Chronic renal failure - a textbook case study

I am going into pedagogue mode now, speaking as a medical professional to all who wish to learn about chronic renal failure (CRF) from the standpoint of the sufferer. So sit still and learn, or change channels now.

Anatomy. We all know they're somewhere towards the lower back part of the body, one on each side, and we know they must have little tubes connecting them to the bladder in some way. But when they're working and pain-free, no one knows where they are, and no-one cares. Only when they have a problem do we care - then the pain in the lower back on one or the other side points to their location in no uncertain terms.

Physiology. They do a lot of things we take for granted: they maintain fluid balance to prevent a build up of excess water; they constantly adjust the pH of the blood to be not too acidic nor too alkaline but "just right"; they maintain salt balance - not just the sodium chloride we shovel on our fish-and-chips, but all the other salts we usually ignore - potassium, calcium, phosphorous, and carbonates. They also bear some responsibility for regulating blood pressure, stimulating haemoglobin levels in the blood, and helping the immune system to cope with life's traumas and the nasties constantly trying to invade our bodies. Oh yes - on top of all this, they get rid of much of the toxic waste our bodies generate each day from burning food for energy ('good' waste), and breaking down all the rubbish we throw into our stomachs ('bad' waste) - especially from the evil meat, that palatable temptation of the devil to ingest poison in the guise of tempting steaks and succulant stews. Be not deceived - the stuff is poison as I have learnt to my cost. [Oops - I am straying from the true disinterest of the good medical text here.]

Clinical manifestations of CRF. These are the manifestations of each of the functions of the kidneys. Having many functions, it follows that there may be many manifestations. At the moment, I seem to have them all.
I have had erratic hypertension and been anaemic for some time. This leaves me tired; I would add irritable, but I think this is just my normal state, not the CRF. The toxic wastes and acidity of the urine makes it burn like crazy, and I need to keep running every hour or two (dysuria and frequency), or I won't make it in time (urgency), and there are horrid sharp pains shooting up my insides like knives. Last night I woke with bad nausea and had to sit downstairs sipping water with a bowl beside me.  The toxic products irritate the skin, and I now have red blotches everywhere, especially the back and legs, that itch like crazy and bleed easily everytime I scratch too vigorously (generalised pruritis). Additionally, a strong immune system helps prevent cancers developing, and the depressed immune system allows them to develop. I therefore blame the CRF for giving me two independent cancers (melanoma and bladder cancer), rather than the other way round.  In short - and in lay parlance - I'm a miserable wreck.

Management. I have to drink plenty and watch my diet. Basically, I must leave off all the things I like (bananas, tomatoes, oranges, olives and avacado) which have too much salt and potassium, and eat plenty of all the things I dislike (broccoli, cabbage, cauliflower and onions!). Also, I repeat, leave off the poison of red meat. If the CRF continues to deteriorate, younger men than me might be offered dialysis to rest the kidneys and remove the toxins, or ultimately renal transplant. Neither option is available for old men over the hill, so I shall have to continue on the downward slope.

The only other management options are to hope for a miracle (trip to Lourdes?), and be thankful for someone like Ann to put up with the grouchiness, and administer creams and drinks and manage my diet like an angel!

Confessions

Grandad-John in the Flamingo Chair

I must admit a confession to my reading public, one borne with shame and one from whose admittance I must expect ridicule and condemnation in equal measure. We are in Budapest, a most beautiful city where we are taking a short break from the rigours of a peaceful village. Yesterday we indulged in quaint history at the museum of electrical inventions from the turn of the 19th century (old motors, switches, bells, telephones etcetera), followed by a visit to the Museum of Sweets and Selfies - a bizarre collection of colour and toys designed more for young adolescents than grown respectable ladies and grizzled bearded men, but heaps of fun battling through a forest of pink bananas or relaxing in a pink flamingo chair. We followed this by a sudden dive into a gluten-free bakery Edwin had spotted where we indulged in gluten-free beers and a choice of delicious cakes and pastries. But I am glossing over the confession.

Ann in Museum of Sweets and Selfies, Budapest

That evening, being late, we dined in the hotel restaurant where – although nominally vegetarian – I succumbed to a starter of Hungarian goulash. This was filled with large cubes of succulent beef, suspended in a carefully spiced stew of vegetables, and I will not pretend it was not delicious.  But then to crown my sin I selected a dish of wiener schnitzel: a large dish which covered the plate in bread-crumbed Bambi. Retribution was swift. I had forgotten how poisonous red meat is to the kidneys. Mine are already shot to pieces, filled as they are with large cysts and in the throes of advanced renal failure, and they were completely unable to cope with the added load of lethal nitrogenous waste to which I challenged them.  The unaccustomed load of heterocyclic amines and breakdown products of urea and uric acid so irritated my kidneys and bladder that I was awake every hour throughout the night having to run to for a painful wee. 

Today I am confined to my room, unable to stray far from the toilet. Believe me, if anyone suffers from kidney disease, the revenge of the animals can be swift and sure. Today, I am dining on salad leaves and drinking weak tea.

More medical problems

West Suffolk Hospital is notorious for loosing test results. They have lost a few blood tests, ECGs, X-rays, and a full batch of respiratory tests. Once, they lost all of Mary-Anne's heart tests. But I finally managed to extract my blood test results from the GP after repeated visits and phone calls to the hospital. They showed stage 3 chronic renal failure. To put this in perspective, stage 4 requires dialysis, and stage 5 is "call the undertaker".

When Lucy heard the news, she immediately said she would be willing to donate a kidney, if required! How caring is that - the last thing I would have expected or wanted from anyone. I have been getting tired and can only walk slowly for some time now, and my taste has changed so even coffee tastes sour. I had put it down to post-radiotherapy, but perhaps it is the effect of having anaemia and being uraemic due to the kidney failure.

Yesterday came unhappy news that baby Theo was very ill, with diarrhoea and low blood sugar. He was rushed into hospital with a blue-light ambulance and kept overnight on a drip and antibiotics. This morning he was more alert though still with the diarrhoea, but the good news now is that he has been allowed to return home, so we all hope for a quick return to good health.

Hacking down Haverhill

Haverhill willows cut down

Beside Sainsbury’s is a wild park where oft I walk the dogs. Or wild it was until the environmental tree cutters took their power saws to it. It had a fine line of mature willows following the stream in  a vast acreage, now not coppiced but savagely butchered along with the scrub land and surrounding tree line. In whose name do they work such savagery? Certainly not for the wild life nor we who walk here.

I phoned for my blood results this afternoon: they show mild renal failure and increasing anaemia. Probably explains why I get so breathless and tire so easily. Renal failure is certainly associated with bladder cancer, and may account for my severe itching and weakness also. I will start some iron tablets today, and see if they help.