Chronic Kidney Disease and Autoimmune Diseases

Chronic Kidney Disease and Autoimmune Diseases

Kidney
Image courtesy of hywards at FreeDigitalPhotos.net

Chronic Kidney Disease affects thirty million people. Think about that number. It’s equivalent to 9% of the population of the United States. Many more people are at risk of developing CKD.

The causes are varied, but the leading causes are hypertension (high blood pressure) and diabetes. For those who have autoimmune diseases, the causes can range from the disease itself (for example, Lupus Nephritis), to comorbid conditions (coexisting diseases) like hypertension or diabetes to the treatment for the autoimmune disease.

Types of Kidney Disease

There are two types of kidney disease. Chronic (CKD) and Acute. In this post, we are concentrating on CKD because that type of kidney disease has long-term consequences. Acute Kidney disease is treated in a hospital setting as an emergency.

Prevention

One in three adults is at risk for developing chronic kidney disease. This insidious disease can develop without the victim realizing it. If you have diabetes or hypertension, work with your doctor to keep those diseases under good control. Hypertension or high blood pressure damages the small blood vessels in the kidneys. It’s the second leading cause of chronic kidney disease. Diabetes is the leading cause.

For those who have autoimmune diseases, limit the anti-inflammatory drugs such as naproxen, ibuprofen, etc to the prescribed amount. These drugs are eliminated through the kidneys. Overuse of the drugs can lead to CKD.

Work with your physician to identify CKD early. Have routine blood pressure, blood glucose and/or A1C testing to identify these risk factors in addition to the autoimmune disease. This can be done by urine testing for ACR (Albumin Creatinin Ration) and blood testing for GFR (glomerular filtration rate).

Symptoms of CKD

Many of the symptoms of CKD are the same as those of Autoimmune diseases so they can be easy to ignore thinking they’re part of the same stuff you deal with off and on.

The symptoms include:

Image courtesy of photostock at FreeDigitalPhotos.net
Image courtesy of photostock at FreeDigitalPhotos.net
  • Fatigue and weakness
  • Difficult and/or painful urination
  • Foamy or frothy urine 1Lupus Foundation of American – www.lupus.org
  • Pink, dark urine (this is an indication of blood in the urine)
  • Increased thirst
  • Increased need to urinate especially at night
  • Swelling – puffy eyes, swollen face, abdomen, ankles, feet
  • Unusual weight gain – related to fluid retention.2National Kidney Foundation – www.kidney.org

Lupus nephritis

Approximately 40% of those with Lupus will develop Lupus Nephritis (or glomerulonephritis). In Lupus Nephritis, the nephrons (parts of the kidney that filter the blood become inflamed and the kidneys can no longer eliminate the toxins. They begin to build up in the bloodstream. The patient begins swell or gains unexplained weight.

CKD and Heart Disease

Heart disease is very common in CKD. If you have CKD, learn about heart disease and preventing it. Many of the same diseases that cause CKD also cause heart disease.

While the link between heart and kidney disease isn’t completely clear, it has been shown that damage to either organ affects the other one. If you develop CKD, you are much more prone to developing heart disease. 3National Kidney Foundation – www.kidney.org4National Institute of Diabetes and Digestive and Kidney Diseases – www.niddk.nih.gov

Heart disease is the leading cause of death in Chronic Kidney patients at all stages. In addition to normal cardiac risk factors, those with CKD have unique risk factors.

  • Protein in the urine (proteinuria or albuminuria)
  • Elevated phosphorus levels in the blood – in CKD the body is often unable to eliminate the excess phosphorus found in some food. As this build up in the bloodstream, it can cause de-calcification of the bones and hardening of the arteries.
  • Elevated calcium levels – Calcium and parathytroid often go hand in hand. When the calcium levels are too high, it can cause calcium deposits in the arteries.
  • High levels of parathyroid hormone (PTH) – Often in CKD the parathyroid gland produces too much of the hormone and causes elevated calcium levels.
  • Electrolyte imbalances (especially potassium) – Potassium levels must be kept within strict ranges. In CKD the kidneys are often unable to eliminate excess potassium resulting hyperkalemia (elevated potassium). Hyperkalemia or hypokalemia(low potassium) can result in the cardiac arrest (heart failure).
  • Fluid overload – When the kidneys aren’t working correctly, they fail to filter and excrete excess fluid. Excess fluid in the bloodstream places extra strain on the heart and causes elevated blood pressure)
  • Anemia – When a patient is anemic, their level of red blood cells becomes low. the red blood cells carry oxygen to the various organs including the heart muscle.
  • Malnutrition
  • Inflammation 5Davita Dialysis Centers – www.davita.com
Image courtesy of cooldesign at FreeDigitalPhotos.net
Image courtesy of cooldesign at FreeDigitalPhotos.net

In conclusion:

For more information on kidney disease, please visit the National Kidney Foundation – http://www.kidney.org

The NKF has local chapters that offer free screenings and education on kidney failure. The website contains a wealth of information on kidney disease and transplantation. They offer free memberships to the organization and online communities for those on dialysis or who have been diagnosed with CKD.

The NKF also provides information on clinical trials and how to find one that might be right for you.

Your kidneys are essential to your overall health. Know your numbers: glucose, blood pressure, and glomerular filtration rate. Know the symptoms of kidney failure, and don’t assume that any symptoms you’re experiencing are caused by your autoimmune disease. The earlier you catch kidney failure, the better the outcomes.

You Know You Have a Chronic Debilitating Disease When…

You know you have a chronic, debilitating disease when…

You miss your job and grieve over having to give up your career – often when you’re quite young. Some of us spent our last days in tears because the job was so hard and painful, but we kept pushing because we’ve heard so often that people on disability are “lazy” and other hateful comments. Often from friends.

Nurse

 

You spend all of your disability check on insurance and medicines – many of people with disabilities struggle month to month because the cost of insurance, doctors, and medications bankrupt them. After two years of being disabled (according to the Social Security Administration) the person qualifies for Medicare. Medicare doesn’t pay for any medications, and the person must pay twenty percent out of pocket. Most states don’t require supplemental policies to cover the disabled. Most, however, can obtain Medicare part D to help with the cost of medications, but it’s a guessing game to figure out which policy to choose that won’t leave the person in the lurch on the cost of expensive medications.

 

Your house looks like a medical supply store – for the days when you’re having problems with your knees or hips, you have a walker or a cane. Most of us have both. Some days you chose one, and other days you must choose the other one.

 

And then there are times when neither a walker or cane is enough… Many of us have wheelchairs and electric scooters stowed somewhere. If we go anywhere that involves much walking, the cane or the walker’s just not enough. Then, when we use our scooter in places like Disney, we hear snide remarks about being lazy, because of course, we don’t “look” disabled. What does disabled even look like?

Scooter

 

We spend so much time with doctors, you’d think we would have a great relationship with them… And many of us do with some of our doctors. Two of my many doctors who listen to me and act upon what I tell them. They don’t ignore me. Unfortunately, that’s not always been the case. Before I was diagnosed (which by the way, can take YEARS because the symptoms are nonspecific and often mimic other diseases) I was told to try things like “a high protein diet” for the fatigue that I constantly complained about. It’s hard for us to trust a new doctor. If we’re told we need to see a new specialist, it strikes fear into our hearts because we recall all of the previous times when we had doctors who treated us as though we were lying. I mean who would lie about the symptoms we have?

doctor button

 

We take enough pills to choke a horse – and often times we take pills to counteract the side effects of the pills that we take for our disease. Of course, we can opt not to take the pills for our diseases, but that leads to another set of problems.

Pills

 

Many of our medications are given through an IV, or we must learn to self-inject – next time commercials for Enbrel, Humira, etc come on TV, check out the drug. The lists of side effects are endless, the method of administration isn’t fun, and they cost a small fortune.

shot

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We’ve been xrayed, MRId, and CT scanned from stem to stern…  Since most of these diseases can affect any and every part of us, we’ve been subjected to all sorts of testing. Including spinal punctures, blood tests, nerve conduction tests, etc.

hand xray

 

Nice rash! We develop very weird symptoms. Often, they stump the doctors. We have flu-like symptoms most of the time – fever sometimes as high as 102), our brains are foggy at times preventing us from making good decisions, remembering appointments, etc. We have a pervasive feeling of being unwell. Sometimes the symptoms are actually a sign of an additional disease taking up residence because autoimmune diseases like to come in groups.

rash

 

Some of the diseases affect the spine – but those of us with the diseases that “don’t” affect the spine, know better. We’ve developed multiple disc herniations, etc over the years. Recent studies have shown that we were correct all a long. Many of the Autoimmune Diseases that doctors originally told us won’t affect the spine, recent research has proven they affect the joints and the discs of the spine.

spine

And the top way to know you suffer from a chronic, debilitating disease? You wake up more tired than when you went to bed the night before. Family and friends wonder what your problems because you’re late for church, work, school, etc. Your body is so exhausted, it doesn’t want to move. You feel like you could sleep until the end of time. Then, after you’re up a while, you hit your high point which lasts a couple of hours if you’re lucky.

Tired

 

Disabled or Not? Part Two

In my last post, I discussed how someone can look fine, yet be profoundly disabled. I shared my story of living with autoimmune diseases for many years.

Church

Today, I would like to discuss what those disabilities cannot do. They cannot:

  • Steal my faith or my joy. Yes, I have days where I get down because of the changes in my life. However, I still have joy. The Bible tells us we’ll have troubles. Jesus never promised that our lives on earth would be pain-free, but He does promise to walk through the valleys with us. “I will never leave you, nor forsake you.” Since my trust is in Christ, my joy rests in him also.
  • Rob me of laughter. I choose to laugh every day. My husband cannot go a day without making a joke. Even in troubled times, we laugh together. No matter the situation, we can find a sliver of happiness and laughter.
  • Snatch love from me. I know people who’ve had spouses leave them over their diseases, and I’m not making light of that, but disabilities cannot steal the love of my family. Mostly, it cannot steal the love of my Lord. He’s promised to love me forever. In fact, “love” is one of the most used words in the Bible. Disabilities cannot steal my love for others. Jesus commanded us to love others – including our enemies. Having multiple health issues isn’t an excuse to not love others. Hurting and feeling bad doesn’t give me a pass on reaching out in love.
  • Change who I am. Health issues may change the things I can do. I may spend more time sleeping, and more time recovering from activities, but they cannot change who I am. My inner being. The part of me God created, illness cannot change.

Yes, I’ve lost much because of my chronic illnesses, but I’ve also gained much.

  • Patience – waiting for medical procedures and insurance is teaching me patience. While I’m still not nearly as patient as I should be, I’m learning.
  • Understanding – As nurse, when I first became ill, it gave me more empathy toward my patients. Now, I try to have more empathy towards those who don’t understand. When I have friends who make hurtful comments, I remind myself that they don’t understand what I’m going through. At times, my understanding flies out the window, but I’m trying to be more understanding and forgiving of others.
  • To be still. I used to stay on the go day and night. Being still was foreign to me. I didn’t know how to sit quietly and just be still. I didn’t want to be alone with my thoughts. Now, I’m learning to sit still and listen, but I’m better. God tells us to be still and listen to Him. I’m still working on sitting quietly and just listening to Him but having a chronic illness is teaching me to sit still.

I’ve been guilty of saying, “I have no life anymore.” Yet, nothing could be further from the truth. I have an incredible life. It’s changed drastically over the years, and I can no longer do many of the things I used to do, but I still have a good life.

Years ago we went on a cruise, and I chose shore excursions like climbing the Dunn’s River Falls or parasailing. ParasailingDunn's River Falls

Now, if we go on a cruise or a trip, I choose things that are easier. We took an Alaska cruise, and we didn’t go on any shore excursions. I used my scooter, and we explored the towns. While we didn’t spend long at any stop because I tire easily, we still had fun. Alaska

We spent a lot of time watching out our balcony windows and saw many beautiful sights like whales and icebergs.

IMG_1198 IMG_1648

My life has changed, but it is still a good one. God has richly blessed me in many ways. My prayer for you, if you find yourself with a chronic illness, is that you would look outside of the disabilities and see the good, beautiful parts of life that are left. The sunsets, the flowers that bloom in your neighborhood, the sound of the birds calling to each other in the trees – – find joy in the small things.

Rheumatoid Arthritis Clinical Trial

 

Rheumatoid Arthritis Clinical Trial Seeking Participants

Rheumatoid Arthritis is a chronic inflammatory disorder affecting small joints in the hands and feet that affects about 1.5 million people in the United States today.

There is a clinical study available to those with Rheumatoid Arthritis, where the purpose of the study is to compare the proposed biosimilar study drug rituximab (GP2013) against a standard approved treatment rituximab (Rituxan®) to see if the study drug is as safe and effective in treating rheumatoid arthritis.

RA Card

More about the study:

  • The study drug (GP2013 and Rituximab) is administered by IV Injection (IV).
  • At least 174 people have already taken this drug in clinical trials

If you are interested, the full study details and eligibility criteria are listed here.

Eligibility Criteria:

Participants must:

  • be at least 18 years old
  • have been diagnosed with rheumatoid arthritis for at least 6 months
  • have had inadequate response or intolerance to DMARDs (disease-modifying anti-rheumatic drugs) and 1 – 3 anti-TNF (tumor necrosis factor) therapies
  • have received methotrexate for at least 4 months with 25 mg/week as the maximal dose

Participants must not:

  • have significant liver disease, or congestive heart failure
  • be taking a high potency of opioid analgesics (e.g. methadone, hydromorphone, morphine)

Please complete the online questionnaire to check if you’re eligible for the trial.

If you’re not familiar with clinical trials, here are some FAQs:

What are clinical trials?

Clinical trials are research studies to determine whether investigational drugs or treatments are safe and effective for humans. All new investigational medications and devices must undergo several clinical trials, often involving thousands of people.

Why participate in a clinical trial?

You will have access to new investigational treatments that would be available to the general public only upon approval. You will also receive study-related medical care and attention from clinical trial staff at research facilities. Clinical trials offer hope for many people and an opportunity to help researchers find better treatments for others in the future.

“My Relationship to CureClick” (full-disclosure link): http://curec.lk/1Gb4toG

Please note: Comments are user-generated and may not be factually accurate. Please click here for information on the trial.

New Clinical Trial for RA #RA Click To Tweet

Rheumatoid Arthritis Treatments – NSAIDs

Rheumatoid Arthritis Treatments

Oral Meds

 

 

There are many different treatments for RA. Some of the more common ones include NSAIDs (non-steroidal anti-inflammatory drugs), DMARDs (disease modifying anti-rheumatic drugs), steroids,  and biologics. Today, I’m focusing on NSAIDs

Anti-inflammatory drugs include (generic names used):

  • Ibuprofen
  • Naproxen Sodium
  • Aspirin
  • Celecoxib
  • Sulindac
  • Oxaprozin
  • Salsalate
  • Diflunisal
  • Piroxicam
  • Indomethacin
  • Etodolac
  • Meloxicam
  • Naproxen
  • Nabumetone
  • Diclofenac

NSAIDs work to decrease inflammation. They can work quite well in RA and other inflammatory diseases, however, they should be used in the lowest dose possible to help decrease the risk of side effects.

Side effects of NSAIDs can include:

  • Ulcers
  • Gastrointestinal bleeding
  • Increased bleeding tendency
  • Liver and/or kidney problems
  • High blood pressure
  • Edema

If you are taking NSAIDs for RA, your doctor will want to periodically assess your liver and kidney function. This is done through blood tests and if your liver enzymes or kidney function is not within range, your physician may ask you to stop the medications.

You should report ulcers or gastrointestinal bleeding to your physician right away. Symptoms of ulcer may include stomach pain and nausea. Gastrointestinal bleeding may present with coffee ground emesis, black or tarry stools, pale skin, severe fatigue.

Please consult your physician for any concerns or before initiating NSAID therapy.


http://www.webmd.com/osteoarthritis/guide/anti-inflammatory-drugs

Harrison’s Rheumatology: Editor Anthony S. Fauci

 

Rheumatoid Arthritis Complications

rt hand 5

Rheumatoid Arthritis Complications

 

Rheumatoid Arthritis is an autoimmune disease that can cause widespread complications.

Muscles and Joints: 

Joint deterioration and deformities making it difficult to perform daily tasks, like buttoning a shirt, pulling up a zipper, tying shoes, or even just pulling on clothing.

Carpal tunnel syndrome

Inflammation may cause tendon rupture. This most commonly affects the tendons on the back of the hands.

Cervical myelopathy – a dislocation of the cervical spine which can put pressure on the spinal cord.

Muscles may become weak and patients may have severe muscle spasms. In the photo below, the toes are spasming and pulling downward.

Spasming Toes

Nerves: Peripheral Neuropathy can result in numbness, tingling, and burning tingling in the hands and feet from nerve damage

Blood/Blood Vessels: Many patients with RA develop anemia, and some of the medications used to treat RA can affect other blood components, like the white blood cells. Anemia can lead to dizziness, weakness, and fatigue.  Decreased white count can make the RA patient more prone to infection.

Inflammation of the blood vessels, or vasculitis is a rare complication of RA. It causes thickening, of the blood vessel walls leading to problems with blood flow through the vessels.

Eyes: Scleritis and Episcleritis – inflammation of the blood vessels of the eye – can cause a gritty sensation and redness of the eyes. This can result in corneal damage.

Increased Risk of Infection: Just having RA makes the patient more prone to infection, but also the medications taken can put the person at a higher risk of developing an infection.

Skin: Rheumatoid nodules develop in about one fifth of RA patients. These nodules are usually under the skin and appear on the forearms, heels, fingers, and elbows. They may develop gradually or appear suddenly. These nodules may also occur in the lungs and heart.

Osteoporosis: Loss of bone density is more common in RA patients.

Lung Issues: Chronic lung diseases like interstitial fibrosis, pulmonary hypertension, pleural effusion, and nodules.

Rheumatoid Lung is a group of lung conditions commonly found in RA patients. It includes nodules, fibrosis, and pleural effusions.

These lung issues may present with symptoms of shortness of breath, chest pain, and cough.

Heart: RA patients have an increased risk for developing heart disease, heart attack, stroke, and blood clots. They also have a higher risk for developing pericarditis – inflammation of the sac surrounding the heart and myocarditis – inflammation of the heart muscle.

Cancer: RA patients have an increased risk of developing lymphoma, leukemia, and other cancers. Use of TNF blockers may possibly lead to an increased risk.

Emotional: Living day to day with a chronic, painful illness may lead to depression and anxiety, yet many RA sufferers don’t discuss this with their physicians.

While there are many complications of RA, getting an early diagnosis and following the treatment plan may help lower your risk of developing any of them.

If you have symptoms of any of the complications of this disease, please talk to your physician about it right away. Delaying may lead to worsening of the condition.

 References:

http://www.nhs.uk/Conditions/Rheumatoid-arthritis/Pages/Complications.aspx

http://umm.edu/health/medical/reports/articles/rheumatoid-arthritis

http://www.nytimes.com/health/guides/disease/rheumatoid-arthritis/complications.html

http://www.healthline.com/health/rheumatoid-arthritis-complications#1

http://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-arthritis-complications

 

Rheumatoid Arthritis


Feet

 Rheumatoid Arthritis

A look at symptoms

RA or Rheumatoid Arthritis is a poly-inflammatory arthritis meaning it causes swelling and pain in more than one joint.

It’s not your granny’s arthritis. While Osteoarthritis can develop in patients with Rheumatoid Arthritis, they are two distinct processes.

Rheumatoid Arthritis is an autoimmune disease. This means the patient’s immune system is malfunctioning and attacking the patient’s joints.  Since RA is a systemic disease, it can affect the heart, lungs, eyes, blood vessels, neurological system,  and even the blood components.

Symptoms of RA are usually insidious. At first the patient will have fatigue, loss of appetite, weakness, low-grade fever, and vague musculoskeletal symptoms.

As the disease progresses, the patient develops pain and swelling in multiple joints.  This usually happens in a symmetrical pattern–both hands, both feet, both knees. All joints may be affected by the disease.

The joints become painful, tender, and stiff. Morning stiffness lasts more than an hour and can last several hours. The stiffness of Rheumatoid Arthritis is nothing like muscle stiffness or joint stiffness from over-use. It’s much worse and can affect the person’s gait due to stiffness in the joints of the feet.

Possible symptoms of RA include:

  • Fatigue – The fatigue associated with RA is not relieved by rest. In fact, many times the patient wakes more fatigued than when he went to sleep the night before.
  • Joint inflammation – it may start in the joints nearest the hand – the wrists and fingers, but it may involve all of the joints. This inflammation can lead to joint erosion causing increased pain and deformity
  • Fever – Usually a low-grade temperature
  • RA Nodules – Not everyone develops these small bumps of tissue that form under the skin, but those who do, develop them on pressure areas. Nodules vary in size and aren’t usually painful.
  • Tendon inflammation and possible rupture
  • Anemia
  • Ischemic heart disease
  • Pericarditis – inflammation of the sac surrounding the heart
  • Pericardial effusion – fluid in the pericardial sac (sac around the heart).
  • Cardiac Tamponade – compression of the heart muscle caused by fluid in the pericardial sac – can be very serious.
  • Pleural Effusion – fluid accumulation in the sac lining the lungs
  • Pulmonary nodules – nodules forming in the lungs
  • Dry eye syndrome
  • Scleritis – inflammation of the sclera(whites) of the eye.
  • Keratitis – inflammation of the cornea
  • Scleromalacia – Thinning of the sclera of the eye
  • Nodules near nerve roots causing neurological symptoms
  • Cervical spine subluxation – dislocation of the first vertebra of the neck.
  • Hoarseness – caused by Rheumatoid changes in the cricoarytenoid joints (joints of the voice box)
  • Systemic vasculitis – inflammation of the blood vessels
  • Felty’s Syndrome – A syndrome that affects the blood countsBook Ad
  • Increased susceptibility to infection
  • Depression
  • Anxiety

Rheumatoid Arthritis is so much more than “just arthritis”.  This debilitating disease impacts the patient’s life significantly. On average, within ten years from diagnosis, the patient is no longer able to continue working, relationships are impacted because the patient is no longer able to participate in the activities he use to love.

As a systemic disease, RA decreases the life span an average of ten years. In patients with severe disease, untreated disease, or disease affecting the heart, lungs or blood vessels may have a severely decreased life span.

Sources:

WebMD
Family Practice Notebook
Arthritis.com
Healthline
Harrison’s Rheumatology Second Edition; Editor Anthony S. Fauci