Ologies with Alie Ward - Nephrology (KIDNEYS) with Samira Farouk

Episode Date: March 10, 2021

What’s in pee? Should you donate a kidney to a stranger? Which hurts worse: childbirth or kidney stones? Why are some kidneys the size of footballs? March is World Kidney Month and before you shrug it off: 15% of adults have chronic kidney disease -- and most don’t even know it. This episode could save a life. Transplant Nephrologist Dr. Samira Farouk chats about how nephrology is for cool kids, how transplant chains work, legends about bathtubs filled with ice, how dialysis works, where nephrology ends and urology begins, how much water you should drink and why kidney punches aren’t allowed in boxing. Also: asparagus pee and #NephMadness. Follow Dr. Samira Farouk at Twitter.com/ssfarouk or @nehmadness Check out #NephMadness and nephmadness.com Interested in being a living donor? Here’s some info. A donation was made to the American Association of Kidney Patients, AAKP.org Sponsor links: www.alieward.com/ologies-sponsors More links at: http://alieward.com/ologies/nephology Become a patron of Ologies for as little as a buck a month: www.Patreon.com/ologies OlogiesMerch.com has hats, shirts, pins, totes! Follow twitter.com/ologies or instagram.com/ologies Follow Dr. Samira Farouk at Twitter.com/ssfarouk or @nehmadness Check out #NephMadness Interested in being a living donor? Here’s some info. A donation was made to the American Association of Kidney Patients, AAPK.org Sponsor links: www.alieward.com/ologies-sponsors More links at: http://alieward.com/ologies/nephology Become a patron of Ologies for as little as a buck a month: www.Patreon.com/ologies OlogiesMerch.com has hats, shirts, pins, totes! Follow twitter.com/ologies or instagram.com/ologiesSupport the show: http://Patreon.com/ologies

Oh, hey, it's that piece of gum that you managed to gnaw on through an entire movie. Allie Ward, I'm back with a very special episode celebrating March. It is the month of the kidney. Did you know that? Or maybe it's the two fortnight of each kidney, depending on how many you have. How many should you have? How many do you really need is the question. Who has the most kidneys?

We're going to get there, my little beans, but nephrology. You have not heard this one before. This is not about clouds. That was nephrology. This topic might be a little foggy for a lot of us, because how does a kidney even work? Why can we take them out of our bodies and pretty much be fine? Why does your pee smell like coffee? Nephrologist ways in.

Nephrology comes from the Greek for nephro. Thisologist and I met over a year ago via Science Twitter. She was like, really? No nephrology episodes? I was like, well, welcome to my spreadsheet of people I want to interview. She tweeted back a gif of ready when you are. So here we are. It's a year later at the start of World Kidney Month, the week of World Kidney Day.

We're doing it. We could not do it without you. So a quick thanks to everyone at patreon.com slash ologies who supports the show. It costs a dollar a month to join and you can submit your questions to the ologists. And thank you to everyone who shares this episode, especially to folks needing kidney info or maybe who are interested in donating, perhaps no pressure. I could donate a kidney and coast on that for the rest of my life. I'm honestly fine with that.

Thank you to everyone reviewing and rating the show. I read every single review and I bust out a new one as proof each week, such as this one from BKTCo who says, thanks dad, I decided to go back to graduate school for forensic anthropology solely because I started listening to ologies during a global pandemic that made me slow down for the first time in my adult life. You do brain cells with the soothing sounds of old dad word. They say, oh, I'm so proud of you. Your brain cells and your P organs, all of us, they're in for a treat.

So just in the US, just learned this, 15% of adults have chronic kidney disease. What? That's 37 million people and a lot of them don't even know. The ologist is going to tell you all about it. So she did her undergrad at Princeton University, got her MD from Rutgers University from the Robert Wood Johnson Medical School where she graduated with a distinction. Thank you very much in research. And she is an assistant professor of nephrology and medical education and the assistant director

of the nephrology fellowship program, the Mount Sinai. She is also one of the organizers of something called Neff Madness, which is like March Madness, but with different disciplines in kidney medicine as the brackets, neff madness, hashtag, check that out. She lives and breathes the beans and, well, this podcast is obviously not qualified or intended to treat or diagnose any medical condition. It is not medical advice for so many legal reasons. It does offer a wealth of info such as, where are the kidneys?

Why shouldn't you punch them? How much should I pee? How much should you pee? Shouldn't you ever drink pee? What's worse? Childbirth or kidney stones? How hard is it to get a kidney donation? Do people really wake up in ice baths, with stolen organs?

What's the most altruistic way to get a free tattoo? What bad habits do your kidneys hate? And should you invest in a motivational thermos? And more with transplant nephrologist Dr. Samira Farouk. I like to keep all the awkward bits in sometimes. If you end up confessing to something, we can cut it out. Don't worry. I appreciate that.

I'm so excited to talk to you. First thing I always have people do is if you could say your first and last name and also your pronouns. Sure. My name is Samira Farouk. My pronouns are she, her. Awesome. My pronouns are a nephrologist.

I am a nephrologist at Mount Sinai Hospital in New York City. Heard of it, heard of it. Very exciting. A lot of listeners were all very hyped about this because a lot of us have kidneys, which is crazy. Yeah. I love to talk about the kidneys. I will do it anywhere.

I'd like to get into arguments with people about which organ is the best and specifically why the kidney is better than the brain and the heart. If you want to hear those arguments, we can get into that. I love a Lincoln Douglas style debate about the brain versus the kidneys. The brain wouldn't work without the kidneys properly working. Really nothing would work without the kidneys. They're just behind the scenes doing all the work quietly. They're also the martyrs.

A lot happening that no one appreciates. We don't even have an emoji. There's a whole movement on social media to try to get a kidney emoji. We were very upset that recently a lung emoji was added. You'd think, at least it would double duty, would they put it in the food area? Would they put it in the organ area? It could be used for both. Yeah.

It could definitely be used for both. There's actually a petition that's been circulating. Serious stuff. I'm signing it. This petition is on change.org and it currently has 3,171 signatures and counting, my friends. I will link that on my website. It's one small graphic for phones, one big emotion for kidney doctors and donors and very patient patients.

I've always wondered, do kidneys look like the kidney beans? Are they the same color? Are they a completely different color palette? They are pinkish, light pinkish. I'm a transplant nephrologist, so I see patients with beef before and after kidney transplant. If you're in the OR with a kidney transplant surgeon, pre and post the kidney being hooked up, it's kind of like a whitish grayish color. Once it gets blood going into it, starts making urine, it pinks up is the term that

we use. Was there something that attracted you to this field in particular? Did you have any brushes with transplants when you were younger? Do you have kidney disease? How did you end up doing this very necessary and specialized field? I'm just going to go back to my nephrology fellowship interviews when I got asked this question. I actually wanted to be a cardiologist when I was in medical school and before that, I

had done some research in cardiology and that's kind of like the cool internal medicine specialty. I had done a little bit of research and when I was in residency, that was the plan. I'd always love nephrology because the disease processes were very complex and all the nephrologists that I met seemed like very smart people that were really great educators and they just made their very complicated topic feel easy to understand. My first interactions with dialysis in medical school, I just was not that interested. I thought it was not the right field for me.

Yeah, I'm not in duty either. But then in residency training, I had some more experiences with patients with kidney disease and kind of fell in love with it and realized that it was a topic that I loved to teach about myself when I had opportunities to do that. And then I think like anyone in medicine, mentorship was really huge for me and I got lucky to be paired up with some nephrologists at Mount Sinai that became mentors for me and kind of inducted me into their nerd club. And so I made a pretty dramatic switch from like the cool cardiologist to the nerd nephrologist.

I love that it's different tables in the cafeteria talking about medical processes. Oh yeah, we definitely have our own table. Can you explain to me what is a kidney? What is it doing? Like what's happening in these big beans in our back? Yeah, I was waiting for that question. So what do they do? So one of the words that we use when we try to describe what the kidneys do is maintain

a word called homeostasis. And so kind of what that word means simply is it kind of keeps everything the way it needs to be. So those are things like your blood levels of different things like potassium and sodium and what is the balance of water that you should have. And so, you know, everyone drinks different amounts of fluids and so how does your body know like what to get rid of and what to hold on to? There are other things like pH, like how acidic is your blood?

The kidney plays a really important role in making sure that our blood isn't, the pH isn't too low or isn't too high. When we're talking about balance of fluids and then the other category that we think about is electrolytes. And so the main ones that we talk about are things that can go wrong in patients that develop kidney disease would be problems with their sodium or their potassium levels are too high or their blood becomes a little bit too acidic. And so a lot of that work is done by the small units of the kidney that are called nephrons.

And so what happens is that the blood comes into the kidney through the artery that's called the renal artery, and that artery basically sends the blood into these smaller filtering units. And then within each of those filtering units, that's kind of where all this magic happens. And so these little units decide kind of what needs to stay in the body and what needs to leave. And so what leaves comes out as urine. Urine luck.

And then what stays goes back into our circulation and so we hold on to those things. So that's why we don't hemorrhage out fluid or blood and that's why we can kind of maintain our blood pressure and keep everything in a normal range. And so that's why you don't develop lots of fluid in your legs and other parts of your body. And if your kidneys are not working well, that's one of the signs that the kidney may not be doing what it's supposed to do. And so on top of all that, which is incredibly time consuming, I imagine, there's also hormones

that the kidneys make that manage a couple other important things. So one of those things are your blood counts. And so specifically the hemoglobin levels. So the kidney actually produces a hormone called erythropoietin, which tells your body to make red blood cells. And so when the kidneys are injured or damaged, that hormone does not get produced as well. And so another presentation of kidney disease would be low blood counts or anemia. And then another hormone or hormone pathway that the kidneys are involved with is regulation

of vitamin D and calcium and phosphorus pathways. And those are our three things that are really important for us maintaining our bone health. So to recap, your renal artery brings your dirty, dirty blood into your kidney, which has an outer skin-like thing called a cortex and an inner layer called the medulla. And it filters the blood through a million or more microscopic nephrons that have structures inside to further filter it. And then that area where the kidney kind of bunches up in the center, that's called a renal pelvis.

And your two P-tubes, if you have both of them, are your ureters, which are kind of like P-filled waterslides that lead to the splash pool of your bladder. So right now, if they're healthy, your kidneys are making sure that your electrolytes or salts like sodium and potassium are all in check. It's also making hormones to help keep your blood counts healthy, your bones strong. If they're not healthy, they're probably still working their hardest to take care of you. Have you even thanked them?

You shouldn't do that. How many symptoms do people have that they don't relate to kidney function? Is that part of what you have to do in terms of diagnosis? Do people not realize, like, oh, swollen feet has something to do with my back beans? So one of the challenges that we face as nephrologists in trying to treat patients with chronic kidney disease is that it's actually a silent disease until the very, very, very end. And so there are different stages of chronic kidney disease, and so there are stages one through five, and generally patients probably will not have any symptoms until they're at

stage five. Unfortunately, once they've reached stage five, the opportunities for treatment become much more limited because what happens with kidney injuries is that it's kind of like the skin in some ways, and that if you get a cut on your skin, it turns into a scar. So when the kidney is damaged, it's going to scar, and right now we don't really have anything to kind of reverse that scar process. And so what we really try to do is to try to have patients come and see us when they're a bit earlier in their disease process because if they come and see us stay at stage three,

for example, then we may have some room to do some treatment options that may actually slow down their progression of the disease and maybe even keep them away from that more advanced stage. And so I know if you're like me and you love to worry and just thought to yourself, what if I have stage four kidney disease and I don't even know it? I'm going to run it down for you. So the stages are based on something called an estimated glomerular filtration rate, I think, and that's how good your kidneys clean your pee and your water out of your

blood. Okay, so stage one and two, you might have high blood pressure swelling in the legs, urinary tract infections, or wonky urine tests. Stage three, you might have changes in how you pee, swelling in your hands or feet, you might be tired, you might have dry, itchy skin, back pain, some muscle cramps. Stage four, anemia, decreased appetite, abnormal levels of phosphorus or calcium or vitamin D. In stage five, you might experience fatigue, shortness of breath, nausea, vomiting, your thyroid might be wonky and swelling in your hands or legs or lower back.

And that EGFR rate is based on the levels of creatinine in your blood, which is not to be confused with creatine, which is an organic compound in protein that's used as a supplement that can bulk up your muscles, maybe enhance cognitive performance. And also I just thought maybe I should get some and put some in coffee. Anyway, that's neither here nor there. Your pee is not a pre-workout elixir, I think, either way. Are your kidneys taking out the stuff they need to take out? Can you run through some of the things that end up in pee?

I know the notion that if you're stranded and you have nothing to drink, you can drink your pee. Other people say you can't. Some people say it's sterile. What exactly is in pee? So there's actually an article about this, I think a couple years ago where someone somewhere in the UK was drinking their pee and it turned into an article. I guess it's safe to do that and we definitely don't recommend that.

What is in pee? So water, a lot of water and that water content will depend on how much water you drink and so if you're drinking a lot of water, urine might be lighter colored or even clear and if you're in a more kind of dehydrated state or not drinking water all day, your pee is going to be a little bit darker. There are some electrolytes that are in there. There might not be that much, but there might be some and so some of those would be sodium or salt, sodium chloride, potassium.

One of the quote waste products would be called urea. Okay, quick aside. So urea is a colorless, odorless, nitrogenous metabolite. It's also called carbamide and it's in pee as the result of breaking down amino acids that make up proteins, but urea also breaks down into ammonia, hence fresh versus stale pee odors. And urea is still used in just a boggling array of industrial applications. It's in moisturizers, tooth whiteners.

It's used as a cloud seeding agent to make rain and as the main hair removal chemical in there. Now, Romans were hip to pee. They knew what was up. They used to collect pee in public urinals on the street and be like, thanks for the money, folks, and then they'd sell it to launder togas and they'd also use it as mouthwash. But don't worry, we can synthesize it these days if you really want. That's something that actually increases in the blood of patients that have kidney disease

because they're not really able to get rid of that. But really not else much that's really worth mentioning. If you are stranded, can you drink your pee or will that just double toxify you? I'm going to say, don't drink your pee. Most doctors agree, do not drink your pee. You're just adding more salt to your blood that could dehydrate you faster. Also, I watched a clip of TV survivalist Bear Grylls making people sip their own wee-wee out of Nalgene bottles and one chick was just throwing it back up.

And I noped out of that video so hard I didn't need to do that to myself, neither do you in real life or on the internet. So if you're like, by the way, why is pee yellow? That is a remnant of breaking down your older red blood cells. So think about that next time you're watching yourself pee. And if yours smells like coffee, doctors say you're drinking too much coffee or just not enough water. Now, if you've never gotten the jokes about asparagus pee, you may be in the 50% of people

who genetically are not able to smell asparagusic acid, which is broken down from asparagus. If you do have musky asparagus pee and it's driving you away from this delicious vegetable, just try skipping the tips where most of the smelly compound lies and just enjoy the slimy woody stalks of asparagus, I guess, or just get some air freshener and move on. Where does nephrology end and urology begin? Is there a poison or a juncture at the bladder? Where does it stop? Yes, I love that question.

So we often incorrectly have patients that come into our offices and they would benefit a lot more from seeing a urologist. And so the way that we describe it to our patients is that we deal with the problems that are happening within the kidney. Another way to think about it is that the urologists are more kind of thinking about the plumbing and we're thinking about kind of all the really cool stuff that's happening in the kidney. And now what about bathtubs and black market organs?

No, no, no, no, no, no. Doesn't happen? So unfortunately, it happens not as much in the US, but definitely in other countries. And the kind of official term for that is transplant tourism. So definitely something that we try to try to limit and there are efforts in other countries that are trying to limit that as well. But unfortunately, we know that it happens that people are buying and selling organs. And aside from ethical problems with that, another kind of medical issue is that those

organs are not screened for infections and other things that may potentially transmit to the person who's receiving that kidney. And so it's possible that someone that buys a kidney is now going to end up with hepatitis C, for example, because we didn't know that that was present before. I do want to say that we are very excited to be in the last year or so. We've started to be able to actually transplant kidneys that do have hepatitis C virus into individuals that don't have it because we have a cure now, perhaps C. So that has really been very cool to expand our donor pool significantly.

So while the widespread threat of waking up in a bathtub of ice, missing a kidney was a late 1990s email chain urban legend, there are plenty, plenty of suspected organ harvestings on the black market, reportedly a lot from political prisoners in some countries and impoverished folks who are just lured into it for money. And in China, where living organ donors are rare, wait time for a liver or a kidney in the early 2000s at least was just a few weeks or a month as opposed to the U.S., where around 100,000 patients at a time wait years hoping for a life-saving match. Why the short wait times?

Some reports accuse the government of harvesting from prisoners. Do we have enough kidneys from living donors to get everyone who's on dialysis or who has kidney disease kind of healthy again? Is it not a matter of maybe supply but just reluctance? Yeah, that's an interesting question. We definitely, the number of living donor kidney transplants that are performed varies by institution to institution, but at most centers, the majority of transplants that are done are going to come from deceased donors or people that have agreed to be organ donors

and then their organs are donated after they pass away. And so there's a lot of reasons for why the numbers may be low for a living donation. A lot of it, I think in my opinion, is that it really takes a really concerted effort to communicate with the patient, their family, their potential individuals that may be potential living donors to find potential donors. And then there is a whole process that has to happen after that where living donors have to be screened pretty rigorously similar to the person that's going to be receiving the kidney.

And so a lot of times the conversation is hard because patients with kidney disease or any disease really may not be willing to share that with other people. And so we often see patients in our clinic that no one in their family or community knows about their kidney disease. And so it's really something that they're trying to manage on their own. And so if you're presented with that kind of situation, it can be challenging to find someone that's going to be a living donor for you. And what types of things are you looking for when you're screening for a match?

Is it just blood type or are there tissue types and sizes? Yeah. So there's two main things that we look at. And so the first thing is a blood type match. And so the different types are A, B, O, and A, B blood type. But I think what's really most important as part of the living donor evaluation process is that even if, to say, I need a kidney transplant and I have someone that's willing to donate to me, but we're two different blood type matches.

So that doesn't mean that I'm all out of the system and now I have to just get a deceased donor kidney transplant. So there is a program called the SWAT program or something called Paired Kidney Donation. And so the idea behind that is that, so say that there's another pair of people that are very similar to me. So someone else needs a kidney transplant, but they have a donor that's not a match for them, but that living donor is a match for me. And so what happens is that I get someone else's donor and then my donor donates to

this other patient and now we've both ended up with a living kidney transplant on the other side. And is that called a chain? Yep. That's the chain. It's also called Paired Donation. It's part of the National Kidney Registry program. And so sometimes we can have very, very long chains of 11 to 12 donor recipient pairs.

And so our goal is, how can we maximize patients getting that living donor kidney transplant? And that's another piece that really takes a lot of education from our end because oftentimes we see patients that you ask them in the visit, is there anyone that's a potential living donor for you? And they say no. And if we don't probe that a bit more, it could be that they do have a couple of living donors, but they've excluded them in their mind because they know that they're not a blood type match.

Got it. Have you ever seen those videos of hermit crabs exchanging shells? I have seen them. Is that what's happening with... Yeah, basically, yeah. After a close inspection, the big crab moves in. This triggers a chain reaction. Each crab hurriedly moves into the shell vacated by the crab ahead of it in the line.

It's one of the cutest things on the planet, just the idea of like, oh, I got one line up. I gotta be negative. It's like so great. The other type of match you mentioned, tissue typing, and what we're looking for is something called HLA typing that's human leukocyte antigen. And so the way that that works is that we each inherit two copies. So one from your biological mother, one from your biological father.

And so we basically look for the degree of similarity between what yours is and what your potential donors would be, but the better the match, typically, the better that that pair may do. So they go by blood type and human leukocyte antigen, which tells transplant coordinators about your immune system compatibility. Do you get to make the phone call like, hey, are you sitting? I have a kidney for you. Who gets to make that phone call?

So transplant institutes have very, very massive care teams because it's a pretty complicated process. And so we have transplant coordinators that are actually the ones that make that initial call. And so once they start that process, then there are many other individuals, including the transplant surgeons, the transplant nephrologists, and we all kind of make a decision together. For now, I'm not the one that gets to make the call. I wonder what those phone calls are like.

Do you ever hear heartwarming stories about that? Oh, yeah, especially for some of our patients that have been on dialysis for 10 years. And then we call them and say, hey, there's an organ for you. I mean, it's why I went into transplant nephrology. And when we see the patients in the hospital, in addition to the patients that are admitted for their surgeries for living donors, we also have their donors that are admitted for a day or so after their donation surgery. And it just, every time, it makes me pretty emotional to kind of interact with the donors

as well as their recipients. Do they usually know, I guess, each other or are they part of a chain or do they get to meet the person who is getting their kidney? Is there usually a bond there? So if they're not part of the paired program, then they almost always have some sort of connection to that recipient. If they don't have a connection, then you have to question a bit, what are the motives for that kidney transplant donation?

We do a lot of background work to make sure that the donor-recipient relationship makes sense to us and that there's no coercion, donors in being forced or being paid to do the donation. There are instances of altruistic donation, which basically means that you say, I want to donate your kidney and I don't know the person that it's going to, and that's a little bit less common. I haven't really been a part of that many cases like that. Oh, wow.

There actually is a really interesting podcast. I can't remember. I think it's called Two Strangers, maybe, but it basically is a series of podcasts of the journey of someone that actually did do an altruistic donation and it goes through her process kind of before the transplant and then during, and there were some interesting questions about how the altruistic donor wanted to select her recipient. And there's a lot of ethical questions there because there is already a waitlist in place. And so she kind of wanted to make her own rules about who she thought was the best recipient.

And so because this was all happening on the podcast, there was actually a lot of interaction from the podcast listeners who kind of weighed in on what their opinions were. Okay, so I looked around for this and I believe it's the podcast Strangers and it's the three part series, Elizabeth and Mary. Also Epidemiology guests, the doctors Aaron from this podcast will kill you, recently did an organ donation episode in February. And Dr. Farouk is a host on her own kidney podcast, a P-cast, if you will. It's called Freely Filtered, pun absolutely intended.

Well done. And so it's me and one, two, three, three other nephrologists and we try to meet a couple times a month and sometimes we invite guests depending on the topic and we have a good time. Okay, this is something that made me definitely want to do nephrology. One thing I feel like people were talking about a few months ago that I did not know is when you put in a kidney, you don't take out the old one. Is this true?

This is true. Yeah. That's amazing. Yeah. So the native kidneys, which is what we call them, they stay there and so the kind of classic kidney transplant is that those stay and then the new kidney comes in and there's three connections that need to be made. And so it's an artery, a vein and the ureter, which is how the urine is going to come out

and then that's it. And so there are some instances when someone's own kidneys may need to come out, but generally those are because they are causing some sort of problem. Like, for example, if someone has a disease called polycystic kidney disease, that's a disease in which the kidney basically becomes filled with these fluid filled sacs that are called cysts and the kidneys can become very, very large. And so that would be a potential reason to remove the kidneys if those are causing symptoms for the patients.

If kidneys are becoming infected, that would be another reason to remove them. But generally those kidneys are left in because it just becomes a much more complicated surgery. Unfortunately, kidney transplants don't last forever. They probably last somewhere between 10 to 15 years, depending on the type of kidney and how other factors related to the patient. The kidney transplant will stay. And so I think the most number of kidneys that I've seen in a patient are seven. Oh, wow.

Oh my gosh, that's like a bunch of grapes. Wow. Yeah. And my surgical colleagues will say that as long as they can find a place to make those three connections, then it can happen. Oh, so wait. Okay. So the connections, are they still going to the old kidneys or they must be hooked up

to be receiving blood so that they're not just gangrenous in there. But are you, you're able to kind of splice? Is it like splicing cables? So the native kidneys and their blood supply, they're actually kind of left alone. And so the arteries and the veins are going to be connected, you know, away from, from that. Wow. Oh my gosh.

That's so interesting. Yeah, you're exactly right. The artery just needs to be connected to another artery and the vein just needs to be connected to another vein. It's a little bit more complicated that I'm sure, but I'm not a surgeon. So that's how they explain it to me. So that's how I, that's how I explain it. Wow.

That's amazing. That's such good. Two truths and a lie fodder. If you wanted to say like one truth is I have seven kidneys, no one would believe me. Okay. I'm talking to you, Dutch schoolteacher Bjorn van Ampel, who has received the Guinness Book of World Records highest number of kidney transplants at seven, the last of which was from his sister, a living donor.

And I'm happy to report that with persistent Googling, I discovered that Bjorn is doing very well, 41 years old now, married to a wonderful woman who also had a kidney transplant as a child. They recently had a baby against a lot of odds. And he has written a heartwarming book about his experience called Psy of Enlightenment. And yes, I will link the book on my website in case you want to purchase it for March 12th World Kidney Day. Because there are so many people out there who need spare kidneys or who maybe are packing

a few extra. That is so fascinating. And I've always wondered too, how does dialysis essentially work? Does it reroute your blood, clean your blood through machinery and then bring it back as a kidney one? Yeah. Yeah, basically. So I think an important thing about dialysis that we try to emphasize is that the dialysis,

one, it doesn't fix the kidneys, and two, it only replaces a fraction of what the kidney is doing. And so again, the kidney does a ton of stuff. And dialysis is basically going to do two main things. One is to try to restore some of the balance of some of those electrolytes. And so it's going to get rid of the, quote, bad stuff that the kidney cannot get rid of on its own. And the second thing is to try to maintain your fluid balance.

And so again, if you have kidney disease, you're not making any urine. If you don't have any way to remove that fluid, you're essentially going to kind of keep becoming more and more swollen. And so what the dialysis treatments do is provide a way to kind of remove some of that fluid and to get rid of some of that bad stuff. And so one of the important things that the dialysis removes is potassium. And why do we, as nephrologists, care so much about potassium if the potassium levels become too high, that can be very dangerous for the heart and cause abnormal and potentially

life-threatening arrhythmias. And so the dialysis importantly takes care of that and also removes a few other what we would call toxins. There's two different types of dialysis I should also mention. So one is done through the blood. That's probably the more common one in the United States and that's called hemodialysis. And so that the blood is directly being removed. And so the blood is removed, goes through the filter, the bad things are removed, some

fluid is removed, and then the clean blood is returned. And that goes on for about three, three and a half hours. And the patients generally do that three times a week. And that can be done in like a clinic type setting. So that would be called a dialysis unit. But that can actually also be done at home. It's something called home hemodialysis. And so patients that are able to kind of manage that can do the treatments at home.

To be able to DIY it at home seems like something that 50 years ago couldn't even be imagined. I feel like. Yeah. It's really amazing what the patients can do at home. And for many patients, I think that can really be changing for their quality of life as well. So I looked up a hemodialysis machine and they're about the size of a large nightstand or maybe like a speaking podium or a slot machine. But I imagine less loud and blinky.

And Dr. Farouk says the type of dialysis that's right really depends on the patient because there's hemodialysis, which goes straight for the blood, but then there's another flavor too. And the other type of dialysis is called peritoneal dialysis. It's a bit different because it doesn't require needles or accessing the blood. And so how that works is there's a plastic catheter that's placed in the abdomen and it sits in the peritoneal space. So it's like between your organs and your abdominal wall.

Basically that space between is used as the cleaning filter. And so for patients that are on peritoneal dialysis, they are able to put fluid through the catheter into that space in the abdomen and that fluid sits in there for four to six hours and that's when the dialysis is quote happening. And then they can drain that fluid and then they can put in new fluid again. And there are actually machines that can do this for them overnight while they're sleeping. And so that can be really awesome because in the dialysis happens at night when they're asleep and then during the daytime, there's nothing for them to worry about.

That's got to be a quality of life upgrade too. Yeah. I have so many questions from listeners. Is it okay to rapid fire you? Yeah, yeah. I'll try my best. Like a lightning round. We'll do like lightning round.

Okay. But before we zip zap through your very good questions, a quick word about ward approved sponsors of the show who let us shower a charity in a golden donation. And this week, Dr. Fruick says a donation to AAKP would be awesome and that is the American Association of Kidney Patients, which since 1969 is dedicated to improving the lives and long-term outcomes of kidney patients through education, advocacy, patient engagement, and the fostering of patient communities. And they fight for early disease detection and diagnosis, increased kidney transplantation,

patient dialysis choice, and more. And you can learn about them at aakp.org or on Twitter at Kidney Patients. And that donation was facilitated by sponsors of the show who you may hear about now. Okay. Back to your questions, which I filtered through to the best of my ability. Will Pliwa wanted to know camels and hopping mice? And I was like, what does that mean? Have you heard of how camels and hopping mice, like what their kidney deal is?

Like how can camels not drink water for a while? Yeah. So that's a really awesome question and something that I actually recently have spoken to about with my nephrology colleagues. Different animals have different abilities to what we call concentrate their urine. I think that's the easiest way to put it. And so depending on your version of the kidney, however concentrated that system can make the urine, that's kind of how much water you need to or do not need to drink, if that

makes sense. Mm-hmm. So like, for example, like as humans, like we have a certain capacity, so like we can only what's called kind of keep in a certain amount of water. And beyond that point, like we just can't do it anymore. Either gonna cry or wet my pants. And so if you're, if you're an animal that's able to just hold on to all of your water and never get rid of it, then yeah, you can go longer period of time without drinking water.

Ah, how do they do this? Okay. So they excrete less water in their wastes, solid and liquid. And if you're a camel, your humps hold fat and not water. But when you break down the fat, there's some water released. Also you can drink up to 32 gallons at a time camels. Now should we, as human beings, drink one 32nd of that in a day? Patrons Kelona Ostwald and Charlotte are both good hydrators and TBH frequent peers.

And they wanted to know if this is okay. Now what about drinking a gallon a day? You know how people are like, it's so good for your skin. Is that impossible? I actually was just talking to one of my freely filtered filtrates and I said, I'm worried she's gonna ask me how much water people should drink. So what do we tell patients that ask us this question? So we always get asked, like it makes sense that you should drink more water, right?

Because it's gonna flush out the kidney, whatever that means. And so the kidney's smarter than that. And so we can't just kind of flush it out. It's not like the heart where it's just like a pump. It's like more sophisticated. We say drink to your thirst and the kidney will figure out the rest. And so drinking too much water is probably not gonna help or hurt anything. Drinking too little water is probably for some short period of time is okay.

Because again, if your kidneys are working appropriately, it's going to be able to respond and regulate to kind of keep everything where it needs to be. Does it ever happen to you where you are dehydrated, but you don't feel thirsty and then you start drinking water and then you're like, oh, I didn't realize how thirsty I was. Why does our brain do that? Personally, yes. Yeah, that's happened to me. Sometimes I'll be like, I didn't realize that I'm like, oh, water's so good.

Why didn't I drink it for six hours? So another cool thing that's not directly related to the kidney, but kind of is that one of our mechanisms for thirst is actually your level of sodium in the blood. And so the reason we feel thirsty is that one of the reasons is that your sodium level, if it starts to go up, then that's kind of a signal to your brain that you need more water. And so for people that have what we call a normal thirst mechanism, even very small rises in your sodium will make you incredibly thirsty.

And so another way that we maintain kind of what is the normal balance or our homeostasis is by kind of responding to that thirst mechanism. Boy, these pretzels are making me thirsty. Now if you have salt cravings that shock your friends and family, that can be one symptom of Addison's disease or adrenal insufficiency alongside fatigue and skin pigment changes. The adrenal glands sit on top of your kidneys kind of like little hats or nipple tassels and they deserve their own episode. We will get to that in the future.

Now what about if you're sick and you're supposed to drink a lot of fluids? Is this because the kidneys are also germ custodians and virus cleaners? Not really. It's because you can lose fluids sweating through a fever. And also dehydration makes your thick, disgusting mucous more thick and disgusting, no offense. But before you chug a gallon of water in the span of this episode, just slow down, champ. If your electrolytes get too diluted, it can lead to hyponatremia, which makes you feel drunken and can cause a coma and even death.

So if you need to get one of those water bottles with the timestamps and the motivational benchmarks on it every hour, I will not judge you. Me and your kidneys will be very pee-roud of you. You're not flushing your money down the toilet. Let's see. Marika asked, who was Henley and how did he get the most memorable structure named after him? I mean, guessing she's talking about the loop of Henley?

Oh, no. I don't know a lot about Henley. But I do love the loop of Henley. And I think in nephrology, we like to kind of get very nerdy with how we name different things. And so I just started this nephrology mentorship program for medical students and residents that want to kind of learn a little bit more about nephrology. So it's a year-long program.

And we've broken up the trainees into different groups, and they're each named based on a different part of the kidney. And so we have actually two groups that are inspired by the loop of Henley. And so there's the ascending limb of the loop of Henley and the descending limb of the loop of Henley. And so they do different things. And so within our little mentorship program, we've had some nice kind of debate about whose group is better and whose part of the nephron is better.

You know, Ethan Patano, a listener, asked, why do several parts of the kidneys and pancreas have really weird names, like the aisles of Langerhands and Bowman's capsule? Is it just because nephrologists are cooler and more imaginative? Yeah, yeah, absolutely. And so that we kind of have our own little secret language. And so that when we have a mentorship program, we have options for how to name our groups. That's why. That's the origin of it, of course.

Henley, by the by, is Dr. Frederick Gustav Jacob Henley, a Bavarian-born doctor from the 1800s. And you have all kinds of Henley thingamabobs in your body and face, including the crypts of Henley. Those are in your eyeball area. And he was the founder of modern medicine and also a big proponent of germ theory. So a hero today, but I'm sure at least a few people back then were like, yeah, that guy with the clean shaven face and the hairy neck beard cuts up dead people all day.

And he thinks invisible animals are responsible for plagues. But he was right. And we're lucky that he was a little loopy. Melissa Wise, first time question asker, wanted to know, what is it about trauma damage to the kidneys that's so bad? You get stabbed there and almost immediately die. Why? And then we had another question.

Julie Baer said, why are kidney strikes verboten in most boxing and martial arts? Caitlin Powell said, kidney punches are illegal in boxing. And why is it more painful or dangerous? So what is it about kidneys where it's like, don't even think about punching me there. Huh. If you're thinking about anatomy, there's a lot of structures in that area. And the kidney, I think is, you know, relatively exposed in a sense. And so that's why if you do get trauma to that area, you can get, you know, bruises

of the kidney, just like you can of your skin. And so those are, those are called contusions. And so those definitely are not going to be good for the, for the kidney moving forward. If you're causing trauma, an area that has a big blood supply that can be, be ruptured. That can definitely lead to some, some devastating effects moving forward. Harry Houdini, if you're wondering, didn't die of a kidney punch, but I did stumble upon a few newspaper articles with the titles like, quote, one punch killings. They happen more often than you might think, which suggests that I think about one punch

killings a lot, if at all. And the moral is essentially just don't punch anyone. And if you live in Czechoslovakia and maybe you're having a flirty snowball fight with your husband, just be careful. In a 2017 paper titled, Snowball Fight, An Unusual Cause of Spleen Injury, doctors reported that a patient sought treatment for excruciating pain with no underlying cause, just a snowball fight with his wife five days ago. And with one liter of blood and clots in his abdomen, quote, spleen trauma

suspicion was high. The patient added information about the possible trauma. It was not an ordinary snowball, the report says. But a piece of ice about 40 centimeters or 1.5 feet long, quote, and he endured a spleen removal, but doctors did not note the prognosis of his relationship. So amateur or professional, just lay off the organs. I didn't know that in boxing because I don't watch a lot of boxing, but like, it's just funny that it's like, you can absolutely bust open each other's faces

and eyes, but leave the kidneys alone. The other, the other cool thing, though, is that patients often will say that, you know, my kidneys hurt, which is really interesting because the kidneys are actually not innervated by any nerves. And so we actually should not really feel pain there. And so the only times in my clinical practice that I've had patients that have kidney pain are in the setting of kidney stones, or if they have a severe kidney infection called pylonephritis.

But otherwise chronic kidney disease is painless from, you know, the standpoint of, you know, talking about pain from the kidney itself. I had a kidney infection once it sent me to the hospital and I ignored it for several days because I had taken my first ever yoga class and just thought I was sore and then I was like, this is more sore than it should be. But I was like, I don't know how yoga works. That sounds, sounds very bad. Yeah, it was not, not fun.

So pain receptors in parts of your upper P tubes and where the kidney attaches to arteries can get inflamed and painful, though. And also, no matter how many hours you're working in a week, never deal with the UTI with just cranberry pills because you don't have time to go to the doctor. You will end up at the doctor and it might cost $4,000 because of your high deductible in 2011, Ali. And what about an exotic disease affecting up to 10% of unfortunate human souls? It's called nephrolithiasis and it means there's rocks up in there.

Christina Weaver says, we know soda is bad for your health, but does drinking a lot of soda increase your chance of getting kidney stones and why are some people more susceptible to getting kidney stones than other people? And how do you prevent them from forming in the first place? Yeah, kidney stones are incredibly interesting. And also another area where we collaborate a lot with our urology colleagues. So there's different types of kidney stones. And so one of the first things that we try to do when someone has a kidney

stone is to understand what is it made out of? And so there's different flavors that they come in. And so, for example, they could be made out of something called calcium phosphate. They could be made out of calcium oxalate. They could be made out of uric acid. They could be made out of something called cysteine. And the reason that the composition is so important is that knowing what the kidney stone is made out of, that can give us a clue into why it might be forming.

And then that can help us with what can we do next to prevent them? So across the board, regardless of the type of kidney stone, almost everybody would agree that more water in this situation actually is helpful. We recommend, you know, at least producing two liters of urine per day, which is a lot. And so we do actually give our patients urinals that allow them to measure the volume of urine that they're producing. And another thing that we do specifically for patients with kidney stones, particularly if they're having a lot of kidney stones, is that looking at what's

in the urine can actually help us understand what is their particular risk factor for causing that stone. And so we can do a 24-hour urine collection. And then we send that to a special lab and we do certain tests. And so we actually measure urine volume. We measure urine calcium. We can measure urine oxalate. Remember the calcium oxalate stone.

And so depending on what the levels of those are, like if a certain element is too high or too low, then we can make, you know, give you their medications or dietary recommendations to try to kind of help lower or increase the level of that because there are some things in the urine that if they're too low, that can actually increase your risk of forming stones. And so some of these are going to be genetic. And so they may run in families. And so that may also give us a clue.

But sometimes they're not. And these urine studies can be really enlightening. But the first thing that we say is, you know, when we first see them before we have any data is, you need to drink more water. Really? Yes. So if you have a lot of kidney stones, like we have a listener named Sidney, who's 26 and has had seven kidney stones.

Seven? And she's been told that they could be genetic, but they have more stones than the rest of their family combined. Should Sidney be drinking more water? Absolutely. I mean, if first I would want to know how much urine is, are they currently making? And if it's below that two liter threshold, then we can try a little bit more.

But the key really is knowing what is that stone made out of and what is happening in the urine. Sidney, it's time to start peanut bucket. Two liters, my babies. Now kidney stones are also called nephroliths. And what about the color of different stones? Is it like birthstones? Is it fun to celebrate?

Well, according to nephrologist Dr. Rajesh Shah, a calcium oxalate stone looks single. It's small. It's hard. It's painful and it may cause bleeding. And then the phosphate stones are larger stones. I gather that they're smoother and that they hurt less. Uric acid stones, those are multiple and small and yellowish.

You can't see them in X-rays, but you can feel them coming out of your P-tube. So depending on what you pee out, it might look different. And if you're like, wow, such foamy pee, I have lately, call you doctor. That can be a sign of protein in your urine and is the signal of bigger health problems, maybe even cancer, not to freak you out. And don't freak out if beets turn your pee pink, but also soak in blood. So just when in doubt, check it out. Oh, speaking of color.

In nephrology, urine is gold and has all the answers. And so whenever we don't know what's going on, we need to look at the urine and that's not just for kidney stones. It's really for any kind of kidney disease. But it's actually a pretty easy test that we can do routinely. But basically all you need is a urine sample and a microscope. And then we can look for clues to tell us what's happening inside the kidney. Oh, Megan Walker wants to know what's the biggest kidney stone you've ever seen.

Any whoppers? I would say anything like that's approaching the centimeter mark, that's pretty large. If you live in the US and you're like, how big is the centimeter? It's about one third to half an inch, which is kind of like peeing out a ladybug or some rock candy the size of a ladybug. Can they be made smaller, please? And zapping them? Can you are they zappable?

So they can be zapped and that would be so when we're talking about big kidney stones, that's when we're going to start talking to our urologists about what can we do next? And so do they want to, you know, zap them and make them into smaller kidney stones that may be easier to pass? Or is it so big that the stone needs to be removed surgically? Oh, my gosh. Patron Megan Walker said my mom said her kidney stone was more painful than childbirth. And to be honest, y'all, that was a burning question on my mind also.

Do you have patients who have had kidney stones and have had children? And do they tell you which pain is worse? It's an interesting question. No, I've never asked that. And I haven't that information has not been shared with me. I feel like you always hear that it's on par with childbirth or it's like the childbirth of the penis. You know what I mean?

Do you have kidney stones or like it's supposed to hurt as much? I have never had a kidney stone or baby, so I'm just curious. Same over here. Yeah, kidney stone and pregnancy naive. So yeah, maybe I'll take a Twitter poll if anyone's had both. OK, I took a Twitter poll. So 12,077 people responded. Three hundred and fourteen said that birthing hurt worse than kidney stones.

But three hundred and ninety eight said the kidney stones hurt worse. Eleven thousand three hundred and fifty two chose the third option, which was just show me the results of the people who chimed in. Holly said one hundred percent kidney stones hurt worse. And my first born was a no drug birth. I do that every day before dealing with kidney stone pain again. Holly would have a baby every day before a kidney stone. Michelle Kelly CW says two rounds of kidney stones versus a 40 hour labor with no drugs.

Stones had worse pain. Turtle 63 said I had six kids and only one epidural. I would rather have all six in one day than to have another kidney stone. Well, a biac says the kidney stone hurts worse for sure, but the pain has gone a lot faster. Dr. Tegan Wall said they don't give you an epidural for a kidney stone, but you also don't have to save for the kidney stone to go to college. So Amanda Whitehead said my mother said

they were comparable, but only one had a good price at the end. And she did not mean the stone. I mean, I would keep it, though. You made it. It's yours. It's art. I have had patients bring me kidney stones and Ziploc bags, which is incredibly helpful and awesome. Do they get to keep them afterward? Yeah, well, we also ask them to, particularly for patients

that are having recurrent episodes to try to collect the stone at home. And so we can give them some supplies to help them kind of strain them out because, you know, they're tiny. Yeah, relatively, relatively, relatively tiny. I'm sure it does not feel tiny when it's coming out of you. Definitely not. And, you know, in kidney in someone that has a history of kidney stones, it's an important question that we ask them as part of their pre kidney

transplant evaluation, because if they have had stones in the past, it's likely that they're going to form stones again. And so if I know that going in, then I want to do everything I can to try to prevent stones from forming in that transplant. So if you're like, I have a kidney to spare. I mean, it's hella stony baloney, but I kind of can't wait to get rid of this thing, to be honest. Just tell the docs first and then they'll figure it out. How's that for fatherly advice?

Lizzie C., First Time Question Asker, says, my dad donated a kidney to me almost 23 years ago. And my, quote, new kidney is now 80 years old, while I'm 39. Have there been any studies on the biological age of a transplanted kidney and longevity? So I don't know about official studies that have been done, but it's definitely something that we take into consideration. And so, you know, we have to think about the donor kidney and the characteristics

of that and how we're matching that with the recipient. And so if we have someone that's what we call an age mismatch, then that, that kidney may, may have some, you know, natural wear and tear because, you know, our kidneys are not designed to last forever. And, you know, over time, even patients without any clear cause of chronic kidney disease will lose some of their, you know, kidney function that they were, they were born with essentially. Another important thing that we think about is there's something called a size mismatch.

And so, you know, depending on your, your ideal body weight and how tall you are, your kidney may be, may be a different size than somebody else. And so if I'm transplanting, you know, say, you know, a very tall person and they're getting a kidney from someone that's much smaller than that kidney, even though it's working, you know, the best that I can, it may not be reflected in that recipient because that recipient is just, just bigger. And so it doesn't mean that we wouldn't do that transplant, but, you know, when we're looking at measures of kidney function in that recipient,

and we're wondering, you know, we expect this kidney to be working a little bit better that could be related to the size mismatch. Also, I had to Google how big our kidneys and in itty-bitty babies, they're two to three inches. And in adults, they're about 10 to 11 centimeters long or four to five inches. Also, your right kidney is usually longer than the left. So take a sip of water, give them a little pat. Good job, buddies.

But before you assume that bigger is better, consider polycystic kidney disease or PKT. I did not know this until today o'clock. But when cysts form in a kidney, they can get huge and be incredibly dangerous. Patron Nicole Wackery wrote in to say, quote, I'm amazed at how huge some polycystic kidneys could be. I work in the OR and have seen some removed that were the size of a human baby and so heavy.

And I'm amazed that the person was just walking around with it inside them for so long. Now, are there photos online? Yes. Did I find them? Of course. Do they look like footballs bound in blood filled bubble wrap? They do. And if you have PKD and are listening, I hope your match comes along soon. And you and a new kidney walk off into the sunset happily ever after. Speaking of which, we had a few people who had questions about mental health and kidney.

Is Chris Brewer asking kidney disease caused mental health problems? And Karin Celestine, first time question asker says, why do some people get depression after donating a kidney? They say, I think it's called kidney depression. Have you ever heard about that? So I haven't heard about a depression after kidney donation, but, you know, I'm sure it's been studied and maybe described. But there is a strong association between patients with not just chronic kidney

disease or patients that are on dialysis, but anyone with chronic illness. There are significant links to depression and other mental health challenges. I'm not sure that there's been any, you know, biological link between what the kidney is unable to do and the link to that. But it's definitely plausible. OK, I looked into some studies and one titled depression and kidney transplantation in the journal Transplantation said that end stage renal disease patients experience high levels of depression with approximately 20 to 30

percent suffering from depressive symptoms and post transplant can be tough because of all the physical realities of recovery and inflammation. But there are transplantation trained psychiatrists who are experts of this. And if you have any chronic illness, it's very understandable to have that affect your mental well-being. So as Raven Baxter said a few episodes ago, give yourself grace and give any sick pals some extra patience and support and reach out to a doctor. Because you matter, you deserve it.

This is a flim flam question. Ariel Vansant wants to know, what is your reaction when you hear talk of cleanses and detox teas, they immediately start defending the kidneys and the liver? And my thought of that is be careful. We don't always know what's what's in these things. And, you know, they're not, you know, often approved by the FDA. And oftentimes it's hard to even know what's in them. We do try to tell our patients that if you're you are going to take something,

if you can bring it into the office, so we can at least see what might be on the label, even though that may not have all of the information. And just to just be very, very cautious when you when you do those things. And if you start to not feel well, definitely stop and seek professional medical care. Good to know. As long as we're talking about things to put in your mouth, a bunch of folks asked about diet and kidney function, such as Eve Ross, Juan Martin Heineken, Chris Rosendale, first time question askers,

Kayugpa, Alexia Keiger, and Chris Brewer asked about low carb diets. And first time question asker, Genevieve Pellerin, wrote in eating too much protein can cause kidney failure, myth or reality. So with patients with normal kidney function, we don't generally think that there's any really dietary link. However, you know, there are associations between other other disease processes and kidney disease. So for example, if you have diabetes, particularly for a prolonged period of time

that has not been controlled very well, that is definitely associated with higher incidence of kidney disease. For a low carb diet specifically should not, you know, hurt the kidneys. However, as kidney disease becomes more advanced, there is a debate about whether or not, you know, changing the protein intake could be harmful or helpful. And so again, I think our best recommendation is generally everything is really kind of a patient by patient basis. And so if you are thinking about trying a diet that is going to, you know,

cut something out or have you take in a lot of, you know, for example, protein to discuss that with your physician first. Especially do that if you have a history of kidney stones. And PS, I looked into global kidney disease rates and thought the US was going to land on top because deductibles can be brutal. We don't go to the doctor unless we have to. And we feed babies, pepsis and stuff. But actually, according to a 2017 study, Saudi Arabia and Belgium have

the highest estimated rates of chronic kidney disease prevalence. Twenty four percent lowest rates, seven percent. South Asia, eight percent in Africa and the US and Canada are around 14 percent. One 2007 study published in the Journal of Epidemiology pointed a fizzy finger toward cola consumption, saying, quote, cola beverages in particular contain phosphoric acid and have been associated with urinary changes that promote kidney stones. So if this episode has made you fall in love with your hearty but vulnerable pee beans, just think about reducing or quitting some habits, maybe booze,

smoking, cola type of things and doing all the things that we know we should do like sleeping and hydrating. Your kidneys are going to be so happy. And though genetics does play a role, it may not be as impactful or broad as previously thought. Amy Skinner says, first time question, ask her, I'm an RN for 35 years and I want to know why or why do we still look at and divide GFR results based on a person's race? It seems really outdated and ridiculously racist.

And I cannot believe that we still look at results this way. And Jacqueline, also first time question, ask her, said that I've heard that kidney failure is more common in black populations than white. Any thoughts or any updates on that? Any new current research? Yeah, so a lot. We actually did a whole podcast on this a couple of months ago called Race and EGFR. So there's been a lot of talk around the country about this and the use of race

as a biological variable in the equations that we use to estimate GFR. Many of us believe that this is incorrect. And a lot of close analysis of the previous studies that this came from have been thought to be flawed in how the analysis was done. And so at several institutions, including Mount Sinai, we actually a couple weeks ago, this became official, we've removed the race coefficient. And so now we no longer report GFR or the glomerular filtration rate as a black and non-black, we just report one value.

And so this actually started when a couple of medical students in the summer started a petition at Mount Sinai to kind of address this issue. And why do we do this in this way that that is incorrect? And so it was signed by thousands of people at the Mount Sinai Health System. I was part of a task force, actually, that kind of discussed the data behind this. And what do we do here and what would be the consequences of removing this race coefficient? And so the result of all of that was, in my opinion, a success. So we're very happy that we're kind of moving forward with this.

But it really doesn't end here. I think even outside of nephrology, there's a lot of risk scores and calculations that include race as a variable and have important implications on care for different patient populations. And specifically for kidney transplant, we use our cutoff for who can be listed for kidney transplant as a glomerular filtration rate of less than 20. And so if you use the quote race coefficient at the same time point, a person that is black, their GFR would be a bit higher.

And so so that that raises the possibility that we could be delaying listing for patients that are black. And so I think this is going to have important implications moving forward. And there are significant disparities in care, not only in kidney transplant, but also in nephrology. And so I think this is one small step in starting to address some of these. And there's a lot of research being done within nephrology to understand these a bit better and to improve the care that we provide.

This very important topic was discussed on her freely filtered podcast episode number 23 titled Race and Estimated GFR from August of 2020. So it's good news that these standards are changing at last. And this question is from a longtime friend of the show. Marcy has a daughter, Emmy, and her husband, Andrew, donated a kidney to her. Amazing. I know. So, Andrew, Marcy, Emmy, Marcy wanted to ask, she's really curious about the COVID

vaccine, how is the COVID vaccine or COVID affecting people with transplants or with kidney disease? Yeah, so I can't speak a lot about pediatrics. However, in our kidney transplant population, and we've done a lot of work to look at how our patients have been impacted, has it been different? Do they present differently? And so the data, you know, it's still fresh. We haven't been studying it for that long. But what we found is that they tend to present similarly.

There are few symptoms that maybe are more prevalent in patients with kidney transplants. For example, there was one study that found that maybe patients with transplants might present more often with diarrhea than respiratory symptoms. But that hasn't really been the case across the board. And in large studies looking at how have patients done survival wise, again, kind of mixed data, some studies have found that they do about the same. Some studies have found that maybe they do a little bit worse. So when it comes to the COVID-19 vaccines, they haven't seen any significantly different

adverse reactions, but definitely check in with your own doctor. But Dr. Farouk mentioned that some initial studies showed that the anti-rejection drugs that transplant patients take could help curb the inflammation that's dangerous in other types of SARS-CoV infections. And so for the majority of our patients that develop severe COVID-19 that that required hospitalization, we've really kind of minimally lowered their immunosuppression and left the rest of it on. What about non-human kidneys?

I mean, I hope that's what this question is about. Patricia Hanley had a great question. Is it safe to eat kidney knowing their function in the body seems sketchy? So I've never eaten it, but people do eat kidney from other animals. I've never done it, but people do it. And I guess it's OK. Apparently, organ meats like kidney and liver are high in iron and as one columnist on Sirius Eats opined poetically, quote, there is nothing quite like them.

That feral taste combined with a mouthfeel not quite as tender and fatty as liver, nor as chewiest gizzards. So I guess it's not awful. Many patrons are curious about saving life such as Bex Woodruff, kidney enthusiasts, Lucy McGuffey, Mandy Wong, Rachel Weiss, Megan Walker, first-time question asker Rebecca Small. They all wanted to know, am I going to regret this? Is it safe?

So many people ask this. Here are McDowell, first-time question asker. I wanted to know, assuming the actual surgery and recovery goes well, how dangerous is it to donate a kidney? Are you any more likely than the average person to be in trouble later in life because you only have one left? Can you speak to that and what type of outreach do you try to do to encourage living donations?

Yeah, thanks for asking that. So the living donation is safe. We do a lot of evaluation beforehand to ensure that our living donors are safe to donate their kidneys. And so that includes, again, you know, kind of full testing similar to what the recipient would receive. So that being said, there have been studies that compare, you know, what is the, what is the long-term risk of developing end-stage kidney disease?

And so if you compare patients that donate their kidney to what we call a matched control so that someone that's equally as healthy as them, there's a slightly increased risk that the donor will develop end-stage kidney disease. However, if you compare them to the rest of the population, there is no increased risk. If that, yeah. So, you know, the first successful kidney transplant was actually today in 1954. It was in Boston.

It was a transplant at a twin donated to his twin. What are the odds we would talk on this day? I'm telling you, it was auspicious. And of course, I looked up the twins and they were Richard and Ronald Herrick. And there's a picture of them in the 50s in the hospital. And they look like a pair of Dan Levy's in gowns. And also Allergy's patron and first time commenter, Kristen Herrera wrote in to say, I'm going to read what they wrote.

I donated a kidney to a stranger five years ago. I started a donation chain through the National Kidney Registry and 10 people received kidneys because of my donation. My husband donated six months before me and four people received kidneys because of him. I encourage everyone to look into donating. It was an amazing experience. I would do it again if I could. It's at KidneyRegistry.org.

And Kristen says, the surgery wasn't terrible, nor was the healing. My husband went back to work after two weeks. I went back to work after three. There's the usual don't lift anything heavy for five weeks, etc. It's a major abdominal surgery, of course, so your mileage may vary. But Kristen said it was a laparoscopic surgery. So there were four small incisions and then one big one at the bikini line, apparently in the same place where you would have a C-section.

Good to know. And the only expense on their part was using their sick and vacation time. And Kristen continues, my life has not changed much because of it. I have noticed zero difference in my life having one kidney versus two, the one kidney takes up the slack of the missing one. I think my remaining one gives me 70% function over the 100% of two. And she concludes, if you do end up donating two words of advice, take the laxative when they offer it to you and two, have or borrow a card that

has excellent shock absorbers for when you get driven home from the hospital, especially if there is road work happening nearby. So that is Kristen's experience. But yes, the first ever lasting donation was in 1954 between Rick and Ron, kidney twins, sharing more than just fashion choices. And that individual that donated when he was in his 70s, he went on to develop end-stage kidney disease, which could have happened even without the donation.

And so in general, it's a very safe procedure. We don't see significantly increased risk. But then the question always comes up, why do we evolutionarily have two kidneys? But all the studies that we've done so far do suggest that living donation is safe. And so what do we do for outreach? We try to empower our patients as best as we can to try to help them find donors within their existing communities.

And so at Mount Sinai, we have a program actually called the Kidney Coach Program. And it's for patients that are on the wait list that currently do not have a living donor and we help them identify someone within their circle already, who is like an advocate or can be an advocate for them. And then they come to a few meetings where they're basically educated about different strategies about how they might be able to reach out. You know, they might be given some language that they can use to start to talk about their disease if they've never done that before.

And the end goal of that is to help them find someone that can be a living donor for them. And what we try to avoid is that we don't want individuals using social media to just find any stranger to donate. And we find that people are actually more likely to donate when they know the person that they're donating to. Take Selena Gomez and her best friend and grown-ish actress, Francia Raisa. And though it's rumored that the two had a falling out afterward, they are supposedly pals again, which helped my heart.

And they also have matching tattoos, which I'm going to guess Selena probably picked up the tab for. So if you want a free tattoo, maybe. And if you're considering kidney donation or you have done it, there are groups and message boards where you can make new friends and ask questions like at livingdonorsonline.org. And there's another program through the National Kidney Foundation called the Big Ask, Big Give, which is a national campaign to try to raise awareness about living kidney donation.

I think probably getting people over the fear that, oh, no, what if I need that later? I guess it's probably the biggest challenge. Definitely. If patients with that donate their kidney do develop end-stage kidney disease for some reason, then they actually, they would go to the top of the list, essentially. Oh, good. Oh, that's good to know.

Like you have a little VIP. Yeah, it's like a safety net. Yeah. And last questions I always ask everyologist, what sucks? What's the shittiest thing about your job? What sucks? What's frustrating? Is it the gallons of pee people have to bring in for a 24 hour collection? Is it meetings? I think for me, not to get too emotional is that not being able to

help all of our patients on dialysis come off of dialysis. And there's many reasons why we can't do that. And another important issue that's important to me is that we, for patients that in New York, for example, have emergency Medicaid that really only allows them to have coverage for their dialysis. It's very hard for us to get them the coverage that they need to not only get through the kidney transplant procedure, but also to get coverage for their medications afterwards.

And so I think that's really, really hard when we do have this treatment that we know can be successful and that's not something that we can provide to everyone. And so I think a lot of what I do in my work is try to think about how we can kind of do that better. And yeah, I think that's for me the worst part. And I think even as not thinking about transplant, we don't have a cure for chronic kidney disease, and that really sucks. And a lot of research is being done to try to try to figure this out and to try to

better understand what is that process that happens during the scarring? Are there ways that we can reverse that? Are there ways that we can slow that? Because right now, unfortunately, with the exception of a few diseases that do have some targeted treatment, a lot of what we do, unfortunately, is kind of watch and wait, and we have a couple of drugs that we can use. And in the last year, we've had a had a really huge drug that was approved for us. It's called the SGL2 inhibitors or sodium glucose transport 2 inhibitors

that have shown a lot of improvement. But we haven't had a drug like that in a long time. And so I think there's some kind of excitement in the field that we finally have something that can potentially help. Because before that, we were just really providing supportive care and trying to help patients prepare for dialysis and kidney transplant. And that's not fun when you can't can't really kind of stop what's happening. Just minor annoyances, you know, like health care, not really being a human

right and letting people die as a for-profit business, just kind of petty. Do you think that recruiting more people to the cool table, the nerd table, will increase survival and treatment options in the future? Yeah, I hope so. And, you know, my passion is actually in medical education and kind of doing exactly that. And unfortunately, nephrology has struggled a bit in the recent few years with interest in the field, people that are applying to be nephrologists. And so I think all of us are trying our best to kind of show how cool our field is

and all the potential that we have and to get people excited about it. And we need, you know, people that are fresh and young trainees that have new ideas to help us and to make our field and options for our patients a lot better. And so the Advancing American Kidney Health Initiative was passed recently, which shown some light on kidney disease. There were some new parameters that were outlined to try to, you know, improve the number of kidney transplants, improve our organ procurement process to try to maximize the number of patients that are able to do dialysis at home.

That's been really important for us. And the other thing that actually just happened in the last couple of days was that the Immunobill was passed, which allows now lifelong Medicare coverage for kidney transplant recipients to have coverage for the immunosuppressants. Because before that, it was only for three years. OK, this blew my mind. And so I remember on one of my exams that I took when I was in training, there was a question that said, how long are kidney transplant patients

medications covered by Medicare? And I couldn't believe that that was a question. And the options were 12 months, 24 months, 36 months, 48 months. The answer at that time was 36 months. But now after, you know, decades of advocacy that a lot of my mentors have been kind of working on since the early 2000s, it's finally a reality that these medications are going to be covered. And so I think that's that's really huge because we unfortunately have seen patients

that have lost their coverage and then then show up with with rejections of their kidney transplants. Oh, my gosh, oh, it's horrible. Like, like you're only going to need it for three years. And then you're just suddenly going to be like, well, wean yourself off. What? There is there's so many reasons why that is so wrong. And so I'm just so happy to see that that is something that has been been changed. Oh, for real.

You know what this world needs, by the way, is just like a really good rom-com about some kind of kidney transplant and just just a sexy, goofy, cute, something to do with kidney transplants. And then, boom, before you know it, the most competitive field to get into, you know? I mean, I would love to collaborate with you on that. So we can combine our resources. I do want to say that I've spoken a lot about kidney transplant and kidney transplant is definitely not the right treatment plan for everyone.

They're definitely patients that that, you know, that don't want that for for different reasons or that's not the best thing for them. And so I think what I want to get across is that as nephrologists, we really try to do a personalized approach to care. And so whether that is home dialysis for you, whether that's kidney transplant for you, whether that is, you know, more conservative care, we definitely have patients that are approaching the need for dialysis, but that's not in line with what they want. We definitely have options for them.

And so I don't want to paint this as like a kidney transplant or bust because it's definitely not that. Yeah. And what about your favorite thing about what you do? It's too many. My favorite thing about what I do. So I, so one, I love when I'm seeing patients, you know, the the evening after or the morning after

their their kidney transplant surgery, and they ask me if they need dialysis today. And I can say no. And the other moment kind of parallel to that is walking into the donor's room. And when they ask ask us how their, you know, recipient is doing and we can kind of tell them that everything went really well and that they've saved that person's life, maybe. And from a career standpoint, I think what I what I love is I love to teach and I love to talk about nephrology and kidney transplant and transplant nephrology

and to try to motivate and inspire trainees to come and join us and to show them that we have more fun than cardiologists. You have just as much heart as cardiologists. And puns like her vintage pink kidney t-shirt that reads, you're in good hands. Now, for more medical attire, you can always check out iHeartGuts.com, which I found out today helps you wear your heart and your goopy viscera on your sleeve. Is that if you get for a clumped on the job,

is there like a stairwell that you duck into to dry your tears? Yeah, bathroom stalls are good for that. Empty elevators are good for that. Definitely a few stairwells that have some favorite spots for my residency. And for me, you know, your microscopy room is like my little safe haven. So my gosh, you're doing such wonderful work. Thank you so much on behalf of all of our kidneys out there and all of the kidneys who might get to live a second life in a different body.

What's more exciting than that? You know, thank you for having me. And, you know, I have to say that the reason that I came across this was that I saw a tweet about the podcast on Nephrology, but I thought it was Nephrology. And so I was really excited. And then it wasn't. And I learned a lot about clouds, but I thought that, you know, Nephrology should be in the party 100 percent.

Absolutely. So ask smart people simple questions because they just want you to sit at their cool table with them and talk about guts. So sit with Dr. Samira Farouk, you can follow her on Twitter at SS Farouk. There are links to so many things we talked about on my website at the link in the show notes, as well as links to sponsors and the cause we donated to. And also, if you're in the market for more science podcasts, you might also like

my friend Wendy Zuckerman's Science Versus. We're doing a little promo swap this week. And I just have to tell you that if you like wonderful questions and thorough research and just a charming Australian accent, Science Versus has you so covered. She just did an episode on science versus immune boosting. And then the next episode this week is all about Brutex. So if you heard Cicadology last week and you need to know more, hit up Science Versus.

She has covered everything from UFOs to sharks and is a human delight. So Science Versus, check them out wherever you get your podcasts and find allergies at oligies on Twitter and Instagram. I am findable at Ali Ward on Twitter and Instagram. Thank you, Erin Talber for admitting the oligies podcast Facebook group. Thank you, Shannon Feltes and Bonnie Dutch for managing our merch, which you can find at oligiesmerch.com. Thank you to Emily White and all the folks helping me.

Transcripts available and free. Those are on the website linked in the show notes alongside free bleeped kids. Save versions. Thank you, Kayla Patton for bleeping those. Thank you, Noel Dilworth for scheduling and all kinds of life help. Thanks as always to Hunk, Jared Sleeper for the assistant editing. And he hosts Quarantine Calisthenics on Twitch every weekday morning at 9 a.m. in case you want some free exercise and want to see our garage.

Thanks, of course, to the lovely human being Stephen Ray Morris as editor on oligies, Nick Thorburn of the band Islands wrote and performed the theme music and Islands has a new album due out soon. It's called Ilomania and it's out on June 11th, so get stoked for that. And if you listen to the end of the episode, I divulge a life hack or an embarrassing secret. And back when you would go to someone's house for the first time, especially obviously pre-pandemic or back when I was dating people, I would go to someone's house for the first time.

And when I saw their bathroom, my little hobgoblin brain would be like, that's really poop, they poop in that. So gross. And I would be like, no, hobgoblin brain. Don't think about that. And I would be like, he just did sicko. But that now the problem is solved because we all just live in our own houses. Just getting people are getting vaccines.

We got this kids. OK, drink some water. All right, treat yourself to one of those giant chug, luggard jugs with motivational sayings on them. You can do it. The kidneys are going to thank you. OK, I got to pee for my. I am sick and tired of the entire Western world.

Knowing how my kidneys are functioning.