On Tuesday evening, May 14, the community gathered at Congregation Etz Chaim to hear another fascinating lecture from the Navigating the Medical System Lecture Series. Bruce S. Spinowitz, MD, Internal Medicine and Nephrology at NewYork-Presbyterian Queens and Professor of Clinical Medicine at Weill Cornell Medicine, shared an in-depth, detailed lecture about the latest in kidney treatment. He began with explaining: “Not only do people not know what kidneys do, but more mysterious to them is what nephrologists do.”
He explained that nephrologists are very busy. The most common cause of kidney disease is diabetes. We still don’t have any cures. “The ultimate goal – to bring back the fibrotic process that scars the kidney – still eludes us.” He then reviewed that there are two kidneys located in your back. People can function well with only one, which is why people can donate kidneys if they are relatively healthy.
Kidneys are composed of filtering bags called nephrons. A kidney will filter 180 liters of blood per day. It reabsorbs all of your sodium and sugar. This happens in the proximal tubule. Toxins are also filtered through the kidney. Also, the kidney has some hormonal activity. Thus, the kidney is a cleansing and an endocrine organ. Kidney failure causes a buildup of toxins and loss of the two important hormones that it produces. Swelling or edema can be a sign of kidney problems. He explained how kidneys regulate the salt and water balance in the body. He then taught that potassium is an important element, and most of it is in our muscles. The amount outside of the cells is two percent. Potassium goes into the intestine and is eventually excreted by the kidney. If potassium builds up too much, it can lead to abnormal arrhythmias. He said, “We watch potassium very closely.”
He then shared information on the research front. There are two new medications that improve quality of life for patients with kidney problems. These are Lokelma and Veltassa for hyperkalemia, which are in phase three and are not available yet.They are able to have a more robust diet when on these medications. He explained that kidneys filter a lot of carbon dioxide. Kidneys dispose of acid to maintain a base level. Patients with progressive kidney failure cannot get rid of acid load, but there is a new compound being evaluated by the pharmaceutical company, Tricida; it is not yet available, but it is in phase three. It traps acid within the stomach to allow for a more normal acid-base balanced environment. This should be available in a year. He explained also that patients with kidney failure retain phosphorus. “Phosphorus goes up and then calcium goes down.” There are also two new medications, not yet available, for oxalate stones; they are also in phase three.
He pointed out that an imbalance of calcium and phosphorus can be part of the increase in cardiovascular disease that we see in kidney patients. The most accurate way to measure kidney function is to look at serum creatinine, which is a byproduct of muscles. The only way to get rid of creatinine is through the kidney. Elevated serum creatinine is a signal of kidney dysfunction. If a patient is down to ten percent kidney function, then pharmaceuticals cannot compensate.
He then spoke about kidney stones. He said that 50 percent of people who experience a kidney stone will never pass another stone. Most stones are calcium-based, and some may have uric acid. Urologists generally treat kidney stones. He said that one part of corrective therapy for kidney stones is to drink a lot of water.
Following this lecture, there was a lively Q&A session.
The evening concluded with a brief lecture from Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, on hypertension. He noted there will be a more extensive session dealing with this topic in the fall. Dr. Breite explained Hypertension 101. Normal blood pressure is 130/80. Blood pressure has two numbers: systolic and diastolic. Systolic is the pressure of the heart pumping blood out. Diastolic is resistance of blood vessels against blood going through it.
He explained how a blood pressure machine works, and he recommended to take blood pressure slowly. If you purchase an electronic blood pressure machine, you should have it calibrated in a doctor’s office. It should be checked yearly for accuracy. Ideal blood pressure is 115/75. A person with these numbers will have less chance of experiencing a stroke or a heart attack. “If your blood pressure is high, treat it. It adds years to your life.”
People with hypertension need to limit sodium, and they may need to lose weight. When you shop, check the sodium content of the product you are considering buying. If you take your blood pressure every day, you should do it at the same time of day. Hypertension is one of the most common ailments.
The next lecture will be on Tuesday, June 4, and the topic will be Infertility.
By Susie Garber