September 5, 2025 • 28 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. Listen to the weekend here in the art
of the dusty eh wah and desert in West Texas
and you're listening to the Medical Hackers. However, you may
be tuned in this week and I'm your host, doctor
Sandy Brow. I'm here to bring the border Land the
latest information on healthcare, medicine and technology on the show.
I consider myself a hacker in the positive sense, a
hacker using my intimate knowledge in the medical system to
(00:25):
breaking down some various to accessing new medical technologies and
current healthcare information. So this week again I have a
frequent guest and at this point he's really a part
of the show of doctor ukber Khan.
Speaker 2 (00:37):
You're too kind. Thank you. Good morning.
Speaker 1 (00:40):
Yeah, it's great to have you because you allow me
to get into more depth on some of these topics
that I care about. I see a lot, but I
don't have that knowledge that you do, since you are
an expert in You're a nephrologist, you're a kidney doctor,
and you have a lot of knowledge in the way
(01:00):
of dealing with high blood pressure. So these are all
things that I deal with, but you are able to
talk to these topics on a much more deeper level
and deeper understanding that really, honestly, I get educated just
as much as some of our listeners. So one of
the things that you actually brought up that actually I
actually went in, I went and read up a little
bit more about it was this idea of what is
(01:22):
the goal with patients who have kidney diseases and they
may initially get dallasis and you know, when you're in
an acute setting, when you're in a setting where you
just realize you need kidney support, you get dallass But
what is the end goal with this this whole pathway.
Is it to just have you on DALLAS the rest
of your life? Or what are we trying to achieve?
(01:43):
And so one of the things I was reading about
was there are a set of incentives that have been
in place from CMS, from Medicare, from the major payer
out there called the end stage renal disease treatment choices.
It's called the ETC model, and they're trying to make
it more of a mandatory model, something that will help
align the incentives of kidney doctors, the healthcare systems along
(02:05):
with the incentives of patients, because there can be some
conflicting incentives there because sometimes there's a kidney doctor man,
you can correct me if I'm wrong. Maybe, if you
have ownership in a dallas center, maybe you want to
keep patients. You want to keep those beds full. You
want to have patients on Dallasis as long as possible
because you get paid for Dallasis sessions. But the goal
(02:26):
for patients obviously to get off that, and the goal
of the healthcare system is to reduce costs by not
having patients on dalyasis.
Speaker 3 (02:33):
Sure, yeah, you're speaking facts. If I know you're keeping
patients on dialysis for other causes, we're going to have
an issue. But usually that's not the case. Usually, thankfully.
The goal of when someone is on dialysis is to
get off of it as soon as possible, and there
are many things that we look forward to get a
patient off dialysis. One is the patient making urine. We
(02:55):
have this phrase in kidney medicine where we say, is
the patient making good urine? I would laugh at my attendings.
I go, that sounds strange, and sometimes it happens. Sometimes
you pee a lot, sometimes you pee less and it's
more concentrated. Well, the main thing is to get off
dialysis and you know, we usually have we set a timeframe,
usually around three months. If you're three months on dialysis
(03:16):
and you're not recovering, then it's then it's then it's
you know, by by definition we say you're end stage
renal disease. There's there's lots of minutia in this, but
dialysis is only a temporary bridge to kidney transplant, which
I know you're going to talk about later. Uh, dialysis
is a tool, it's not a cure. It can save
lives because it helps the body recover. Overall, dialysis, we
(03:40):
don't want you on it.
Speaker 1 (03:42):
So what I did find interesting is so now they
are trying to increase the incentives, and these are pay
for performance incentives that payers have placed on dialysis facilities
and on doctors nefrolgist such as yourselves, to sort of
increase the need for patients to get home dialysis, which
is something we discussed before. I don't want to go
(04:02):
into too much depth on it, but basically this allows
patients to not have to go to a facility to
get dallasas to do it at your home. And so
there's two goals with this incentive program. One increase home
dialysis and two try to increase the amount of kidney transplants,
patients who are waiting kidney transplants, and patients who actually
get kidney transplants. But what's interesting is this, So this
(04:24):
is a program that's going to be running through twenty
twenty seven, and what they have found, the preliminary thing,
is that this model has not actually really moved the
needle on changing provider behavior, on changing doctor behavior. Dallasis
facility behavior and we're not entirely sure why. But there
are a couple of theories. One is that when it
comes to home dialysis, they're finding that a lot of
(04:45):
patients may not be wanting to go that route or
are having difficulty getting on that route. Is because one
is some patients because of the demographics, maybe because of
the social situation if they don't have a stable housing situation.
Speaker 3 (04:58):
Yeah, there are some things you need in order to
proceed with home dialysis, whether it's through the belly peritoneal dialysis,
which we discussed last time.
Speaker 2 (05:06):
Which I was thinking about.
Speaker 3 (05:07):
I said something wrong and I said it's through convention,
it's actually through diffusion. I got some of my terms
mixed up last time.
Speaker 2 (05:14):
That was like three weeks ago. But continue.
Speaker 1 (05:17):
Sorry, Sure, so when it is table housing. The other
one is that you know, some of these patients, if
you're trying to do dialysis on your own at home
without the help of a diasis center, you have to
kind of learn how to self administer. It's pretty much
a complex medical regimen. So that's another thing. The other
thing is sometimes people just don't have caregiver support at home.
What if you're alone and you don't have somebody to
(05:37):
plug you in to this continuous dialysis at home. The
other one is just sometimes there's some financial burden of
doing modifications to your home.
Speaker 2 (05:46):
Sure.
Speaker 1 (05:47):
And the other one is that sometimes it's just you know,
costs or going up, rent is going up, higher utility
bills which can be encountered if you do home DOALSA.
So this can really contribute to the slow uptake of
home dialysis. And I don't want to get into what
we discussed home Dallas as before, but really quick summary
from what I get and you can correct me if
I'm wrong, doctor, You're usually right, You're good. The goal,
(06:08):
the reason why we want to encourage patients to do
home dialyasis as opposed to coming to a treatment center
is by being able to do it at home, you
can do dallasis pretty much every single day, and you
can try to control your blood levels on a more
consistent basis as opposed to if you're doing dallases at
a facility, you only tend to get dallass maybe Monday, Wednesday, Friday,
(06:30):
maybe Tuesday Thursday, or Tuesday Thursday Saturday, if it's two
or three days, and that's sort of a you're only
trying to go after it in that setting when we
bring you into the center. But if you can do
it more continuously, that's better for your body overall.
Speaker 3 (06:46):
Exactly. Yes, you patients feel better. That's what they say
you are able to. So first it's a choice. If
you're lucky enough and able to pass through the rigorous
testing and the training, you will be able to dialize
at home for one to two hours a day, four
to five days, right, And this allows better quality of life.
And this is what we've gotten from all the feedback
(07:07):
and all the surveys that they take. It's that doing
it at home gives a patient the opportunity to do
it in their home, own home setting, which allows more comfort,
which you know, brings higher satisfaction to the patient itself. Remember,
dialysis is not easy at all. It's very cumbersome. It's
it can help you live longer, but it's it's definitely
(07:31):
not an easy task. And you know, we've done studies
over the years, since the eighties and nineties about how
much if you dialize more than Monday, Wednesday, Friday, or
you do it four or five days or even more
time at the incenter, and we've realized that whether it's
three hours or four hours, five days or six days,
it doesn't matter as long as if it's three days
(07:52):
and three days is enough for you to get the
minimum to feel better.
Speaker 1 (07:56):
Sure, So, as I said, so, this model to improve
access home dialysis to improve kidney transplant was launched in
twenty twenty one by the government and it's laid to
run through twenty twenty seven. And the penalties to doctors
is quite huge. You can get a payment bonus of
up to eight percent or even a penalty up to
minus ten percent. But despite these this carrot or the
(08:18):
stick that the government's offering only there's only been less
than two percent improvement. And I kind of want to
get into since we're running on the break here in
the next segment, I want to discuss how do you
decide and how do you get patients on for kidney transplant,
because that really is the goal. So we're going to
take a quick break here on the Hackers and continue
this discussion on kidney disease.
Speaker 4 (08:40):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing Row at medical hackers
(09:02):
dot com.
Speaker 1 (09:05):
Back around the Hackers. I'm doctor Rout here with doctor
Khn with the Ivcivastular Center on Pelicano on the east
side of l Paso. Yes, Sir, resident kidney experts, And
one of the things that we wanted to get into
is sort of the what is the next step patients
(09:26):
who are on dalysis And really the goal is if
we know you have kidney injury, maybe you can recover
enough kidney function potentially to get off dallasis. But there
are patients who are going to need a kidney transplant.
So just walk me through that process. Sure, a patient
comes in to your office, maybe they came in first
through the hospital setting, they got some kidney injury. Maybe
(09:47):
you find out they have as you said earlier, they
have three months of failure of recovery, three months of
failure to get off d alasis. How do you determine
this patient needs to on the kidney transplant list? How
do you how do they get up on that list?
How do we just walk me through that into our process?
Because that's very.
Speaker 3 (10:08):
Excellent, excellent question, and a lot of confusion about this
because a kidney transplant, you know, we hear a lot
about it, and we've been doing them for a long time.
Speaker 2 (10:18):
And you know, here in.
Speaker 3 (10:19):
Texas we are proud to say we do many transplants
all the major academic institutions. Here in El Paso at
Las Palmas Medical Center, we have a kidney transplant program
where I work at IBC below me, El Paso Kidney Specialist,
Doctor Fernando Moran is a Kidney UH Nephrology Fellowship trained
transplant kidney nephrologist. So so we do do them. They
(10:43):
are real, It does happen. I know many people with
transplants when you get a kidney. Okay, let's back it up.
So there are many ways to get on dialysis. We
had discussed before a few weeks ago this term crash landing.
When you come to the hospital super sick, everything's not
worth you go into something called multi organ failure. Oh
my gosh, this is scary, but it happens a lot.
(11:05):
People go to the ICU for some reason, their body
gets super into they go into what we call shock.
They're not able to make urine. We are able to
put them on dialysis. In the ICU, it's called slow dialysis.
Because you know, we're really smart, we have different technology
we have. We have slow dialysis with people who need
help with their blood pressure. It's called c RRT Continuous
(11:27):
renal replacement therapy. And then we have the normal dialysis
which you go three days a week, which we've been
talking about, and home dialysis. But in the ICU it's
a different type of dialysis. But these people aren't able
to make urine, and sometimes they recover, and it's possible
people on dialysis do recover. I've seen it myself in
my training. Lots of times it doesn't happen, though, So
(11:47):
what we do is you go to your local kidney
doctor and at our kidney doctor, we optimize. You love
this word optimize medications. We have some incredible medications out
right now. We have Jardians farsiga. These are SGLT two inhibitors,
which were initially prescribed for type two diabetic kidney disease
only and people who are diabetics. Now we're finding out
(12:09):
that they have excellent, excellent effects on the heart and
the body lowers blood pressure one or two points.
Speaker 2 (12:17):
These are SGLT two inhibitors.
Speaker 3 (12:18):
And then we got other flavors like ozembic, wagov, trzeppatide,
the GLP one inhibitors, which also are incredible. And did
you know that this GLP one inhibitors was taken out
of a lizard in Arizona. It's it's poisoned from it.
It's a North American poisonous lizard and that's how they
(12:39):
extracted GLP one from So that's weird, right, Yeah, I'm
forgetting the name of this of this of this animal.
So yeah, so you get on the kidney transplant list.
It's called the HeLa monster. That's what it was. I've
been thinking about this. It's the HeLa Monster. It's a
native lizard to southwestern US, and it secretes this hormone
(13:01):
in its venom that's exactly similar to the hormone g
LP one GOLP one. It's called xend in four in
the venom.
Speaker 1 (13:09):
Are you saying that it was initially founder or are
you saying they continuously No.
Speaker 3 (13:13):
They found it in there. Can you believe it's so weird?
Why why did they know to get the venom from
this lizard, the yela monster.
Speaker 1 (13:19):
Yeah, but all these folks who are on it, they're
you're not continuous to get having to milk theirds. Well,
they probably are synthetically making them correct.
Speaker 3 (13:27):
Well, I don't know what Lily Lily did over in Indianapolis,
but these these pharma people really did do a number.
Speaker 2 (13:33):
Because it's taken over as you know. Of course.
Speaker 3 (13:37):
Okay, so you get it, so you go to your
local kidney doctor and we put you on these medicines.
There's another one called corendia. You know, a sign that
we look for as kidney doctors is if you have
protein coming out of your urine. So we do these
spot urine protein checks. So we get into, you know,
some nerdy stuff. We figure out how your kidneys are affected.
But there's a number we look for. It's called your GFR,
(13:59):
your gloomy glomarial.
Speaker 2 (14:00):
Ar filtration rate.
Speaker 3 (14:01):
Okay, this is kind of taken from your blood exam
and it correlates how much functioning kidney you have left.
And a normal healthy person like Amber, our producer, doctor
Rao here and myself, our kidneys are functioning around ninety
to one hundred percent. People who have kidney disease, chronic
kidney disease, you know CKD stage three or four, their
(14:24):
kidney number, their GFR could be around sixty percent, which
is still good, right, that's amazing. You want anything above fifty,
I mean, does it. You don't have to do anything.
Speaker 2 (14:33):
It's good. You just have to monitor.
Speaker 3 (14:34):
But people who have kidney disease, it goes down to
GFR thirties and in the upper twenties, and this is
when it gets kind of sketchy. You have to start
looking at your medications because certain medications aren't able to
be given if you have kidney disease. But there's one
number that sticks out, doctor raw and that's twenty. When
your GFR gets to twenty is when a kidney patient
can be eligible for the transplant list and you know
(14:58):
it sounds daunting. Oh wow, you're GFRS twenty.
Speaker 2 (15:02):
You know what's gonna happen? Am I gonna die?
Speaker 4 (15:04):
No?
Speaker 3 (15:04):
This is just a gateway into this whole other world
of kidney transplants. And this is where some heavy testing
comes in. We're checking your whole body head to toe,
heart exams, brain exams, you know, chest exams, seeing all
types of stuff, including social stuff. You know, you know
you can't drink alcohol, no smoking, obviously none of our
(15:28):
listeners smoke cigarettes right here in Texas or.
Speaker 2 (15:31):
Or drink or drink. Yeah.
Speaker 3 (15:34):
So these things are important, and this is why kidney
doctors like doctor Moran at El Paso Kidney Specialists and
doctor Jim Gonzalez, who I'm gonna see later. If you're listening,
shout out to him. He invited me to dinner tonight.
These people, these doctors are taking such good care of
their patients that we see less people on dialysis over
the last few years. These medications are game changers, and
(15:56):
it's only starting. Kidney medicine is taken over, doctor Row.
We have lots of drugs in the pipeline that are
going after kidney disease that you know, another shout out
to help PASSO kidney specialists. They are running clinical trials
downstairs in the outpatient setting, and you know, historically clinical
trials are given, you know, in the hospital, but nephrology
(16:18):
is changing the game and we have taken this to
the outpatient world and now we're doing it in real
life moments where people who are just your regular patients,
yourtos well eat those you know, they're the ones trying
these medications because they save lives. So it's exciting because
you know, we don't want people on dialysis. You know,
dialysis patients aren't dollar signs. They're real people who need
(16:41):
to stay off of it. So when we talk about
kidney transplant, we have to talk about finding the local
kidney doctor who is making sure you're optimized and then
going from there and just monitoring where you're going and
hopefully you can just ride it out into the sunset
and be at GFR thirty for as long as you can.
And that's our goal in the Caney Clinic. We want
to just keep you riding off to make sure you
(17:03):
avoid dialysis.
Speaker 1 (17:04):
Thanks doctor con We're gonna take a quick break here
on the Hackers.
Speaker 4 (17:08):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(17:30):
dot com.
Speaker 1 (17:33):
Background the Hackers and of doctor con here who is
educating me on transplant kidney transplant for patients who have
kidney disease so CKD for those who don't know, that's
chronic kidney disease ESRD. If you ever see that, that's
end stage renal disease. And I always have a question
about donating a kidney because everybody, unless you're unless there's
(17:58):
some you're from some different planet, you should have two kidneys,
right everyone, Yeah, there's probably some sort of embryological things.
I suppose you could. You could probably only have one
kidney possibly.
Speaker 3 (18:09):
Remember, kidneys are in sequence with your brain and heart,
it being the top three. The top three organs in
my opinion are brain, heart, kidney, and the kidneys work
and simultaneously with the heart for blood pressure hormonal imbalance.
I mean having more than two would likely not work.
So two works. Having one is fine too, which I
(18:29):
think you're gonna get too shortly.
Speaker 1 (18:30):
Yeah, so that's my question. So there are a lot
of people who will voluntarily give up their kidney, maybe
to a friend or a relative who is in need
of a kidney.
Speaker 2 (18:43):
Right, So if you have an.
Speaker 3 (18:44):
Altruistic kidney donor yes, I know an attending out of Milwaukee.
Her name is doctor Anna Gaddy in credit what she's
a iu alum. She is a kidney doctor and altruistically
this is a cool word. Right, she wanted to because
she just won to and she gave up her kidney.
Speaker 2 (19:02):
Nice, So incredible, right, who?
Speaker 1 (19:05):
Well, the question is, so if you do give up
a kidney, what does that do to my body? So
if I gave up my kidney to somebody out there
who needs a kidney, what does that do to my body?
What does that do to my kidney function? Do am
I more at risk for potentially going down the pathway
of Dallasis? Is that something I should be scared of?
Obviously there's risks with any surgery, right, So if you
(19:28):
know when you have a surgery to remove a kidney.
There's obviously risks with that, but I'm not talking about
those risks that we all know about, because you know,
we can take out a kidney both there's open nefructomies.
There's also probably laparoscopic ways to possibly take these out.
But I guess the question.
Speaker 2 (19:41):
More we should leave them in.
Speaker 3 (19:43):
I so out of IU shout out to doctor William
Goggins been doing surgery kidney translants for decades, which I
was lucky enough to celebrate his three thousand kidney donation
or not do it? Three thousand kidney surgery?
Speaker 2 (19:57):
Excuse me?
Speaker 3 (19:58):
Yeah, I won't forget because he catered nothing bunt cakes
for the entire hospital.
Speaker 2 (20:02):
Yeah, we got, we got. It was a great lunch break.
Speaker 3 (20:05):
I remember being on rounds and uh, everyone got nothing
bun cakes.
Speaker 2 (20:08):
Those things are expensive. They're like so sure.
Speaker 1 (20:11):
So I guess the question is this, if we if you,
if I do give up a kidney, what what risks
does that post to me? Or does it post any
like is something that I should be worried about? I
gave up a kidney to you or somebody else? Like, now,
am I at risk of going down the pathway of dialysis?
Is my kidney function going to be worse before a
(20:31):
kidney transplant verse after transplant.
Speaker 2 (20:34):
Okay, so good question.
Speaker 3 (20:36):
Your risks are just like the regular population. Okay, the
whole I mean, there are some caveats to that. If
you're pregnant, and if you're a female and you donate
your kidney when you get pregnant, you are at increased
risk for c k D and pre acclampsia, which is
a scary thing to have when you are pregnant and
you got yeah, blood pressure and proteins in the urine.
(20:59):
But let's say you, you or myself or a misamber
here uh donate a kidney. Our risks are the same
as a regular uh uh population. The surgery itself has
its risks which are just your normal surgical risks, and
but the long term outlook for healthy donors is excellent.
So when you when we talk about kidney transplants, we
(21:20):
have two types.
Speaker 2 (21:21):
They branch off.
Speaker 3 (21:22):
We have living kidney donor, which is the best one
by far, or we have deceased kidney donors. And this
is when it gets very difficult because you have to
match Our technology is superior, you know right now, where
we are able to match you know your UH all
these different health all these different UH antibodies and stuff
(21:43):
like this between.
Speaker 1 (21:44):
It doesn't reject it, yes'.
Speaker 3 (21:45):
Because yeah, because once you have a kidney transplant, you're
on lifelong immunosuppression, which is drugs to calm your immune
system to not attack the kidney that's coming. In interesting fact,
you usually don't take out the kidney, so people have
extra kidney in them and the kidney will kind of
like get a little you know, fibrost and get smaller,
but you don't take out the kidney unless you need
(22:07):
to make room for the other one.
Speaker 2 (22:09):
I asked doctor Goggins, this.
Speaker 3 (22:10):
By the way I go, So you have how many
kidney kidneys have you seen in one person? He said
up to five he's seen, right, because if you're a
young kid and you have a kidney transplant because you
have a congenital problem, you know, God forbid this is
the very sad. But you can have multiple kidney transplants.
So he had done almost he did four kidney transplants
in a person over their life, and he kept all
of them in. So I know it's not interesting.
Speaker 1 (22:32):
Yeah, So because I read a lot of seats when
I have my radiology had on and so I see
these transplants, sure, and usually you'll have you know, let's
say you have received a kidney, you'll have your two
original kidneys that are essentially probably shrunken down. That's what
it kind of looks like on a CT scan because
you're your native kidneys, the ones that you were born with,
aren't functioning. That's why you obviously you went on Dallas
(22:53):
is down this pathway of getting a kidney transplant. Then
they put in the new kidney, but.
Speaker 2 (22:57):
They usually in the front left, yes, and they put
it exactly.
Speaker 1 (22:59):
They tend to put it in the pelvis, and so
it's very easily accessible, and it's usually a larger kidney,
and so we're always keeping track of the kidney function.
And to me, maybe I'm biased because I'm a radiologist.
I always read a lot of ultrasounds, and so I
know that you guys order a lot of ultra sounds,
just whether it's in the acute setting, meaning you know,
(23:20):
a patient has just found out they have a need
for dialysis, and so I'll just kind of go into
what I look for onland. I'm actually kind of curious
actually before I even go into this how much do
you rely on my ultrasound findings in terms of deciding
what path or is it mostly chemical? Because I feel
I don't know how much do you really need to know?
(23:43):
For example, when I look at an ultrasound of the
kidney's what I'm looking for is is there any obstruction,
meaning is there any what we call hydro nephrosis, that
luckage that means that there's some sort of a blockage.
Maybe you have a stone, maybe you have some sort
of a stricture, a narrowing in your in your ardors,
in your in your your urinary excretion system that's causing
(24:05):
a blockage, causing a problem there. Sometimes we're also looking
at the what we call the ecogenicity. So when I
look at a kidney on an ould sound, it can
be a variety of different grays, right, So on our
entire you know, there's there's multiple shades of gray that
we have when we look at look at a kidney
on or not just a kidney ultrasound in general, either
(24:26):
black or white, right, and it's shades of gray all
in between. And so sometimes if there's more gray, that
just means there's more ecogenicity. And so sometimes when I
see more gray in your kidney. That just means to me,
I just interpreted that it's having just some underlying medical
renal disease, And really I just leave it at that.
But I'm not sure how much it's a helpful term.
(24:46):
I'm not sure how much help I'm giving to you
as an affront you're helping us, don't say that in
that set. And so we're also looking for any anomalies
and if there's any you know, duplicated collecting systems, different
things like that. But I guess the question for you
is how much do you rely on a kidney ultrasound,
because I personally feel like I read a lot of them,
It's one of the most common things that pops up
(25:07):
on my work. Or do you rely more on lab values.
I know that you're always looking at the urine. You're
doing lots of urine studies. Is that is that the
main things? Where are you looking at blood pressure when
you get a patient who's going down this pathway of
dallasis or a patient who's also maybe had a transplant. Sure,
what are you relying on? What are the main And
(25:29):
we don't have much time. We only have maybe about
one minute frenswer. This is a huge question.
Speaker 2 (25:34):
Thank you for that, Aliu, doctor Owl.
Speaker 3 (25:35):
Okay, So when you have somebody with kidney injury, kidney aki,
as we say, a cute kidney injury console, it's multifaceted,
doctor Row. We yes, an ultrasound is super important. We
have to rule out obstruction because that could easily be fixed.
We can put a stint in there, we can put
in a Foley catheter. Right, this is very important. So
(25:56):
what you're doing is saving lives. Structure out, don't give up. Okay,
keep eating those ultrasounds. But also we do look at everything.
We look at medications, which is a common culprit which
can cause kidney problems. People who have low blood pressure
because not enough blood pressure goes to the kidneys. Right,
kidneys love high blood pressure. It's highly vascularized, lots of
blood vessels in there. So when you have low blood pressure,
(26:19):
it can affect the kidneys and cause some damage. But
one of the main things we do is urine microscopy
for all new acute kidney injuries. If you're fortunate enough
in the hospital or in your clinic, we take your
urine and we look at the urine sediment after putting
it in a centriviews for five minutes, spin it around
super fast. We dump out the sediment, we resuspend it,
and we look at it, look at it under the microscope,
(26:42):
and this tells us so many clues. It's kind of
like our perpheral blood smear the hematologists do. We do
it as a kidney doctor, and we're able to look
at all these things under the urine. We get something
called casts. We get you know, we can look at
the types of RBCs, the red blood cells if they're
the shape is normal. So there's a lot of things
that we can do to look up a kidney injury problem.
But it's a team effort and you're definitely a part
(27:05):
of it. So please keep reading those things.
Speaker 1 (27:07):
Thanks doctor KHN. So I kind of want to close
this thing with a few hacks things that I kind
of learned from you, and maybe you can correct me
if I'm wrong. I think the top three things for
me is one is I think it's good to know
that if you do donate a kidney, you're not really
at risk for developing a further disease. The second thing
is I think it's always good to know that kidney
(27:28):
transplant should be the goal. If you are going down
this pathway, it's probably best not to be on dallass
for the rest of your life. And the third thing
is I think it's good to be plugged into systems
like you know what. Doctor khn is in place all
his contacts here, so if you are in need of
kidney disease, he's definitely a please reach out good source
at the Ivaskar Center. So unfortunate our time this Saturday
(27:50):
is up. If you are interested in more information on
any of the mentioned MINIMALI invased treatments, you can always
call to get more information at nine one five hundred
forty three seventy that's five zero zero four seven zero.
You can also reach me about email at rawat medicalhackers
dot com. That's my last name, r A O at
Medicalactors dot com. I hope these healthcare hacks have helped
you navigate our complex medical system. If you've been tuned
(28:12):
into us this whole time, bless your heart and your health.
I'm doctor sandeep Row, and you've been listening to the
Medical Actors
Good afternoon. Listen to the weekend here in the art
of the dusty eh wah and desert in West Texas
and you're listening to the Medical Hackers. However, you may
be tuned in this week and I'm your host, doctor
Sandy Brow. I'm here to bring the border Land the
latest information on healthcare, medicine and technology on the show.
I consider myself a hacker in the positive sense, a
hacker using my intimate knowledge in the medical system to
(00:25):
breaking down some various to accessing new medical technologies and
current healthcare information. So this week again I have a
frequent guest and at this point he's really a part
of the show of doctor ukber Khan.
Speaker 2 (00:37):
You're too kind. Thank you. Good morning.
Speaker 1 (00:40):
Yeah, it's great to have you because you allow me
to get into more depth on some of these topics
that I care about. I see a lot, but I
don't have that knowledge that you do, since you are
an expert in You're a nephrologist, you're a kidney doctor,
and you have a lot of knowledge in the way
(01:00):
of dealing with high blood pressure. So these are all
things that I deal with, but you are able to
talk to these topics on a much more deeper level
and deeper understanding that really, honestly, I get educated just
as much as some of our listeners. So one of
the things that you actually brought up that actually I
actually went in, I went and read up a little
bit more about it was this idea of what is
(01:22):
the goal with patients who have kidney diseases and they
may initially get dallasis and you know, when you're in
an acute setting, when you're in a setting where you
just realize you need kidney support, you get dallass But
what is the end goal with this this whole pathway.
Is it to just have you on DALLAS the rest
of your life? Or what are we trying to achieve?
(01:43):
And so one of the things I was reading about
was there are a set of incentives that have been
in place from CMS, from Medicare, from the major payer
out there called the end stage renal disease treatment choices.
It's called the ETC model, and they're trying to make
it more of a mandatory model, something that will help
align the incentives of kidney doctors, the healthcare systems along
(02:05):
with the incentives of patients, because there can be some
conflicting incentives there because sometimes there's a kidney doctor man,
you can correct me if I'm wrong. Maybe, if you
have ownership in a dallas center, maybe you want to
keep patients. You want to keep those beds full. You
want to have patients on Dallasis as long as possible
because you get paid for Dallasis sessions. But the goal
(02:26):
for patients obviously to get off that, and the goal
of the healthcare system is to reduce costs by not
having patients on dalyasis.
Speaker 3 (02:33):
Sure, yeah, you're speaking facts. If I know you're keeping
patients on dialysis for other causes, we're going to have
an issue. But usually that's not the case. Usually, thankfully.
The goal of when someone is on dialysis is to
get off of it as soon as possible, and there
are many things that we look forward to get a
patient off dialysis. One is the patient making urine. We
(02:55):
have this phrase in kidney medicine where we say, is
the patient making good urine? I would laugh at my attendings.
I go, that sounds strange, and sometimes it happens. Sometimes
you pee a lot, sometimes you pee less and it's
more concentrated. Well, the main thing is to get off
dialysis and you know, we usually have we set a timeframe,
usually around three months. If you're three months on dialysis
(03:16):
and you're not recovering, then it's then it's then it's
you know, by by definition we say you're end stage
renal disease. There's there's lots of minutia in this, but
dialysis is only a temporary bridge to kidney transplant, which
I know you're going to talk about later. Uh, dialysis
is a tool, it's not a cure. It can save
lives because it helps the body recover. Overall, dialysis, we
(03:40):
don't want you on it.
Speaker 1 (03:42):
So what I did find interesting is so now they
are trying to increase the incentives, and these are pay
for performance incentives that payers have placed on dialysis facilities
and on doctors nefrolgist such as yourselves, to sort of
increase the need for patients to get home dialysis, which
is something we discussed before. I don't want to go
(04:02):
into too much depth on it, but basically this allows
patients to not have to go to a facility to
get dallasas to do it at your home. And so
there's two goals with this incentive program. One increase home
dialysis and two try to increase the amount of kidney transplants,
patients who are waiting kidney transplants, and patients who actually
get kidney transplants. But what's interesting is this, So this
(04:24):
is a program that's going to be running through twenty
twenty seven, and what they have found, the preliminary thing,
is that this model has not actually really moved the
needle on changing provider behavior, on changing doctor behavior. Dallasis
facility behavior and we're not entirely sure why. But there
are a couple of theories. One is that when it
comes to home dialysis, they're finding that a lot of
(04:45):
patients may not be wanting to go that route or
are having difficulty getting on that route. Is because one
is some patients because of the demographics, maybe because of
the social situation if they don't have a stable housing situation.
Speaker 3 (04:58):
Yeah, there are some things you need in order to
proceed with home dialysis, whether it's through the belly peritoneal dialysis,
which we discussed last time.
Speaker 2 (05:06):
Which I was thinking about.
Speaker 3 (05:07):
I said something wrong and I said it's through convention,
it's actually through diffusion. I got some of my terms
mixed up last time.
Speaker 2 (05:14):
That was like three weeks ago. But continue.
Speaker 1 (05:17):
Sorry, Sure, so when it is table housing. The other
one is that you know, some of these patients, if
you're trying to do dialysis on your own at home
without the help of a diasis center, you have to
kind of learn how to self administer. It's pretty much
a complex medical regimen. So that's another thing. The other
thing is sometimes people just don't have caregiver support at home.
What if you're alone and you don't have somebody to
(05:37):
plug you in to this continuous dialysis at home. The
other one is just sometimes there's some financial burden of
doing modifications to your home.
Speaker 2 (05:46):
Sure.
Speaker 1 (05:47):
And the other one is that sometimes it's just you know,
costs or going up, rent is going up, higher utility
bills which can be encountered if you do home DOALSA.
So this can really contribute to the slow uptake of
home dialysis. And I don't want to get into what
we discussed home Dallas as before, but really quick summary
from what I get and you can correct me if
I'm wrong, doctor, You're usually right, You're good. The goal,
(06:08):
the reason why we want to encourage patients to do
home dialyasis as opposed to coming to a treatment center
is by being able to do it at home, you
can do dallasis pretty much every single day, and you
can try to control your blood levels on a more
consistent basis as opposed to if you're doing dallases at
a facility, you only tend to get dallass maybe Monday, Wednesday, Friday,
(06:30):
maybe Tuesday Thursday, or Tuesday Thursday Saturday, if it's two
or three days, and that's sort of a you're only
trying to go after it in that setting when we
bring you into the center. But if you can do
it more continuously, that's better for your body overall.
Speaker 3 (06:46):
Exactly. Yes, you patients feel better. That's what they say
you are able to. So first it's a choice. If
you're lucky enough and able to pass through the rigorous
testing and the training, you will be able to dialize
at home for one to two hours a day, four
to five days, right, And this allows better quality of life.
And this is what we've gotten from all the feedback
(07:07):
and all the surveys that they take. It's that doing
it at home gives a patient the opportunity to do
it in their home, own home setting, which allows more comfort,
which you know, brings higher satisfaction to the patient itself. Remember,
dialysis is not easy at all. It's very cumbersome. It's
it can help you live longer, but it's it's definitely
(07:31):
not an easy task. And you know, we've done studies
over the years, since the eighties and nineties about how
much if you dialize more than Monday, Wednesday, Friday, or
you do it four or five days or even more
time at the incenter, and we've realized that whether it's
three hours or four hours, five days or six days,
it doesn't matter as long as if it's three days
(07:52):
and three days is enough for you to get the
minimum to feel better.
Speaker 1 (07:56):
Sure, So, as I said, so, this model to improve
access home dialysis to improve kidney transplant was launched in
twenty twenty one by the government and it's laid to
run through twenty twenty seven. And the penalties to doctors
is quite huge. You can get a payment bonus of
up to eight percent or even a penalty up to
minus ten percent. But despite these this carrot or the
(08:18):
stick that the government's offering only there's only been less
than two percent improvement. And I kind of want to
get into since we're running on the break here in
the next segment, I want to discuss how do you
decide and how do you get patients on for kidney transplant,
because that really is the goal. So we're going to
take a quick break here on the Hackers and continue
this discussion on kidney disease.
Speaker 4 (08:40):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing Row at medical hackers
(09:02):
dot com.
Speaker 1 (09:05):
Back around the Hackers. I'm doctor Rout here with doctor
Khn with the Ivcivastular Center on Pelicano on the east
side of l Paso. Yes, Sir, resident kidney experts, And
one of the things that we wanted to get into
is sort of the what is the next step patients
(09:26):
who are on dalysis And really the goal is if
we know you have kidney injury, maybe you can recover
enough kidney function potentially to get off dallasis. But there
are patients who are going to need a kidney transplant.
So just walk me through that process. Sure, a patient
comes in to your office, maybe they came in first
through the hospital setting, they got some kidney injury. Maybe
(09:47):
you find out they have as you said earlier, they
have three months of failure of recovery, three months of
failure to get off d alasis. How do you determine
this patient needs to on the kidney transplant list? How
do you how do they get up on that list?
How do we just walk me through that into our process?
Because that's very.
Speaker 3 (10:08):
Excellent, excellent question, and a lot of confusion about this
because a kidney transplant, you know, we hear a lot
about it, and we've been doing them for a long time.
Speaker 2 (10:18):
And you know, here in.
Speaker 3 (10:19):
Texas we are proud to say we do many transplants
all the major academic institutions. Here in El Paso at
Las Palmas Medical Center, we have a kidney transplant program
where I work at IBC below me, El Paso Kidney Specialist,
Doctor Fernando Moran is a Kidney UH Nephrology Fellowship trained
transplant kidney nephrologist. So so we do do them. They
(10:43):
are real, It does happen. I know many people with
transplants when you get a kidney. Okay, let's back it up.
So there are many ways to get on dialysis. We
had discussed before a few weeks ago this term crash landing.
When you come to the hospital super sick, everything's not
worth you go into something called multi organ failure. Oh
my gosh, this is scary, but it happens a lot.
(11:05):
People go to the ICU for some reason, their body
gets super into they go into what we call shock.
They're not able to make urine. We are able to
put them on dialysis. In the ICU, it's called slow dialysis.
Because you know, we're really smart, we have different technology
we have. We have slow dialysis with people who need
help with their blood pressure. It's called c RRT Continuous
(11:27):
renal replacement therapy. And then we have the normal dialysis
which you go three days a week, which we've been
talking about, and home dialysis. But in the ICU it's
a different type of dialysis. But these people aren't able
to make urine, and sometimes they recover, and it's possible
people on dialysis do recover. I've seen it myself in
my training. Lots of times it doesn't happen, though, So
(11:47):
what we do is you go to your local kidney
doctor and at our kidney doctor, we optimize. You love
this word optimize medications. We have some incredible medications out
right now. We have Jardians farsiga. These are SGLT two inhibitors,
which were initially prescribed for type two diabetic kidney disease
only and people who are diabetics. Now we're finding out
(12:09):
that they have excellent, excellent effects on the heart and
the body lowers blood pressure one or two points.
Speaker 2 (12:17):
These are SGLT two inhibitors.
Speaker 3 (12:18):
And then we got other flavors like ozembic, wagov, trzeppatide,
the GLP one inhibitors, which also are incredible. And did
you know that this GLP one inhibitors was taken out
of a lizard in Arizona. It's it's poisoned from it.
It's a North American poisonous lizard and that's how they
(12:39):
extracted GLP one from So that's weird, right, Yeah, I'm
forgetting the name of this of this of this animal.
So yeah, so you get on the kidney transplant list.
It's called the HeLa monster. That's what it was. I've
been thinking about this. It's the HeLa Monster. It's a
native lizard to southwestern US, and it secretes this hormone
(13:01):
in its venom that's exactly similar to the hormone g
LP one GOLP one. It's called xend in four in
the venom.
Speaker 1 (13:09):
Are you saying that it was initially founder or are
you saying they continuously No.
Speaker 3 (13:13):
They found it in there. Can you believe it's so weird?
Why why did they know to get the venom from
this lizard, the yela monster.
Speaker 1 (13:19):
Yeah, but all these folks who are on it, they're
you're not continuous to get having to milk theirds. Well,
they probably are synthetically making them correct.
Speaker 3 (13:27):
Well, I don't know what Lily Lily did over in Indianapolis,
but these these pharma people really did do a number.
Speaker 2 (13:33):
Because it's taken over as you know. Of course.
Speaker 3 (13:37):
Okay, so you get it, so you go to your
local kidney doctor and we put you on these medicines.
There's another one called corendia. You know, a sign that
we look for as kidney doctors is if you have
protein coming out of your urine. So we do these
spot urine protein checks. So we get into, you know,
some nerdy stuff. We figure out how your kidneys are affected.
But there's a number we look for. It's called your GFR,
(13:59):
your gloomy glomarial.
Speaker 2 (14:00):
Ar filtration rate.
Speaker 3 (14:01):
Okay, this is kind of taken from your blood exam
and it correlates how much functioning kidney you have left.
And a normal healthy person like Amber, our producer, doctor
Rao here and myself, our kidneys are functioning around ninety
to one hundred percent. People who have kidney disease, chronic
kidney disease, you know CKD stage three or four, their
(14:24):
kidney number, their GFR could be around sixty percent, which
is still good, right, that's amazing. You want anything above fifty,
I mean, does it. You don't have to do anything.
Speaker 2 (14:33):
It's good. You just have to monitor.
Speaker 3 (14:34):
But people who have kidney disease, it goes down to
GFR thirties and in the upper twenties, and this is
when it gets kind of sketchy. You have to start
looking at your medications because certain medications aren't able to
be given if you have kidney disease. But there's one
number that sticks out, doctor raw and that's twenty. When
your GFR gets to twenty is when a kidney patient
can be eligible for the transplant list and you know
(14:58):
it sounds daunting. Oh wow, you're GFRS twenty.
Speaker 2 (15:02):
You know what's gonna happen? Am I gonna die?
Speaker 4 (15:04):
No?
Speaker 3 (15:04):
This is just a gateway into this whole other world
of kidney transplants. And this is where some heavy testing
comes in. We're checking your whole body head to toe,
heart exams, brain exams, you know, chest exams, seeing all
types of stuff, including social stuff. You know, you know
you can't drink alcohol, no smoking, obviously none of our
(15:28):
listeners smoke cigarettes right here in Texas or.
Speaker 2 (15:31):
Or drink or drink. Yeah.
Speaker 3 (15:34):
So these things are important, and this is why kidney
doctors like doctor Moran at El Paso Kidney Specialists and
doctor Jim Gonzalez, who I'm gonna see later. If you're listening,
shout out to him. He invited me to dinner tonight.
These people, these doctors are taking such good care of
their patients that we see less people on dialysis over
the last few years. These medications are game changers, and
(15:56):
it's only starting. Kidney medicine is taken over, doctor Row.
We have lots of drugs in the pipeline that are
going after kidney disease that you know, another shout out
to help PASSO kidney specialists. They are running clinical trials
downstairs in the outpatient setting, and you know, historically clinical
trials are given, you know, in the hospital, but nephrology
(16:18):
is changing the game and we have taken this to
the outpatient world and now we're doing it in real
life moments where people who are just your regular patients,
yourtos well eat those you know, they're the ones trying
these medications because they save lives. So it's exciting because
you know, we don't want people on dialysis. You know,
dialysis patients aren't dollar signs. They're real people who need
(16:41):
to stay off of it. So when we talk about
kidney transplant, we have to talk about finding the local
kidney doctor who is making sure you're optimized and then
going from there and just monitoring where you're going and
hopefully you can just ride it out into the sunset
and be at GFR thirty for as long as you can.
And that's our goal in the Caney Clinic. We want
to just keep you riding off to make sure you
(17:03):
avoid dialysis.
Speaker 1 (17:04):
Thanks doctor con We're gonna take a quick break here
on the Hackers.
Speaker 4 (17:08):
You're listening to the Medical Hackers with doctor Sandy Brow,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(17:30):
dot com.
Speaker 1 (17:33):
Background the Hackers and of doctor con here who is
educating me on transplant kidney transplant for patients who have
kidney disease so CKD for those who don't know, that's
chronic kidney disease ESRD. If you ever see that, that's
end stage renal disease. And I always have a question
about donating a kidney because everybody, unless you're unless there's
(17:58):
some you're from some different planet, you should have two kidneys,
right everyone, Yeah, there's probably some sort of embryological things.
I suppose you could. You could probably only have one
kidney possibly.
Speaker 3 (18:09):
Remember, kidneys are in sequence with your brain and heart,
it being the top three. The top three organs in
my opinion are brain, heart, kidney, and the kidneys work
and simultaneously with the heart for blood pressure hormonal imbalance.
I mean having more than two would likely not work.
So two works. Having one is fine too, which I
(18:29):
think you're gonna get too shortly.
Speaker 1 (18:30):
Yeah, so that's my question. So there are a lot
of people who will voluntarily give up their kidney, maybe
to a friend or a relative who is in need
of a kidney.
Speaker 2 (18:43):
Right, So if you have an.
Speaker 3 (18:44):
Altruistic kidney donor yes, I know an attending out of Milwaukee.
Her name is doctor Anna Gaddy in credit what she's
a iu alum. She is a kidney doctor and altruistically
this is a cool word. Right, she wanted to because
she just won to and she gave up her kidney.
Speaker 2 (19:02):
Nice, So incredible, right, who?
Speaker 1 (19:05):
Well, the question is, so if you do give up
a kidney, what does that do to my body? So
if I gave up my kidney to somebody out there
who needs a kidney, what does that do to my body?
What does that do to my kidney function? Do am
I more at risk for potentially going down the pathway
of Dallasis? Is that something I should be scared of?
Obviously there's risks with any surgery, right, So if you
(19:28):
know when you have a surgery to remove a kidney.
There's obviously risks with that, but I'm not talking about
those risks that we all know about, because you know,
we can take out a kidney both there's open nefructomies.
There's also probably laparoscopic ways to possibly take these out.
But I guess the question.
Speaker 2 (19:41):
More we should leave them in.
Speaker 3 (19:43):
I so out of IU shout out to doctor William
Goggins been doing surgery kidney translants for decades, which I
was lucky enough to celebrate his three thousand kidney donation
or not do it? Three thousand kidney surgery?
Speaker 2 (19:57):
Excuse me?
Speaker 3 (19:58):
Yeah, I won't forget because he catered nothing bunt cakes
for the entire hospital.
Speaker 2 (20:02):
Yeah, we got, we got. It was a great lunch break.
Speaker 3 (20:05):
I remember being on rounds and uh, everyone got nothing
bun cakes.
Speaker 2 (20:08):
Those things are expensive. They're like so sure.
Speaker 1 (20:11):
So I guess the question is this, if we if you,
if I do give up a kidney, what what risks
does that post to me? Or does it post any
like is something that I should be worried about? I
gave up a kidney to you or somebody else? Like, now,
am I at risk of going down the pathway of dialysis?
Is my kidney function going to be worse before a
(20:31):
kidney transplant verse after transplant.
Speaker 2 (20:34):
Okay, so good question.
Speaker 3 (20:36):
Your risks are just like the regular population. Okay, the
whole I mean, there are some caveats to that. If
you're pregnant, and if you're a female and you donate
your kidney when you get pregnant, you are at increased
risk for c k D and pre acclampsia, which is
a scary thing to have when you are pregnant and
you got yeah, blood pressure and proteins in the urine.
(20:59):
But let's say you, you or myself or a misamber
here uh donate a kidney. Our risks are the same
as a regular uh uh population. The surgery itself has
its risks which are just your normal surgical risks, and
but the long term outlook for healthy donors is excellent.
So when you when we talk about kidney transplants, we
(21:20):
have two types.
Speaker 2 (21:21):
They branch off.
Speaker 3 (21:22):
We have living kidney donor, which is the best one
by far, or we have deceased kidney donors. And this
is when it gets very difficult because you have to
match Our technology is superior, you know right now, where
we are able to match you know your UH all
these different health all these different UH antibodies and stuff
(21:43):
like this between.
Speaker 1 (21:44):
It doesn't reject it, yes'.
Speaker 3 (21:45):
Because yeah, because once you have a kidney transplant, you're
on lifelong immunosuppression, which is drugs to calm your immune
system to not attack the kidney that's coming. In interesting fact,
you usually don't take out the kidney, so people have
extra kidney in them and the kidney will kind of
like get a little you know, fibrost and get smaller,
but you don't take out the kidney unless you need
(22:07):
to make room for the other one.
Speaker 2 (22:09):
I asked doctor Goggins, this.
Speaker 3 (22:10):
By the way I go, So you have how many
kidney kidneys have you seen in one person? He said
up to five he's seen, right, because if you're a
young kid and you have a kidney transplant because you
have a congenital problem, you know, God forbid this is
the very sad. But you can have multiple kidney transplants.
So he had done almost he did four kidney transplants
in a person over their life, and he kept all
of them in. So I know it's not interesting.
Speaker 1 (22:32):
Yeah, So because I read a lot of seats when
I have my radiology had on and so I see
these transplants, sure, and usually you'll have you know, let's
say you have received a kidney, you'll have your two
original kidneys that are essentially probably shrunken down. That's what
it kind of looks like on a CT scan because
you're your native kidneys, the ones that you were born with,
aren't functioning. That's why you obviously you went on Dallas
(22:53):
is down this pathway of getting a kidney transplant. Then
they put in the new kidney, but.
Speaker 2 (22:57):
They usually in the front left, yes, and they put
it exactly.
Speaker 1 (22:59):
They tend to put it in the pelvis, and so
it's very easily accessible, and it's usually a larger kidney,
and so we're always keeping track of the kidney function.
And to me, maybe I'm biased because I'm a radiologist.
I always read a lot of ultrasounds, and so I
know that you guys order a lot of ultra sounds,
just whether it's in the acute setting, meaning you know,
(23:20):
a patient has just found out they have a need
for dialysis, and so I'll just kind of go into
what I look for onland. I'm actually kind of curious
actually before I even go into this how much do
you rely on my ultrasound findings in terms of deciding
what path or is it mostly chemical? Because I feel
I don't know how much do you really need to know?
(23:43):
For example, when I look at an ultrasound of the
kidney's what I'm looking for is is there any obstruction,
meaning is there any what we call hydro nephrosis, that
luckage that means that there's some sort of a blockage.
Maybe you have a stone, maybe you have some sort
of a stricture, a narrowing in your in your ardors,
in your in your your urinary excretion system that's causing
(24:05):
a blockage, causing a problem there. Sometimes we're also looking
at the what we call the ecogenicity. So when I
look at a kidney on an ould sound, it can
be a variety of different grays, right, So on our
entire you know, there's there's multiple shades of gray that
we have when we look at look at a kidney
on or not just a kidney ultrasound in general, either
(24:26):
black or white, right, and it's shades of gray all
in between. And so sometimes if there's more gray, that
just means there's more ecogenicity. And so sometimes when I
see more gray in your kidney. That just means to me,
I just interpreted that it's having just some underlying medical
renal disease, And really I just leave it at that.
But I'm not sure how much it's a helpful term.
(24:46):
I'm not sure how much help I'm giving to you
as an affront you're helping us, don't say that in
that set. And so we're also looking for any anomalies
and if there's any you know, duplicated collecting systems, different
things like that. But I guess the question for you
is how much do you rely on a kidney ultrasound,
because I personally feel like I read a lot of them,
It's one of the most common things that pops up
(25:07):
on my work. Or do you rely more on lab values.
I know that you're always looking at the urine. You're
doing lots of urine studies. Is that is that the
main things? Where are you looking at blood pressure when
you get a patient who's going down this pathway of
dallasis or a patient who's also maybe had a transplant. Sure,
what are you relying on? What are the main And
(25:29):
we don't have much time. We only have maybe about
one minute frenswer. This is a huge question.
Speaker 2 (25:34):
Thank you for that, Aliu, doctor Owl.
Speaker 3 (25:35):
Okay, So when you have somebody with kidney injury, kidney aki,
as we say, a cute kidney injury console, it's multifaceted,
doctor Row. We yes, an ultrasound is super important. We
have to rule out obstruction because that could easily be fixed.
We can put a stint in there, we can put
in a Foley catheter. Right, this is very important. So
(25:56):
what you're doing is saving lives. Structure out, don't give up. Okay,
keep eating those ultrasounds. But also we do look at everything.
We look at medications, which is a common culprit which
can cause kidney problems. People who have low blood pressure
because not enough blood pressure goes to the kidneys. Right,
kidneys love high blood pressure. It's highly vascularized, lots of
blood vessels in there. So when you have low blood pressure,
(26:19):
it can affect the kidneys and cause some damage. But
one of the main things we do is urine microscopy
for all new acute kidney injuries. If you're fortunate enough
in the hospital or in your clinic, we take your
urine and we look at the urine sediment after putting
it in a centriviews for five minutes, spin it around
super fast. We dump out the sediment, we resuspend it,
and we look at it, look at it under the microscope,
(26:42):
and this tells us so many clues. It's kind of
like our perpheral blood smear the hematologists do. We do
it as a kidney doctor, and we're able to look
at all these things under the urine. We get something
called casts. We get you know, we can look at
the types of RBCs, the red blood cells if they're
the shape is normal. So there's a lot of things
that we can do to look up a kidney injury problem.
But it's a team effort and you're definitely a part
(27:05):
of it. So please keep reading those things.
Speaker 1 (27:07):
Thanks doctor KHN. So I kind of want to close
this thing with a few hacks things that I kind
of learned from you, and maybe you can correct me
if I'm wrong. I think the top three things for
me is one is I think it's good to know
that if you do donate a kidney, you're not really
at risk for developing a further disease. The second thing
is I think it's always good to know that kidney
(27:28):
transplant should be the goal. If you are going down
this pathway, it's probably best not to be on dallass
for the rest of your life. And the third thing
is I think it's good to be plugged into systems
like you know what. Doctor khn is in place all
his contacts here, so if you are in need of
kidney disease, he's definitely a please reach out good source
at the Ivaskar Center. So unfortunate our time this Saturday
(27:50):
is up. If you are interested in more information on
any of the mentioned MINIMALI invased treatments, you can always
call to get more information at nine one five hundred
forty three seventy that's five zero zero four seven zero.
You can also reach me about email at rawat medicalhackers
dot com. That's my last name, r A O at
Medicalactors dot com. I hope these healthcare hacks have helped
you navigate our complex medical system. If you've been tuned
(28:12):
into us this whole time, bless your heart and your health.
I'm doctor sandeep Row, and you've been listening to the
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