disease
Speaker 5: rates and thought the US was going to land on
Speaker 5: top because deductibles can be brutal. Well, we don't go
Speaker 5: to the doctor unless we have to, and we feed
Speaker 5: babies pepsis and stuff. But actually, according to a twenty
Speaker 5: seventeen study, Saudi Arabia and Belgium have the highest estimated
Speaker 5: rates of chronic kidney disease prevalence twenty four percent, lowest
Speaker 5: rates seven percent South Asia eight percent. In Africa, and
Speaker 5: the US and Canada around fourteen percent. One two thousand
Speaker 5: and seven study published in the Journal of Epidemiology pointed
Speaker 5: a fizzy finger toward cola consumption, saying, quote, cola beverages
Speaker 5: in particular contain phosphoric acid and have been associated with
Speaker 5: urinary changes that promote kidney stones. So if this episode
Speaker 5: has made you fall in love with your hearty but
Speaker 5: vulnerable pee beans, just think about reducing or quitting some habits,
Speaker 5: maybe booze, smoking cola type of things, and doing all
Speaker 5: the things that we know we should do, like sleeping
Speaker 5: and hydrating. Your kidneys are gonna be so happy. And
Speaker 5: though genetics does play a role, it may not be
Speaker 5: as impactful or broad as previously thought. Amy Skinner says
Speaker 5: first time question asker, I'm an RN for thirty five years,
Speaker 5: and I want to know why, oh why do we
Speaker 5: still look at and divide GFR results based on a
Speaker 5: person's race. It seems really outdated and ridiculously racist, and
Speaker 5: I cannot believe that we still look at results this way.
Speaker 5: And Jacquelin, also first time question asker, said that I've
Speaker 5: heard that kidney failure is more common in black populations
Speaker 5: than white. Any like thoughts or any updates on that
Speaker 5: any new current research.
Speaker 6: Yeah, so a lot. We actually did a whole podcast
Speaker 6: on this a couple of months ago called race and EGFR.
Speaker 6: So there's been a lot of talk around the country
Speaker 6: about this, and you know, the use of race as
Speaker 6: a biological variable in the equations that we use to
Speaker 6: estimate GFR. Many of us believe that this is incorrect,
Speaker 6: and a lot of close analysis of the previous studies
Speaker 6: that this this came from have been thought to be
Speaker 6: be flawed and how the analysis was done, and so
Speaker 6: at several institutions, including Mount Sinai. We actually actually a
Speaker 6: couple of weeks ago that this became official. We've removed
Speaker 6: the race coefficient and so now we no longer report
Speaker 6: GFR or the glomorilar filtration rate as a black and
Speaker 6: non black. We just report one value. And so this
Speaker 6: actually started when a couple of medical students in the
Speaker 6: summer started a petition at Mound sign I to kind
Speaker 6: of address this issue and why do we do this
Speaker 6: in this way that is incorrect, And so it was
Speaker 6: signed by a thousands of people at the Mount sign
Speaker 6: A House system. I was part of a task force
Speaker 6: actually that kind of discussed the data behind this and
Speaker 6: what do we do here, and what would be the
Speaker 6: consequences of removing this race coefficient, and so the result
Speaker 6: of all of that was, in my opinion, at success.
Speaker 6: So we're very happy that we're kind of moving forward
Speaker 6: with this, but it really doesn't end here. I think
Speaker 6: even outside of neuprology, there's a lot of risk scores
Speaker 6: and calculations that include race as a variable and have
Speaker 6: important implications on care for different patient populations, and specifically
Speaker 6: for kidney transplant. You know, we use our cutoff for
Speaker 6: who can be listed for kidney transplant as a glomorular
Speaker 6: filtration rate of less than twenty and so if you
Speaker 6: use the quote race coefficient at the same time point
Speaker 6: a person that is black, their GFR would be a
Speaker 6: bit higher, and so that raises the possibility that we
Speaker 6: could be delaying listing for patients that are black. And
Speaker 6: so I think this is going to have important implications
Speaker 6: moving forward. And there are significant disparities and care not
Speaker 6: only in kidney transplant, but also in nephrology, and so
Speaker 6: I think this is one small step in starting to
Speaker 6: address some of these And you know, there's a lot
Speaker 6: of research being done within nephrology to understand these a
Speaker 6: bit better and to improve the care that we provide.
Speaker 5: This very important topic was discussed on her Freely Filtered
Speaker 5: podcast episode number twenty three titled Race and estimated GFR
Speaker 5: from August of twenty twenty. So it's good news that
Speaker 5: these standards are changing at last. And this question is
Speaker 5: from a longtime friend of the show. Marcie has a daughter, Emmy,
Speaker 5: and her husband Andrew donated a kidney to her.
Speaker 6: Amazing.
Speaker 5: I know, so Andrew, Marcy, I mean, Marcy wanted to ask.
Speaker 5: She's really curious about the COVID vaccine. How is the
Speaker 5: COVID vaccine or COVID affecting people with transplants or with
Speaker 5: kidney disease.
Speaker 6: Yeah, so I can't speak a lot about pediatrics. However,
Speaker 6: in our kidney transplant population, and we've done a lot
Speaker 6: of work to look at how our patients have been impacted.
Speaker 6: Has it been different, do they present differently? And so
Speaker 6: the data, you know, it's still fresh, we haven't been
Speaker 6: studying it for that long. But what we found is
Speaker 6: that they tend to present similarly. There are few symptoms
Speaker 6: that maybe are more prevalent in the in patients with
Speaker 6: kidney transplant. For example, there was one study that found
Speaker 6: that maybe patients with transplants might present more often with
Speaker 6: diarrhea than you know, respiratory symptoms, but that hasn't really
Speaker 6: been the case across the board, and in large studies
Speaker 6: looking at you know, how have patients done survival wise, again,
Speaker 6: kind of mixed data. Some studies have found that they
Speaker 6: do about the same. Some studies have found that maybe
Speaker 6: they do a little bit worse.
Speaker 5: So when it comes to the COVID nineteen vaccines, they
Speaker 5: haven't seen any significantly different adverse reactions, but definitely check
Speaker 5: in with your own doctor. But doctor Faruk mentioned that
Speaker 5: some initial studies showed that the anti rejection drugs that
Speaker 5: transplant patients take could help curb the inflammation that's dangerous
Speaker 5: in other types of SARS cove infections.
Speaker 6: And so for the majority of our patients that developed
Speaker 6: severe COVID nineteen that required hospitalization, we've really kind of
Speaker 6: minimally lowered their ammunis oppression and left the rest of
Speaker 6: it on.
Speaker 5: What about non human kidneys, I mean, I hope that's
Speaker 5: what this question is about. Patricia Hanley had a great question,
Speaker 5: is it safe to eat kidney? Knowing their function in
Speaker 5: the body seems sketchy.
Speaker 6: So I've never eaten it, but people do eat kidney
Speaker 6: from other animals. I've never done it, but people do it,
Speaker 6: and I guess it's okay.
Speaker 5: Apparently, organ meats like kidney and liver are high and
Speaker 5: iron and as one columnist on Sirius Eats opined poetically quote,
Speaker 5: there is nothing quite like them That feral taste, combined
Speaker 5: with a mouth feel not quite as tender and fatty
Speaker 5: as liver, nor as chewy as gizzards. So I guess
Speaker 5: it's not awful. Many patrons are curious about saving life,
Speaker 5: such as Beck's Woodruff kidney enthusiasts Lucy McGuffey, Mandy Wong,
Speaker 5: Rachel Weiss, Nigan Walker, first time question asker, Rebecca Small.
Speaker 5: They all wanted to know, am I going to regret this?
Speaker 5: Is it safe? So many people ask us Kiera McDonald
Speaker 5: first time question asker, and wanted to know, assuming the
Speaker 5: actual surgery and recovery goes well, how dangerous is it
Speaker 5: to donate a kidney? Are you any more likely than
Speaker 5: the average person to be in trouble later in life
Speaker 5: because you only have wood left? Can you speak to that?
Speaker 5: And what type of outreach do you try to do
Speaker 5: to encourage living donations.
Speaker 6: Yeah, thanks for asking that. So the living donation is safe.
Speaker 6: We do a lot of evaluation beforehand to ensure that
Speaker 6: our living donors are safe to donate their kidneys. And
Speaker 6: so that includes again, you know, kind of full testing
Speaker 6: similar to what the recipient would receive. So that being said,
Speaker 6: there have been studies that compare, you know, what, what
Speaker 6: is the long term risk of developing end stage kidney disease.
Speaker 6: And so if you compare patients that donate their kidney
Speaker 6: to what we call a matched control, so that someone
Speaker 6: that's equally as healthy as them, there is a slightly
Speaker 6: increased risk that the donor will develop en stage kidney disease. However,
Speaker 6: if you compare them to the rest of the population,
Speaker 6: there is no increased risk. If that's yeah. So you know,
Speaker 6: if the first successful kidney transplant was actually today, in
Speaker 6: nineteen fifty four, it was in Boston, it was a
Speaker 6: transplant a twin donated to his twin.
Speaker 5: What are the odds we would talk on this day?
Speaker 5: I'm telling you it was auspicious. And of course I
Speaker 5: looked up the twins and they were Richard and Ronald Herrick,
Speaker 5: and there's a picture of them in the fifties in
Speaker 5: the hospital and they look like a pair of Dan
Speaker 5: Leavey's in gowns. And also Ology's patron and first time commenter,
Speaker 5: Kristin Herrera wrote in to say I'm going to read
Speaker 5: what they wrote. I donated a kidney to a stranger
Speaker 5: five years ago. I started a donation chain through the
Speaker 5: National Kidney Registry and ten people received kidneys because of
Speaker 5: my donation. My husband donated six months before me, and
Speaker 5: four people received kidneys because of him. I encourage everyone
Speaker 5: to look into donating. It was an amazing experience. I
Speaker 5: would do it again if I could. It's at Kidney
Speaker 5: Registry dot org. And Kristen says the surgery wasn't terrible,
Speaker 5: nor was the healing. My husband went back to work
Speaker 5: after two weeks. I went back to work after three.
Speaker 5: There's the usual don't lift anything heavy for five weeks,
Speaker 5: et cetera. It's a major abdominal surgery, of course, so
Speaker 5: you're My ledge may vary, but Kristin said it was
Speaker 5: a laparoscopic surgery, so there were four small incisions and
Speaker 5: then one big one at the bikini line. Apparently in
Speaker 5: the same place where you would have a C section.
Speaker 5: Good to know, and the only expense on their part
Speaker 5: was using their sick and vacation time. And Kristin continues,
Speaker 5: my life has not changed much because of it. I
Speaker 5: have noticed zero difference in my life having one kidney
Speaker 5: versus two. The one kidney takes up the slack of
Speaker 5: the missing one. I think my remaining one gives me
Speaker 5: seventy percent function over the one hundred percent of two.
Speaker 5: And she concludes if you do end up donating, two
Speaker 5: words of advice, take the laxative when they offer it
Speaker 5: to you, and two have or borrow a car that
Speaker 5: has excellent shock absorbers for when you get driven home
Speaker 5: from the hospital, especially if there is roadwork happening nearby.
Speaker 5: So that is Kristen's experience. But yes, the first ever
Speaker 5: lasting donation was in nineteen fifty four between Rick and
Speaker 5: Ron kidney twins sharing more than just fashion choices.
Speaker 6: And that individual that donated when he was in his seventies,
Speaker 6: he went on to develop end stage kidney disease, which
Speaker 6: you know could have happened even you know, without the donation.
Speaker 6: And so in general it's a very safe procedure. We
Speaker 6: don't see significantly increase risk. But then the question always
Speaker 6: comes up, you know, why do we evolutionarily have two kidneys?
Speaker 6: But all the studies that we've done so far do
Speaker 6: suggest that living donation is safe, and so what do
Speaker 6: we do for outreach? We try to empower our patients
Speaker 6: as best as we can to try to help them
Speaker 6: find donors within their existing communities, and so at Mount
Speaker 6: Sinai we have a program actually called the Kidney Coach program,
Speaker 6: and it's for patients that are on the waitlist that
Speaker 6: currently do not have a living donor, and we help them,
Speaker 6: I identify someone within their circle already who's like an
Speaker 6: advocate or can be an advocate for them, and then
Speaker 6: they come to a few meetings where they're basically educated
Speaker 6: about different strategies about how they might be able to
Speaker 6: reach out. You know, they might be given some language
Speaker 6: that they can use to start to talk about their
Speaker 6: disease if they've never done that before. And the end
Speaker 6: goal of that is to help them find someone that
Speaker 6: can be a living donor for them. And what we
Speaker 6: try to avoid is that we don't want, you know,
Speaker 6: individuals using social media to just find any stranger to
Speaker 6: donate and we find that people actually more likely to
Speaker 6: donate when they know the person that they're donating to.
Speaker 5: Take Selena Gomez and her best friend and Grownish actress
Speaker 5: Francia Raisa, and though it's rumored that the two had
Speaker 5: a falling out afterward, they are supposedly pals again, which
Speaker 5: helped my heart. And they also have matching tattoos, which
Speaker 5: I'm going to guess Selena probably picked up the tab for.
Speaker 5: So if you want a free tattoo, maybe, And if
Speaker 5: you're considering kidney donation or you have done it, there
Speaker 5: are groups and message boards where you can make new
Speaker 5: friends and ask questions, like at Living donors Online dot org.
Speaker 6: And there's another program through the National Kidney Foundation called
Speaker 6: the Big Ask, Big Give, which is a national campaign
Speaker 6: to try to raise awareness about living kidney donation.
Speaker 5: I think probably getting people over the fear that, oh no,
Speaker 5: what if I need that later? I guess it's probably
Speaker 5: the biggest challenge mm hm.
Speaker 6: Definitely if patients with that donate their kidney do develop
Speaker 6: and sage kenney disease for some reason, then they actually
Speaker 6: they would go to the top of the list essentially.
Speaker 5: Oh good, Oh that's good to know. Like you have
Speaker 5: a like a little VIP.
Speaker 6: Yeah, it's it's like a safety net.
Speaker 5: Yeah. And last questions, I always ask everyologist what sucks?
Speaker 5: What's the shittiest thing about your job? What sucks? What's frustrating?
Speaker 5: Is it the gallons of pe people have to bring
Speaker 5: in for a twenty four hour collection? Is it meetings?
Speaker 6: I think for me not to get too emotional, is
Speaker 6: that not being able to help all of our patients
Speaker 6: on dialysis come off of dialysis. I mean, there's many
Speaker 6: reasons why we can't do that. And you know, another
Speaker 6: important issue that's important to me is that, you know,
Speaker 6: we for patients that in New York, for example, have
Speaker 6: emergency Medicaid that really only allows them to have coverage
Speaker 6: for their dialysis. It's very hard for us to get
Speaker 6: them the coverage that they need to not only get
Speaker 6: through the kidney transplant procedure, but also to get coverage
Speaker 6: for their medications afterwards. And so I think that's really
Speaker 6: really hard when we do have this treatment that we
Speaker 6: know can be successful, and that's not something that we
Speaker 6: can provide to everyone. And so I think a lot
Speaker 6: of what I do in my work is try to
Speaker 6: think about how we can kind of do that better.
Speaker 6: And yeah, I think that's that's for me, the worst part.
Speaker 6: And I think even as you know, not thinking about transplant,
Speaker 6: we don't have a cure for kind of kidney disease
Speaker 6: and that really sucks. And a lot of research is
Speaker 6: being done to try to try to figure this out
Speaker 6: and to try to better under stand like, what is
Speaker 6: that process that happens during the scarring? Are there ways
Speaker 6: that we can reverse that, Are there ways that we
Speaker 6: can slow that because right now, unfortunately, you know, with
Speaker 6: the exception of a few diseases that do have some
Speaker 6: some targeted treatment, a lot of what we do, unfortunately
Speaker 6: is kind of watch and wait. And we have a
Speaker 6: couple of drugs that we can use, and in the
Speaker 6: last year, we've had a really huge drug that was
Speaker 6: approved for us. It's called the SGL two inhibitors. There
Speaker 6: sodium glucose transport two inhibitors that have shown a lot
Speaker 6: of improvement. But we haven't had a drug like that
Speaker 6: in a long time, and so I think there's some
Speaker 6: kind of excitement in the field that we finally have
Speaker 6: something that can potentially help because before that we were
Speaker 6: just really providing supportive care and trying to help patients
Speaker 6: prepare for dialysis and kidney transplant. And that's not fun
Speaker 6: when you can't can't really kind of stop what's happening.
Speaker 5: Just minor annoyances, you know, like healthcare not really being
Speaker 5: a human right and letting people die as a for
Speaker 5: profit business just kind of petty. Do you think that
Speaker 5: recruiting more people to the cool table, the nerd table
Speaker 5: will increase survival and treatment options in the future.
Speaker 6: Yeah, I hope so. And you know that my passion
Speaker 6: is actually in medical education and kind of doing exactly that.
Speaker 6: And unfortunately the nephrology has has struggled a bit in
Speaker 6: the in the recent few years with interest in the
Speaker 6: field people that are applying to be a nephrologist. And
Speaker 6: so I think all of us are trying our best
Speaker 6: to kind of show how cool our field is and
Speaker 6: all the potential that we have and to get people
Speaker 6: excited about it. And we need, you know, people that
Speaker 6: are are are fresh and young trainees that have new
Speaker 6: ideas to to help us and to make our field
Speaker 6: and options for our patients a lot better. And so
Speaker 6: the Advancing American Kidney Health Initiative was passed recently which
Speaker 6: shone some light on kidney disease. There were some new
Speaker 6: parameters that were outlined to try to you know, improve
Speaker 6: then the number of kidney transplants, improve our organ procurement process,
Speaker 6: us to try to maximize the number of patients that
Speaker 6: are able to do dialysis at home. That's been really
Speaker 6: important for us. And the other thing actually just happened
Speaker 6: in the last couple of days was that the immuno
Speaker 6: A Bill was passed, which which allows now lifelong Medicare
Speaker 6: coverage for kidney transplant recipients to have coverage for the
Speaker 6: immuni suppressants, because before that it was only for three years.
Speaker 5: Okay, this blew my mind.
Speaker 6: And so I remember on one of my exams that
Speaker 6: I took when I was when I was in training,
Speaker 6: there was a question that said how long are kidney
Speaker 6: transplant patients medications covered by Medicare? And I couldn't believe
Speaker 6: that was a question. And the options were twelve months,
Speaker 6: twenty four months, thirty six months, forty eight months. The
Speaker 6: answer at that time was thirty six months. But now
Speaker 6: after you know, decades of advocacy that a lot of
Speaker 6: my mentors have been kind of working on since the
Speaker 6: early two thousands, it's finally a reality that these medications
Speaker 6: are going to be covered. And so I think that's
Speaker 6: that's really huge because we unfortunately have seen patients that
Speaker 6: have lost their and then then show up with with
Speaker 6: rejections of their kidney transplants.
Speaker 5: Oh my gosh. Oh it's horrible, like like you're only
Speaker 5: gonna need it for three years and then you're just
Speaker 5: suddenly gonna be like, well wean yourself off.
Speaker 6: What There's there's so many reasons why that is so wrong,
Speaker 6: and so I'm just so happy to see that that
Speaker 6: that is something that has been been changed for real.
Speaker 5: You know. What this world needs, by the way, is
Speaker 5: just like a really good rom com about some kind
Speaker 5: of kidney transplant and just just a sexy, goofy cute
Speaker 5: something to do with kidney transplants and then boom, before
Speaker 5: you know it the most competitive field to get into,
Speaker 5: you know.
Speaker 6: I mean, I would love to collaborate with you on
Speaker 6: that so we can combine our resources. I do want
Speaker 6: to say that I know I've spoken a lot about
Speaker 6: kidney transplant, and kidney transplant is definitely not the right
Speaker 6: treatment plan for everyone. They are definitely patients that that
Speaker 6: you know that don't want that for different reasons or
Speaker 6: that's not the best thing for them, And so I
Speaker 6: think what I want get across is that as nephrologists,
Speaker 6: we really try to do a personalized approach to care.
Speaker 6: And so whether that is home dialysis for you, whether
Speaker 6: that's kidney transplant for you, whether that is you know,
Speaker 6: more conservative care. We definitely have patients that are approaching
Speaker 6: the need for dialysis, but that's not in line with
Speaker 6: what they want. We definitely have options for them. And
Speaker 6: so I don't want to paint this as like a
Speaker 6: kidney transplant or bust because it's definitely not that.
Speaker 5: Yeah, and what about your favorite thing about what you do?
Speaker 6: It's too many My favorite thing about what I do.
Speaker 6: So I so one I love when I'm seeing patients,
Speaker 6: you know, the evening after or the morning after their
Speaker 6: their kidney transplant surgery and they ask me if they
Speaker 6: need dialysis today and I can say no. And the
Speaker 6: the other moment kind of parallel to that, is walking
Speaker 6: into the donor's room and when they ask ask us
Speaker 6: how their you know, recipient is doing, and we can
Speaker 6: and tell them that everything went really well and that
Speaker 6: they've saved that person's life. Maybe. Oh, and from a
Speaker 6: from a career standpoint, I think what I love is
Speaker 6: I love to teach, and I love to talk about
Speaker 6: nephrology and kidney transplant and transplant nephrology and to try
Speaker 6: to motivate and inspire trainees to come and join us
Speaker 6: and to show them that we have more fun than cardiologists.
Speaker 5: You have just as much heart as cardiology. And puns
Speaker 5: like her vintage pink kidney t shirt that reads You're
Speaker 5: in good hands now. For more medical attire, you can
Speaker 5: always check out iheartguts dot com, which I found out
Speaker 5: today helps you wear your heart and your goofy viscera
Speaker 5: on your sleeve. Is there if you get for clumped
Speaker 5: on the job. Is there like a stairwell that you
Speaker 5: duck into to dry your tears?
Speaker 6: Yeah, Bathroom stalls are good for that. Empty elevators are
Speaker 6: good for that. Definitely, a few stairwells that you have
Speaker 6: some favorite spots for my residency and for me, you know,
Speaker 6: you're in my cross Coulbi room is like my little
Speaker 6: safe haven.
Speaker 5: Soh my gosh, you're doing such wonderful work. Thank you
Speaker 5: so much on behalf of all of our kidneys out
Speaker 5: there and all of the kidneys who might get to
Speaker 5: live a second life in a different body. What's more
Speaker 5: exciting than that?
Speaker 6: You know, Well, thank you for having me. And you know,
Speaker 6: I have to say that the reason that I came
Speaker 6: across this was that I saw a tweet about the
Speaker 6: podcacast on nephology, but I thought it was nephrology, and
Speaker 6: so I was like, really excited, and then it wasn't
Speaker 6: and I learned a lot about clouds. But I thought that,
Speaker 6: you know, nephrology should be in the party.
Speaker 5: One hundred percent. Absolutely, So ask smart people simple questions
Speaker 5: because they just want you to sit at their cool
Speaker 5: table with them and talk about guts. So sit with
Speaker 5: doctor smir Ferruk. You can follow her on Twitter at
Speaker 5: ss Ferruk. There are links to so many things we
Speaker 5: talked about on my website at the link in the
Speaker 5: show notes, as well as links to sponsors and the
Speaker 5: cause we don't do. And also, if you're in the
Speaker 5: market for more science podcasts, you might also like my
Speaker 5: friend Wendy Zuckerman's Science Versus. We're doing a little promo
Speaker 5: swap this week and I just have to tell you
Speaker 5: that if you like wonderful questions and thorough research and
Speaker 5: just a charming Australian accent. Science Versus has you so covered.
Speaker 5: She just did an episode on Science Versus Immune boosting
Speaker 5: and then the next episode this week is all about Brudex.
Speaker 5: So if you heard Cicicdology last week and you need
Speaker 5: to know more, hit up Science Versus. She has covered
Speaker 5: everything from UFOs to sharks and is a human delight
Speaker 5: so Science Versus check them out wherever you get your
Speaker 5: podcasts and find ologies at Ologies on Twitter and Instagram.
Speaker 5: I am findable at Ali Ward on Twitter and Instagram.
Speaker 5: Thank you Aaron Telbert for adminning the Ologies podcast Facebook group.
Speaker 5: Thank you Shin and Felts and Bonnie Dutch for managing
Speaker 5: our merch which you can find at ologiesmarch dot com.
Speaker 5: Thank you to Emily White and all the folks helping me.
Speaker 5: Transcripts available and free. Those are on the website linked
Speaker 5: in the show notes, alongside free leaped kids save versions.
Speaker 5: Thank you Caleb Patten for bleeping those. Thank you Noel
Speaker 5: Dilworth for scheduling and all kinds of life help. Thanks
Speaker 5: as always to hunk Jarrett Sleeper for the assistant editing
Speaker 5: and he hosts Quarantine calistenics on Twitch every weekday morning
Speaker 5: at nine am in case you want some free exercise
Speaker 5: and want to see our garage, thanks of course to
Speaker 5: the lovely human being Stephen Ray Morris as editor on ologies.
Speaker 5: Nick Thorburn of the band Islands wrote and performed the
Speaker 5: theme music, and Islands has a new album do out soon.
Speaker 5: It's called Ilomnia and it's out on June eleventh, so
Speaker 5: get stoked for that. And if you listen to the
Speaker 5: end of the episode, I divulge a life hack or
Speaker 5: an embarrassing secret. And back when you would go to
Speaker 5: someone's house for the first time, especially obviously pre pandemic,
Speaker 5: or back when I was dating people, I would go
Speaker 5: to someone's house for the first time, and when I
Speaker 5: saw their bathroom, my little hobgoblin brain would be like,
Speaker 5: that's what they poop. They poop in that so gross,
Speaker 5: And I would be like, no, hobgoblin brain, don't think
Speaker 5: about that. And I would be like he he just
Speaker 5: did sicho. But now the problem is solved because we
Speaker 5: all just live in our own houses.
Speaker 1: Just kidding.
Speaker 5: People are getting vaccines. We got the kids. Okay, drink
Speaker 5: some water, all right, treat yourself to one of those
Speaker 5: giant chug lugger jugs with motivational sayings on them. You
Speaker 5: can do it. Kidneys are going to think you, Okay,
Speaker 5: I gotta pay for my pacodermatology, homeology, cryptozoology, lithology, new technology, meteorology, paratology, apology, ceriology, selenology.
Speaker 7: I am sick and tired of the entire Western world
Speaker 7: knowing how my kidneys are fashining.
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