FRIDAY, OCTOBER 24, 2008 04:50 PM, CDT

Fall greetings to everyone!

Brian has asked that I post one of those techno-medico updates re: a recent visit with the kidney specialist. Brian has been informed that he has Stage III Renal Disease.

This time last year Brian was in full blown liver AND kidney failure. (The name of the condition is called Hepatorenal Syndrome). As the liver function improves, the kidneys usually improve also.

The question is, how MUCH do the kidneys recover and what are the effects of continued liver disease?

Brians' kidneys rallied after failing last year and his doctors continue to monitor them regularly. For unknown reasons, once kidneys have been damaged they may continue to deteriorate for months or years, even long after the disease that caused the damage is gone. (Usually, people in stages I – III do not feel ill and the disease is picked up on lab work).

It was always possible that this could happen – and it is also possible that one can remain in stage III for a long time without getting worse. An Ultra Sound is scheduled and will help tell if the filtering system in the kidneys has sustained a lot of damage or not.

Kidney disease is mapped in stages 1 – V. Normal filtration rate is between 90 and 100. Stage III disease is usually indicated by a filtration rate of 30 – 59. Dialysis becomes necessary for some people when the filtration rate falls below 15 or so. Usually, we restrict certain kinds of protein in the diet and use medications like ACE Inhibitors (also used for blood pressure) to protect the kidneys.

It is very important to control the blood pressure (in Brian's case the portal hypertension from liver disease) and follow any diet restrictions. He will have to follow a fluid and salt restriction and take diuretics. His doctor will give him an ideal wt. that he is to monitor daily. Since the kidneys make erythropoietin (EPO for short!) that stimulates the production of red blood cells, many people with renal disease have anemia for which they must take iron. Some people must have the EPO replaced by injections once or twice a week.

An area of concern that does not get the attention that it needs is that of renal bone disease. It may not develop but it is crucial to prevent it as treatment after the fact is very difficult. In renal failure, the calcium level falls and the phosphate level rises in the blood. If this happens the body makes too much parathyroid hormone in an attempt to control it, causing the bones to thin. So…..Brian may have to take some active form of Vitamin D and perhaps a phosphate binding agent.

Okay –well I’m sure that’s enough info for now!!! Too bad Brian couldn’t get some SIMPLE thing once in a while!

In general, Bri is feeling well. He walks and swims as much as possible, sometimes 2 - 3 hours a day! He completed a 3 mile Walk for the Hungry and is doing all that he can to stay healthy. Of course he continues to minister at OLA at the 9:00 and 11:00 AM Masses. The later part of the day, usually from 2 - 6 are the "witching" hours during which he battles fatige, nausea and generally feeling icky.

I have missed all of the communication with everyone but have been more DELIGHTED than I can say that our Brian is up and about and communicating for himself these past several months! As always, thanks for your prayers.

Tina Marie