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How To Treat Kidney Disease

Cardiac Catheterizations and Other Invasive Studies 

With the degree of coronary artery disease (CAD) and peripheral vascular disease (PVD) in our society, procedures such as cardiac catheterizations and angiograms have saved both lives and limbs. These procedures have helped many patients open up clogged and diseased arteries, maintaining the blood flow of the heart and keeping their extremities intact. The above two procedures are referred to as percutaneous (perk-yu-tane-eus) interventions, as they access internal organs through a small puncture in the skin.
How To Treat Kidney Disease

In these interventions, a cardiologist, vascular surgeon, or other trained doctor needs to look at the blood flow of the heart or extremity. To get an accurate assessment of the degree of blockage, it is necessary for the doctor to inject dye.

If a blockage is present in the artery, a specific type of intervention - an angioplasty (opening a narrowed vessel with a type of balloon) - may be performed. If needed, a stent, which is a device placed in the artery to keep the blood flow open, will be added. If this is the case, more dye may be needed to better see the affected area. As before, the more dye that is used the higher the risk of the kidney being affected. Other risks of this "dye nephropathy" include CKD, diabetes, and dehydration.

There are important precautions you can take to reduce these risks. Your doctor may suggest the following:

  • You may be asked to come to the hospital one day before the procedure to get some intravenous fluids. Doing this keeps your kidneys "flushed" and is the best thing you can do to reduce the dye risk.
  • Your doctor may ask you to take Mucomyst, an oral form of Nacetylcysteine (NAC), starting one day prior to the procedure. NAC is an herbal supplement with antioxidant activity. Taken twice a day for two days, it may have a protective effect on the kidney. 
  • If you are on the medication metformin (Glucophage) for diabetes, you will be asked to stop taking this medication for forty-eight hours prior to the procedure. 
  • Stop taking the ACE inhibitor/ARB at least twenty-four hours prior to the procedure. 
As always, talk with your doctor about your options.
Between a Rock and a Hard Place 

Procedures like cardiac catheterizations occur when people are in the hospital. A common scenario that doctors see is this:

A man comes into the hospital because of chest pain. He has both advanced CKD and bad heart disease. A cardiac catheterization is requested. In this scenario, both doctor and patient are between a rock and a hard place.

Without the cardiac catheterization, the man will likely continue to have heart problems. If the cardiac catheterization is performed, however, there is a risk of worsening kidney function, especially in the setting of advanced kidney disease. So what is the right answer to this situation?

The entire medical team will discuss all of the options with the patient. In the above scenario, without a cardiac intervention the heart will not get any better. Here, the man and his family elected to go ahead with the heart catheterization. He was given intravenous fluids and Mucormyst one day prior to the procedure. Fortunately, his kidney function remained stable.

In a situation like this, there are sometimes no right answers. In helping the heart, the kidneys can be affected. This is an example of why communication with the other members of the medical team and the patient is so important.

Magnetic Reasonance Imaging (MRI) and the Use of Gadolinium
In addition to CAT scans, MRIs are a common type of imaging procedure your doctor may order. Like CAT scans, they can be done with or without contrast. The type of contrast used in MRI studies, however, is called gadolinium (gad-o-lin-eum). There have only been a few reports of MRI studies where gadolinium has been used and blamed as causing kidney failure. The more significant risk may be a skin condition called nephrogenic systemic fibrosis (NSF).

NSF was initially discovered several years ago when people would complain to their doctors about a bronzing or thickening of the skin. Biopsies of those areas revealed gadolinium in the layers of the skin. It was thought that the use of MRI, particularly in those with advanced kidney disease (GFR < 30 ml/min), increased the risk of this process. How this happens is still not quite known, and as of yet there is no recommended treatment.

If your doctor requests that you get an MRI, ask if the study is truly needed. If so, ask if gadolinium needs to be given. When it does, ask what will be done to minimize the potential toxicities of the suggested study. Depending on your kidney function, your doctor may suggest avoiding the use of gadolinium altogether (less than 30 percent) unless it is absolutely needed.

It is important to understand the effects of the medications and imaging studies your doctor may prescribe for you. With every medication, every imaging study, and every procedure, it is important to assess the risks and benefits. Will this medication benefit me? Could this imaging study or procedure hurt me or my kidneys in any way? If you have kidney disease, and even if you don't, it is sometimes important enough to ask your doctor when not to take a medication as well as when to take one. To find out more, you can check out How To Treat Kidney Disease.

Treatment Of Chronic Kidney Disease


Like diuretics and ACE inhibitors/ARBs, in a situation where the body is stressed, NSAIDS can stun the kidney and worsen kidney function. This is a different reaction than the nephritis or inflammatory response discussed in the prior post.
Treatment Of Chronic Kidney Disease

If your loved one complains to you of nausea, vomiting, or diarrhea, I strongly urge you to call his doctor and ask if any or all of the above medications should temporarily be stopped.

Patients who are scheduled for colonoscopies are usually given oral phosphate-containing solutions as part of the preparation in order to cause a significant bowel movement before the procedure. However, there have been reports of such compounds causing acute kidney failure; in some cases the kidney function didn't return to normal.

The term for this form of kidney failure is acute phosphate nephropathy. The combination of the patients being dehydrated from the preparatory agent in addition to the use of ACE inhibitors/ARBs and a diuretic is felt to be a contributing factor.

If you need to get a colonoscopy, question your doctor as to the type of preparation he is using. I would recommend avoiding the use of any phosphorus-containing enemas as they can affect kidney function. If you are on an ACE inhibitor/ARB or diuretic, ask which medications should be temporarily stopped prior to the procedure.


There are imaging studies such as CAT scans and MRIs that your doctor may ask you to obtain. In order to get a more detailed "picture" of what the doctor is looking for, you may be asked to get these studies using either contrast dye or a type of contrast called gadolinium (gad-olin-eum). If you have CKD, there are possible risks to the kidneys.

Contrast Dye for a CAT Scan
Your doctor may ask you to obtain a special kind of imaging study called a CAT scan. This can be of your head, chest, or abdomen - or a combination of all three depending on what he is looking for. You may be asked to obtain this study with intravenous contrast, which is a type of dye that is injected into a vein at the time of the study.

Depending on your level of kidney function, the use of such a dye can pose a risk to your kidneys. The higher the dose and concentration of the contrast used, the greater the risk. If you have CKD, there is a greater risk, as well. If you need to obtain a CAT scan, ask your doctor if dye needs to be used. When the answer is yes, there are a couple things you can do to minimize the risk to your kidneys. The first is to avoid using any diuretic or ACE inhibitor/ARB, at least on the day of the study. And the second is to increase your fluid intake at least by 25 to 50 percent the day before the study. The key is to talk with your doctor before any type of study like this is done.

Sometimes, on an emergent basis, you may not have the luxury of preparing beforehand. For example, some people come to the emergency room with severe shortness of breath, and the doctor may order a CAT scan with IV dye to make sure there is no clot in the lungs. As this is a life-threatening emergency, this type of study will be done as quickly as possible. Your doctor will be following your kidney function closely. And while the use of intravenous dye in imaging studies can affect kidney function, other, more invasive procedures can pose a greater risk. To find out more, you can check out Treatment Of Chronic Kidney Disease.

Chronic Kidney Failure Symptoms


In certain situations, medications that are normally beneficial and kidney protective can actually worsen the kidney function. Here is a common scenario that doctors often see:

Your dad (or mom) calls and tells you he is feeling weak. He may have had either a recent cold or "viral bug" accompanied by nausea, vomiting, or diarrhea, or some combination of the three. He hasn't had much of an appetite over the last several days, yet he has still taken all of his medications faithfully. He may have diabetes, hypertension, heart disease, or congestive heart failure, all of which are very common conditions in the older population.
Chronic Kidney Failure Symptoms

Regarding his medications, he has been taking an ACE inhibitor and is also on a diuretic, such as furosemide (Lasix). He may also have significant arthritis, and despite his doctor's warnings he has been taking ibuprofen, more so when the weather changes and he notices his arthritis acting up more.

Concerned, you visit and notice that he is very weak and debilitated. You call 911 or take him to the hospital yourself. You're now in the emergency room of your local hospital. Your dad had some blood work done, and the next thing you know you are being told by the emergency room doctor that his "kidneys are bad" and that a kidney doctor will be coming. There may be other abnormalities in his blood work, too, including abnormal sodium and potassium levels. You are in shock by the news because your dad has never had a kidney problem that you were aware of.
So what happened? His kidneys were "stunned" by the illness, dehydration, and the negative effect of the medications on his kidneys in this situation. When the body is physically stressed, the kidneys have built-in defense mechanisms to try to maintain normal kidney function. Depending on how badly the kidneys will be affected by an illness or other body stressors depends on one of three factors:

  • The severity of the illness. The kidneys are in harmony with the rest of the body and will be affected by a severe illness. It is common to see the kidney function affected by a bad illness, especially in people who are admitted to the hospital.
  • The degree of kidney disease present. Often, doctors will find that there was some degree of CKD present that no one ever knew about. The less kidney "reserve" one has, the less able the kidneys are to fully recover from significant body stressors like an acute illness.
  • The medications that interfere with the kidneys" built-in defense mechanisms. Some medications get in the way of the kidneys' defense mechanisms as they try to maintain normal function in the face of a bad illness. 
Let's review the effects of some of the medications that interfere with the kidneys.

ACE Inhibitors/ARBs 

These classes of medication are effective in treating heart and kidney disease over a long-term basis. In this acute situation, however, when the body is not in its normal state, relaxing the kidney can actually make the kidney function worse. If your doctor is going to put you on one of these medications, understand that if you have an acute illness, nausea, vomiting, or diarrhea, you should not take it until those symptoms resolve. Your doctor will likely check your blood work to closely monitor your kidney function.

Many older patients may have a history of congestive heart failure or have significant problems with edema. From personal experience, I can tell you that many of them are deathly afraid of stopping their diuretic for fear of fluid building up in their lungs or legs, and the necessity of possibly having to go into the hospital. Yet when they have nausea, vomiting, and diarrhea, and are eating and drinking less, they can make themselves really dehydrated if they continue to take their diuretic. This can dramatically worsen their kidney function. To find out more, you can check out Chronic Kidney Failure Symptoms.

Causes Of Chronic Kidney Disease

You have now learned about several different classes of medications, specifically those that lower blood pressure and reduce proteinuria. Yet under certain circumstances, these same medications can be harmful to the kidneys. Other classes of prescribed medication can also affect kidney function, including anti-inflammatory drugs, antibiotics, and medications used for the treatment of ulcers and gastroesophageal reflux (GERD). Moreover, certain over-the-counter medications such as ibuprofen and acetaminophen can also affect kidney function.

Causes Of Chronic Kidney Disease

Some standard treatments can trigger an inflammatory reaction in the kidneys, and some can "stun" the kidneys. We will examine the possible effects and risks that certain imaging studies and procedures, as well as medications, have on kidney function.

Certain classes of medications can cause a type of nephritis, or inflammatory response, in the kidneys. We have discussed one type of nephritis in detail. The focus of this post is another type called interstitial (inter-sti-shull) nephritis. Here, the inflammatory response is not directed against the glomerulus, but other areas of the kidneys. In this post, we will examine certain classes of medications that can cause this type of reaction in the kidneys.
Antibiotics are extremely popular and are very commonly prescribed. Certain classes of antibiotics, including pencillins such as amoxicillin (Trimox); and a closely related drug class called cephalosporins (cef-ello-spor-ins) such as cephalexin (Keflex) and cef-urox-ime (Ceftin) can cause interstitial nephritis in certain individuals. Trimethoprim-sulfamethoxozole (Bactrim) is usually prescribed for urinary tract infections and can cause this reaction, as well. In fact, any class of antibiotics can cause this type of inflammatory reaction, not just those described above.
Non-Steroidal Anti-Inflammatory Drugs (NSMDS) 

This class of medications, including the over-the-counter brands Motrin and Advil, as well as the prescription brands Celebrex and Naprosyn, can also induce a similar type of inflammatory reaction in the kidneys. Sometimes this reaction can be accompanied by a dramatic increase in proteinuria.

There is an irony here; these medications are used to treat a variety of inflammatory conditions like arthritis, but they themselves can stimulate an inflammatory reaction in the kidneys. Because of their side-effect profile, especially concerning the kidneys, you should be careful in using this class of medication. We will be talking more about NSAIDS later, as they can affect the kidney function in multiple ways.
Proton-Pump Inhibitors (PPI)
PPIs are used to treat ulcers of the stomach and small intestine, as well as to treat gastroesophogeal reflux disease (usually referred to as GERD). Examples include pantoprazole (Protonix) and esomeprazole (Nexium). Commonly prescribed for people both in and out of the hospital, PPIs can cause an inflammatory reaction in the kidneys, even after the medication has been taken for a while.

The bisphosphonates (biss-phos-pho-nates) refer to a class of medications used to treat osteoporosis. They are also commonly used in people with cancer. Here I am referring to medications that need to be given through a vein, including pamidronate sodium (Aredia) and zoledronic acid (Zometa). Pamidronate sodium (Aredia) can trigger a type of inflammatory reaction causing the nephrotic syndrome and worsening kidney function. Zoledronic acid can also worsen kidney function. The usage and dosing of both medications need close monitoring if kidney disease is present. To find out more, you can check out Causes Of Chronic Kidney Disease.