AOPA Pilot Magazine - March 2012 - 38

FLYWELL

BY DR. JONATHAN M. SACKIER

My favorite pie

or many, “England” and “fantastic food” should never appear in the same sentence. As a native, I dispute this egregious mischaracterization—

drugs. Glomerulonephritis—inflammation of glomeruli—with renal failure may develop after strep throat or other infection, or in connective tissue diseases such as lupus. Children with poor bladder/ureter valve mechanisms may suffer recurrent urinary tract infections (UTI), which can lead to renal damage. Later in life, repeated or untreated UTI can damage kidneys. High blood concentrations of certain substances, parathyroid organ dysfunction, or problems with the blood itself can manifest as kidney stones, causing there’s darn good nosh to be had in the land of my birth. Granted, steak and kidney pie isn’t to everysevere pain and organ damage. Dr. Jonathan M. one’s liking, but I am a fan and encourage you to Symptoms and signs of kidney problems may Sackier is a native sample this delicacy. It tastes great and will provide be absent or might reflect the causative problem of London now new respect for humble kidneys, whether wrapped such as a sore throat with strep, blood in the urine, living in Virginia. in pastry or not. As more than 10 percent of Amerior severe pain with stones. Sometimes symptoms cans harbor kidney disease, please read on about are subtle: reduced appetite; insomnia; general this crafty killer. fatigue; aching muscles; nausea and vomiting; or Shaped like large kidney beans—no surprise—and fist- dry, itchy skin. Renal failure may present with anemia, puffy size like the heart (or fist), approximately four and one-half face in the morning, reduced or altered urination pattern, inches long and weighing five and one-half ounces, our “foamy” urine, shortness of breath, or a dry cough because kidneys sit behind the belly, on either side of the spine, the of lung fluid buildup. Lots of stuff to think about, or just one right a bit lower, the left closer to the midline. Each has a big thing—see your doctor if you are worried. artery delivering blood and a large vein taking it away, while After taking a careful history your physician should check a conduit—the ureter—carries urine to the bladder. Inside, for raised blood pressure; dipstick the urine for blood, protein, 1 million filtration units, nephrons, each consisting of a tangle and sugar; and order blood and urine tests to evaluate levels of of blood vessels (glomeruli) and a pipe (tubule), convey urine blood urea nitrogen (BUN), creatinine, and glomerular filtraon its journey south. tion rate (GFR), a measure of how well nephrons perform; it Kidneys filter 400 pints of body fluid per day, discarding 1 varies with age, sex, body size, and race. percent as urine. Waste products are removed while imporKidney disease may be prevented by staying fit, thereby tant elements such as sodium and potassium are balanced, lowering blood pressure, cholesterol, and diabetes risk—as and water concentrations kept correct. When dehydrated, little as three days a week, do 30 minutes of exercise—walkour urine is concentrated; if we are drinking a lot, the color ing, swimming, or cycling. Be careful using over-the-counter is pale. The bladder stores urine for up to eight hours. Addi- pain medications, drink water liberally, and see your doctor tionally, kidneys stimulate red blood cell production, help for a checkup—more often if you have risk factors. Other than control blood pressure, and ensure bone health through cal- blood pressure and urinalysis, your AME will not do tests to cium metabolism. Diseases damaging kidney filtration cause exclude renal disease, so consider extra screening if you have predictable signs, as failure to filter properly allows goop raised blood pressure, BUN, creatinine, or poor GFR. Also, accumulation, impairing human function—sounds like an races other than Caucasians are at increased risk. aircraft fuel system. Therapies are aimed at the causative problem and for raised Inherited illnesses include polycystic disease where blood pressure, one specific class of medication—ACE inhibimultiple fluid-filled sacks squish good nephrons or tors—may also improve kidney function. If chronic renal failure faulty genetics cause problems handling consumed sub- develops, filtration can be provided episodically either at home stances; subsequent buildups damage the organ. Acute or a hospital using one’s abdominal cavity (peritoneal dialysis) renal (kidney) failure occurs in dehydration, trauma, or heart or an external machine (hemodialysis). In many cases, transattacks, becoming chronic if protein leaks into the urine for planting a new kidney—donated either after death or by a living at least three months. Of acquired causes, raised blood pres- donor—can change a life. So, if nothing else about this article sure (hypertension) and diabetes are common, preventable, is relevant to your life, please consider carrying an organ donor and treatable. Hypertension damages blood-vessel walls and card. And give steak and kidney pie a chance. I assure you, diabetes affects small, internal vessels, while excess sugar kidney juice is not involved in the culinary process. floods into urine. Medication abuse (aspirin, acetaminophen, ibuprofen) may cause renal failure, as can various illegal Email the author at jonathan.sackier@aopa.org. 38 • MARCH 2012

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AOPA Pilot Magazine - March 2012

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