Welcome to our second Q & A session with Dr. Yu! You’ll notice that we’ve added a cool new glossary feature to this blog.   Mouse over any underlined medical term here (and throughout the website) and you’ll see a pop-up with the definition.

By the way, this thought-provoking question comes to us from one of our Facebook followers.  Many thanks to him for suggesting it!

Q: Why isn’t there a permanent cure for Chronic Kidney Disease (CKD), since it is on a par with cancer and is very costly to treat.  What are the main obstacles to a cure?

A: What a great question!

There are both scientific and socioeconomic obstacles:

Scientific:
CKD is not a single disease, but a common disease process caused by many different underlying diseases, such as diabetes, hypertension, glomerulonephritis, etc.  By the time CKD ensues, the damage to the kidney is already done, and is very difficult to reverse.  The best that can be expected at that point is to slow down further deterioration of the kidney, for which there are, in fact, some quite effective treatments.

There is active research going on to find a cure for some of the underlying diseases, with some minor successes. For example, some patients with Type I diabetes have received pancreatic cell transplants that allow the pancreas to function normally, effectively “curing” their diabetes.  Some types of hypertension are curable and some types of glomerulonephritis can be cured with steroids and other immunosuppressant drugs.  Obviously though, there is a very long way to go!

Socioeconomic:
CKD is extremely common (more than 10% of the adult population suffers from it), but it does not have the visibility of cancer.  This is because few patients with CKD actually  die from it.  In fact, it is estimated that less than 10% ever reach end-stage kidney disease and need dialysis or a transplant.  The remaining 90+% die of cardiovascular diseases (heart attacks, heart failure, strokes).  CKD is the major risk factor in these deaths, but most people do not know to attribute them to kidney disease.  Thus, the general public is not fully aware of how common or how serious CKD is, and consequently, the amount of money available for kidney disease research is tiny compared to that devoted to cancer research.  Conclusion: we need to get the word out!

Michelle, is there any way to research how much money goes to cancer research vs kidney research in this country? I predict that the disparity will be shockingly large.

A quick search on the web turned up many articles with conflicting numbers for dollars spent on cancer research – estimates of $10 to 12 million yearly for the American Cancer Society and $5 to 6 million for the National Cancer Institute.  (This doesn’t even account for all the dollars raised by organizations devoted to specific types of cancer.) Yet, I found it very difficult to find any information on how much money is spent on kidney research.  This could have had something to do with the search terms I was using (I’ll be sure to refine them and try another web search soon), but it’s more likely evidence that Dr. Yu is right.  We really must get the word out about CKD and the need for more research!

DIARY OF A KIDNEY LOVER

This was meant to be a quick entry to share the trends – some alarming, some inspiring – I’ve been noticing lately.  Somehow it grew.  First of all, kidney disease is a worldwide problem.  It’s getting a lot of press these days, particularly in Australia, where the number of people admitted to the hospital for dialysis treatments has jumped by more than 70% in the last decade.  This may be because they have a tendency to dialyze patients very early – a practice they appear to be re-evaluating given the high cost and questionable health benefits.  But it is also an indicator that the Australian population, like ours, is getting older and more importantly, getting fatter.  You can check out the whole article here. http://www.abc.net.au/news/stories/2010/08/18/2986720.htm?section=justin

And fat naturally brings me to food.  I’ve just read a really interesting post explaining why fructose in drinks and foods is so bad for us.  I want to talk more to Dr. Yu about this, because it’s fairly technical, but it appears that fructose could greatly increase the risk of high blood pressure, diabetes and kidney disease.  At the same time I was reading this, I saw a Tweet touting the miracles of chocolate.  An American Heart Association journal stated that moderate chocolate consumption is linked to lower risks of heart failure in older and middle-aged women.  Of course, the article stressed that the benefits must be weighed against the negatives – excess calories and fat.  Right!  So when my Mom offered me some chocolates yesterday, needless to say, I passed.

Now on to the inspiring.  You probably heard that Grizz Chapman from 30 Rock had a kidney transplant recently – fantastic news!  Transplant stories just make me feel good and I have heard so many lately.  On Twitter, I came upon The Match Story, an upcoming book about one of only 2 face transplants ever.  The Match Story website has a fascinating video about a Boston Med episode based on the story (see it at http://thematchstory.com/) and the Match Story Facebook page is lovingly hosted by the wife of the man whose face was used in this amazing transplant.  Now I really want to explore the facts and history of kidney transplants with one of the USC experts I met recently and I will be reporting what I discover, either here or in our Q & A blogs.  Stay tuned!

DIARY OF A KIDNEY LOVER

This is the diary entry I didn’t want to write because I have to tell you that my Uncle Bob passed away a few weeks ago.  I have been thinking about this a lot, trying to figure out how to start this blog, how to include all the things I want to say.  I even tried writing some of this in a handmade journal in a Starbuck’s, without edits or stalling, just words and scribbles and arrows.  It helped a little, but in the end, it was time to go and the entry was not complete.  And when I left, I thought I saw my uncle sitting at a table outside.  The mind sometimes sees what it wants to see.  On the walk home, I saw three very real and very tiny lizards cross my path, felt the sun on my back and thought how beautiful the planet is.  And I thought about all the days that had led up to that one.  My uncle, a long-time diabetic and more recent kidney disease patient, had been admitted to the hospital following a stroke and heart attack – pretty typical ailments for someone afflicted with kidney disease.  Seven weeks of up and down days followed.  This, too, was probably pretty typical.  Everyone thought he was finally getting better until a series of infections took over his body.

On that walk, I didn’t want to think too much about the physical part of his illness.  I figured there would be time for that later.  I decided simply to remember my uncle.  I dug deep and realized that he and my aunt had taught me two of my most important lessons.  They made a good team, you see; she was everyone’s favorite nursery school teacher and he was a policeman with the city of LA.  Uncle Bob could be fun and he could be stern, obviously a good disciplinarian, which brings me back to my lessons.  First, don’t be a tattletale.  People don’t like tattletales and ultimately, they stop listening to your stories.  Second, don’t throw a metal toy gun at anyone’s head.  Yes, my cousin Matt made me so mad that I threw a little gun at him.  Thankfully, he was a moving target and the gun must have just grazed him, but it made him bleed.  I still remember the faces of my aunt and uncle, near tears with concern for their son.  They were gentle with me though, determined to get through.  And they taught me in the kindest way possible – through the visible love they demonstrated that day – that violence is never the answer.

I think I will end it here.  August 10 was my Uncle Bob’s birthday.  He would have been 64 today.  What an example he has been in my life!

Welcome to the first of our Q & A sessions with Alan S. L. Yu, M.D.  Dr. Yu is a practicing nephrologist as well as a professor and scientist with a lab at USC Keck School of Medicine.  Visit  http://ukrocharity.org/about-ukro/medical-scientific-advisory-board/alan-s-l-yu-md/ for more information about Dr. Yu and his research.

Q: So we decided to start with a really simple question.  Can you tell me why we have two kidneys?

A: Actually that is a great question!

Having two kidneys is not essential for adult life. Adults who donate one kidney for transplantation, or who undergo unilateral nephrectomy for some reason, live a normal lifespan and have no increased risk of complications. Thus, we assume that the reason we have two kidneys is so that there is some extra reserve of kidney mass in case we sustain some renal insult (e.g. toxic injury, or traumatic injury).

Having said that, about 1 in 1000 individuals are born with one kidney (unilateral renal agenesis). The limited data available suggest that these individuals have an increased risk of hypertension, proteinuria and focal segmental glomerulosclerosis in later life. Whether this is because of the reduced renal mass since birth, or because of some other factor is unclear.

Q: Why exactly is the kidney mass important?

A: The kidney is made up of nephrons, whose job is to filter, secrete and reabsorb solutes and water. More kidney mass = more nephrons.

So there you have it. If you have any questions or comments regarding this Q & A, please post them on our blog or on Facebook and we will get them answered. Special thanks to my friend Karen for suggesting this first question! And if you have a new question you’d like answered, just ask.  We can’t dispense medical advice, but we can certainly enlighten you on the workings of the kidney and kidney disease.

DIARY OF A KIDNEY LOVER

At a party some Sundays ago, a man I’d just met said to me, “You must love kidneys.”  No, I wasn’t slurping them up with fava beans and a nice Chianti.  (I’m a vegetarian, for the record.)  He was referring to my work – the hours I divide between UKRO and DaVita Dialysis.  “You give a lot of time to those lucky organs,” he said.  I admit that sometimes I am “all kidney all the time.”  However, I know I can do more.  And this is how I know.  I like to read the obituaries.  When I come across one eulogizing a lifelong advocate of this or a tireless activist for that, I am particularly inspired.  Here was a person who cared enough to fight for something.  I want to be that kind of person.  I think of some of the dedicated people I have known, past and present – the nurses whose compassion means everything to their patients, the researchers who light up describing the complexity of the kidney.  Dedicated people are not necessarily content.  They keep pushing themselves.  They keep asking themselves how they can do better.

So how can I do better?  How can I do more?

First, I will embrace who I am.  My name is Michelle and I am a kidney lover.  I worked as a DaVita marketing manager for just over 8 years and I continue to work for them as a graphic design consultant.  In my time there, I have guided traveling patients to dialysis centers, have organized and attended trade shows for nephrologists and patients and have worked on ads that I hope attracted a few good nurses and doctors.  For the last 6 months, I have been working with UKRO, learning more about kidney disease than ever before.  That may be because the disease is suddenly personal.  My uncle, who is diabetic, started dialysis barely a year ago.  And I know way too many diabetics who are at increased risk for kidney disease.

Second, I will raise awareness about this devastating and, in many cases, preventable disease.  I will blog about kidney disease, sharing personal stories and the latest news about research, causes, prevention, treatment, diet, whatever I see and hear.

Third, I will make a donation to UKRO.  It takes a lot of money and time to make a medical breakthrough, but it does happen.  Every dollar helps.  Small grants help researchers take their work to the next level so they can get even bigger government grants.  With more dollars come more researchers, more ideas, more approaches to a cure.

I am taking a little break from writing this blog, going to our website, clicking on the Donate Now button.

There!  It’s done.  That was easy.  I hope that you’ll join me.

Now I am ready to make it official.  I am updating my Facebook status today:  Yes, I am a kidney lover!