Questions for the Nephrologist

With many thanks to Connie from http://www.mydepuyhiprecall.com:

Implications of Ion Toxicity on the kidneys (Questions that must be answered.)

Questions for my consults (in no particular order):

1)      What is the cancer risk in  the kidney given the statistically significant results found in the Sweden study?

2)      What is the risk of a trivalent chromium being a carcinogen with the primary target being the kidney?

3)      Kidney epithelial cells are 10x more sensitive towards Cr 6 than the same liver cells. Humm hepatoxic issues as well ?

4)      Can non toxic Cr3 be oxidized to Cr 6 under certain conditions and what are they? (very important question/studies indicate yes.)

5)      What is the toxic range for Cr and Co in the kidney?

6)      What are the signs for this?

7)      What are the tests for measuring the accumulation of these metals in the kidneys?

8)      What is my risk given I have only one left?

9)      What is the risk differentiator with metal implants vs inhaled or oral exposure? Studies seem to be focused on the latter not the former?

10)   What are the genotoxic effects for a trivalent Cr to the kidney?

11)   What oxidation is this metal exposed to in the body once it is in there?

12)   What solubility issues should be considered?

13)   Once absorbed, Cr 6 IS QUICKLY REDUCED TO THE TIRVALENT FORM WHICH ACCOUNTS FOR ALL OF THIE ELEMENT PRESENT IN THE BLOOD STREAM OR TAKEN UP BY THE TISSUE?  What??  Then how is CR 6 responsible for cancer and other things if it is non toxic?

14)   How is this absorbed by the kidney?

15)   Two main features of kidney damage re metals: (Is this correct overall?)

a.       Lack of dose-effect/response relationships or progression toward more severe impairment when the exposure intensity increases

b.      The recent absorption rate more than the cumulated does is responsible for the observed nephrotoxic effects.

16)   What is renal oligio anuric deficiency?  How is it caused?

17)    There is good evidence that Cr 6 is the ion responsible for MOST of the toxic actions although much of the underlying molecular damage may be due to the intracellular reduction to the even more highly reactive and short-lived Cr3 and Cr6. ??

18)   What about Cobalt?  “Patients with impaired renal function may experience Co poisoning without the presence of pain despite a well positioned implant because the cobalt released by normal implant wear is not adequately cleared by their kidneys? (2010/Alaska epidemiology)

19)   In short term tests, the hexavalent Cr demonstrated genotoxic effects 4 times more frequently than did the trivalent Cr compounds.  Well this is not comforting. This tells me that there are geneotoxic effects with trivalent as well.  So what are they?

Kidney Check

I have learnt a big lesson from this - IT'S YOUR LIFE; TAKE IT INTO YOUR OWN HANDS!
If I had waited for medical professionals to come to my rescue, I would probably be near dead in 3 years time.

My urine pathology came back and I'm investigating it. I see something that raises a red flag: GFR=65 ml/min.
I got the FAQ from the National Kidney Foundation about GFR Estimates, and here is some vital information:

"1) What is GFR? {My notes: it's the basic measuring of kidney function}
GFR (glomerular filtration rate) is equal to the total of the filtration rates of the functioning nephrons in the kidney.

3) What does GFR indicate? {My notes: my GFR is less than half of what it should be. ALARM BELLS!}
GFR is usually accepted as the best overall index of kidney function. A clinician or medical laboratory can estimate GFR from a person’s serum creatinine level and some or all of the following variables: gender, age, weight, and race.

Normal GFR varies according to age, sex, and body size; in young adults it is approximately 120-130 mL/min/1.73 m2 and declines with age. A decrease in GFR precedes the onset of kidney failure; therefore, a persistently reduced GFR is a specific diagnostic criterion for chronic kidney disease (CKD). Below 60 mL/min/1.73 m2, the prevalence of complications of CKD increases, as does the risk of cardiovascular disease (CVD).

This is very interesting, taken from http://mydepuyhiprecall.com:

Nine-Year Incidence of Kidney Disease in Patients Who Have had Total Hip Arthroplasty. 

Chandran SE, Giori NJ. J Arthroplasty. 2011 Apr 18. [Epub ahead of print]

Department of Orthopedic Surgery, Stanford University, Stanford, California.

Abstract

Metal-metal total hip arthroplasty (THA) is contraindicated in patients with impaired renal function due to increased metal ion output relative to other bearings and renal excretion of metal ions. Although one can avoid a metal-metal THA in a patient with renal disease, a patient may be destined to develop renal disease later in life. In this study, we sought to determine the incidence of newly diagnosed renal disease in the 9 years after THA. Using the Department of Veterans Affairs national database, we identified 1709 patients who had a primary THA in 2000without preexisting renal disease. We found the 9-year risk of developing chronic renal disease after primary THA to be 14% and severe or end-stage renal disease to be 6%

xxxx

What a difference 3 years make!  Very interesting indeed."

I have made an appointment with a nephrologist, and will update again on progress, results and findings.