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kidney disease: Nephrotic syndrome
https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/symptoms-causes/syc-20375608
Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine.
Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. Nephrotic syndrome causes swelling (edema), particularly in your feet and ankles, and increases the risk of other health problems.
Treatment for nephrotic syndrome includes treating the underlying condition that's causing it and taking medications. Nephrotic syndrome can increase your risk of infections and blood clots. Your doctor may recommend medications and dietary changes to prevent these and other complications of nephrotic syndrome.
Symptoms
Signs and symptoms of nephrotic syndrome include:
- Severe swelling (edema), particularly around your eyes and in your ankles and feet
- Foamy urine, which may be caused by excess protein in your urine
- Weight gain due to excess fluid retention
- Fatigue
- Loss of appetite
It just so happens that Retinoic Acid is implicated in Nephrotic Syndrome....
https://synapse.koreamed.org/pdf/10.5045/kjh.2008.43.3.166
A 24-year-old man was admitted to our hospital in March 2007 for evaluation of uncontrolled gingival bleeding and fever occurring after a dental procedure...…….. There was no proteinuria in the initial urinalysis. Bone marrow (BM) examination revealed a hypercellular marrow; the results confirmed APL with a microgranular variant [AML- M3v (WHO classification)]. ……. treatment was started with oral ATRA at a dose 45mg/m2/day divided into 2 doses......On day 14 of ATRA therapy, the spot urine showed >300mg/dL of protein. Therefore, we performed a 24-hour urinalysis that revealed a nephrotic-range proteinuria (nephrotic-range: ＞3.5g/ day; patient value: 19.24g/day)……….. Renal dysfunction occurs frequently in patients with APL during ATRA therapy. Renal failure has been reported in 39% of cases of the ATRA syndrome.
https://www.ncbi.nlm.nih.gov/pubmed/22081164
Nephrotic-range proteinuria in a child with retinoic acid syndrome.
BACKGROUND:
All-trans retinoic acid (ATRA) is a vitamin A derivative that is used in combination with chemotherapy to treat acute promyelocytic leukemia (APL). A serious complication of ATRA is retinoic acid syndrome (RAS), which is characterized by an inflammatory reaction with capillary leakage and myeloid cell tissue invasion that presents with cardiopulmonary symptoms and occasionally acute kidney injury.
CASE-DIAGNOSIS/TREATMENT:
We report the case of a 3-year-old child with APL who developed transient nephrotic-range proteinuria (max urine protein:creatinine ratio 8.6) during two episodes of RAS while on ATRA therapy. ATRA was temporarily discontinued and the patient was treated with a 3-day course of dexamethasone during each episode. He maintained normal renal function throughout and the proteinuria completely resolved.
CONCLUSIONS:
This is the first reported occurrence of nephrotic-range proteinuria in a child treated with ATRA. Nephrologists should be aware that RAS is a serious complication of ATRA that may lead to proteinuria.
https://hrcak.srce.hr/file/237653
Adverse effects of isotretinoin
Very common (>1/10)
Cheilitis, dryness, peeling, itching, redness of the skin; features resembling hand eczema; increase of transaminases; increase of triglycerides; muscle and joint pain; decreased exercise tolerance; decreased high-density lipoprotein; dry eye; irritation of the eye; blepharitis; conjunctivitis; night vision disturbances; anemia; accelerated erythrocyte sedimentation rate; thrombocytopenia; thrombocytosis
Common (>1/100)
Neutropenia, headache, epistaxis, dryness of nose mucus membrane, increase of the cholesterol and glucose concentration, hematuria, proteinuria
Rare (>1/10.000)
Allergic skin reactions, anaphylactic reactions, depression, anxiety, aggression, mood swings, hair loss
Very rare (<1/10.000)
Bacterial infections of the skin and mucous membranes, lymphadenopathy, diabetes, hyperuricemia, abnormal behavior, suicidal ideation, pseudotumor cerebri (when administrated simultaneously with oral tetracycline), drowsiness, seizures, blurred vision, cataract, color vision disorder, intolerance of contact lenses, keratitis, photophobia, impaired hearing, allergic vasculitis, Wegener’s granulomatosis, pancreatitis, hepatitis, fulminant acne, exacerbation of acne, hirsutism, nail dystrophy, paronychia, hyperpigmentations, photosensitivity, myositis and arthritis, tendonitis, increase of creatine phosphokinase
Nephrotic syndrome developed after 4 months treatment with isotretinoin 40mg/day...….During tretinoin therapy some patients with retinoic acid syndrome or with a hypercoagulable state develop acute renal insufficiency, usually accompanied by dysfunction of other organs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879014/
Acute kidney injury following isotretinoin treatment
Isotretinoin is widely used for the treatment of acne that is unresponsive to topical therapy. Despite its efficacy, isotretinoin has various adverse effects, including cheilitis, increased risk of cutaneous Staphylococcus aureus infections, and liver function abnormalities.
Flank pain should raise suspicion of Isotretinoin-induced acute kidney injury, suggesting that a careful kidney function test besides testing for liver function is warranted in patients with these symptoms.....
In line with these effects, retinoids were shown to reduce both glomerular and tubular damage and inflammation in experimental models of glomerulonephritis and renal interstitial disease
Bumping this very good post!
Is anyone here on kidney meds?
Are kidney meds doing things that fit our model? (ie that VA is a cause of kidney disease)
My cat (sorry, but I love the guy) has protein coming out in his urine and has been prescribed Enalapril.
I would like to bump this thread because I think possibly many of us are or will be having kidney problems in the mix.
So, I would like to know
WHAT is the BEST KIDNEY DIET
(vitamin A aside...)
For instance, here is a quote: "This is because a diet very high in protein can make the kidneys work harder and may cause more damage. Ask your doctor or dietitian how much protein you should have and what the best sources of protein are for you."
Is this bunk?
I think the theory of dietary protein stressing the kidneys is total nonsense. My bet is that it’s origin is just based on the fact that when the kidneys start to become damaged they “leak” protein, whereas in a healthy state they do not. But, in no way does that mean the protein caused the damage.
The nephron tubules of the kidneys are an epithelium tissue. Once damaged, protein can pass into the urine. The protein is just a marker for the presence of damage.
What I do know is that a very low protein diet is deadly for those with kidney disease.
The best diet for KD is one that does not destroy epithelium tissues. Protein is needed by every cell in the body every day.
So, a low protein diet is not the answer.
We are designed to process more protein than we need but if protein consumption is through the roof or someone has kidney disease then yes, an excess of protein is harmful. For someone that isnt an athlete or with heavy musculature they dont need much, about 0.8 grams per kg of body weight is the recommended amount. Any protein excess to our needs is used as energy but protein is a dirty energy source compared with fats and carbs, nitrogen has to be eliminated via uric acid, increased calcium excretion is seen also.
I think it is best to let your body be your guide, I think you'll find that the amount of protein you naturally want to eat will probably be similar to the 0.8 formula.
Thank you @ggenereux2014 and @tim-2.
I suppose my Cat is an interesting case study if we really think about it. Maybe it shows us something about what happens when you change to a very low VA diet very late in life (he is 85 in cat years)
The backstory is I believed that this Cat was also VA poisoned along with me and hubs. (due to what I was feeding here) He was having symptoms (like wobblyness). And so for a year I've been feeding him on raw meats/fish with no egg or organ meat, no veggies (or carbs for that matter). A bit of egg shell powder for minerals. He doesn't seem to be able to do much bone or fat. I give him broth. And some cooked meats and fish too.
And now he has been diagnosed with kidney disease. (the wobblyness might have been the start of the kidney disease) He is having trouble with very low appetite, nausea, low weight, bowel issues, dehydration.
The vet is trying to support him with b-vities and fluids. (both of which sounds smart to me. I've decided against most drugs, I want to keep this simple)
To try and decide what he intuitively needs, I put a buffet of different choices in front of him, trying to use his intuition to choose what to feed on. Strangely enough, he chose the canned "kidney disease" cat food over all my home-made meals! Little bugger. But he did throw it up, poor guy. He is very very skinny. Maybe he needs carbs. The "kidney disease" food has carbs.
Perhaps he needs fiber to help his detox, as many think they do here. The "fiber" most cats would eat would be the indigestible parts of mice. But I have heard you can give veg fibers to cats, psyllium, I think.
I wonder too if there is any sort of lesson here about the carnivore diet.