The Kidneys (Duality - Ying and Yang)
Kidney disease can be avoided by eating a healthy diet and drinking clean water. In many cases, it is a preventable disease.
The kidneys, as filters, play a vital role in the body. Herbs such as corn silk, cranberry, dandelion root, and burdock root, etc.
help to flush toxins from urinary tract. Although we can live with one kidney, losing two means certain death. Kidney
dialysis and transplants are not cures. The high rate of acute and chronic kidney disease and UTI’S in communities worldwide is alarming. But whether it is because of diet or environment, we
can do something to prevent and protect our kidneys from disease.
The Kidneys (Duality - Ying and Yang)
Kidney disease can be avoided by eating a healthy diet and drinking clean water. In many cases, it is a preventable disease.
The kidneys, as filters, play a vital role in the body. Herbs such as corn silk, cranberry, dandelion root, and burdock root, etc.
help to flush toxins from urinary tract. Although we can live with one kidney, losing two means certain death. Kidney
dialysis and transplants are not cures. The high rate of acute and chronic kidney disease and UTI’S in communities worldwide is alarming. But whether it is because of diet or environment, we
can do something to prevent and protect our kidneys from disease.
The Kidneys (Duality - Ying and Yang)
Kidney disease can be avoided by eating a healthy diet and drinking clean water. In many cases, it is a preventable disease.
The kidneys, as filters, play a vital role in the body. Herbs such as corn silk, cranberry, dandelion root, and burdock root, etc.
help to flush toxins from urinary tract. Although we can live with one kidney, losing two means certain death. Kidney
dialysis and transplants are not cures. The high rate of acute and chronic kidney disease and UTI’S in communities worldwide is alarming. But whether it is because of diet or environment, we
can do something to prevent and protect our kidneys from disease.
I N S I D E T H I S I S S U E 2 Nigeria: Kidney Disease - 32M Young People on Danger List 3 Afrikan Spirituality Oshun and Chango- Match in Heaven 4 Feature E Coli that cause UTI are Resistant to Antibiotics 6 Feature Urinary Tract Infections U.T.I. in Men 8 Feature Kidney Disease and Your Heart The Hidden Link 12 Irregular Heart Rhythms Increases Kidney Failure Risk 16 Kidney Disease Increases Risk of Early Death in Diabetics 18 Feature Kidney Stones (Renal Stones, Nephrolithiasis) 23 Role-Uric Acid in Hypertension, Renal and Metabolic Disease 27 Feature The Kidney Network: Properties and Functions 36 The Metaphysical Functioning of the Kidneys 39 Feature Pesticides: Health Effects in Drinking Water 50 Thousands of Sugar Cane Workers Die 57 UNEP Reports Highlights Risk of Mercury Emissions Africa 60 Feature Nigeria: The Rate of Kidney Disease 63 Acute Renal Failure as a Complication of Cholera 66 Mercury in Skin Lightening Products 73 Feature Kidney Failure: Causes, Treatment and Prevention 77 Herbal Therapies and the Patient with Kidney Diseases 88 What is Corn Silk? 92 Herb of the Month Cranberry for UTI and E Coli African-Americans and Kidney Disease The African American Community Health Advisory Committee One out of every three people with kidney failure is African- American, compared to only one in eight in the general population. When a person's kidneys are working at only 5 to 10 percent of normal, he or she must have regular dialysis treatments or a kidney transplant in order to live. Kidneys perform many vital functions including filtering waste products from the blood, controlling fluid balance, regulating blood pressure and stimulating red blood cell production. High blood pressure and diabetes are the leading causes of kidney failure. African-Americans, for reasons we don't entirely understand, are at high risk for both of these conditions. High blood pressure, also called hypertension, often doesn't have any obvious symptoms. That's why it's important to have regular medical check- ups and have your blood pressure checked often, even if you feel well. Diabetes symptoms include thirst, passing more urine than usual, hunger, unintended weight loss and fatigue. What is the African Traditional Herbal Research Clinic? We can make you healthy and wise Nakato Lewis Blackherbals at the Source of the Nile, UG Ltd.
The African Traditional Herbal Research Clinic located in Ntinda, Uganda is a modern clinic facility established to create a model space whereby indigenous herbal practitioners and healers can upgrade and update their skills through training and certification and respond to common diseases using African healing methods and traditions in a modern clinical environment. Traditional healers are the major health labor resource in Africa as a whole. In Uganda, indigenous traditional healers are the only source of health services for the majority of the population. An estimated 80% of the population receives its health education and health care from practitioners of traditional medicine. They are knowledgeable of the culture, the local languages and local traditions. Our purpose is to raise public awareness and understanding on the value of African traditional herbal medicine and other healing practices in todays world. The Clinic is open and operational. Some of the services we offer are African herbal medicine, reflexology, acupressure, hot and cold hydrotherapy, body massage, herbal tonics, patient counseling, blood pressure checks, urine testing (sugar), and nutritional profiles. We believe in spirit, mind and body. Spiritual counseling upon request. Visit us also at www.Blackherbals.com Hours: 10:00 am to 6:00 pm Monday thru Friday Saturday by Appointment, Sundays Closed
Continued on page 2 -2 - Traditional African Clinic February/March 2013
However, diabetes also sometimes has no symptoms. This is another reason why checkups are important. Fortunately, you can help prevent both diabetes and hypertension and their complications if you eat a low-fat, low-salt diet, exercise regularly, limit alcohol intake and don't smoke. If you have either diabetes or high blood pressure, take your prescribed medication and monitor your condition often. WARNING SIGNS OF KIDNEY DISEASE Swelling of parts of the body, especially around the eyes or ankles Pain in the lower back Burning or unusual sensation during urination Bloody or coffee colored urine Urinating more often, especially at night Listless or tired feeling High blood pressure You can feel fine and still have kidney disease African-Americans are 2.5 to 5.6 times more likely to suffer from kidney disease with more than 4,000 new cases annually of renal disease requiring either kidney transplant or regular dialysis. A WORD ABOUT LUPUS Lupus is an autoimmune disorder -- a rheumatic disease that belongs to the arthritis family. Lupus can strike different parts of the body. When it damages the kidneys, it is called lupus nephritis. Lupus occurs much more often among African- Americans than whites. African-American women are three times more likely to be affected than white women. http://www.aachac.org/healthfactsheets/kidney_disease.ht ml
Nigeria: Kidney Disease - 32 Million Young People on Danger List By Solomon Chung, Ruby Leo, Ibrahim Musa Giginyu and Rakiya A. Mohammed 8 December 2012 over increase in the number of young persons with chronic kidney disease (CKD). The figure by the National Association of Nephrology of those currently down with the ailment is frightening. More worrisome is the revelation that those mostly hit are the young and active segment of the society. Sunday Elekwa's kidneys are damaged; they can no longer remove waste products from his blood. He has to rely on dialysis machine to stay alive, and he has to do so twice every week at N50,000. For up to four hours a session, the dialysis machine does the job, and will need to do so three times a week to be as effective as his kidneys would have been. Elekwa has what nephrologists call end-stage renal disease. Elekwa is a young man, and not just him, it include much younger people than he is. Like Elekwa, Fidelis Putnang, a 27-year-old graduate of the University of Abuja is suffering from the same condition, thus needs money for dialysis forth nightly. Unlike Elekwa, Putnang did not know he is suffering from the ailment until he visited the National Hospital in Abuja after series of malaria and typhoid symptoms. According to Michael Putnang, his elder brother, "He was shocked the first day he learnt he has kidney ailment. He had regular fever off and on and then later diagnoses to have hepatitis B. It persisted even after treatment, until the kidney ailment was discovered." Like the two above, millions of young men, experts fear, are living with the ailment. The National Association of Nephrology put the figure of those diagnosed with the ailment at 35 million. Thirty two million out of this number are said to be on danger list, because their kidneys are already failing. The body fears that greater percentage of those currently living with the disease is the active segment of the society. It attributed the rising cases of the ailment among younger people to hereditary and other factors. "More and more [of the] younger population are getting affected," Dr. Kiran Kumar of the Internal Medicine Consultant at Primus Hospital, Abuja told Weekly Trust. He attributed the major causes of this to a "wide prevalence of unidentified hypertension," accounting for nearly 60 per cent of patients with CKD, while also not ruling out HIV and hepatitis B also. For Dr. Oluseyi Oniyango, Consultant Paediatrician at the National Hospital, Abuja, "lifestyles that young people have adopted over time are also to blame, especially when they become sedentary, engage in little exercise and indulge in sugary, calorie-densed foods that modern conveniences afford. Continued on page 9 Contd from page 1 African-Americans and Kidney Disease -3 - Traditional African Clinic February/March 2013
AFRI KAN SPI RI TUALI TY New African Spirituality Oshun, Chango, Yin, Yang, Orisha, Orishas Oshun and Chango, A Match Made In Heaven
November 30, 2011 Everyone has heard of the phrase, opposites attract. That is the case in many situations in scenarios. Legend has it that Chango was the king of the Oyo, a great city in West Africa. He had numerous wives, but he was particularly fond of Oshun, the river goddess. Their marriage symbolizes a union of two great basic forces known as the feminine essence and the masculine power. This concept is similar to yin and yang and the ability of opposite forces to unite and same forces to repel and detract. Chango is a representation of the ultimate masculine force. He is dynamic, stimulating, and logical. He is a deity of great height and represents the skies and the heavens. His color is red, and he is considered hot, and is able to produce heat by breathing fireballs from his mouth. -------------------------- Managing Editor: Nakato Lewis PUBLISHER: KIWANUKA LEWIS Published monthly and freely by BHSN for the ATHR Clinic http://www.blackherbals.com/athrc_newsletters.htm
The traditional shrine as a symbol of our cultural history
The goddess Oshun, on the other hand represents yin. She is the ultimate female essence. She is static, calming, and intuitive, much like the rivers she resides in. Chango and Oshun, much like yin and yang characterize two different types of energy, also known as chi, or in Yoruba, ashe. In Chinese philosophy as well as in African practices, everything in nature is perfectly balanced. If things become unbalanced then illness and malady may occur. Too much of Changos heat underlies pain and inflammation. Too much of Oshuns coolness may cause blockages and stagnation. Both forces complement each other, and each force is needed to generate the spark needed for creation. Changos heat can drive out Oshuns cold. While Oshuns cold can reduce Changos heat. Oshun and Chango, much like yin and yang are relative to each other and there is always a relationship fostering a certain condition. One flows into the other and then returns. Their partnerships gives people the ability to understand that they cannot comprehend cold without feeling heat. Their relationship evolves and becomes stronger because there is in inherent checks and balance system that allows them to feed off of each others strength. Oshuns ice, when warmed by Chango can become water. When Chango breathes out balls of fire, Oshuns water becomes steam. In the Chinese system, as well as in African practice, all of life is a cycle of yin and yang, masculine and feminine, light and dark. When these forces come together, they generate an electric charge, or an unified supreme energy that sparked the creation of earth. http://newafricanspirituality.com/page3/files/tag- oshun002c-chango002c-yin002c-yang002c-orisha002c- orishas.html
-4 - Traditional African Clinic February/March 2013 African Traditional Herbal Research Clinic Volume 8, Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES E. Coli That Cause Urinary Tract Infections are Now Resistant to Antibiotics By Veronique Greenwood Discover Magazine, May 2, 2012
Some of this growing resistance in E. coli and other bacteria is due to the fact that antibiotics are being overprescribed, handed out to patients who have no bacterial infections. There is also evidence that the genes that give bacteria resistance to drugs are being spread in livestock farming operations, where antibiotics are a common ingredient in animal feed. Ciprofloxacin is one of those antibiotics, and researchers have found that E. coli resistant to it are thriving in poultry farms. Very closely related strains of drug-resistant E. coli have been found in people, suggesting that the bugs spread from the birds to humans. In this chart from the report, the trends in resistance are clear. People suffered from UTIs long before antibiotics were discovered in the early twentieth century, of course. Should these drugs cease to be effective, well have to go back to what we were doing before. The truth is, though, before antibiotics we had no real treatment. Sicknesses resembling UTIs have been described in medical texts for thousands of years, by everyone from the ancient Greeks and Chinese to the pioneers of evidence-based medicine in the early 1900s. Some of these doctors prescribed various tinctures, ointments, and special diets to deal with the symptoms, but in cases in which the infection spread to the bladder and Continued on page 5 . Thanks to antibiotics, we tend to think of urinary tract infections as no big deal. Pop some cipro, and youre done. A good thing, tooif the E. coli that usually cause UTIs crawl up the urinary tract, they can cause kidney failure and fatal blood poisoning. But antibiotics may not be saving us from UTIs for very much longer. Scientists tracking UTIs from 2000 to 2010 found a dramatic uptick in cases caused by E. coli that do not respond to the drugs that are our first line of defense. In examining more than 12 million urine analyses from that period, they found that cases caused by E. coli resistant to ciprofloxacin grew five-fold, from 3% to 17.1% of cases. And E. coli resistant to the drug trimethoprim-sulfame-thoxazole jumped from 17.9% to 24.2%. These are two of the most commonly prescribed antibiotics used to treat UTIs. When they are not effective, doctors must turn to more toxic drugs, and the more those drugs are used, the less effective they in turn become. When those drugs stop working, doctors will be left with a drastically reduced toolkit with which to fight infection. -5 - Traditional African Clinic February/March 2013
Continued from page 4 E. Coli That Cause Urinary Tract Infections are Now Resistant to Antibiotics kidneys and beyond, they were fairly helpless. As a last- ditch effort, they operated to drain puss from the infected kidneys and hoped the patient would survive. Treatment did not fundamentally change until antibiotics arrived on the scene. In a world without antibiotics, many peoples UTIs would doubtless subside under attack from the immune system. But some fraction of them would not, and those people would find themselves in dire straits. And about the common idea that cranberry juice can prevent or treat UTIs: evidence is pretty spotty. Better to try to reduce the irresponsible use of antibiotics than rely on juice. http://blogs.discovermagazine.com/80beats/2012/05/02/e-coli- that-cause-urinary-tract-infections-are-now-resistant-to- antibiotics/
Urinary Tract Infections (UTI) By Andrew Weil, MD About 10 to 20 percent of women will develop a urinary tract infection (UTI) at some point in their lives. Cystitis (a bladder infection) is a common type of UTI, and is far more prevalent among women than men. It is reported to be one of the most frequent medical complaints among women in their reproductive years. Causes and Symptoms The urinary system helps to eliminate waste products and maintain proper water and salt balance in the body. The waste products are filtered from circulating blood by the kidneys, which are attached to the bladder by thin tubes called the ureters. The bladder is responsible for storing urine, which then flows out of the body through another tube called the urethra. Normally, the bladder is sterile - completely free of bacteria and other infectious organisms. When an infection occurs, it is typically found in either the lower urinary tract - affecting the bladder and urethra - or the upper urinary tract, which affects the kidneys and ureters. When an organism invades the urinary tract, it enters by one of two routes: the lower end of the urinary tract or through the bloodstream. Bacterial infections arising from the lower tract are very common, particularly among women, whose urinary anatomy makes them much more susceptible than men. The bacterium Escherichia coli (E. Coli) is responsible for most urinary tract infections. E. Coli is actually harmless in the small intestine where it normally resides, but becomes a problem when it spreads to the urinary tract. Risk Factors Age and gender. Women are 30 times more likely to develop a bladder infection than men. After menopause, the risk for recurrent infections increases substantially. This may be due to a decrease in estrogen, which may result in a reduction of the number of beneficial bacteria in the vagina that help keep harmful bacteria in check. The bladder also tends to become less elastic with age and may not empty completely. Sexual activity. Frequent or traumatic sexual intercourse can increase the risk of urinary tract infections. Pregnancy. Up to 10 percent of pregnant women tend to have bacteria in their urine, which increases the risk for urinary tract infections. Antibiotics. Some antibiotics can actually eliminate the good bacteria, cause an overgrowth of E. Coli in the vagina and increase risk of UTIs. Addiction to coffee and other forms of caffeine, as well as alcohol addiction and dehydration, are aggravating to the urinary tract. Typical symptoms of a UTI include: Bladder infections. These are marked by a frequent, urgent need to urinate or a painful or burning sensation during urination. Frequent urination may also occur during the night. Urine is typically cloudy. Urethritis (inflammation of the urethra). Marked by painful urination and a frequent need to urinate. Kidney infection. A bladder infection with pain spreading to the lower back or flanks may indicate that the infection is moving to the upper tract. Fever is common and blood in the urine may be visible as a pink tinge. Medical help should be sought immediately if this occurs. Suggested Lifestyle Changes Avoid wearing tight-fitting pants. Also, wear cotton-crotch underwear and pantyhose, and use mild detergents when washing underwear. Don't hold your urine. Be sure to urinate frequently and when you have the urge. Drink the right fluids. Increase your intake of fluids so that you urinate more frequently. Plain water is best, and it is also important to avoid alcohol and coffee. Good hygiene before and after sex. Keep the Continued on page 11 -6 - Traditional African Clinic February/March 2013 African Traditional Herbal Research Clinic Volume 8 Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES Urinary Tract Infections - U.T.I. in Men By Liberator Medical Urinary tract infections (UTIs) are a serious health issue that affects millions of men each year. It is important that men with a urinary tract infection understand the causes and treatments for their infection. Urinary tract infections are the second most common type of infection in males and females. Urinary tract infections account for approximately 8.3 million doctor visits each year 1 , with approximately 20% of all urinary tract infections occurring in men. The overall lifetime prevalence of male urinary tract infections between 1988 to 1994 was estimated to be 13,689 cases per 100,000 adult men, based on the National Health and Nutrition Examination Survey. Rates of urinary tract infections increase with age and are 1.5 times higher in African American men than in other racial/ethnic groups such as Caucasian or Hispanic. Asian men have the lowest rates of inpatient hospitalization for UTI care, followed by Hispanics and Caucasians. The Causes of UTIs in Men Normally, urine is sterile and free from bacteria, viruses, and fungi; however, it usually contains fluids, salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive tract, adhere to the opening of the urethra and begin to reproduce. The urethra is the tube that carries urine from the bladder to be expelled outside the body. Most infections are caused by Escherichia coli (E. coli) bacteria, which normally live in the colon. If bacteria attach to the urethra and begin to multiply, an infection can occur. An infection confined to the urethra is called "urethritis." If the infection moves to the bladder, a bladder infection occurs, called "cystitis." If the infection is not treated immediately, bacteria could travel farther up the ureters to infect the kidneys, which may result in a kidney infection called "pyelonephritis." Chlamydia and Mycoplasma, both microorganisms, can also cause urinary tract infections in men, but the trend of these types of infections is to remain limited to the urethra and reproductive system. Unlike E. coli, Chlamydia and Mycoplasma can be sexually transmitted and infections require treatment of both male and female partners. The urinary system is biologically structured to help ward off infection. The ureters and bladder are supposed to prevent urine from backing up toward the kidneys and the flow of urine from the bladder is designed to wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth, and immune defenses also help avoid infection. Despite these physiological safeguards, infections can still occur. Bladder outlet obstruction due to benign prostatic hyperplasia (BPH) may be associated with urinary stasis. Although a causal relationship has been difficult to prove, chronic prostatic obstruction is considered to increase the risk of urinary tract infections in older men with BPH. Men who are uncircumcised are more at risk to become infected because the bacteria can build up much more easily in the folds of the extra skin on the penis, as are men who engage in anal intercourse. The Risk Factor for Men Some men are more prone to getting a urinary tract infection than others. Any irregularity of the urinary tract that obstructs the flow of urine (e.g., a kidney stone) increases the risk for an infection. An enlarged prostate gland can also impede and slow the flow of urine, thus raising the risk of infection. A common source of infection is catheters, or tubes, placed in the urethra and bladder. A man who cannot void or is unconscious or critically ill might use a catheter that stays in place for a prolonged period. Some men, especially the elderly and those with nervous system disorders that cause loss of bladder control, may need a catheter for life. Men with diabetes have a higher risk of developing a UTI because of changes in the immune system. Any other disorder that suppresses the immune system raises the risk of a urinary tract infection. Urinary tract Continued on page 7
7-- Traditional African Clinic February/March 2013
Continued from page 6 Urinary Tract Infections - U.T.I. in Men infections may occur in infant boys who are born with abnormal urinary tracts that sometimes need to be corrected with surgery. Urinary tract infections occur less frequently in boys and young men than girls and young women. Recurrent Infections in Men In recurrent infections in men, the latest infection stems from a strain or type of bacteria that is different from the previous infection, indicating a separate infection. Even when several urinary tract infections in a row are caused by E. coli, slight differences in the bacteria indicate distinct infections. Research funded by the National Institutes of Health (NIH) suggests that one factor behind recurrent urinary tract infections may be the ability of bacteria to attach to cells lining the urinary tract. A recent study found that bacteria created a protective film on the inner lining of the bladder in mice. If a similar occurrence can be demonstrated in humans, the discovery may lead to new treatments that will be able to prevent recurrent urinary tract infections. Male UTIs are often a result of an obstruction such as a urinary stone or enlarged prostate or a medical procedure involving a catheter. The first step is to identify the infecting organism and the drugs to which it is sensitive. Doctors recommend longer therapy in men than in women to prevent the infection from spreading to the prostate gland. Prostate infections (chronic bacterial prostatitis) are harder to cure because antibiotics are unable to treat infected prostate tissue effectively. Men with prostatitis often need long-term treatment with a carefully selected antibiotic. Urinary tract infections in older men are frequently associated with acute bacterial prostatitis, which can have serious consequences if not treated immediately. The Symptoms of UTI Though most men show signs of a UTI and will experience some discomfort, not all males display symptoms. Symptoms may include a frequent urge to urinate and a painful, burning feeling in the vicinity of the bladder or urethra during urination. It is not unusual to generally feel tired, shaky, washed out, and feels pain even when not urinating. It has been documented that some men have experienced the feeling of fullness in the rectum. It is common for a man with a urinary infection to, despite the urge to urinate, pass only a small amount of urine. The urine itself may look cloudy, milky, or even reddish if blood is present. Normally, a UTI does not cause fever if it is in the urethra or bladder. A fever may indicate that the infection has spread to the kidneys. Symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting. UTI Diagnosis To find out whether your urinary tract has been infected, your doctor will test a sample of your urine for bacteria and pus. The general practice is to ask for a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample in a sterile container. This method of collecting urine prevents bacteria around the genital area from getting into the sample that may complicate the test results. The sample is then sent to a laboratory, if the doctor's office is not equipped to perform the testing. In the urinalysis test, the urine is tested for red and white blood cells and bacteria. If bacteria are present, it is then grown in a culture and tested against different antibiotics to see which drug is most effective against it. Some microbes, like Mycoplasma and Chlamydia, can be detected only with specific bacterial cultures. A doctor suspects a microbial infection when a man displays symptoms of a UTI, but a standard culture doesn't display any bacterial growth. When treatment does not clear up infection and is traced to the same strain of bacteria, the doctor may order more tests to help determine if your system is normal. One of these tests is an intravenous pyelogram, which allows for X-ray images of the kidneys, bladder, and ureters. An opaque dye visible on X-ray film is injected into a vein and a series of X-rays are taken. The film maps the urinary tract, revealing even the minutest changes in the structure of the tract. If infections continue to recur, your doctor also may recommend an ultrasound exam that produces pictures from the echo patterns of sound waves bouncing off internal organs. Another useful test is a cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source that allows the doctor to see the inside of the bladder via the urethra. UTI Treatment The general treatment of urinary tract infections is the use of antibacterial drugs. The length of treatment and choice of drug depend on the patient's medical history and the midstream urine tests that help identify the offending bacteria. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), trimethoprim (Trimpex), nitrofurantoin (Macrodantin, Furadantin), ampicillin (Omnipen, Polycillin, Principen, Totacillin), and amoxicillin (Amoxil, Trimox, Wymox). A class of drugs called quinolones includes four drugs approved in recent Continued on page 11
8-- Traditional African Clinic February/March 2013 African Traditional Herbal Research Clinic Volume 8, Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES Kidney Disease and Your Heart: The Hidden Link By KidneyTrust.Org
raising blood pressure. This renin-angiotensin system (RAS) acts on your heart and your kidneys. An overactive RAS can lead to kidney problems. Cells may grow too fast or too slowly, causing inflammation, hardening of the arteries, and blood clots. vi
High blood pressure is quite common in the United States, and can damage your heart and your kidneys. High blood pressure causes tiny tears in the flexible lining of your blood vessels. The scars that form make vessels walls stiff. vii When this happens, your heart has to work much harder to pump blood through the damaged vessels. These damaged vessels may not be able to deliver enough blood to organs so this can lead to both heart and kidney failure. Whats Blood got to do with it? A number of health problems that involve your blood can harm both your heart and your kidneys. One is anemiaa shortage of oxygen-carrying red blood cells. Kidneys make erythropoietin (EPO), the hormone that tells your bone marrow to make red blood cells. As the kidneys fail, less EPO is made, so you make fewer red blood cells. With fewer red blood cells, your body does not get enough oxygen. Anemia can speed up the rate of kidney failure. Other blood-related risk factors for heart and kidney problems include: 1. High blood levels of cholesterol a waxy fat that can clog your arteries and lead to blood clots that can damage your heart or kidneys 2. Inflammation your bodys response to infection or other injury, which can cause swelling and damage in your blood vessels 3. Blood vessel calcification a build up of stone- like crystals that can occur when kidney disease throws off the balance of calcium and phosphorus in your blood The human body is very complex, and doctors are actively studying even more reasons why the heart and kidneys affect each other. Continued on page 9
When you have kidney disease, it might not occur to you to have your heart checked out. Or, if you have heart disease, you might not think to have your kidneys tested. As it turns out, checking both your heart and your kidneys is a good idea if you have either kind of health problem. Why? Because diseases that affect the kidneys can also damage your heartand vice versa. In fact, many doctors think of the heart and kidneys as one interlinked body system rather than separate organs. i
Having both heart and kidney disease can cause 20 times the risk of death from heart problems than either problem alone. ii In looking at more than 18,000 people, a decline in kidney function predicted a 62% higher risk of death from heart failure. iii Heart disease happens very early in the course of kidney diseaseso even just a small decline in kidney function should trigger efforts to help protect your heart. iv
Your Heart and Kidneys Never Sleep While you can take a break after a hard day, your heart cant. Its job is to pump oxygen-rich blood from your lungs to each cell in your body, minute after minute, day after day. If your heart beats at the average rate of about 75 times a minute, this means more than 39 million beats a year! With each heartbeat, blood is pushed through your kidneys for filtering. Though your two kidneys are each just about the size of your closed fist, they process about 200 quarts of blood per day to make about two liters of urine. v To do their work, your kidneys need a constant supply of blood at a normal pressure. Too little blood or too little pressure can cause acute, sudden kidney failure. Too much blood or too much pressure can lead to scarring that can cause chronic, permanent kidney disease. The Low Side of High Blood Pressure Healthy kidneys work with your heart to control your blood pressure. Any time your blood pressure falls, kidneys release the enzyme renin into your blood. Renin signals your liver to make the hormone angiotensin, which tells blood vessels to constrict
9-- Traditional African Clinic February/March 2013 Continued from page 8 Kidney Disease and Your Heart: the Hidden Link What You Can Do To help your kidneys and your heart work as well as possible, do what you can to keep the normal balance inside your body. The main job of your kidneys is to maintain homeostasisa constant environment inside your body. Kidneys have built in sensors. At any given moment, healthy kidneys ensure that blood levels of water, salts, and other key chemicals are in perfect balance. When they begin to fail, this very precise system starts to fall apart. While we may not yet know exactly why this affects the heart, we know that it does. Here are some things you can do: 1. Control your blood pressure. Blood pressure pills, diet, and exercise can help reduce the stress on your blood vessels. This can help keep both your kidneys and your heart healthy. You may find that a low-salt diet can help make it easier to hit the blood pressure target your doctor gives you. 2. Learn your glomerular filtration rate (GFR). Based on your age, race, sex, and blood level of creatinine (a waste removed by healthy kidneys), your GFR is an estimate of how well your kidneys work. GFR is used to put chronic kidney disease into one of five stages. Finding out that you have loss of kidney function can give you time to get treatment so to protect your kidneys and heart at the same time. In many cases when kidney disease is found early enough kidney failure can be delayed or prevented. 3. Keep your phosphorus in line. If you have kidney disease, your doctor may prescribe phosphate binders for you to take with meals and snacks. These drugs attach to phosphorus molecules like magnets and pull them out of your bodyso you can keep the right balance of calcium and a low-salt diet can help make it easier to hit the blood pressure target your doctor gives you. 4. Ask your doctor to test you for anemia. Most people who have some level of kidney problem also have anemia, which can be found with a simple blood test. Sometimes the symptoms of anemiafeeling very tired, weak, or cold all the time; fuzzy thinking; pale skin, lips, gums, and nail beds, etc. These symptoms can come on so slowly that you dont really notice. If you have anemia, getting treatment can give you more energy and help your heart and kidneys. Forewarned is Forearmed Knowing that kidney disease and heart disease go hand-in- hand can help you know what to look for. You and your doctor can work together and take action to prevent health problems. The good news is that both kidney disease and heart disease can be treated to help you stay healthy. Part 2 of Kidney Disease and Your Heart: The Hidden Link focuses on diabetes. i Tsagalis G, Zerefos S, Zerefos N. Cardiorenal syndrome at different stages of chronic kidney disease. Int J Artif Organs. 2007 Jul;30(7):654-76 ii Efstratiadis G, Tziomalos K, Mikhailidis DP, Athyros VG, Hatzitolios A. Atherogenesis in renal patients: a model of vascular disease? Curr Vasc Pharmacol. 2008 Apr; 6(2):93-107 iii Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, van Veldhuisen DJ, Hillege HL. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail. 2007 Oct;13(8):599-608 iv Stenvinkel P, Carrero JJ, Axelsson J, Lindholm B, Heimburger O, Massy Z. Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle? Clin J Am Soc Nephrol. 2008, 3:503- 521 v http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/ vi Raizada V, Skipper B, Luo W, Griffith J. Intracardiac and intrarenal renin-angiotensin systems: mechanisms of cardiovascular and renal effects. J Investig Med. 2007 Nov;55(7):341-59 vii ORourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol. 2007 Jul 3;50(1):1-13 http://kidneytrust.org/learn/kidney-disease-heart-link/
Continued from page 2 Kidney Disease - 32 Million Young People on Danger List "There are now younger people who have hypertension and diabetes, which are very important risk factors for developing chronic kidney disease." In Sokoto State, medical experts said there is rise in the cases of kidney ailment among young population with studies showing that those affected are particularly between 15 and 40 years of age. Dr. Hamidu Liman, Consultant Nephrologists with the Usmanu Danfodiyo University Teaching Hospital, UDUTH and a lecturer with the Usmanu Danfodiyo University Sokoto disclosed that at UDUTH, they see many patients coming with what they call 'end-stage' kidney disease daily. Continued on page 10
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Continued from page 9 Kidney Disease - 32 Million Young People on Danger List "End-stage means that the kidney has totally failed and that the only solution is to temporarily take over the function of the kidney and we have been observing a trend over the last five years and noticed that about 8-10 per cent of all our medical admissions, that means patients admitted into the medical ward, have some form of kidney problem." He said "in children, the commonest form of kidney disease we see is just simple urinary tract infection then followed by what we call the nephritic syndrome and those that come with chronic renal failure. The Consultant said recently, they did a small community study as part of the World Kidney Day and realized that evidence for early kidney diseases is also prevalent in the population that they were able to explore. "We explored people in Sokoto North during the World Kidney Day celebration of March 2012 and realized also that about 15 per cent of the people who appeared at the free screening have some form of evidence of renal damage that means it is a condition that is quite prevalent in the hospital as well as in the community. "What we noticed from our study is that the young population is affected particularly between 15 and 40 years of age and this is the reproduction age group. "We are also having a little high incidence of schistosomiasis; it is a form of infection that can also affect the kidney, it is fairly prevalent in children here and it is unrecognized. "In Sokoto State, the weather is fairly hot and people become easily dehydrated and that is also an important risk factor for the formation of kidney stones." Dr. Liman said recently, they have noticed the use of herbal medication also is on the rise and that somehow directly or indirectly, it is also contributing to the kidney problem. Within Sokoto, Kebbi and Zamfara region, Weekly Trust gathered that there are three dialysis centers for people whose kidneys had failed. In Kano, a physician at the Aminu Kano Teaching Hospital, Dr. Usman Bashir told Weekly Trust that the hospital has recorded kidney related ailments in those below 15 years old, adding that some of these cases were hereditary while others were due to drugs abuses, among other habits. A relative of a patient undergoing dialysis at AKTH, Alhaji Dauda Suleiman of Hotoro GRA told Weekly Trust that the hospital management has done a great job by relatively reducing the dialysis fee from what the hospital was charging years back. Though he declined mentioning the amount charged, Suleiman said it is affordable to an average salary earner. So far, AKTH has the best diagnostic and dialysis machines in the state. Similarly, it was gathered that the state owned Muhammadu Abdullahi Wase Specialist Hospital has recently acquired additional dialysis machine as part of the state government efforts in enhancing the hospitals capability and capacity. Though there are other specialist hospitals in the state such as the state Urology Hospital that carter for kidney-related ailments. According to Dr. Olatise Olalekan , an Abuja-based Consultant Nephrologists and the CEO of Zenith Kidney Center in Abuja, most of the risks factors, especially as they affects young patients are coming from common diseases and social behavior of people in that age bracket, although he affirmed that there is also a hereditary factor. Among the young patients, kidney diseases associated with HIV/AIDS is more common because of widespread prevalence of the virus among young people. Also obesity, which leads to hypertension is an independent risk factor for developing Chronic Kidney Disease. "Young people become obese these days which leads to hypertension and also diabetes. All these are risks factors." He said over- the - counter drugs can also be a risks factor, especially antibiotics and pain killers. Frequent usage of such drugs without experts' advice may cause kidney damage. He also said some herbal concoctions taken without proper recommendation, control or authorisation may also be toxic to the kidneys, causing damages that mark the start of CKD or worsen existing problems with kidney function. He called for regular exercise to maintain ideal body weight in obese people; non smoking, abstaining from alcohol and drugs abuse; avoiding over-the-counter pain killers; eating healthy and more of natural food, regular kidney and urine tests at least once every year as an antidote to managing the risks." http://allafrica.com/stories/201212080394.htm
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Continued from page 5 - Urinary Tract Infections (UTI) genital and anal areas clean, and urinate before and after intercourse to cleanse the urethra of bacteria. Always wipe front to back after a bowel movement. Try an estrogen vaginal cream. This may be best for post-menopausal women, who have lower levels of estrogen. Some research suggests that estrogen may help increase the number of beneficial bacteria that help fight infections. Nutrition and Supplements Cranberry juice and cranberry extract. Cranberries contain a substance that helps prevent bacteria from adhering to the bladder walls. Drink unsweetened cranberry juice concentrate diluted with water, or take powdered cranberry extract in capsules. http://www.drweil.com/drw/u/ART00699/urinary-tract- infections-UTI.html
Continued from page 7 Urinary Tract Infections - U.T.I. in Men years for treating a UTI. These drugs include ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin (Noroxin), and trovafloxin (Trovan). A UTI can be cured within one or two days of treatment if the infection is not complicated by an obstruction or other disorder. As a precaution, many doctors ask their patients to continue antibiotics for a week or more to make sure that the infection has been cured. Single-dose treatment is not recommended for some patients, such as those who neglected immediate treatment or display signs of kidney infection, diabetic patients, patients with structural abnormalities, or men with prostate infections. Longer treatment is also needed for men with infections caused by Chlamydia or Mycoplasma, which are generally treated with tetracycline, trimethoprim/sulfa methoxazole (TMP/ SMZ), or doxycycline. A follow-up urinalysis test confirms that the urinary tract is free of infection. Symptoms may disappear before the infection is fully cleared so it is important to take the full course of treatment. Severely ill men with kidney infections may be hospitalized until they can take fluids and necessary drugs on their own. Kidney infections typically require several weeks of antibiotic treatment. Researchers at the University of Washington found that two-week therapy with TMP/SMZ was as effective as six weeks of treatment with the same drug in women with kidney
infections that did not involve an obstruction or nervous system disorder. In such cases, kidney infections rarely lead to kidney damage or kidney failure unless untreated. Several drugs are available to help relieve the pain of a UTI. A heating pad may help and most doctors recommend drinking more water because it helps purify the urinary tract of bacteria. While undergoing treatment, it helps to avoid alcohol, coffee, and spicy foods. One of the most beneficial things a smoker can do for his bladder is to quit smoking, as it is one of the major causes of bladder cancer. Curing infections caused by a urinary obstruction or other systemic disorder depends on diagnosing and fixing the underlying problem, sometimes even surgically. If the root cause is untreated, there is an increased risk of kidney damage. Such infections tend to stem from a wider range of bacteria, and sometimes infections can occur from more than one type of bacteria at a time. Sources The National Institute of Health (Book)-Urinary Tract Infection in Men Tomas L. Griebling, MD Associate Professor & Vice Chair of Urology University of Kansas Kansas City, Kansas 1 Ambulatory Care Visits to Physician Offices, Hospital Outpatient Departments, and Emergency Departments: United States, 1999-2000. Vital and Health Statistics. Series 13, No. 157. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; September 2004. http://www.liberatormedical.com/catheters/male-urinary-tract- infection.php#cause
What Your Urine Is Telling You 19 November 2010 The color of your urine can denote a lot of things; the urinary system is a storehouse of information regarding your state of health. Odor and color are key urine characteristics that determine the health of the urinary system as well as indicate possible urinary tract infection, dehydration, abnormal blood sugar levels, and your food as well as medicine intake. Regular urine tests are mandatory to ensure that the kidneys are functioning normally. Here are some characteristics you need to watch out for: Colorless urine: Urologists have stated that clear or colorless urine is produced when a persons water intake is very high. In other cases, there might be some kind of Continued on page 12
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Continued from page 11 - What your Urine is telling you chronic renal failure that prevents the kidneys from absorbing the necessary nutrients and causes them to excrete water as urine. Remember, numerous restroom trips throughout the day are okay. They become a matter of concern only if you feel uncomfortable during the process. Bright yellow urine: Not all urine colors are indicators of poor health. Bright yellow or deep amber colored urine indicates that the body is dehydrated and is not getting sufficient fluids or water intake. The body is under stress to retain the maximum amount of water that it needs, causing the urine to become more concentrated. Apart from this, people who are on certain medications may have bright yellow urine. Hypervitaminosis also results in the production of amber-colored urine. Brown urine: Brown-colored urine that has the color of tea is a clear indicator of a problem with the urinary tract. More often than not, it indicates the presence of old blood in the urinary tract. It is also a sign of severe dehydration. A lighter shade of urine (the color of straw) that is odorless and spotless proves that the body is healthy and problem-free. Blood in urine: More serious medical conditions like hematuria, characterized by the presence of blood in the urine, may need urgent medical attention. They may also indicate possible urinary tract infection and other health problems including cancer, kidney stones, or enlarged blood vessels. Odor of urine: Sweet odor indicates diabetes, while foul odor implies the need for medical diagnosis. Diabetes causes blood sugar levels in the urine to rise, which result in sweetish urine odor. Research indicates that foods like asparagus cause the production of smelly urine due to the production of sulfur-containing amino acid. People tend to develop complications related to their urinary system as part of the aging process. So, as you grow older, it is recommended that you get your urine tested regularly. Pregnant women also need to be cautious and get regular urine tests. http://www.newsmax.com/FastFeatures/Aging-Urinary- System-tract/2010/11/19/id/377627
Irregular Heart Rhythm Increases Kidney Failure Risk By VR Sreeraman January 20, 2013 People with chronic kidney disease who also have atrial fibrillation, the most common forms of irregular heart rhythm, are at an increased risk of developing kidney failure. The finding by researchers at the University of California, San Francisco (UCSF) and the Kaiser Permanente Northern California Division of Research opens the way for further studies into the relationship between the two factors, which could lead to new treatment approaches that would improve outcomes for people with chronic kidney disease. Doctors have known that patients with chronic kidney disease or end-stage renal disease commonly have atrial fibrillation and as a result are more likely to have a stroke or to die. However, the long-term impact of atrial fibrillation on kidney function among patients with known chronic kidney disease has been unknown. The new study involved 206,229 adults with chronic kidney disease who were drawn from members of Kaiser Permanente Northern California, a large integrated health care delivery system. Over the course of about five years, approximately 16,400 patients developed atrial fibrillation, and those who did were 67 percent more likely to progress to end-stage renal disease compared with patients who had chronic kidney disease but did not develop atrial fibrillation. "These novel findings expand on previous knowledge by highlighting that atrial fibrillation is linked to a worse kidney prognosis in patients with underlying kidney dysfunction," said kidney specialist Nisha Bansal, MD, an assistant professor in the Division of Nephrology at UCSF. "There is a knowledge gap about the long-term impact of atrial fibrillation on the risk of adverse kidney-related outcomes in patients with chronic kidney disease," said senior author Alan S. Go, MD, director of the Comprehensive Clinical Research Unit at the Kaiser Permanente Division of Research. "This study addresses that gap and may have important implications for clinical management by providing better prognostic information and leading to future work determining how to improve outcomes in this high-risk group of patients," the researcher added. Bansal added, however, that while the two conditions are Continued on page 13
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Continued from page 12 Irregular Heart Rhythm Increases Kidney Failure Risk intertwined, scientists do not know exactly which specific genes, pathways and biological mechanisms connect irregular heartbeat to declines in kidney function. Neither do they yet know the extent to which treating atrial fibrillation will improve outcomes for people with chronic kidney disease. The study was published online by the journal Circulation last month. http://www.medindia.net/news/irregular-heart-rhythm- increases-kidney-failure-risk-113151-1.htm
Mineral Metabolism Abnormalities may increase Risk of Kidney Failure among African Americans December 14, 2012 Abnormalities of mineral metabolism worsen with progressive chronic kidney disease (CKD) and are linked with a higher risk for kidney failure among African Americans, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings suggest that measuring mineral metabolites may be a useful way to determine a CKD patient's prognosis, and targeting mineral metabolites may help slow progression of the disease. It is often difficult for physicians to differentiate which patients with CKD will go on to develop advanced stages of the disease and which will remain more stable over time. They do know that CKD tends to progress more rapidly to kidney failure in African Americans than in Caucasians and that disordered mineral metabolism which occurs when failing kidneys do not maintain the proper levels of minerals in the bloodis more severe among African Americans with CKD. This might partially explain the accelerated progression of their disease. To investigate, Julia Scialla, MD, Myles Wolf, MD (University of Miami Miller School of Medicine) and their colleagues measured blood levels of various mineral metabolites over an average of four years in 420 CKD patients who participated in the African American Study of Kidney Disease and Hypertension. "We were hoping to determine whether abnormal blood levels of calcium and phosphate, and the hormones that regulate them fibroblast growth factor 23, vitamin D, and parathyroid
hormoneare risk factors for kidney disease progression in African Americans," said Dr. Wolf. The researchers also looked for a potential link between levels of these mineral metabolites at the start of the study and risk for kidney failure or death in 809 participants. Among the major findings: FGF23, PTH, and phosphate levels rose over time; the greatest increases occurred in participants with faster rates of kidney function decline. Patients with the highest levels of FGF23 at the start of the study had more than a two-fold increased risk of kidney failure or death independent of kidney function compared with patients with the lowest levels. Higher blood levels of PTH and phosphate were associated with a more modestly increased risk. Vitamin D insufficiency was present in 95% of participants, but lower levels were not independently linked with kidney failure or death. The findings suggest that abnormal levels of mineral metabolites convey clinically relevant information for assessing the likely progression of CKD beyond measurements of kidney function that clinicians already monitor routinely. "Also, it might be possible to slow kidney disease progression in African Americans using treatments that normalize mineral levels and the hormones that regulate them. Clinical trials are needed to prove this hypothesis," said Dr. Scialla. Source: American Society of Nephrology http://www.news-medical.net/news/20121214/Mineral- metabolism-abnormalities-may-increase-risk-of-kidney-failure- among-African-Americans.aspx?
What Role Does Vitamin D Play in Kidney Function? By Karen Hellesvig-Gaskell May 19, 2011 The primary function of vitamin D is to help the body maintain sufficient blood levels of calcium and phosphorous. Vitamin D also may guard against high blood pressure, certain autoimmune diseases and even cancer. Vitamin D plays a role in kidney function as well. Effects Healthy kidneys produce a form of vitamin D called calcitrol that helps the body absorb calcium, which in turn promotes strong bones. Insufficient levels of calcitrol can Continued on page 14
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Continued from page 13 What Role Does Vitamin D Play in Kidney Function? take away calcium from the bones. If the kidney's fail, the body may stop producing calcitrol, explains the National Kidney and Urologic and Diseases Information Clearinghouse. http://www.livestrong.com/article/445863-what-role-does- vitamin-d-play-in-kidney-function/
BPA Adversely affects Kidney Function in Children By Helen Albert January 16, 2013 Children with high levels of exposure to bisphenol A (BPA) are at increased risk for low-grade albuminuria, report researchers. These findings add to those of previous research showing an association between BPA exposure and adverse cardiometabolic and renal symptoms in adults, as well as an increased risk for obesity in children. "While our cross-sectional study cannot definitively confirm that BPA contributes to heart disease or kidney dysfunction in children, together with our previous study of BPA and obesity, this new data adds to already existing concerns about BPA as a contributor to cardiovascular risk in children and adolescents," said study author Leonardo Trasande (New York University School of Medicine, USA) in a press statement. The researchers analyzed data from 710 children and adolescents, aged 6-19 years, who took part in the National Health and Nutrition Examination Survey 2009- 2010 and had measures of urinary BPA and degree of albuminuria, from morning urine samples of creatinine, calculated. Children with pre-existing kidney disease were excluded from the study. As reported in Kidney International, the team found that children in the highest quartile of BPA exposure (4.3 ng/mL) had a significant 0.91 mg/g higher albumin-to- creatinine ratio than children in the lowest quartile of exposure (<1.1 ng/mL) after adjusting for insulin resistance, elevated cholesterol, and various environ- mental and sociodemographic risk factors. The authors also estimated that each log unit increase in urinary BPA was associated with a significant 0.28 mg/g increase in the albumin-to-creatinine ratio. Commenting to the press, study co-author Howard Trachtman, also from New York University School of Medicine, noted that BPA exposure may have an even greater effect on children with kidney disease. "Because their kidneys are already working harder to compensate and have limited functional reserve, they may be more susceptible to the adverse effects of environmental toxins," he explained. Trasande adds that the results of this study further support calls to limit BPA exposure in the USA, especially in children. "Removing it from aluminum cans is probably one of the best ways we can limit exposure. There are alternatives that manufacturers can use to line aluminum cans," he suggested. http://www.news-medical.net/news/20130116/BPA-adversely- affects-kidney-function-in-children.aspx
NSAIDs pose Kidney Risk in Some Children By Helen Albert January 29, 2013 A small but significant percentage of children develop acute kidney injury (AKI) after taking nonsteroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen, show study findings published in the Journal of Pediatrics. The researchers, led by Jason Misurac, from Indiana University School of Medicine in Indianapolis, USA, analyzed International Classification of Diseases, Ninth Revision screening data from 1015 children with AKI to assess the impact of NSAID use. Of this group, 27 (2.7%) had clinical, laboratory, and radiographic signs of NSAID-associated injury, with 21 cases of acute tubular necrosis and six cases of acute interstitial nephritis. Although the absolute numbers of these children are small, the damage caused can be considerable, notes the team. Indeed, at least seven sustained damage that was likely to be permanent. "These cases, including some in which patients' kidney function will need to be monitored for years, as well as the cost of treatment, are quite significant, especially when you consider that alternatives are available and acute kidney injury from NSAIDs is avoidable," said Misurac in a press statement. The mean age of the children with NSAID-induced AKI was 14.7 years, with only four patients younger than 5 Continued on page 15
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Continued from page 14 NSAIDs pose Kidney Risk in Some Children years old at the time of injury. All four of these patients required dialysis, compared with none of the older children. They were also more likely to need intensive care unit admission than older children (75 vs 9%) and had a longer median stay in the hospital (10 vs 7 days). The majority (75%) of the children with dosing data available (n=20) had received an NSAID dose within the recommended dosing limits for their age. The most common NSAID taken by the children was ibuprofen (67%), followed by naproxen (11%) and ketorolac (7%); the rest of the children took a combination of ibuprofen and naproxen or ketorolac. "This study underscores the importance of understanding the natural history of NSAID-associated AKI, including the potential for development of chronic kidney disease," commented Misurac. "Providers should continue to provide careful NSAID education to parents and children." http://www.news-medical.net/news/20130129/NSAIDs-pose- kidney-risk-in-some-children.aspx
Kidney Disease & Diabetes One of the more common long-term complications of diabetes is diabetic renal disease ("renal" refers to the kidneys). Also known as diabetic nephropathy, this condition is a result of direct vascular abnormalities that accompany diabetes. Furthermore, diabetes mellitus is the main cause of end-stage renal disease (ESRD), the most advanced stage of kidney disease. Stages of Chronic Kidney Disease (CKD) There are some of the progressive stages chronic of kidney disease. Chronic renal insufficiency Even in the first stage of kidney disease, the organ suffers damage. While there is impaired kidney function, during this stage there are only minimal effects to the entire body. Chronic renal failure In stage two of the disease, damage to the kidneys has progressed to a level that causes problems throughout the body. One such problem is an increase in the amount of waste products in the blood such as urea, creatinine and phosphate. When the body functions normally, the kidneys are able to remove these waste products. Other effects of chronic renal failure include anemia, bone disease, acidosis, and salt and fluid retention. Most patients with chronic renal failure progress to the final or
end-stage of kidney disease. End-stage renal disease (ESRD) By the time a patient reaches end-stage renal disease, the condition and its effects are generally irreversible. To sustain life, the patient requires renal replacement therapy, which includes dialysis or a kidney transplant. Why does diabetes increase the risk for kidney disease? High blood sugar can overwork the kidneys, which over time damage them. After many years, they start to leak small amounts of protein (albumin) into the urine, which indicates that the kidneys are damaged. Not everyone with diabetes develops kidney disease. Factors that can influence kidney disease development include genetics, blood sugar control, and blood pressure. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease. How are cardiovascular disease (CVD) and kidney disease related? Chronic kidney disease can lead to cardiovascular disease (CVD). Conversely, CVD can lead to kidney disease, so the two diseases are strongly intertwined. According to studies, CVD begins to have an effect on the body as early as the first stage of kidney disease, and most people with ESRD die as a result of cardiovascular complications. Risks that are often associated with kidney disease also contribute to the development of cardiovascular disease. High blood pressure (hypertension) Diabetes High LDL ("bad") cholesterol Low HDL ("good") cholesterol Smoking Physical Activity Older age What should I do if I have diabetes? Many of the risk factors for kidney disease and CVD are treatable. If you have diabetes, take these steps: Keep your blood sugar levels in the normal range. Control your blood pressure. Manage your weight. Work closely with your health care team to ensure your urine albumin levels are being monitored. (The American Diabetes Association suggests that people with type 2 Continued on page 16
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Continued from page 15 Kidney Disease & Diabetes diabetes should be screened for urine albumin levels at the time of diagnosis and once a year thereafter.) http://www.heart.org/HEARTORG/Conditions/Diabetes/Wh yDiabetesMatters/Kidney-Disease- Diabetes_UCM_313867_Article.jsp
Kidney Disease increases Risk of Premature Death in Diabetic Patients January 25, 2013 One in every 10 Americans has diabetes, and a third or more of those with the condition will develop kidney disease. It may be possible to live a long and healthy life with diabetes, but once kidney disease develops, the risk of dying prematurely increases significantly, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings have significant clinical implications for the prevention and treatment of kidney disease in people with diabetes. Because people with diabetes have an increased likelihood of dying prematurely as well as an increased likelihood of developing kidney disease, Maryam Afkarian, MD, PhD (University of Washington) and her colleagues looked to see how the former affects the latter. In other words, how much does kidney disease contribute to diabetics' increased risk of dying early? The researchers examined 10-year mortality rates in 15,046 US adults. Kidney disease was present in 9.4% and 42.3% of individuals without and with type 2 diabetes, respectively. Among the major findings: Among people without diabetes or kidney disease, 10-year mortality was 7.7% Among individuals with diabetes but without kidney disease, mortality was 11.5%. Among individuals with both diabetes and kidney disease, mortality was 31.1%. "People with type 2 diabetes have many other risk factors for cardiovascular disease and mortality, so we expected that kidney disease would predict a part, but not a majority, of higher mortality associated with type 2 diabetes. To our surprise, we found that even in the medically complex patients with type 2 diabetes, kidney disease is a very powerful predictor of pre- mature death," said Dr. Afkarian. She noted that the findings have important implications. "First, among people with type 2 diabetes, the subgroup with kidney disease carries most of the mortality risk, so targeting intensive risk factor modification on this subgroup is likely to have the highest impact on overall mortality of people with diabetes. Secondly, preventing kidney disease may be a powerful way of reducing mortality in people with diabetes," said Dr. Afkarian. Source: American Society of Nephrology (ASN) http://www.news-medical.net/news/20130125/Kidney-disease- increases-risk-of-premature-death-in-diabetic-patients.aspx
Wellbeing & Healing The Kidney as the Root of the Body By Dr. S. X. Ke August 9, 2005 In Chinese Medicine, the kidney is considered the most important organ in the body. Physiologically, as we all know, it is the key organ involved in purifying the blood, eliminating toxins from the body by means of urination. It is also, as is often forgotten, the rejuvenating recycling source of the body. Every four minutes the total volume of blood in ones body passes through and is filtered by the kidney. This process not only clears away toxins, but also helps recycle nutrients carried in the blood, such as sugar, vitamins and minerals etc. Pathologically, many chronic illnesses are caused by the failure of such recycling processes of the kidneys. In Chinese Medicine, this is diagnosed as kidney deficiency. Osteoporosis, for example, is a common problem amongst the elderly. As is widely known, the problem here lies in the decalcification of the bone: the lack of calcium. Western medicine addresses the problem by increasing the patients daily dose of calcium. They are advised to drink more milk, or take supplementary calcium tablets. But the results are often dissatisfactory. There are cases where a patient is already taking five or ten times the recommended daily allowance of calcium but continues to display symptoms of calcium deficiency; the patients body continues to dissolve its own bone (the process of decalcification) to increase the level of calcium in the blood, in order to maintain calcium levels for certain vital organs of the body to function normally Continued to page 17
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Continued from page 16 The Kidney as the Root of the Body (for the beating of the heart for example), resulting in the deterioration of osteoporosis. So why does taking more calcium not help solve the problem of osteoporosis? This is because the treatment prescribed by western medicine focuses on the superficial cause of calcium deficiency. It does not deal with why the body lacks calcium in the first place, the cause and root of the problem; the kidneys inability to retain calcium, resulting in its leaking away. The kidneys of elderly people are normally weak, through natural wear and tear, or misuse: the result of drinking too much coffee or alcohol for example etc. These weak kidneys are constantly leaking any nutrients, such as calcium, ingested. Thus, you can never replace the leakage fast enough this is not to mention the slow absorption rate of the digestive systems of the elderly, which exacerbates the condition. I often describe such a condition with the help of an analogy; its no use trying desperately to run a car on a leaking tank; it does not matter how much petrol you put in, for the leakage ensures that there will never be enough for the car to run normally. Therefore we must focus on the root of the problem. We can only treat such decalcification by treating the leaking of calcium by the kidneys. Thanks to thousands of years of experience, Chinese Medicine has developed the concept of strengthening kidneys. By consulting an experienced Chinese Doctor, the particular kind of kidney deficiency can be determined and herbal pills prescribed to strengthen the kidney against that particular kind of deficiency and the kidney leakage stopped. Balancing this with some sort of physical exercise, whether it be weight training or Qi Gong, at least three to four times per week will be helpful. Also important is making sure to have a good healthy diet. Maybe including fresh walnuts which are especially nutritious for the kidneys and black sesame seeds for calcium and bones. With this, the osteoporosis can then be halted and even reversed and healed. Dr. S.X.Ke has many specialities and deals with treatments of kidney problems realizing the kidney is considered one of the most important organs in the body. He is involved with the Asanti Academy of Traditional Chinese Medicine, combining Eastern and Western medicine. http://www.merrynjose.com/artman/publish/article_525.sht ml
Diet Soda now promoted as Medicine to Stop Kidney Stones (Opinion) By Mike Adams May 18, 2010 (NaturalNews) The "most retarded science journal of the year" award goes to the Journal of Urology which has published an article suggesting that diet soda is actually an effective type of medicine for preventing kidney stones (April 19, 2010 issue). The research was led by Dr Brian H. Eisner, a urologist at Massachusetts General Hospital in Boston, who is apparently completely clueless about human nutrition and the toxicity of aspartame. According to Dr Eisner, diet sodas are not only good medicine for preventing kidney stones; they're also a good source of water hydration. Noting that patients need to consume 2-3 liters of water each day, Dr Eisner said in a Reuters article, "If drinking these sodas helps people reach that goal, then that may be a good thing." (http://www.reuters.com/article/idUSTRE64D4HO20100514) If you're thinking this is some sort of April Fools joke, it isn't. Dr Eisner and the Journal of Urology are somehow convinced this is good research and that diet sodas may actually have a positive medicinal effect on the human body. Instances of such "scientific" stupidity appear to be increasing in western medicine where doctors remain wildly ignorant of the effects on the human body caused by processed ingredients or toxic chemical additives. Aspartame, used as the primary sweetener in diet sodas, is a potent neurotoxin according to experts like Dr Russell Blaylock. Many believe it promotes headaches, vision problems, endocrine system problems and nervous system disorders. It has never been proven safe for human consumption by any honest testing. Most diet sodas also contain alarmingly high levels of phosphoric acid, a substance that causes a huge increase in acidity throughout the body, suppressing immune function, weakening bones and contributing to kidney stones (not preventing them). The truth about diet soda There is absolutely no question that drinking diet soda is atrocious for your health. That a mainstream western doctor would somehow conclude diet soda to be a medicine for preventing kidney stones is equivalent to declaring "pizza prevents heart disease" or that smoking cigarettes prevents cancer. It shows not merely the shocking nutritional ignorance of Dr Eisner himself, but the utter lack Continue on page 37
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African Traditional Herbal Research Clinic Volume 8, Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES Kidney Stones (Renal Stones, Nephrolithiasis) By Melissa Conrad Stppler, MD Medicinet.com
Kidney stone facts A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Nephrolithiasis is the medical term for kidney stones. Symptoms of a kidney stone include flank pain (which can be quite severe) and blood in the urine (hematuria). Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. Dehydration is a major risk factor for kidney stone formation. People with certain medical conditions, such as gout, and those who take certain medications or supplements are at risk for kidney stones. Dietary and hereditary factors are also related to stone formation. Diagnosis of kidney stones is best accomplished using a CT scan. Most kidney stones will pass through the ureter to the bladder on their own with time. Treatment includes pain control medications and, in some cases, medications to facilitate the passage of urine. If needed, lithotripsy or surgical techniques may be used for stones which do not pass through the ureter to the bladder on their own. What is a kidney stone? A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi. The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters. Who is at risk for kidney stones? Anyone may develop a kidney stone, but people with certain diseases and conditions (see below) or those who are taking certain medications are more susceptible to their development. Urinary tract stones are more common in men than in women. It is estimated that about 12% of men and 7% of women in the U.S. will develop stones in the urinary tract at some point in their lives. About 20 million people seek medical care each year because of kidney stones. Most urinary stones develop in people 20-49 years of age, and those who are prone to multiple attacks of kidney stones usually develop their first stones during the second or third decade of life. People who have already had more than one kidney stone are prone to developing further stones. In residents of industrialized countries, kidney stones are more common than stones in the bladder. The opposite is true for residents of developing areas of the world, where bladder stones are the most common. This difference is believed to be related to dietary factors. People who live in the southern or southwestern regions of the U.S. have a higher rate of kidney stone formation than those living in other areas. Over the last few decades, the percentage of people with kidney stones in the U.S. has been increasing; the reason for this is not well understood. Continued on page 19
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Continued from page 18 Kidney Stones A family history of kidney stones is also a risk factor for developing kidney stones. Kidney stones are more common in Asians and Caucasians than in Native Americans, Africans, or African Americans. Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood (hyperuricemia). A small number of pregnant women (about one out of every 1,500-3,000 pregnancies) develop kidney stones, and there is some evidence that pregnancy-related changes may increase the risk of stone formation. Factors that may contribute to stone formation during pregnancy include a slowing of the passage of urine due to increased progesterone levels and diminished fluid intake due to a decreasing bladder capacity from the enlarging uterus. Healthy pregnant women also have a mild increase in their urinary calcium excretion. However, it remains unclear whether the changes of pregnancy are directly responsible for kidney stone formation or if these women have another underlying factor that predisposes them to kidney stone formation. What causes kidney stones? Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. About 75% of kidney stones are calcium stones. Other chemical compounds that can form stones in the urinary tract include uric acid, magnesium ammonium phosphate (which forms struvite stones; see below), and the amino acid cystine. Dehydration from reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. In this regard, climate may be a risk factor for kidney stone development, since residents of hot and dry areas are more likely to become dehydrated and susceptible to stone formation. Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones. Metabolic abnormalities, including inherited disorders of metabolism, can alter the composition of the urine and increase an individual's risk of stone formation. A number of different medical conditions can lead to an increased risk for developing kidney stones: Gout results in chronically increased amount of uric acid in the blood and urine and can lead to the forma- tion of uric acid stones. Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones. Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and other inherited metabolic conditions, including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones. People with inflammatory bowel disease are also more likely to develop kidney stones. Those who have undergone intestinal bypass or ostomy surgery are also at increased risk for kidney stones. Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection. Dietary factors and practices may increase the risk of stone formation in susceptible individuals. In particular, inadequate fluid intake predisposes to dehydration, which is a major risk factor for stone formation. Other dietary practices that may increase an individual's risk of forming kidney stones include a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and possible excessive intake of oxalate-containing foods such as spinach. Interestingly, low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and a propensity to form oxalate stones. What are kidney stones symptoms and signs? While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The abdominal, groin, and/or back pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. Continued on page 20
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Continued from page 19 Kidney Stones
Pictures of kidney and kidney stone The pain has been described by many as the worst pain of their lives, even worse than the pain of childbirth or broken bones. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills. Sometimes, symptoms such as difficulty urinating, urinary urgency, penile pain, or testicular pain may occur due to kidney stones. How are kidney stones diagnosed? The diagnosis of kidney stones is suspected when the typical pattern of symptoms is noted and when other possible causes of the abdominal or flank pain are excluded. Imaging tests are usually done to confirm the diagnosis. A helical CT scan without contrast material is the most common test to detect stones or obstruction within the urinary tract. Formerly, an intravenous pyelogram (IVP; an X-ray of the abdomen along with the administration of contrast dye into the bloodstream) was the test most commonly used to detect urinary tract stones, but this test has a greater risk of complications, takes longer, and involves higher radiation exposure than the non-contrasted helical CT scan. Helical CT scans have been shown to be a significantly more effective diagnostic tool than the IVP in the diagnosis of kidney or urinary tract stones. In pregnant women or those who should avoid radiation exposure, an ultrasound examination may be done to help establish the diagnosis. What is the treatment for kidney stones? How long does it take to pass a kidney stone? Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Ketorolac (Toradol), an injectable anti-inflammatory drug, and narcotics may be used for pain control when over-the- counter pain control medications are not effective. Intravenous pain medications can be given when nausea and vomiting are present. Although there are no proven home remedies to dissolve kidney stones, home treatment may be considered for patients who have a known history of kidney stones. Since most kidney stones, given time, will pass through the ureter to the bladder on their own, treatment is directed toward control of symptoms. Home care in this case includes the consumption of plenty of fluids. Ibuprofen (Advil) may be used as an anti-inflammatory medication if there is no contraindication to its use. If further pain medication is needed, stronger narcotic pain medications may be recommended. There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9 mm-10 mm rarely pass without specific treatment. Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine (Adalat, Procardia, Afeditab, Nifediac) and alpha blockers such as tamsulosin (Flomax). These drugs may be prescribed to some people who have stones that do not rapidly pass through the urinary tract. For kidney stones that do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system. Surgical techniques have also been developed to remove kidney stones when other treatment methods are not effective. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as an ureteroscope passed through the urethra and bladder up into the ureter. How can kidney stones be prevented? Rather than having to undergo treatment, it is best to avoid kidney stones in the first place when possible. It can be especially helpful to drink more water, since low fluid intake and dehydration are major risk factors for kidney stone formation. Depending on the cause of the kidney stones and an individual's medical history, dietary changes or medications are sometimes recommended to decrease the Continued on page 21
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Continued from page 20 - Kidney Stones likelihood of developing further kidney stones. If one has passed a stone, it can be particularly helpful to have it analyzed in a laboratory to determine the precise type of stone so specific prevention measures can be considered. People who have a tendency to form calcium oxalate kidney stones may be advised to limit their consumption of foods high in oxalate, such as spinach, rhubarb, Swiss chard, beets, wheat germ, and peanuts. What is the outlook (prognosis) for kidney stones? Most kidney stones will pass on their own, and successful treatments have been developed to remove larger stones or stones that do not pass. People who have had a kidney stone remain at risk for future stones throughout their lives. REFERENCES: "Kidney Stones in Adults." National Kidney & Urologic Diseases Information Clearinghouse. Sept. 2, 2010. http://kidney.niddk.nih.gov/Kudiseases/pubs/stonesadults/
Wolf Jr., J. Stuart. "Nephrolithiasis." Medscape.com. June 16, 2011. http://emedicine.medscape.com/article/437096-overview http://www.medicinenet.com/kidney_stone/article.htm
CAN YOUR DIET CAUSE KIDNEY STONES? By Jessica Bruso November 21, 2010 There are five different types of kidney stones: calcium oxalate stones, calcium phosphate stones, uric acid stones, struvite stones and cystine stones. Your diet may cause some types of stones but not all of them. Once your doctor determines which type of stone you have, she may be able to recommend dietary changes to help you avoid getting more. Features Increasing the amount of insoluble fiber and fluid in your diet, and decreasing the amount of calcium, oxalate, protein, sugar and salt can limit your risk for certain types of kidney stones. Not everyone who gets kidney stones needs to make all of these changes, however. Which changes will be helpful depends on the type of kidney stones. Function Decreasing sodium in the diet lowers the amount of calcium in the blood, and so does consuming less calcium. This is helpful in preventing stones that contain calcium. Reducing your consumption of foods that contain oxalate, such as beets, chocolate, nuts, rhubarb, spinach, strawberries, tea and wheat bran, can help prevent stones containing oxalate. Eating less protein decreases the formation of uric acid which, along with purines, increases your risk for uric acid stones. Insoluble fiber helps to lower the amount of calcium in the blood, and drinking lots of fluid can help prevent most types of kidney stones since it makes the urine less concentrated. Considerations You don't want to reduce your calcium intake too much, or you may be at higher risk for osteoporosis. Grapefruit juice, cranberry juice and dark colas all increase the risk of forming calcium oxalate stones. Certain vitamin supplements, including vitamin C and vitamin D, can increase your chances of developing kidney stones, so speak to your doctor about any supplements you may take. Potential Diet is one of the risk factors for kidney stones -- except for struvite stones, which are associated with kidney infections -- but it is not the only risk factor. Age, obesity, being male, having a family or personal history of kidney stones, being dehydrated and having had gastric bypass surgery can all affect your risk for kidney stones. Changing your diet therefore may not eliminate all kidney stones. Warning Although small stones can be treated with pain relievers and an increased fluid intake, larger stones may require shock wave treatment to break them up or surgical removal. Medications may be necessary to help prevent recurrence. References National Kidney and Urologic Diseases Information Clearinghouse: Diet for Kidney Stone Prevention National Kidney Foundation: Diet and Kidney Stones MayoClinic.com: Kidney Stones Jackson Siegelbaum Gastroenterology: Kidney Stone Diet http://www.livestrong.com/article/314331-can-your-diet- cause-kidney-stones/
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High-Dose Vitamin C 'doubles Kidney Stone Risk' Regularly taking high-dose vitamin C pills can double the risk of kidney stones, say researchers. By Stephen Adams 05 February 2013 They made their finding after looking at the incidence of kidney stones over 11 years in 23,355 men. Those who took vitamin C supplements - which typically contain 1,000 milligrammes per tablet - were at twice the risk of developing the stones compared to men who took no vitamins. Those who took the high-dose pills most regularly were at the highest risk. But taking vitamin C as part of a multi-vitamin - which tend to contain much lower doses of the vitamin - did not raise the risk, found the researchers from the Karolinska Institute in Sweden. Kidney stones are small crystals of waste matter that form and can block a part of the organ or the urinary tract, causing intense pain. They affect 10 to 20 per cent of men and three to five per cent of women. According to the Department of Health, adults need just 40mg of vitamin C a day. Its advice notes that taking high doses can cause stomach pain, flatulence and diarrhoea, but it does not mention kidney stones. While widely believed to fight off colds, recent trials have shown it has no discernable effect as a preventive agent. However, it does have a modest effect in shortening colds, if taken as a therapeutic medicine once the infection has begun. Professor Agneta Akesson, who led the Karolinskas study, published in the journal JAMA Internal Medicine, said: Given that there are no well-documented benefits of taking high doses of vitamin C in the form of dietary supplements, the wisest thing might be not to take them at all, especially if you have suffered kidney stones previously. Dr Carrie Ruxton, from the Health Supplements Information Service, said as the study only looked at men results could not be assumed to be the same for women. She added: "Since higher dose vitamin C - 500mg per day or more - is proven to reduce the duration of a cold orflu, it is worth taking these in the short-term when required. "This study looked at people who were habitually taking around 1000mg several times a week. "It is likely that short-term, sporadic use of higher dose vitamin C does not constitute a risk for kidney stones and can be helpful when people have a cold." http://www.telegraph.co.uk/health/healthnews/9849917/High- dose-vitamin-C-doubles-kidney-stone-risk.html
High Uric Acid Level By Mayo Clinic Staff Definition A high uric acid level, or hyperuricemia, is an excess of uric acid in your blood. Uric acid is produced during the breakdown of purine, a substance found in many foods. Once produced, uric acid is carried in your blood and passes through your kidneys, where most of it leaves your body when you urinate. A high uric acid level may result in attacks of gout, but not everyone who has high uric acid gets gout, and not everyone with gout has high uric acid. Causes A high uric acid level can be caused when your body either produces too much uric acid or your kidneys don't eliminate uric acid rapidly enough. A high uric acid level may cause increasingly frequent attacks of gout, or it may never cause problems. A high uric acid level may also cause some people to develop kidney stones or kidney failure. And some people with a high uric acid level also develop high blood pressure, heart disease or chronic kidney disease, but it's often unclear whether this is a direct cause or merely an early warning sign of these conditions. Factors that may cause a high uric acid level in your blood include: Diuretic medications (water pills) Drinking too much alcohol Genetics (inherited tendencies) Hypothyroidism (underactive thyroid) Immune-suppressing drugs Niacin, or vitamin B-3 Obesity Psoriasis Purine-rich diet organ meat, game meat, Continued on page 26
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Role of Uric Acid in Hypertension, Renal Disease, and Metabolic Syndrome ABSTRACT Hyperuricemia has long been known to be associated with cardiovascular disease, and it is particularly common in people with hypertension, metabolic syndrome, or kidney disease. Most authorities have viewed elevated uric acid as a secondary phenomenon that is either innocuous or perhaps even beneficial, since uric acid can be an antioxidant. However, recent experiments have challenged this viewpoint. In this paper we argue that uric acid is a true risk factor for cardiovascular disease. Furthermore, we suggest that the recent increased intake in the American diet of fructose, which is a known cause of hyperuricemia, may be contributing to the current epidemic of obesity and diabetes. MOST AUTHORITIES do not consider hyperuricemia to be an important risk factor for cardiovascular or renal disease. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1 does not recognize it as a risk factor, and neither does the American Heart Association nor the National Kidney Foundation. 2
However, emerging data suggest that elevated uric acid is actually one of the most important risk factors for cardiovascular disease and that it plays a significant role in the development of renal disease and metabolic syndrome as well. Granted, much of this new evidence is based on preliminary animal studies, and the theory is provocative. But as the German philosopher Arthur Schopenhauer (17881860) said, All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident. The goal of this article is to lay out the new evidence and make the case that we need to begin taking uric acid seriously. HUMANS AND APES LACK URICASE Nearly 15 million years ago, one of our hominid ancestors acquired a mutation in the gene for uricase, the hepatic enzyme that degrades uric acid into allantoin. As a consequence, both humans and the great apes, such as chimpanzees and gorillas, have higher uric acid levels than most other mammals. 3,4 The muta- tion affected the ability to regulate uric acid levels, and so changes in diet can cause marked variations in serum uric acid levels, which can range in humans from as low as 2 mg/dL to as high as 12 mg/dL. 5
This wide serum urate range in humans is determined by the balance between purine intake and urate production on the one hand and urate elimination by renal and extrarenal routes on the other. High serum urate levels usually are associated with defects of uric acid transport in the nephron, but until now none of these defects has been unequivocally demonstrated. URIC ACID: CAUSE OR CONSEQUENCE OF DISEASE? Sir Alfred Garrod in the 1800s provided the first evidence that gout was associated with increased levels of uric acid in the blood. 6
Shortly thereafter, Frederick Akbar Mohamed 7 first described essential hypertension, and noted that it was often associated with gout. Writing in the Lancet, he said: People who are subject to this high blood pressure frequently belong to gouty families or have themselves suffered from the symptoms of the disease.7 In subsequent articles, Mohamed proposed that uric acid might be one of the causes of hypertension. After that, many papers reported on the association of gout with hypertension, obesity, and cardiovascular disease. Indeed, in the days before effective therapy was available to lower serum uric acid, more than 70% of patients with gout were obese, more than 50% had hypertension, nearly all had some degree of renal disease (and 10% to 25% died of it), 8,9 and approximately 90% developed some degree of heart disease (and 20% died of a cardiac complication). Thus, gout seemed to be a major risk factor for cardiovascular disease. And clinically evident gout is only the tip of the iceberg. Many patients have hyperuricemia (uric acid > 7.0 mg/dL in men and >6.5 mg/dL in women) but do not have gout. Studies in people with asymptomatic hyperuricemia have also demonstrated a remarkable association with hypertension, obesity, metabolic syndrome, kidney disease, and cardiovascular disease. 10
The key question, however, is whether the hyperuricemia has a causal role in these syndromes or whether it is a secondary phenomenon. Several epidemiologic studies have tried to determine if uric acid is an independent risk factor for cardiovascular disease 11, 12 ; some found that it was, but others did not. Continued on page 24
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Continued from page 23 Role of Uric Acid in Hypertension, Renal Disease, and Metabolic Syndrome The inability to resolve these issues, coupled with the lack of a mechanism by which uric acid might cause cardiovascular disease, has up to now led most authorities to conclude that uric acid is not a true risk factor for cardiovascular disease. 1,2 Uric acid rediscovered While the idea that hyperuricemia may be a secondary phenomenon appears reasonable, a number of observations argue against it. For one thing, the elevated uric acid often precedes the hypertension, 1315 obesity, 16
or kidney disease. 17 Until recently, however, no one had evaluated the effect of raising uric acid levels in animals. URIC ACID RAISES BLOOD PRESSURE In studies in our laboratory, we found that rats develop high blood pressure 3 to 5 weeks after we mildly raise their uric acid level by giving them an inhibitor of uricase, oxonic acid. 18
The mechanism of hypertension is by lowering endothelial nitric oxide levels, reducing neuronal nitric oxide synthase in the macula densa of the kidney, and stimulating the renin-angiotensin system. 18 Over time, the rats develop renal microvascular disease in which the afferent arterioles thicken and occasionally develop hyalinosis. The renal microvascular disease develops independently of hypertension and is likely due to direct effects of uric acid, which stimulates vascular smooth muscle cell proliferation. 19
Additional studies demonstrated that once the micro- vascular lesion occurs, the hypertension is self- sustained. 20 Further evidence has now come from studies in humans. Hyperuricemia is strongly associated with endothelial dysfunction, 21,22 and lowering uric acid improves endothelial dysfunction markedly in a variety of conditions. 2325 Also, hyperuricemia has now been found to be an independent risk factor for hypertension in several studies. 1316,2631
Many patients with new-onset hypertension have elevated uric acid. We found a uric acid level higher than 5.5 mg/dL in 89% of untreated adolescents with essential hypertension, but in 0% of controls. 32 The hyperuricemia was not secondary to hypertension in that study, as the patients with secondary hypertension (mostly due to renal parenchymal disease) had uric acid levels significantly lower than those who had essential hypertension. The relationship of uric acid to hypertension was also independent of obesity or renal function. After pilot studies suggested that lowering uric acid might lower blood pressure in these patients, 33 several trials funded by the National Institutes of Health were launched to explore the role of uric acid in hypertension. URIC ACID DAMAGES THE KIDNEYS In other studies in rats, experimental hyperuricemia (again induced by oxonic acid) was also associated with the development of mild renal disease, characterized by mild proteinuria, renal arteriolar changes, glomerular hypertrophy, tubulointerstitial fibrosis, and eventually glomerulosclerosis. 34
Interestingly, when hyperuricemia was induced in rats with preexisting renal disease (ie, in which one entire kidney and two thirds of the other kidney had been removed), their renal lesions were dramatically worse than in similar rats without hyperuricemia. 35 This suggests that the hyperuricemia may not only cause renal disease, but may also exacerbate preexistent renal disease. The mechanism by which uric acid might cause renal disease was revealed by micropuncture studies, which demonstrated that elevated uric acid (3.1 0.2 mg/dL) caused glomerular hypertension and cortical vaso- constriction. 36 These changes would be expected to induce glomerular damage and tubular ischemia. In addition, uric acid stimulated inflammatory mediators in vascular cells, including C-reactive protein and monocyte chemoattractant protein- 1,37,38 and vasoconstrictive factors such as thromboxane.35 Recent studies in humans also suggest that uric acid is a true risk factor for kidney disease. Numerous recent papers have reported elevated uric acid is an independent risk factor for kidney disease in the general population 17,39,40 and in patients with preexistent renal disease. 41 Elevated uric acid has also been reported to be more common in patients with diabetes with progressive renal disease. 42
While earlier studies have reported mixed results from lowering uric acid in patients with renal disease (reviewed by Johnson et al 43 ), a recent clinical study found that lowering uric acid in patients with renal disease and asymptomatic hyperuricemia resulted in less progression of their renal disease. 44
While these findings need to be confirmed, these studies, as well as reports by others, suggest that lowering uric acid may be another way to help slow the progression of renal disease. 45 HIGH-FRUCTOSE CORN SYRUP AND THE EPIDEMIC OF OBESITY Since the 1970s, the prevalence of obesity has risen dramatically. Perhaps not coincidentally, the 1970s was Continued on page 25
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Recent studies in humans found that elevated uric acid predicts the development of hyperinsulinemia, 31
obesity, 16 and type 2 diabetes. 15,31 Elevated uric acid is also common in the metabolic syndrome and other insulinresistant states. 53,54 Interestingly, uricosuric agents have been reported to lower serum triglycerides. 55 However, studies to formally test the effect of lowering uric acid on features of the metabolic syndrome in humans have yet to be performed. SATISFYING KOCHS POSTULATES The mean uric acid level in the United States has steadily increased over the past 60 years. The reason may relate to the Western diet, and particularly to its fructose content. Indeed, Yudkin 56 reported in the 1960s that there was a striking relationship between the rise in cardiovascular disease and the dietary intake of sugar. He and others later showed that diets high in sugar, and in particular fructose, can induce features of the metabolic syndrome in humans. 57 Given that fructose increases uric acid levels, it is tempting to link the rise in cardiovascular disease in part to this pathway. Renal mechanisms, not yet well established, are responsible for the hyperuricemia in most patients with gout, but secondary events such as high dietary intake of fructose may contribute to an increased production of uric acid in those cases as well. Combined mechanisms commonly cause hyperuricemia; another example is high alcohol consumption, which accelerates the hepatic breakdown of adenosine triphosphate, contributing to the higher urate levels frequently seen in those patients. This theory does not negate the importance of other key factors, including excessive caloric intake, excessive salt intake, physical inactivity, increased societal stress, and genetic mechanisms. However, together, the data do suggest that a reappraisal of the role of uric acid in cardiovascular disease is indicated, and that studies should be performed to address the potential role of this factor in cardiovascular disease. In 1882, Robert Koch presented his evidence that Mycobacterium tuberculosis was the cause of tuberculosis. 58 His studies were based on the demonstration that M tuberculosis was present in patients with tuberculosis, and that this organism could be cultured and subsequently inoculated in experimental animals in which manifestations of the disease could be reproduced. 58
It is now apparent that the evidence that uric acid is a Continued on page 26 Continued from page 24 - Role of Uric Acid in Hypertension, Renal Disease, and Metabolic Syndrome also the decade in which Japanese investigators developed a method to create high fructose corn syrup. Ordinary corn syrup is composed mainly of glucose, but when it is treated with an enzyme called glucose isomerase, 42% to 55% of the glucose is converted to fructose. Because fructose is less expensive, is more soluble at lower temperatures, and has a longer shelf life than other sweeteners, it soon became the most common type of artificial sweetener. Today, most sweetened processed foods, such as soft drinks and pastries, are laden with high- fructose corn syrup. In addition, table sugar (sucrose) also contains 50% fructose. Between corn syrup and table sugar, Americans are consuming much more fructose than before, and the trend corresponds with the increase in obesity over the past 25 years. 46 Fruit juices have been linked to obesity in children, and the consumption of soft drinks has been linked to diabetes, hypertension, and weight gain. 4749 Fructose may be uniquely unhealthy because it is the only sugar that raises uric acid levels. 50 Both humans (who lack uricase) and rodents (which express uricase) show a marked rise in uric acid after ingesting fructose. These levels peak within 30 minutes, remain elevated for90 minutes, and then tend to return to baseline. Normally, when we eat, blood glucose levels rise, stimulating insulin release and a rise in endothelial nitric oxide that enhances blood flow to the skeletal muscle, effects that are critical for the efficient uptake of glucose. 51
However, by raising uric acid levels, fructose reduces endothelial nitric oxide and hence interferes with glucose uptake by skeletal muscle. As a consequence, the insulin level rises as the body attempts to overcome the blockade of glucose uptake: hyperinsulinemia due to insulin resistance. But uric acid can be lowered. Recently, Nakagawa et al 52
(our group) reported what happened when we fed rats fructose with or without the uric acid-lowering drugs allopurinol or benzbromarone. The rats that did not receive the drugs developed the metabolic syndrome, with elevated insulin, triglycerides, blood pressure, uric acid, and body weight. Lowering the uric acid level prevented or reversed these effects. In particular, when allopurinol was started early, it prevented hyperinsulinemia, systolic hypertension, hypertriglyceridemia, and weight gain. The rats did not eat less if they received the drugs, so dietary intake could not account for the differences.
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Continued from page 24 - Role of Uric Acid in Hypertension, Renal Disease, and Metabolic Syndrome mediator of hypertension is as strong as the evidence presented by Koch that M tuberculosis is a cause of tuberculosis. In the case of tuberculosis, the key proof of causationthat eradicating the organism would cure the diseasedid not come until the 1950s with the introduction of streptomycin and isoniazid. In the case of uric acid, the effect of lowering uric acid on blood pressure in humans is only now being tested. CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 73 NUMBER 12 DECEMBER 2006 1063 http://www.ccjm.org/content/73/12/1059.full.pdf
Continued from page 22 - High Uric Acid Level anchovies, herring, gravy, dried beans, dried peas, mushrooms and other foods Renal insufficiency inability of the kidneys to filter waste Tumor lysis syndrome a rapid release of cells into the blood caused by certain cancers or by chemotherapy for those cancers Also, you may be monitored for high uric acid levels when undergoing chemotherapy or radiation treatment for cancer. http://www.mayoclinic.com/health/high-uric-acid- level/MY00160/DSECTION=causes
Calcium Deficiency causes Bone Fractures, Kidney Stones By J. D. Heyes November 17, 2012 (NaturalNews) Not enough calcium in their diet can increase the risk in women of a hormone condition that causes bone fractures and kidney stones, according to scientists. The condition, primary hyperparathyroidism (PHPT), can affect one in 800 people during their lifetime, but it's occurrence is most common in post-menopausal women, said researchers, who wrote about their findings in the British Medical Journal. The research team suggested that increasing calcium intake cuts the risk of developing the disease. "Primary hyperparathyroidism is the most common cause of hypercalcemia and the third most common endocrine disorder, with 100,000 new cases in the United States each year," said the team of Dr. Julie Paik, Dr. Gary Curhan and Dr. Eric Taylor, of the Brigham and Women's Hospital at Boston's Harvard Medical School wrote, noting that as many as two percent of post-menopausal women could have the condition. Hypercalcemia is defined as "too much calcium in the blood," according to the National Institutes of Health. Dietary guidelines call for adults to consume around 700 mg of calcium daily. 44 percent reduced risk Calcium is readily available in milk and other dairy products, nuts and fish such as sardines and pilchards (where the bones are also eaten), and in oral supplements. But taking too much could cause stomach pains and diarrhea, say doctors and dieticians. Researchers say PHPT is caused by overactive parathyroid glands that secrete too much parathyroid hormone. In addition to bone and kidney problems, there are also suggestions that PHPT is linked to an increased risk of high blood pressure, heart attack and stroke. The team examined 58,300 women who were taking part in a much broader, ongoing piece of research called the Nurses' Health Study, the BBC reported. All of the women were between the ages of 39 and 66 in 1986, when the study launched. None had a history of PHPT. The participating women completed food questionnaires to let researchers know how often they consumed specific foods or supplements, including calcium, every four years. The last year data was collected was 2008. Women were divided into five groups, depending on their calcium intake. The participant groups accounted for such factors as age, body mass and ethnicity.
Over the period of time of study, 277 cases of PHPT were discovered, the team said, noting that those women with the highest intake of dietary calcium had a 44 percent reduced risk of developing PHPT when compared to the group with the lowest intake. "Increased calcium intake, including both dietary and supplemental calcium, is independently associated with a reduced risk of developing primary hyperparathyroidism in women," Paik wrote in the journal Continued on page 27
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Continued from page 26 Calcium Deficiency causes Bone Fractures, Kidney Stones James Norman of the Norman Parathyroid Center in Florida added that "modest doses" of daily calcium supplements could like provide "more benefits than risks." Calcium, the primary mineral in building strong bones and teeth, also helps regulate muscle contraction and works to ensure blood clots normally. Improve your diet to improve your levels of calcium Vitamin D is also important because it helps you absorb and retain calcium in the bones. Other experts say you are better off getting your calcium from the foods you eat. A previous meta analysis of several studies involving the benefits of calcium have found that taking supplemental calcium tablets doesn't necessarily work to prevent osteoporosis - a disease that results in weakened bones. Writing in Natural News, Dr. David Jockers said: The best forms of calcium and bone building nutrients come from leafy green vegetables and fermented, raw milk products from 100-green fed cows and goats. Pasteurized forms of milk and grain-fed animals provide inflammatory fatty-acids and other metabolites that promote calcium mineralization into arterioles. The point? A better diet will provide better, more effective levels of calcium in your body. Sources: http://www.bbc.co.uk/news/health-19991610 http://www.bmj.com/content/345/bmj.e6390 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001404/
Eating Hot Foods on Melamine Dishes Increases Risk of Kidney Stones By Sarah Glynn 24 January 2013 Eating hot foods on melamine dishes increases the risk of developing kidney stones. The finding came from a new study conducted by Taiwan- ese researchers and was published in the journal JAMA Internal Medicine. The researchers discovered that the amount of melamine we are exposed to increases with hot temperatures, therefore,
the chance of developing kidney stones rises. The team, led by Chia-Fang Wu, M.S., Ph.D., of Kaohsiung Medical University, Taiwan, performed a crossover investigation of consumption of noodle soup in melamine bowls and total melamine excretion in urine. According to background information in the report, a constant exposure to low doses of melamine may be linked to urolithiasis (urinary system stones) in kids and adults. A previous report demonstrated that there was an increase in the number of children experiencing urinary stones due to melamine-tainted formula. There were twelve healthy people, six were males and six were females, who took part in the research. The 12 participants were split up into 2 groups: one group ate 500 ml of hot noodle soup in melamine bowls the other group ate soup in ceramic bowls Twelve hours after the subjects consumed the soup, they were asked to give samples of their urine. After a "three-week washout", the group who ate from the ceramic bowls ate from the melamine bowls and the group who ate from the melamine bowls ate from the ceramic bowls. The participants were asked to give urine samples a second time so that the researchers could compare. The results showed that total melamine excretion in urine for 12 hours was 8.35 micrograms in melamine bowls and total melamine excretion in urine for 12 hours was 1.31 micrograms in ceramic bowls. The scientists concluded: "Melamine tableware may release large amounts of melamine when used to serve high-temperature foods. The amount of melamine released into food and beverages from melamine tableware varies by brand, so the results of this study of one brand may not be generalized to other brands. Although the clinical significance of what levels of urinary melamine concentration has not yet been established, the consequences of long-term melamine exposure still should be of concern." The research received support from the National Science Council, the Taiwan National Health Research Institutes, and Kaohsiung Medical University Hospital. http://www.medicalnewstoday.com/articles/255305.php
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Statin Drugs cause Liver Damage, Kidney Failure and Cataracts, says BMJ By David Gutierrez
November 07, 2010 (NaturalNews) Cholesterol-lowering statin drugs significantly increase a person's risk of cataracts, muscle weakness, liver dysfunction and kidney failure, according to a study in the British Medical Journal. The study also confirmed that the drugs lower the risk of heart disease and esophageal cancer, but claims of other health benefits were unsupported. Researchers from Nottingham University in the United Kingdom examined data on more than 2 million patients between the ages of 30 and 84, seen at 38 different general practices, who had been prescribed the cholesterol-lowering drugs. More than 70 percent were taking simvastatin (Zocor), 22.3 percent were taking atorvastatin (Lipitor), 3.6 percent were taking pravastatin (Pravachol, Selektine), 1.9 percent were taking rosuvastatin (Crestor) and 1.4 percent were taking fluvastatin (Canef, Lescol, Lochol, Vastin). The researchers confirmed prior data suggesting that statins increase patients' risk of cataracts, liver dysfunction, kidney failure and a form of muscle weakness known as myopathy. They found that for every 10,000 women treated with the drugs, 23 would develop acute kidney (renal) failure, 39 would develop myopathy, 74 would develop liver dysfunction and 309 would develop cataracts. Men suffered an even higher risk of myopathy, but their risks of the other three conditions were similar to those suffered by women. Putting it in different terms, the researchers found that only 434 people would need to be treated with the drugs for five years for one case of acute renal failure to develop. It would take only 136 treated for each case of liver dysfunction and 33 for each case of cataracts. Among women, 259 would need to be treated for each case of myopathy; among men, the number was only 91. The risk of developing all conditions was highest during the first year of treatment, but continued throughout the course of the study. Risk of liver and kidney problems increased proportionally with the dose of statins being taken. All drugs appeared to pose a similar risk of all conditions, with the exception of fluvastatin, which increased the risk
of liver dysfunction more than its competitors. Men taking fluvastatin were twice as likely to develop liver dysfunction as those not taking statins, while women's risk increased by 2.5 times. The researchers did find, however, that the risk of cataracts returned to normal within one year of stopping statin treatment, while the risk of liver and kidney problems returned to normal within one to three years. Additionally, they found no connection between statin use and the risk of dementia, osteoporotic fracture, Parkinson's disease, rheumatoid arthritis or venous thromboembolism. Examining the purported benefits of the drugs, researchers found that they did in fact lower the risk of heart disease, averting 271 cases for every 10,000 high- risk patients treated. Put another way, 33 high-risk men or 37 high-risk women would need to be treated with the drugs to avert one case of the disease. Although advocates of the drugs have claimed that they may also reduce the risk cancer, the researchers found almost no data supporting these claims. The study "largely confirmed other studies that reported no clear association between statins and risk of cancers," the researchers wrote. The only cancer-fighting effect uncovered in the study was a slightly lower risk of esophageal cancer, with eight cases averted for every 10,000 high-risk women treated. In other words, 1,266 high-risk women or 1,082 high- risk men would need to be treated with the drugs to prevent one case of esophageal cancer. Although sales of the blockbuster drugs are unlikely to be reduced as a result of the study, the researchers encouraged closer monitoring of patients for side effects and said their findings "would tend to support a policy of using lower doses of statins in people at high risk of the adverse event." Sources: http://www.reuters.com/article/idUSTRE64J7B820100520; http://www.medpagetoday.com/Cardiology/Atherosclerosis/20 232. http://www.naturalnews.com/030317_statin_drugs_liver_dama ge.html
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African Traditional Herbal Research Clinic Volume 8, Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES THE KIDNEY NETWORK: Properties and Functions a common admonition that spans two thousand years of Chinese medical literature. While most Daoist and medical writings take up both the general topic and the detailed techniques of safeguarding jing, it is the realm of literature which best reflects the Chinese fear of continuous jing loss by way of sexual indulgence. The epic Ming Dynasty novel, Flower In the Golden Vase (Jin Ping Mei), narrates the story of the erotomaniac Ximen Qing who peddles his money and political influence to assemble a harem of six women, then resorts to tonic drugs to bolster his flagging virility, and finally comes to a horrid end after a final ejaculation of "mercury-like fluid, followed by blood and a gust of cold air." A Daoist physician who is called to the deathbed comments: "The candle flickers once the oil is used up." Both mercury and lamp oil are often used metaphors for the kidney jing. To avoid such a gruesome death, the handsome protagonist of the second moralist novel of the Ming dynasty, Prayer Mat of Flesh (Rou Putuan), decided to become a Buddhist hermit, cut off his surgically amplified penis, and utilize his jing for spiritual cultivation. Although the word jing is synonymous with the Chinese word semen, the seminal fluid represents only one form of jing. Other dense fluid essences such as saliva (particularly the kind that gets spontaneously excreted during meditation), vaginal fluids, breast milk, or blood are all regarded to be different transformations of one and the same jing; these are refined essences. Female "leakage" problems, such as metrorrhagia or leukorrhea occurring in older women, are therefore taken seriously for the same reasons as loss of semen in men. Daoist body science even features a special category called female alchemy (nu dan), wherein adepts are instructed in the conservation of (menstrual) blood and its transformation into physical and spiritual energy. The jing stored in the kidney can be differentiated into prenatal jing and postnatal jing. Prenatal jing contains the information that is given to us before birth (we Continued on page 30 1, The Kidney Stores the Jing (Essences) Jing is the Chinese designation for the essential fluid of our physical body. The archaic Chinese character for jing denoted the most refined essence obtained from rice (which is the main staple of the Oriental diet, so this means the refined essence from food). The basic yin (matter) from which all yang (physical action) springs is jing. In classical Chinese medical texts, jing is sometimes referred to as the body's "original water" with water representing the ultimate yin ("original fire" being the ultimate yang). Water has a tendency to drain downward. The kidney, the lowest of the organ networks, is where the body's water assembles and goes into storage until needed elsewhere. If the kidney function is weak, its storage capability will become inhibited and jing will leak from the body. Due to the Daoist belief that the jing is lost when a man excretes semen (of particular concern, when an elderly man, who already had deficiency of jing through aging, excretes semen), virtually all of the ancient medical texts mention spermatorrhea (a code for release during the disallowed practice of masturbation, wet dreams, and ejaculation during intercourse when the attempt is being made to prevent it) as a condition to be treated, since it indicates a breach of the kidney's function of safeguarding and storing jing. According to the Daoist ideal, except during early adulthood, men should refrain from releasing semen or, at the very least, experience this infrequently. Therefore, excessive sexual indulgence by males is considered to be a major health hazard in all genres of traditional Chinese writing. Since most men cannot control their urge to ejaculate, every intercourse means an irrevocable giving away of jing. Although Chinese medical texts consent that this may be affordable for young men (who have a rich supply of jing and who can easily replenish jing through post-natal sources), they generally warn that the health of elderly males will suffer serious consequences from frequent ejaculations. "What gives life will take life" is therefore
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Continued from page 29 THE KIDNEY NETWORK: Properties and Functions would today describe it as genetic information) that is intimately linked to the growth and maturation of an individual, which differs for men and women. The defining passage in the Neijing for women reads: "At the age of seven, the kidney qi [the physical action generated by the material basis of kidney jing] in females is strong, and the teeth come in. At the age of two times seven, the tiangui (stage of hormonal and reproductive maturity) arrives, the conception vessel opens, the penetrating vessel flourishes, menstruation is regular, and pregnancy becomes possible." With regard to male physiology: "At the age of eight, the kidney qi solidifies in males and teeth develop. At the age of two times eight, the kidney qi flourishes, the tiangui arrives, ejaculation occurs, and it becomes possible to have intercourse with females and beget children...; at the age of seven times eight, the liver qi is exhausted, the tendons are unable to facilitate smooth movement, the tiangui is dried up, jing is sparse, the kidney system is exhausted, and symptoms of physical aging are plentiful." Postnatal jing is the nutritive essence distilled from food by the spleen/stomach, and used to provide a constant flow of nourishing dew to the other organ networks. If all the networks are plentifully supplied, the surplus of the body's vital fluid transformation is stored in the kidney. The Neijing states: "The kidney is in charge of water, and it receives the essences of the other zang and fu organ networks and stores it." Before birth, prenatal jing forms the material basis for the development of postnatal jing. Once born, postnatal jing continuously boosts the body's limited supply of prenatal jing. Both forms of essence compose an indivisible entity. Kidney jing encompasses both kidney yin and kidney yang, often referred to as the body's original yin and original yang. Kidney qi is produced by the dynamic interaction between the two, specifically the action of functional/warming kidney yang steaming the material kidney yin. Kidney yin is the source of all material body fluids, in charge of nourishing and moistening all organ networks. Kidney yang, sometimes also called true yang, is the source of all types of yang qi. It is the driving force behind all processes of warming, generation, and transformation. The yin and yang aspects of the kidney both rely on each other and control each other. The proper balance between kidney yin and kidney yang is an important precondition for health. 2. The Kidneys contains the Will/Determination Will, determination, and power of memory are attributed to the kidney. The ability to keep a secret is attributed to the kidney's power of retention and safeguarding against leakage. The Neijing defined that "the kidney stores jing, and jing houses will power." In turn, if kidney jing becomes exhausted, a weak will and poor memory will result. 3. The Kidney is in Charge of Water Fluids reach the kidney after they have been absorbed by the stomach, raised upwards by the spleen, and sprinkled downwards by the lung. At this point they become differentiated into clear and turbid aspects by virtue of the transformative powers of kidney yang. The clear part of fluid essence returns to the lung, from where it moistens each one of the zang organs. From the lung, it turns into nasal discharge, or sweat, or saliva, or tears; and it differentiates into jing, blood, jin (liquids, that is the thinner fluids moistening the muscles), and ye (the denser fluids lubricating the joints and bone marrow). The turbid part feeds into the bladder, where it is being transformed into urine, and excreted. 4. The Kidney is in Charge of the Bones and Generates Marrow: its External Manifestation is in the Hair Bone marrow is considered to be a transformation of kidney jing that has the specific task of nourishing the bones. It is differentiated into bone marrow, spinal marrow, and brain marrow. Spinal marrow feeds into the brain, where the densest concentration of "marrow" can be observed. The brain is therefore also called the sea of marrow. If kidney jing is plentiful, both the bone (supporting the body) and the brain (supporting the mind) will be at a level of ideal strength. On the other hand, a deficiency of kidney jing will bring about brittle bones and a listless spirit. As the Neijing puts it: "The kidney is the master of physical strength; it produces exquisite movements/ actions." Since the teeth are considered to be the "surplus of the bones," they also rely on the nourishment of the kidney. If the jing is plentiful, the teeth are firm; if not, they come loose or fall out. The hair's growth process is governed by the waxing and waning of kidney qi. Again the crucial Neijing quote: "At the age of seven, a female's kidney qi is in high gear, the second teeth come in and the hair grows." Ancient texts often consider the head's hair to be a direct outgrowth of the brain, which would relate it to the kidney. The growth pattern and general luster of the hair is an important indication for the condition of prenatal jing. 5. The Kidneys is in Charge of Grasping (Containing) Qi Continued on page 31
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Continued from page 30 THE KIDNEY NETWORK: Properties and Functions Although the process of breathing is governed by the lung, the containment of incoming qi within the lower burner is governed by kidney qi. Only if kidney qi is plentiful and its grasping power sufficient, can the qi passages of the lung be unobstructed and the breathing be harmonious. If the kidney is weak and the breath cannot "root" in the kidney, disease will eventually arise. Shallow breathing, particularly in patients suffering from chronic asthma, is therefore often associated with a kidney qi deficiency. In this situation, the breath gets stuck above the diaphragm and cannot descend into its rightful abode, the lower dantian. This aspect of the kidney is one reason why there is such an intent focus on abdominal breathing in Oriental cultures. 6. The Kidney is connected to the Bladder The kidney and bladder form a zang-fu pair: "The kidney is connected with the bladder," states the Neijing; "the bladder is the store house of the liquids and humors." This statement reminds us that the bladder, similar to the gallbladder and the small intestine, not only excretes unwanted waste materials, but comprises a temporary station along the body's complex highway of vital fluid transformation. Bladder function, particular its function of "opening and closing," is largely dependent on the power of kidney qi. If kidney qi is strong, normal water metabolism will take place. The storage and excretion process of water through the bladder is thus intimately related to the general functioning of the kidney. 7. The Kidney has its Opening in the Ears and Two Private Parts (Anus and Genitalia) The ears, which faintly resemble the kidneys in shape, are thought to reflect the condition of kidney jing. Large ears and sharp hearing indicate an excellent condition of kidney jing. As people grow older, they not only become more forgetful, but their power of hearing decreases (and sometimes their ears shrivel up) as their jing depletes. As the original statement of the Neijing goes: "The kidney qi communicates with the ears; if the kidney functions properly, the ears can distinguish the five essential sounds." Kidney qi, due to its mother organ's close proximity to the openings in the lower burner, governs the opening and closing function of the "two private parts," including sexual functions like erection, ejaculation, and lubrication of the vaginal tract, and maintenance of fecal continence (as well as urinary continence via the control of the bladder). 8. The Fire of Mingmen is stored in Between the Kidneys
The concept of mingmen, the vital gate of life, is an integral part of the kidney system. The Nanjing (Classic of Difficulties) elaborated on basic Neijing theory by figuratively differentiating these two aspects of the kidney in structural terms, thereby initiating a medical theory that was later referred to as the mingmen school: "There are two kidney parts. Actually, not both of them are kidneys. The left one is the kidney, the right one is mingmen." The classic then goes on to elaborate that mingmen is the place "where the entirety of bodily jing and shen is at home, and where the original qi is generated." "It is the root of all zang-fu networks, the foundation of the twelve channels, the gate of breath, and the source of all three burning spaces." Later medical scholars argued that mingmen is an immaterial force that could not be physically located in the right kidney. Rather, its location is the central point on the spine between the two anatomical kidneys and opposite the umbilicus, thus forming a "posterior dantian." The Chinese name for the acupuncture point located there is mingmen (GV-4). The fire lodged within kidney water is often referred to as the body's ministerial fire (xiang huo), as opposed to the imperial fire (jun huo) of the heart. In its role of the "minister" serving the higher centers, it warms the spleen, ripens food, grasps lung qi, and gives volume to a person's voice. 9. The Kidney Cooperates with the Triple Burner to Transform Qi and Move Water The triple burner, a fu organ that is said to pass through and connect all of the body's three burning spaces, stimulates qi transformation with a specific focus on water metabolism. It keeps the body's water ways unobstructed and smoothly operating. These functions of the triple burner are intimately tied to the kidney and bladder. The Neijing says: "The upper burner is like a mist, the middle burner is like a swamp, and the lower burner is like a ditch," referring to the essence misting activity of the lung on top, the fermenting action of the spleen/stomach at the center, and the canalization of water in the lowest part of the torso. The Kidney Network: Pathogenesis Injury to Kidney (Yin) and Mingmen (Yang) Fire: if the kidney's ability to store jing becomes disturbed, a person's growth patterns and reproductive ability will be affected; infertility, hair and tooth loss, slow physical development, or softness and malformation of the bones may result. If within the kidney jing the crucial controlling/ generating balance between kidney yin and kidney yang Continued on page 32
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Continued from page 31 THE KIDNEY NETWORK: Properties and Functions becomes disturbed, different symptom patterns may arise. Typical manifestations of hyperactivity of yang due to kidney yin deficiency are burning sensation in the palms and soles, tidal heat sensations, night sweats, spermatorrhea, or sexual dreams. When the kidney yang is exhausted and thus unable to execute its ministerial warming function, symptoms of listless spirit may result: sore lower back and knees; cold sensations in the body and its extremities; inhibited urination or frequent and profuse urination; early morning diarrhea; asthmatic panting upon slight physical exertion; difficult breathing; impotence and premature ejaculation; or infertility due to a "cold uterus." If there is evidence of kidney deficiency without obvious cold or heat symptoms, this symptom complex is usually referred to as kidney qi (or kidney jing) deficiency. It is important to understand the intimate relationship of kidney yin and kidney yang, and that prolonged kidney yin deficiency will eventually influence kidney yang and vice versa. This phenomenon is usually called a deficiency of kidney yin implicating kidney yang, or a deficiency of kidney yang implicating kidney yin. Changes in Water Metabolism: since the kidney is said to be in charge of water, all pathological changes involving water are in some way associated with the kidney. If there is a lack of kidney yang, the body's general process of qi transformation will suffer, and consequently water metabolism will be inhibited. As the Treatise on Blood Diseases (Xuezheng Lun) explains: "If there is not enough yang qi, pathological water accumulations will turn into phlegm and distress the heart or attack the lung, or cause symptoms of edema, abdominal pain accompanied by a sensation of qi rushing upwards, or diarrhea and intense cold." Most cases of phlegm or edema occur when the yang fire is unable to transform yin water. Figuratively speaking, the kidney is the general commanding the two water fu organs which are mainly involved in the transportation and transformation of water, namely the triple burner and the bladder. As the Neijing says: "The shaoyang [triple burner] belongs to the kidney; above, the kidney connects with the lung, and thus has two fu organs under its command [triple burner and bladder]." Therefore, if there is not enough kidney yang, the upper burner cannot properly distribute fluids, the middle burner cannot properly steam and ripen food and separate the clear from the turbid, and the lower burner cannot properly transform qi, thus influencing the opening and
closing ability of the bladder (causing excessive or inhibited urination, as in bed wetting, frequent urination, nocturia, etc.). Moreover, since urine is manufactured from body fluids which are in part produced by the kidney, a deficiency of kidney water will always involve a deficiency of fluids, causing inhibited urination. Along the same lines, too much urination will eventually harm the body's fluid supply. Emotional Influences on Proper Kidney Function: the kidney is said to house the force of will power and determination. Will power, therefore, relies on nourishment by kidney jing. If jing is weak, then will power and its sustained expression (memory) will also be weak. Intense or prolonged fear, the emotion associated with the kidney, will cause injury to the kidney qi, resulting in impotence, spermatorrhea, or the gradual development of cowardly behavior. The other way around, a physical deficiency of kidney jing can cause a disposition for panicky and fearful behavior. Kidney Disorders Causing Pathological Changes in the Bones, the Marrow, the Hair, and the Ears: if kidney jing is sufficient, the continuous production of high quality marrow is assured, resulting in properly nourished and, thus, firm and strong bones. Otherwise the skeletal structure will be weak, or structural changes such as osteoporosis might occur. If the kidney is harmed by pernicious qi affecting the kidney jing and consequently the marrow and bones, there will be symptoms of weak and sore waist and legs, or even atrophy of the legs causing severely limited mobility. As the Neijing states: "If kidney qi is pathologically hot, the lumbar spine will be inhibited, the bones will become brittle and the marrow scorched, and atrophy of the bones will result." For the same reasons, symptoms of loosening and deteriorating teeth, or the drying, greying, and gradual falling out of hair are related to the state of the kidney's jing qi. Since the ears and the associated sense of hearing also depend on nourishment by the kidney's jing qi, ringing in the ears, loss of hearing, or deafness are typical symptoms for various aspects of kidney deficiency. Representative Substances for the Treatment of Kidney Disorders Moisten the kidney (tonify kidney yin) (zi yin; bu shen yin): rehmannia (dihuang), tortoise shell (guiban), asparagus root (tianmendong), lycium fruit (gouqizi), morus fruit (sangshenzi), ligustrum (nuzhenzi). Continued on page 33
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Continued from page 32 THE KIDNEY NETWORK: Properties and Functions Warm the kidney (strengthen yang; tonify the vital flame of life) (wen shen; zhuang yang; bu ming huo): aconite (fuzi), cinnamon bark (rougui), sulphur (liuhuang), morinda (bajitian), deer antler (lurong), cnidium fruit (shechuangzi), cistanche (roucongrong). Complement jing and tonify the marrow (tian jing bu sui): animal bone marrow (dongwu jisui), animal brain (naosui), placenta (ziheche), deer antler (lurong), antler gelatin (lujiaojiao), tortoise plaster gelatin (guijiao), cordyceps (dongchong xiacao). Restore the storing action of the kidney (astringe jing; stop vaginal discharge; curb frequent and profuse urination) (gu shen; se jing; zhi dai; shou se xiao bian): schizandra (wuweizi), cornus (shanzhuyu), alpinia (yizhiren), rubia (fupenzi), mantis egg case (sangpiaoxiao), rose hips (jinyingzi). Restore the kidney's function of grasping and retaining qi (na qi gui shen): schizandra (wuweizi), psoralea (buguzhi), gecko (gejie), cornus (shanzhuyu), aquilaria (chenxiang). Aid the transformation of bladder qi (hua pangguang qi): cinnamon twig (guizhi) and hoelen (fuling), cinnamon bark (rougui), lindera (wuyao), fennel (xiao huixiang), saussurea (muxiang), citrus seed (juhe), litchi seed (lizhihe). Open and disinhibit the water passages of the bladder and the triple burner (tongli pangguang, sanjiao): alisma (zexie), hoelen (fuling), polyporus (zhuling), talc (huashi), akebia (mutong), tetrapanax (tongcao), tokoro (pixie), polygonum (bianxu), lygodium (haijinsha). Clear kidney heat (moisten yin and descend deficiency fire) (qing shen re; zi yin jiang huo): anemarrhena (zhimu), phellodendron (huangbai), morus bark (digupi), eclipta (hanliancao). Discharge kidney fire (purge fire with salty and cold materials) (xie shen huo; xian han xie huo): salt (qingyan), halite (qingyan), urine (tongbian), calcitum (hanshuishi). The Kidney Network: Basic Guidelines for the Treatment of Kidney Disorders Since the kidney is the representative lower burner organ, it generally needs to be addressed with high amounts of heavy and sticky substances. The 18th century fever school authority Wu Jutong once described this characteristic in graphic terms: "Lower burner therapy is like a weight-if it is not heavy enough, it does not reach the bottom." Kidney disorders are generally of a cold and deficient nature. Kidney therapy, therefore, needs to focus primarily on the tonification of deficiency; purging of excess is a definite taboo. If kidney water is deficient, the kidney needs to be tonified by moistening yin. If kidney jing is deficient, it needs to be replenished by supplementing jing and tonifying the bone marrow. If kidney yang is deficient, the kidney needs to be tonified by using modalities that strengthen yang. In the more advanced scenario of mingmen fire exhaustion, materials that warm and tonify the vital flame of life need to be employed. Since the kidney has both yin and yang aspects, pathological situations may arise from an imbalance in the ratio of kidney yin and kidney yang. The most typical example is the upflaring of deficiency fire due to a deficiency in kidney water, which calls for a descending action that re-anchors the floating fire in the yin waters of the kidney. This is primarily achieved by the use of yin tonics which will bring the diminished yin level back to full capacity and thus naturally extinguish the deficiency type of pathological heat. If yang deficiency has begun to implicate yin, both jing and marrow should be supplemented and the vital flame of life be warmed and tonified. If both kidney yin and yang are deficient, both the various aspects of the kidney and the vital flame of life should be tonified. In the common scenario of spleen and kidney deficiency, both spleen and kidney yang need to be tonified. In case of lung and kidney deficiency, both lung and kidney yin need to be moistened. In chronic asthma patients where kidney deficiency results in an inability of the kidney to grasp the descending qi from the lung, the kidney needs to be warmed with substances that specifically assist with the action of grasping and retaining qi, such as gecko (gejie) and schizandra (wuweizi). If lung metal fails to properly generate kidney water, kidney yin needs to be moistened indirectly by nourishing the yin of its mother system, the lung. If kidney water fails to nourish its son, liver wood, the liver needs to be supported by moistening kidney yin and/or kidney jing. In the case that kidney deficiency has caused an exhaustion of the earth network, the lower burner's vital flame of life needs to be rekindled with warming substances in order to provide the transformative forces of the middle burner above with the activating heat they require. If the extended water network (including the kidney, the bladder, and the triple burner) is compromised by a damp heat condition, the dampness should be disinhibited with materials of a cooling nature that have Continued on page 34
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Continued from page 33 - THE KIDNEY NETWORK: Properties and Functions a specific affinity to the lower burner, such as alisma (zexie), polyporus (zhuling), and talc (huashi). If the transformative powers of the bladder and the triple burner fail due to an exhaustion of the kidney's vital flame of life, then this type of pathological water accumulation needs to be transformed by primarily warming kidney qi, and secondarily by adding several herbs that directly move out the pathological water. If phlegm, dampness, or water rheum stagnate internally, phlegm damp needs to be disinhibited, and water rheum driven out. If the kidney has been damaged due to chronic illness, exaggerated emotions, or excessive sexual activity, a change of the situation or life style that has originally caused the condition is imperative. Simultaneously, the recovery of the kidney system can be supported by prescribing a selection of tonic agents that moisten yin, strengthen yang, or nourish jing and marrow. As the water network, the kidney has an aversion to dry influences. It would be particularly detrimental to exclusively employ bitter and drying substances in a situation where the kidney yin is deficient. Perhaps unexpectedly, the Neijing recommends pungent flavors to counteract dryness in the kidney; these pungent flavors aid the lung in distributing moisture to the kidney. In clinical reality, herbs like cuscuta (tusizi) and cnidium fruit (shechuangzi) fit this category. The kidney strives for a state of guarded firmness and tight solidity. If the storage fortress of the kidney is properly buttressed, precious essence will not leak out. Many bitter materials, although they should be used cautiously for the reasons just mentioned, have a stabilizing affect on kidney yin. Anemarrhena (zhimu), an herb that is both bitter and moistening, and phellodendron (huangbai) are the prime substances used in situations of continuous jing leakage, particularly lower burner deficiency fire fueling obsessive sexual urges, excessive masturbation, recurrent sexual dreams, spermatorrhea, or certain types of leucorrhea. Salty flavors have a direct affinity to the kidney network, and are generally beneficial when used in moderation. "Salty flavors generate the kidney," comments the Neijing. Increased dietary intake of salt, usually obtained from stored foods with salt as the preserving element, taken during the water season (winter) contributes to preserving the kidney against the cold. On the other hand, salt has a percolating and leakage-promoting affect that is overall unsuitable for an organ system that is in charge of storing and metabolizing physiological jing, humors, and fluids. Therefore, excessive consumption of salty foods is discouraged, as it will harm the kidney and its affiliated body layer. "If the disease is in the bone layer," the Neijing points out elsewhere, "do not eat salty foods." If the kidney root is damaged, many of the body's stem and branch organs have already entered a pathological state first. If kidney yin-that is the base substance from which liver yin, stomach yin, heart yin, lung yin, and the body's humors and fluids are formed-is deficient, it usually means that the condition is preceded by a yin deficiency in other organs. Similarly, the essential flame of the lower burner only flickers after the light in the upper levels has grown dim. This situation has given rise to a school of medicine that favors kidney tonification in most deficiency situations. Tonifying kidney yin and kidney yang, proponents have argued since the 13th century, means to moisten and strengthen the body's source yin/yang and thereby the yin/yang of all organ networks. However, the root status of the kidney also implies that kidney deficiency is often accompanied by inadequate spleen/stomach function. This poses a problem in light of the fact that herbal kidney therapy requires heavy amounts of sticky substances that are generally hard to digest. One attempt to remedy this situation was the addition of herbal "digestive aids" to kidney formulas such as Rehmannia Six Formula (Liuwei Dihuang Wan). Pharmacists at the renowned Beijing herb emporium Tongren Tang, for instance, used to automatically add small amounts of the aromatic cardamon (sharen) if the patient's prescription called for large amounts of the greasy kidney tonic rehmannia (dihuang). Proponents of the spleen/stomach school, on the other hand, have argued that kidney deficiency is often the result of a deficiency of its controlling network, namely spleen earth. Spleen tonification advocates have said for more than half a millennium that this should be the primary modality to regenerate the kidney system. In any case, caution needs to be exercised regarding the prescription of heavy "water" substances to patients who show signs of digestive weakness, such as poor appetite, bloating, and tendency to experience diarrhea or loose stool. A safe method for the direct tonification of lower burner source qi has been developed by the ancestors of Chinese medicine, namely Daoist practitioners of "inner alchemy." The term inner alchemy refers to Qigong exercises of the quiet, meditative kind that focus on generating warmth and fullness in the lower dantian. The Kidney Network: Typical Disease Patterns KIDNEY YIN DEFICIENCY (shen yin xu): primary symptoms are dizziness; blurry vision; ringing in the ears; sore and weak lower back or knees; burning in palms and soles; tidal heat sensations; night sweats. Secondary Continued on page 35
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Continued from page 34 THE KIDNEY NETWORK: Properties and Functions symptoms include dry mouth and throat; flushed face; emaciated features; premature graying of hair; low sperm count in males; decreased menstrual flow and infertility in females; forgetfulness; insomnia; spermatorrhea; premature ejaculation; heel pain; yellow urination; dry stool. The tongue typically presents with a red body and little or no coating; the pulse tends to be fine and rapid. Representative Herbs: rehmannia (dihuang), cornus (shanzhuyu), asparagus root (tianmendong), ho-shou-wu (heshouwu), lycium fruit (gouqizi), ligustrum (nuzhenzi), tortoise shell (guiban), turtle shell (biejia), scrophularia (xuanshen), eclipta (hanliancao), anemarrhena (zhimu). Representative Formulas: Return the Left Decoction; Achyranthes and Rehmannia Formula (Zuogui Yin); Rehmannia Six Formula (Liuwei Dihuang Wan). KIDNEY YANG DEFICIENCY (shen yang xu): primary symptoms are pale or dark complexion; listless spirit; obvious aversion to cold; cold extremities; low sex drive; weak or cold and painful lower back and knees; early morning diarrhea; frequent urination or clear and profuse urination. Secondary symptoms include impotence; premature ejaculation; infertility; clear vaginal discharge; inhibited urination and edema; dizziness; ringing in the ears. The tongue typically presents with a pale, tender, and often toothmarked body, and a white and slippery coating; the pulse tends to be deep, slow, and forceless. Representative Herbs: aconite (fuzi), cinnamon bark (rougui), epimedium (yinyanghuo), morinda (bajitian), psoralea (buguzhi), deer antler (lurong), curculigo (xianmao), fenugreek (huluba), cistanche (roucongrong), cynomorium (suoyang). Representative Formulas: Return the Right Pill (Yougui Wan). KIDNEY QI DEFICIENCY (shen qi xu): primary symptoms are dizziness; ringing in the ears; weak or sore lower back and knees; physical and mental fatigue; shortness of breath. Secondary symptoms include pale complexion; spontaneous sweating; decreased mental and physical growth rate in children; frequent urination; nocturia; spermatorrhea; premature ejaculation; asthmatic panting upon exertion. The tongue typically presents with a pale body and a white coating; the pulse tends to be fine and weak. Representative Herbs: walnut (hutaorou), dioscorea (shanyao), eucommia (duzhong), cuscuta (tusizi), schizandra (wuweizi), cornus (shanzhuyu), morinda (bajitian). Representative Formula: Rehmannia Eight Formula (Shenqi Wan). KIDNEY JING DEPLETION (shen jing bu zu): primary symptoms are dizziness; ringing in the ears; weak or sore lower back and knees; low sperm count in males; amenorrhea and infertility in females; delayed mental and physical development in children. Secondary symptoms include decreased memory; slow and clumsy body movements; dull facial expressions; emaciated body structure; hair loss; loose teeth; late closing of fontanella in babies; muscular atrophy. Representative Herbs: placenta (ziheche), deer antler (lurong), tortoise shell gelatin (guijiaojiao), cordyceps (dongchong xiacao), cooked rehmannia (shu dihuang), lycium fruit (gouqizi), cornus (shanzhuyu), eucommia (duzhong), cistanche (roucongrong). Representative Formula: Placenta Restorative Pills (Heche Dazao Wan). BILATERAL DEFICIENCY OF KIDNEY YIN AND YANG (shen yin yang liang xu): primary symptoms are dizziness; ringing in the ears; weak, sore, or painful lower back and knees; cold fingers and toes and/or burning sensations in palms and soles; night sweats or spontaneous sweating. Secondary symptoms include pale complexion and/or flushed face; poor memory; insomnia; vivid dreaming; listless spirit; loose teeth; dry and split hair; unsteady walk; swollen feet; asthmatic panting upon physical exertion. The tongue typically presents with a red body and little or no coating, or with a pale body and white coa ting; the pulse tends to be fine and rapid, or deep, slow, and weak. Representative Herbs: cooked rehmannia (shu dihuang), ho-shou-wu (heshouwu), lycium fruit (gouqizi), ligustrum (nuzhenzi), cornus (shanzhuyu), cuscuta (tusizi), schizandra (wuweizi). Representative Formulas: Rehmannia Eight Formula (Shenqi Wan); Five Seed Fertilize the Ancestral Force Pill (Wuzi Yanzong Wan). THE KIDNEY QI FAILS TO EXECUTE ITS STORING ACTION (shen qi bu gu): primary symptoms include clear, frequent, and dribbling urination; enuresis; bedwetting; spermatorrhea; premature ejaculation; tendency to miscarry; clear vaginal discharge. Secondary symptoms include pale complexion; mental and physical fatigue; weak or sore back; loss of hearing; spontaneous sweating. The tongue typically presents with a pale body and a white coating; the pulse tends to be fine and weak. Representative Herbs: schizandra (wuweizi), Euryale Continued on page 36
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Continued from page 35 THE KIDNEY NETWORK: Properties and Functions (qianshi), rose hips (jinyingzi), mantis egg cases (sangpiaoxiao), dioscorea (shanyao), alpinia (yizhiren), dragon bone (longgu), oyster shell (muli), cuscuta (tusizi). Representative Formulas: Golden Lock Shore Up the Jing Pill (Jinsuo Gujing Wan); Mantis Formula (Sangpiaoxiao San); Retract the Source Pill (Suoquan Wan). THE KIDNEY FAILS TO GRASP AND RETAIN QI (shen bu na qi): primary symptoms are shortness of breath or asthmatic panting (brief inhale, longer exhale), especially following physical exertion. Secondary symptoms include pale complexion; puffy face; blue lips; emission of small amounts of urine when coughing; spontaneous sweating; general aversion to cold; cold extremities; weak or sore lower back and knees; mental and physical fatigue. The tongue typically presents with a pale body and a white coating; the pulse tends to be fine and weak, or floating and uprooted. Representative Herbs: walnut (hutaorou), gecko (gejie), psoralea (buguzhi), schizandra (wuweizi), cooked reh mannia (shu dihuang), ginseng (renshen), codonopsis (dangshen), aquilaria (chenxiang), amethystum (zishiying). Representative Formulas: Ginseng and Walnut Decoction (Renshen Hutao Tang); Ginseng and Gecko Powder (Shen Jie San); All Encompassing Qi Pill (Du Qi Wan). YIN DEFICIENCY CAUSING FIRE EFFULGENCE (yin xu huo wang): primary symptoms are flushed face and red lips; restlessness; difficulty falling asleep; dry mouth and throat; burning sensation in palms and soles; tidal heat sensations; night sweats. Secondary symptoms include obsessive sexual fantasies; excessive urge to masturbate; frequent sexual dreams; dark urination; constipation. The tongue typically presents with a red body and little or no coating; the pulse tends to be fine and rapid. Representative Herbs: anemarrhena (zhimu), phellodendron (huangbai), coptis (huanglian), raw rehmannia ( sheng dihuang), peony (baishao), cynanchum (baiwei), eclipta (hanliancao), lycium bark (digupi). Representative Formulas: Anemarrhena, Phellodendron, and Rehmannia Formula (Zhi Bai Dihuang Wan); Lock in the Marrow Pellet (Fengsui Dan). KIDNEY YANG DEFICIENCY CAUSING WATER EFFUSION (shen yang xu shui fan): primary symptoms are puffiness and edema (especially prominent in lower extremities). Secondary symptoms include ashen or waxen face color; inhibited urination; obvious aversion to cold; cold extremities; palpitations; stuffy sensation in chest; shortness of breath; cough or asthmatic panting accompanied by expectoration of runny and clear phlegm; heavy and painful waist; abdominal fullness; scrotal edema. The tongue typically presents with a fat, pale, and toothmarked body, and a white and slippery coating; the pulse tends to be deep and wiry; or deep and fine. Representative Herbs: aconite (fuzi), cinnamon twig (guizhi), hoelen (fuling), curculigo (xianmao), alisma (zexie), plantago seed (cheqianzi), polyporus (zhuling). Representative Formula: Vitality Combination (Zhenwu Tang). http://www.itmonline.org/5organs/kidney.htm
The Metaphysical Functioning of the Kidneys October 10, 2011 Occult Anatomy For you created my inmost being; you knit me together in my mothers womb.I praise you because I am fearfully and wonderfully made; your works are wonderful I know that full well. ~ Psalm 139:13-14 The Kidneys are a pair of organs whose shape looks very similar to beans. They are located in the posterior part of the abdomen, and they are the motor force behind the urinary tract system. They perform the function of highly specialized filters, selectively purifying the blood and eliminating impurities. By the end of the cleaning process, the Kidneys will have filtered all the fluids that belong to the human body, which represents 60 to 75% of the weight of an adult body. It is important to remember that there is a spirited and symbolic relationship between all the liquids, or fluids, and the emotional aspect of our lives. In truth, all the situations that lead us to cry are ultimately processed by the action process of the Kidneys. Metaphysically, the process of filtration alludes to the ability to exercise discernment; the selection of what can be used and what should be sifted out in order to be eliminated from the system. All the substances that enter the blood stream Continued on page 37
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Continued from page 36 The Metaphysical Functioning of the Kidneys have to pass through a selection process. This is also a metabolic process that is intimately interconnected with the internal capability to detach from and eliminate disagreeable facts and situations of life; such as past behaviors and thought patterns that do not align with the demands and needs of the present time. The Kidneys, always used in the plural (kelayot), are mentioned more than 30 times in the Bible. In the Pentateuch, the Kidneys are cited 11 times in the detailed instructions given for the sacrificial offering of animals at the altar. Whereas those instructions were for purification ceremonies at the Temple, sacrificial offerings were made subsequently in seeking Divine intervention for the relief of medical problems. In the books of the Bible that follow the Pentateuch, mostly in Jeremiah and Psalms, the human Kidneys are cited figuratively as the site of temperament, emotions, prudence, vigor, and wisdom. The Kidneys are the fundamental cornerstones for the energies of the Yang and Yin. They are the organs that allow us to anchor the energies of Xing (Zhi) or Jing [2], the congenital essence inherited from our parents, which determine our constitution, our strength and vitality, and are responsible for our growth and development, and how we process aging.
The Chinese character Zhi means beliefs, awareness, intensive will, sentiment, purpose, record, or remembrance. The Zhi energy is also related with the heart. We can interpret the image of the Chinese character Zhi as footprint in the heart. Zhi is the spiritual energy of the Kidneys, is the hereditary memory or imprint of your past life and the ancestral energy of human beings, which records who we are and where we come from. It is the reservoir of life energy. The spiritual name of the Kidneys, Yuying, literally meaning rear a baby, emphasizes that the kidney organ system is related to the origin of our life. The Kidneys have the primordial function to control the distribution and circulation of fluids along with the bladder. Some problems can arise from the malfunction of the Kidneys such as constipation, dark urine, noc- turnal perspirations, dry mouth, edema and diarrhea. It can also be responsible for other disturbances with teeth, bones, asthma, ear pains and disorders of the nervous system
They are the organ responsible for the power that arises from the natural genetic abilities, and capabilities. In short we can say that our Kidneys can be the activators of our genetic potentialities. On the other hand, the weakness of this organ can be manifested by individuals that are controlled by their fears, which can damage their motivation and their will; slowing their thought process, and generating the tendency of getting stuck in various life situational challenges. Metaphysically the Kidneys can crystallize the criticism disappointed and failures. They are intimately related to fear, low self-esteem, insecurities, and apathy for the present moment, isolation and indifference. It is believed that just one of the Kidneys do the heavy work for the purification of the body, while the other one concentrates its functionality on keeping the lightness of the spiritual life and the sustenance of the other bodies. The Kidneys sometimes get involved with the functions related to the lungs through the metabolism of the water, through respiration. They can be also connected with the bones, teeth, ears and hair on the head. When out of balance, they can cause the collapse of the entire urinary tract system and also the lymphatic system; and can cause lack of memory, temporary hearing loss, accelerating graying of the hair, and osteoporosis. Footnotes [1] Bible Dictionary - REINS - Or KIDNEYS. The Hebrews often make the reins the seat of the affections, and ascribe to them knowledge, joy, pain, pleasure; hence in Scripture it is said that God searches the heart and tries the reins.
[2] Jing is the Chinese word for essence,specifically kidney essence. Along with q and shn, it is considered one of the Continued on page 38
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Continued from page 37 - The Metaphysical Functioning of the Kidneys Three Treasures Sanbao of Traditional Chinese Medicine or TCM. Jing is stored in the kidneys and is the densest physical matter within the body (as opposed to shn which is the most volatile). It is said to be the material basis for the physical body and is yin in nature, which means it nourishes, fuels, and cools the body. As such it is an important concept in the internal martial arts. Jing is also believed by some to be the carrier of our heritage (similar to DNA). Produc tion of semen, in the man, and menstrual blood (or pregnancy), in the woman, are believed to place the biggest strains on jing. One is said to be born with a set amount of jing (pre-natal jing, also sometimes called yuan qi) and also can acquire jing from food and various forms of stimulation (exercise, study, meditation.) Theoretically, jing is consumed continuously in life; by everyday stress, illness, substance abuse, sexual intemperance, etc. Pre-natal jing by definition cannot be renewed, and it is said it is completely consumed upon dying. http://humanityhealing.net/2011/10/the-metaphysical- functionality-of-the-kidneys-i/
Continued from page 17 Diet soda now promoted as Medicine to stop Kidney Stones of nutritional knowledge among his peers at the Journal of Urology who somehow saw fit to publish his study. This is called science? Keep in mind that the entire claim is based on the idea that certain diet sodas contain citrate and that frequent consumption of citrate from natural sources (lemonade, lime juice, etc.) is well known to prevent kidney stones. Consuming natural lemonade actually does prevent kidney stones, but you can't extrapolate from that and claim a lemon-flavored diet soda will accomplish the same thing. That's like saying that since fruit helps prevent cancer, then drinking fruit punch must prevent cancer, too. This research, by the way, never even tested diet sodas on human subjects. It's really just a "thought experiment" from someone who isn't even very good at thinking. The entire paper is the scientific equivalent of saying, "Hey, I betcha that thar diet soda might prevent them kidney stones 'cuz there's citrate in it!" And the Journal of Urology was just silly enough to actually publish it as science. It makes you wonder: What are the requirements for having a scientific paper rejected by the Journal of Urology?
No coverage of medicinal herbs I bet a paper touting the very real benefits of the Amazon rainforest herb Chanca Piedra would be rejected by the journal. Chanca Piedra is known as the "stonebreaker" herb throughout South America. It really works to dissolve and eliminate kidney stones, but you'd never see that in a science journal in North America. No, they're too busy touting the "medicinal benefits" of diet soda, if you can believe that. At this point in the article, I would normally point out how little credibility remains in the world of western medicine and its loony research conclusions. This is an industry that calls homeopathy "witchcraft", that thinks medicinal herbs are dangerous, and that now apparently believes diet sodas are a form of medicine. Any discussion of "credibility" about such an industry is frankly just pointless. If aspartame and phosphoric acid was somehow good for you, America would be the healthiest nation in the world! And if diet sodas actually worked, then all the people drinking them wouldn't be so obese, would they? And if diet soda prevents kidney stones, they why are most of the people suffering from kidney stones the very same people who drink a lot of soda? If anything, diet soda causes kidney stones. But I suppose the Journal of Urology can print exactly the opposite and call it "science" if they want, right? That's exactly why modern "science" has lost so much credibility these days. Because practically any corporate- sponsored idea, no matter how ridiculous, can end up being printed in a "scientific journal" even if its conclusions violate the laws of the known biological universe. If diet soda prevents kidney stones, then mammogram radiation prevents cancer, too. http://www.naturalnews.com/028814_diet_soda_kidney_stones.h tml
The Disease Cholera and Kidney Failure Cholera is a life-threatening diarrhea induced by a toxin secreted by bacteria called Vibrio cholerae. (There are other bacterial diseases caused by toxins released by non- invasive bacteria. The disease caused by the enterotoxigenic -- remember that term? -- strains of Escherichia coli are probably the most important of these diseases.) Although shock and severe dehydration are the most devastating complications of cholera, other problems can occur, such as: Continued on page 63
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African Traditional Herbal Research Clinic Volume 8, Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES Pesticides: Health Effects in Drinking Water By Nancy M. Trautmann and Keith S. Porter Center for Environmental Research Robert J. Wagenet, Dept. of Agronomy Cornell University
Traditionally, groundwater has been assumed to be a relatively pristine source of water, cleaner and better protected than surface water supplies. Although nitrate and bacterial contamination were known to occur in some locations, groundwater was thought to be immune from more serious forms of pollution such as industrial discharges, hazardous waste dumps, or leaching of pesticides from agricultural operations. Within the past decade, however, a variety of synthetic organic compounds have been discovered in the nation's groundwater, often at concentrations far exceeding those in surface water supplies. Synthetic organic compounds are chemicals synthesized from carbon and other elements such as hydrogen, nitrogen, or chlorine. They do not occur naturally, but are manufactured to meet hundreds of needs in our daily lives, ranging from moth balls to hair sprays, from solvents to pesticides. Why have they only recently been discovered in groundwater? One reason is that use of synthetic organic compounds has greatly increased within the past 40 years, and some of these gradually have made their way into groundwater. Another reason for the recent discoveries of organic contaminants in groundwater is that the laboratory capability to detect these chemicals has greatly improved within the past decade. A classic example of this occurred in Bedford, Massachusetts, where severe organic chemical contamination of the town groundwater supply was discovered in 1978 only because a resident engineer took a sample of his home tap water with him to work where he was developing and testing a new laboratory instrument for analyzing organic chemicals. A total of nine toxic organic compounds were discovered in this drinking water sample, resulting in permanent closure of the town's water supply wells. The Bedford contamination event- ually was traced to several local industries that were improperly disposing of their chemical wastes. Now that people are aware of organic contaminants in drinking water, sampling for such chemicals has increased, and more than 700 synthetic organic compounds have been identified in various U.S. drinking water supplies. This contamination originates from a variety of sources, including household products and leakage or improper disposal of chemical wastes from commercial and industrial establishments. By-products of industrial manufacturing or cleaning operations have been disposed of in unrecorded dump sites across the nation, and some of these chemicals have leached to groundwater. Pesticides constitute another, smaller category of synthetic organic compounds, some of which have been found in groundwater. Between 1950 and 1980 production of synthetic organic pesticides more than tripled in the United States, from about 400 million pounds in 1950 to over 1.4 billion pounds in 1980. Although most of these compounds have not been detected in groundwater, a few have become significant contaminants. Twenty- two pesticides have been detected in U.S. wells, and up to 80 are estimated to have the potential for movement to groundwater under favorable conditions. One area with conditions highly conducive to leaching is Long Island, New York, where soils are sandy, the water table is shallow, and agriculture is intensive. A total of 13 pesticides have been detected at least once in Long Island groundwater, and 8 of these have been found multiple times through continued monitoring. In upstate New York, sampling for pesticides has been limited to measurement of aldicarb in wells Continued on page 40
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Health Effects of Pesticides Studies of the health effects of pesticides on humans focus on two aspects, the acute toxicity, or immediate effects resulting from short-term exposure, and the chronic toxicity, or effects resulting from more- prolonged exposures. Acute toxicity typically is expressed as the concentration required to kill 50 percent of a population of test animals such as laboratory rats, either through ingestion or through contact with the skin. These lethal concentrations can vary greatly from one pesticide to another. Aldicarb, for example, is considered to be highly toxic because the oral lethal dose is less than 1 milligram per kilogram (mg/kg) of body weight, compared with 500 mg/kg for carbaryl, or 5,000 mg/kg for methoxychlor. Tools When pesticides are found in water supplies, they normally are not present in high enough concentrations to cause acute health effects such as chemical burns, nausea, or convulsions. Instead, they typically occur in trace levels, and the concern is primarily for their potential for causing chronic health problems. To estimate chronic toxicity, laboratory animals are exposed to lower than lethal concentrations for extended periods of time. Measurements are made of the incidence of cancer, birth defects, genetic mutations, or other problems such as damage to the liver or central nervous system . Although we may encounter many toxic substances in our daily lives, in low enough concentrations they do not impair our health. Caffeine, for example, is regularly consumed in coffee, tea, chocolate, and soft drinks. Although the amount of caffeine consumed in a normal diet does not cause illness, just 50 times this amount is sufficient to kill a human. Similarly, the oxalic acid found in rhubarb and spinach is harmless at low concentrations found in these foods, but will lead to kidney damage or death at higher doses. Laboratory measurements of a pesticide's toxicity must be interpreted in the context of its potential hazard under actual field conditions. Pesticides by definition are toxic to at least some forms of life, but whether or not a particular pesticide in groundwater is hazardous to human health depends on its concentration, how much is absorbed from water or other sources. The duration of exposure to the chemical, and how quickly the compound is metabolized and excreted from the body. Drinking water guidelines are aimed at keeping pesticides at levels below those that are considered to cause any health effects in humans. They are derived from laboratory data using one of two methods, Continued on page 41 Continued from page 39 - Pesticides: Health Effects in Drinking Water near treated fields. Low concentrations of aldicarb have been detected in 30 percent of the 76 wells sampled. Twenty-two other states, including Maine, Maryland, and New Jersey, also have reported some pesticide contamination of groundwater. This bulletin focuses on the health effects of pesticides in drinking water, although the same concepts also apply to the much wider range of synthetic organic compounds contaminating groundwater supplies. Types of Pesticides in Groundwater The health effects of pesticides depend upon their chemical characteristics. Before the 1940s most pesticides were compounds of arsenic, mercury, copper, or lead. Although these compounds may have made their way into drinking water, they were not highly soluble, and the residues ingested in foods were of far greater concern. Synthetic organic pesticides were introduced during World War II and were thought to be far safer and more effective. These included chlorinated hydrocarbons such as DDT, aldrin, dieldrin, chlordane, heptachlor, lindane, endrin, and toxaphene. Because of their low solubility in water and their strong tendency to chemically attach to soil particles, these compounds have rarely contaminated groundwater. They originally were thought to be safe to humans and the environment, but later were discovered to accumulate in the environment and build up to toxic concentrations in food chains. Use of most of the chlorinated hydrocarbon pesticides, consequently, has been restricted, suspended, or canceled. One group replacing them has been the organophosphorous compounds such as malathion and diazinon. Although some organophosphorous compounds are highly toxic to humans, they generally break down rapidly in the environment and rarely have been found in groundwater. Another group replacing the chlorinated hydrocarbons are carbamate pesticides including aldicarb, carbofuran, and oxamyl. These compounds tend to be soluble in water and weakly adsorbed to soil. Consequently, if not degraded in the upper soil layers, they have a tendency to migrate to groundwater. The most significant occurrences of groundwater contamination have been with the carbamate pesticides. Aldicarb has been detected in over 2,000 wells on Long Island as well as in 12 other states including Maine and New Jersey. As awareness has grown of the potential for pesticides to leach to groundwater, attention has focused on ways of changing registration and monitoring requirements to prevent such contamination from occurring in the future. Intensive studies have also been carried out in an attempt to determine what levels of pesticides are acceptable in water supplies.
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20% of daily intake in drinking water 0.07 x 0.2 = 0.014 mg/person/day Average intake of 2 liters water per day 0.014/2 = 0.007 mg/liter Drinking water guideline 0.007 mg/l = 7 ug/l or 7 ppb (parts per billion) Although this appears to be a precise calculation, there actually is quite a bit of estimation and human judgment involved. Estimates must be made, for example, of the average weight of a person and the amount of water consumed per day. The percentage of the daily intake of pesticide that would be consumed in drinking water must also be estimated, based on factors such as how much is contained in foods and whether the compound can also be absorbed through the skin while bathing. Although aldicarb has a high dermal toxicity, probably only negligible amounts would be absorbed through skin unless the pesticide is dissolved in oil or an organic solvent rather than water. The U.S. Environmental Protection Agency calculated drinking water guidelines differently, basing the calculation on the amount that would be consumed by a 10-kilogram (22-pound) child who drinks 1 liter (approximately 1 quart) of water per day: Drinking water guideline = 0.001 mg/kg/day x 10 kg child 1 liter/day = 0.0l mg/l, or 10 ppb (parts per billion) The resulting guideline is not intended to indicate a toxicity threshold, above which an imminent threat to human health exists. Instead, it is a health advisory that simply indicates a conservative estimate of the concentration that can be consumed in drinking water with no adverse health effects. Other sources of exposure, such as pesticides consumed in food, inhaled, or absorbed through the skin, are not included. The Environmental Protection Agency currently is attempting to revise this system to provide a more realistic assessment of total exposure from all sources. Carcinogenic Compounds Drinking water standards are set in a different manner for carcinogenic pesticides. For compounds shown to cause cancer in laboratory animals, no NOEL or ADI is set. Current regulatory policy is that there is no specific threshold below which these chemicals do not cause an effect, although this is a matter of considerable scientific controversy. Instead of setting a threshold value, analysis focuses on the relationship between concentration and the risk of causing a specified number of cancer cases in Continued on page 42 Continued from page 40 - Pesticides: Health Effects in Drinking Water depending on whether or not the compound causes cancer. Noncarcinogenic Compounds For chemicals that do not cause cancer, a variety of tests are conducted on laboratory animals, bacteria, and tissue cultures to determine what daily dose produces no indications of toxicity. The lowest level from all these tests is defined to be the NOEL (no observed effect level) and is used as the starting point from which drinking water standards are derived. The NOEL for aldicarb is 7 mg/person/day, based on measurement of inhibition of an enzyme called cholinesterase in rats fed various doses for 6 months. Although aldicarb is the most acutely toxic pesticide registered by the Environmental Protection Agency, its hazard at levels typically found in groundwater is relatively low because it is rapidly metabolized and excreted. It does not accumulate in body tissues and has not been found to cause cancer, birth defects, genetic changes, or other chronic health problems in laboratory animals. In setting drinking water guidelines, the acceptable daily intake (ADI) for a pesticide is calculated by dividing the NOEL by a "safety factor" determined by the level of uncertainty in the experimental data. If valid experimental results are available from studies on prolonged ingestion by humans, for example, a minimum safety factor of 10 might be chosen. This could increase to as much as several thousand if human data were lacking and laboratory data inconclusive. Most commonly, long-term animal feeding data are available, and a safety factor of 100 is used. This is based on the assumption that humans are roughly 10 times more sensitive to toxic substances than laboratory animals and that the susceptibility between different individuals can vary by another lO-fold. The resulting ADI represents an estimate of the amount of a pesticide that a typical person can consume daily for a lifetime with no adverse health effects. For aldicarb, the currently accepted NOEL is 0.1 mg/kg/day, and a safety factor of 100 is used, resulting in an ADI of 0.001 mg/kg/day. The method for conversion from an ADI to a drinking water guideline varies form one agency to another. In New York State the 7 ppb guideline for aldicarb was derived in the following manner: No Observed Effect Level (NOEL) 0.1 mg/kg/day = 7 mg/70 kg person/day Acceptable Daily Intake (ADI = NOEL/safety factor of 100) 7/100 = 0.07 mg/person/day
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Continued from page 41 - Pesticides: Health Effects in Drinking Water a population of a specified size. Experiments with laboratory animals are used to correlate dose with expected frequency of cancer occurrence. These data are then extrapolated to humans, and regulatory decisions are made about the level of risk considered acceptable to human populations. Whether this level of risk is acceptable to an individual is a highly subjective and complex issue. Studies have shown, for example, that the public is willing to accept a risk as high as 1 in 10,000 from eating peanut butter, which may be contaminated with aflatoxin, a natural mold and one of the most potent carcinogens known to man, but would reject using a synthetic chemical with a cancer risk factor 100 times lower. Federal regulatory agencies commonly define acceptable risk in drinking water to be one that causes no more than one additional case of cancer in a popula tion of a million people who drink the water over the course of a lifetime. This risk is roughly the same as that of dying from diptheria, polio, or German measles, or of being in a fatal plane accident. For pesticides that are carcinogenic, the concentrations causing no more than one cancer per million people typically are in the range of a few parts per trillion. In some cases these concentrations are so low that they exceed our capability for accurate laboratory measurement. For most pesticides, drinking water standards have yet to be set. The Environmental Protection Agency has authority to develop nationwide standards, and some of the states are setting local standards as well. The New York State Department of Health has set advisory guidelines for aldicarb and carbofuran. Other organic pesticides are covered by a guideline limiting the concentration of any single organic chemical to no more than 50 parts per million and the combined concentration of all organics found to no higher than 100 parts per million. One of the complicating factors in setting standards for the individual chemicals is that it generally is not known how a given compound might interact with other chemicals to affect human health. Often when one organic compound is found in groundwater, others are there also, and their effects together may be either greater or less than that observed when any one is ingested individually. The number of possible interactions makes thorough analysis of them all an impossible task. Health studies have been conducted of people drinking contaminated water supplies, but these studies are limited by the fact that many health problems are difficult to trace to a specific cause, especially since some cancers can remain latent
for up to 40 years. Conclusions Approximately 50,000 different pesticide products are used in this country, composed of over 600 active ingredients. Although the acute health effects of ingesting large amounts of a pesticide can readily be measured, the chronic effects of long-term exposure to low levels are much harder to define. Extensive laboratory experiments are required, and in many cases these experiments are incomplete or inconclusive. The Environmental Protection Agency is currently working on reevaluation of all pesticides registered before 1972 to bring them up to modern health standards and is requiring extensive testing of new products before they come on the market. Many questions remain, however, about the chronic health effects of pesticides and other synthetic organic contaminants in drinking water. Establishment of drinking water standards is an inexact science, with many assumptions and value judgments needed in the conversion from laboratory animal data to an estimate of health effects in humans. The resulting standards represent the best judgment of regulatory authorities about the acceptable level of risk to people exposed to chemicals in drinking water. Many pesticides and other synthetic organic compounds are potent chemicals with potential health effects in humans even at very low concentrations. The drinking water standard for aldicarb, for example, is 7 parts per billion, meaning that a single pound of this compound could contaminate the entire amount of water needed to supply the yearly needs of over 2,000 people. Clearly, it is of primary importance to keep such chemicals out of our water supplies. Following articles in this series will address issues important in preventing pesticide contamination of water supplies: protection of groundwater recharge, careful management of pesticides on the farm, government screening and regulation of pesticides, and use of farming methods that minimize damage to the environment. See Table Below Sources: SCAMP computerized data base maintained by Cornell University, and Drinking Water and Health, vol. 5, National Research Council, Washington, D.C., 1983. *Acute toxicity is defined to be the amount needed to kill 50 percent of a population of laboratory rats. It is expressed as milligrams of pesticide per kilogram of body weight. Ranges are defined as follows: high: <500 mg/kg moderate: 500 - 5000 mg/kg; low: >5000 mg/kg Continued on page 43
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Health effects of some pesticides found in groundwater ------------------------------------------------------------------------------ Chemical name Representative Chronic effects Acute toxicity* Acute effects trade name at high concentrations ------------------------------------------------------------------------------ alachlor Lasso Growth depres- moderate sion in labor- atory animals
aldicarb Temik None observed high Diarrhea, nausea, vomiting, abdominal pain, profuse sweating, salivation, and blurred vision
atrazine Atranex None observed moderate Mildly irritating to skin, eyes, and upper respiratory tract
carbofuran Furadan None observed high Diarrhea, nausea, vomiting, abdominal pain, profuse sweating, salivation, and blurred vision chlorothalonil Bravo None observed low in laboratory rats
DCPA Dacthal None observed moderate in dogs or rats 1,2-dich- loropropane D-D Possible liver high Acute gastro- and kidney intestinal damage distress, with congestion and edema of lungs ethylene dibromide (EDB) Bromofume Causes cancer, high Headache, genetic dizziness, mutations, and nausea, fetal deform- drowsiness, aties in some tremors, lab animals. seizures Possible injury Continued on page 44
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to lungs, liver and kidneys from prolonged exposure
oxamyl Vydate None observed high Diarrhea, nausea, vomiting, abdominal pain, profuse sweating, salivation, and blurred vision ------------------------------------------------------------------------------ http://psep.cce.cornell.edu/facts-slides-self/facts/pes-heef-grw85.aspx
El Salvador: Pesticides Fill Graveyards in Rural Villages By Edgardo Ayala 16 January 2012 (IPS) - Sitting in the shade under a tree at a careful distance, Francisco Sosa watches his son prepare the land for planting by spraying the weeds with an herbicide from a tank carried on his back. The 60-year-old Salvadoran farmer would like to help his son Sal, 25, but on doctor's orders, he can't. Like many other peasant farmers in this rural community in the southeast of El Salvador, he suffers from chronic renal insufficiency. "The doctors told me not to spray poison anymore, that it could complicate my illness further," Sosa told IPS on his farm in Nueva Esperanza, a rural community of around 500 people that was settled in the 1990s in the Bajo Lempa region in the province of Usulutn on El Salvadors Pacific coast. For years, local residents and the media have denounced the alarming increase in cases of kidney failure in the Bajo Lempa region, which for over a century was a cotton-growing area where pesticides and herbicides were heavily used. Although cotton gave way to other crops in the 1970s, highly toxic agrochemicals continue to be used by the local farmers, who take no safety measures, on their corn, beans and vegetable crops. In some communities in the Bajo Lempa region, like Ciudad Romero, over 20 percent of the population suffers from chronic kidney disease, with the proportion rising to one out of four among adult men.
This prevalence rate is alarmingly higher than those found in other countries, says a health ministry study titled Nefrolempa, which began to be carried out in 2009, when moderate left-wing President Mauricio Funes took power with the backing of the insurgency-turned-political party Farabundo Marti National Liberation Front (FMLN). The prevalence of chronic kidney disease found by similar epidemiological studies in other countries in Latin America and in other regions ranged between 1.4 and 6.3 percent, the Nefrolempa study says. The report, whose final results were released in October, does not conclusively establish a cause-effect relationship between the wide use of pesticides and herbicides and the high incidence of renal failure. But the data it provides backs up the argument of local farmers and environmentalists that there is a link. Among the risk factors, the study points out that 82.5 percent of local men in the area are in contact with agrochemicals. "The disease has to do with all of the chemicals contaminating the area, especially the agricultural zone along the coast," Health Minister Mara Isabel Rodrguez told IPS. "We have appalling statistics that are not found anywhere else in the world," she said, explaining that among those with kidney disease, "there is an occupational factor, with farmers between the ages of 18 and 60 most heavily affected." Environmentalist Mauricio Sermeo with the Unidad Ecolgica Salvadorea (Salvadoran Ecological Unit), a local NGO, told IPS that "When all of these people with renal insufficiency started to appear, it became clear that there was a direct link between the disease and the Continued on page 45
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Continued from page 44 El Salvador: Pesticides Fill Graveyards in Rural Villages extensive use of chemical insecticides." Sermeo was referring to the heavy exposure to pesticides and herbicides in this area during the cotton boom period, when chemicals like DDT an insecticide that has now been widely banned - were heavily used. But other highly toxic chemicals like gramoxone or hedonal continue to be sold in El Salvador, he pointed out. Most of the pesticides are sold by foreign companies like the Germany-based Bayer AG, which Sermeo largely blames for the high levels of toxicity in the Bajo Lempa region. IPS received no response to repeated requests for a comment on this question from the offices of Bayer in El Salvador. In the communities of the Bajo Lempa region, virtually everyone has a family member or friend who died of renal failure, activists and peasant farmers say. "Just over there lived Chunguito, thats what we called him. And Isidro also died from that, so did Lidia Sorto, and Ton too, and Neftal and Abrahn so many people have died of that," said Donato Santos, who years ago was hospitalised for pesticide poisoning after spraying his corn field. Rosa Mara Colindres, a nurse in the first public health clinic for kidney patients opened in this area, told IPS that 95 percent of the graves in the Nueva Esperanza cemetery are of people who have died of renal failure. The clinic offers treatment for patients at all five stages of kidney disease. The patients with end-stage renal disease must go to a nearby hospital to receive training in how to do hemodialysis at home, including how to insert the needles and operate a home dialysis machine. "If I didnt get dialysis, I would be dead by now," Wilfredo Ordoo, another local farmer, told IPS. He remembers how, years ago, the pesticide he carried in a backpack sprayer "would run all down my back. I think thats what did me in," he says. The Bajo Lempa region is a broad flood plain where the Lempa river - Central Americas longest - runs into the Pacific Ocean. Every year, the area has been hit harder and harder by floods that destroy the crops and force local residents, mainly poor farmers, to evacuate to shelters. After El Salvador's bloody 12-year civil war came to an end in 1992, the land in this area, which once belonged to large landholders who grew cotton and sugar cane, was parcelled out to former guerrillas and their families, to help them settle back into civilian life, as farmers. The local population is markedly leftist, and for that reason some believe that previous governments, of the right-wing Nationalist Republican Alliance (ARENA) - which governed the country from 1989 to 2009 - were not interested in detecting or combating the epidemic or in establishing legal mechanisms to ensure that agrochemicals were properly sold and handled. A 2004 executive order established regulations to control the use of agrochemicals. But they are not enforced. For example, article 5 of the executive order holds crop- owners and importers, sellers and end-users of agrochemicals responsible for ensuring that those who handle pesticides and herbicides have received the necessary training, and use the safety gear recommended for each product. But the farmers of Bajo Lempa rarely receive instructions on how to use pesticides, and very few wear gloves or masks. Indeed, as this reporter chats with Francisco Sosa in the shade of a tree on his farm, his son Sal is spraying pesticide wearing only a Barcelona Football Club neckerchief as a mask. http://upsidedownworld.org/main/news-briefs-archives- 68/3407-el-salvador-pesticides-fill-graveyards-in-rural-villages
SRI LANKA: Drought Link with Kidney Disease Risk COLOMBO, 28 August 2012 (IRIN) - Soaring temperatures in Sri Lankas dry zone in the northeast of the country are likely to heighten the risk of chronic kidney disease as residents increasingly consume poor quality drinking water, experts warn. More than a decade since the first cases of the fatal disease were reported, health experts are now blaming contaminated groundwater as the main cause. The illness slowly destroys kidneys, making it impossible to get rid of body waste or excess water, eventually requiring dialysis or a transplant. Wide areas of Sri Lankas North Central, Northern and Eastern provinces have recorded a high prevalence of chronic kidney disease in the last two decades. Recently published research by the New Delhi-based Centre for Science and Environment (CSE) estimated affected areas cover 17,000sqkm where 2.2 million people live. Continued on page 46
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Continued from page 45 SRI LANKA: Drought Link with Kidney Disease Risk These provinces are also the islands main rice- producing regions. CSE found male farmers at highest risk with at least 15,000 currently affected. From 2009-2011 in the north-central Anuradhapura District, health officials reported that the number of registered patients with chronic kidney disease diagnoses increased by 25 percent to 1,424. The district reported some 1,600 chronic kidney-disease-related deaths from 2003-2010. Drinking water CSE officials told IRIN that water consumption is high in the dry zone and likely to increase during droughts. Research carried out in 2011 by Sri Lankas University of Peradeniya, Central Province, found the farmers most at risk spent long hours working alone without hired help. Dhammika Dissanayake, a researcher at the university who co-authored the November 2011 report, said farm- ers sometimes spent 12 hours a day in extreme heat. Field studies showed that they did not take enough water. If the temperatures are going up, the situation is likely to worsen. According to the Ministry of Environment, there were 1,400 reported droughts nationwide between 1985 and 2004, mainly in the dry zone, with the most severe being in 2001, 2004 and this year when the monsoon rains arrived almost one month later than usual. The country has two monsoons annually, with the next one expected to arrive in December and ending next March. [Farmers] need to take in more water to flush out the chemicals, but they dont. Sometimes we just cant imagine the extreme heat they work in, Dissanayake added. The water farmers are drinking is contaminated with high levels of calcium, fluoride and dissolved solids due, in part, to geography, CSE reported. High temperatures in Sri Lanka and long working hours in the paddy field mean that there is a high consumption of [contaminated] water, which is readily filtered by the kidney but not readily secreted by the renal tubules. According to the National Water Supply and Drainage Board, 80 percent of the population has access to safe water sources, but only 30 percent has access to piped water, which health experts say is safer than the more commonly used hand-dug wells. Sri Lanka has been going through a severe dry spell since mid-April with temperatures in some of the areas reporting chronic kidney disease, including the north- central Pollonnaruwa District, reaching 34-35 Celsius. Though rains have arrived in the countrys south, they have yet to reach the central-northern dry zone. Temperatures are on the rise and will keep rising, even after this dry spell is over, said Malika Wimalasooriya, head of the climate change unit at the Department of Meteorology, who attributed rising temperatures to changing global weather patterns. The more extreme heat has sped up surface water evaporation and shrunk groundwater resources, he added. Other researchers point to unregulated use of fertilizer and pesticide as causes. But water is at the heart of the problem, said Channa Jayasumana from the faculty of medicine at Rajarata University in North Central Province, who explained how farmers try to salvage heat- withered crops with often incorrectly used fertilizer and pesticide. Since the leading causes of chronic kidney disease worldwide are diabetes and hypertension, the fact that doctors reported the cases in Sri Lankas dry zone as water-related makes comparisons with other outbreaks difficult, said CSE's deputy director, Chandra Bushan. The closest comparison he noted is Balkan Endemic Nephropathy, a kidney disease (the causes of which remain unconfirmed) affecting farmers in parts of the former Yugoslavia. No new cases have been reported since the 1990s. What to do? Bushan calls for providing clean water through water purification units in the short term and piped water in the long term to the population at risk as well as improving medical facilities to handle kidney complications. Though doctors conduct mobile clinics in high-risk areas, researchers say early detection is still weak overall. Treatment at government hospitals is free. There are renal units at North Central Provinces main Anuradhapura Hospital, smaller units at two city hospitals in the province, a larger facility at Kandy hospital in neighbouring Central Province and a standalone national kidney unit in the capital, Colombo. Jayasumana from Rajarata University told IRIN the government should regulate fertilizer and pesticide imports and use nationwide due to what he calls rampant unrestrained use of the products - an idea that has not received official backing. Continued on page 47
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Continued from page 46 SRI LANKA: Drought Link with Kidney Disease Risk On 22 August the Sri Lankan government announced it will begin distribution of water purification units in affected areas. The most effective way to curb the spread quickly would be to educate those at risk [on a regional level] on the dangers and the importance of water quality and water intake, said Dissanayake. http://m.irinnews.org/report/96177/SRI-LANKA-Drought- link-with-kidney-disease-risk
The Worlds Kidneys: Why Forests Matter for World Water Day and Rio+20 By Karin Holzknecht BOGOR, Indonesia (22 March, 2012)_The fact that trees play a critical role in supplying clean water is a point yet to be fully grasped by many cities in the world. Not New York City, which is actively protecting a forest 100 miles away for the role its trees play in providing the Big Apple with a clean water supply. The surprising role of forests in supplying clean water for one of the most densely populated cities on the planet reminds us that forests also deserve applause for their vital role in sustainable water and food resources as we celebrate World Water Day and the 2012 theme, water and food security. Water is one of seven critical issues to be discussed at Rio+20, and the link between water and food security is immediately made on the campaign website: Water scarcity, poor water quality and inadequate sanitation negatively impact food security, livelihood choices and educational opportunities for poor families across the world. What is not mentioned by the Rio+20 website is the vital role that forests play in water availability, water quality, climate regulation and food security, highlighted in recent research by CIFOR and others. A recent report by the International Water Management Institute and UN Environment Programme discusses how a new focus on ecosystems, such as forests, can deliver improved food and water security. Forests help sustain the soil and water base that underpins agriculture. According to the UN Food and Agriculture Organization (FAO), eight percent of the worlds forests play a primary role in soil and water conservation. Forested catchments supply a vital source of clean water for human use: an estimated 75% of usable water worldwide. Forests provide a range of watershed services, such as the protection of water quality, the reduction of flows during storms, the recharge of groundwater aquifers and the conservation of water flow during dry seasons, said CIFOR and CIRAD scientist Bruno Locatelli. These services are essential to many of us: for example, the conservation of dry season stream flows is essential for drinking water supply, agriculture, navigation, hydropower, freshwater wildlife, or recreation. The reduction of storm flow benefits housing, infrastructure, or agriculture in flood-prone areas. Forests may even help attract rain. While there are many uncertainties surrounding the links between deforestation and declining rainfall, recent research (also discussed by CIFOR scientists Daniel Murdiyarso and Douglas Sheil in their 2009 paper) suggests that forest cover plays a much greater role in determining rainfall than previously recognised by climatologists. According to Locatelli, these hydrological services are particularly crucial for rural communities in the tropics, where livelihoods depend directly on seasonal rainfall and river flows, for example for agriculture, fishing or transportation. And the hydrological services of forests are equally important for urban populations. According to a report published by the World Wildlife Fund in 2003, around a third (33 of 105) of the worlds largest cities get a significant proportion of their drinking water directly from forest protected areas. Eight more cities get their water from forests that are managed in a way that prioritises their functions in providing water One of the major functions forests provide in this respect is improving water quality. Water pollution is a main cause of reduced water availability and can have serious impacts on the environment and on human health, particularly in developing countries where 70 percent of industrial wastes are pumped, untreated, into the water system not to mention the two million tonnes of sewage and other effluents draining into the worlds waters every day. Scientists refer to wetlands as the worlds kidneys because they purify and slow the flow of water to the sea, helping to control floods and water pollution. But our world is experiencing kidney failure according to UN Water, half of the worlds wetlands have been lost since 1900. When forests around lakes and streams are intact, they act Continued on page 48
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Continued from page 47 The Worlds Kidneys: Why Forests Matter for World Water Day and Rio+20 as a filtering system, reducing the amount of sediment, agricultural chemicals and pesticides in the water table. Apart from being the worlds kidneys, forests are also often called the worlds lungs because they take carbon from the atmosphere and produce oxygen, and it is this function has attracted growing attention in recent years as the world faces the challenge of climate change. Forests are instrumental to efforts to help communities and agriculture handle the more frequent droughts and floods that come with an increasingly variable climate. While the role of forests in mitigating large-scale floods is still under debate, a study by CIFOR and FAO has shown that forests mitigate small and local floods, and appear to slow down the floodwaters from bigger floods as they run downstream. Forests can also act as emergency supplies in disaster situations. For example, when rural communities in Indonesia were recently devastated by a catastrophic flash flood, a CIFOR study found that nearby forests helped provide vulnerable communities with basic subsistence for many months following the disaster. And they provide a similar function during drought. But it is not only in times of crisis that people depend on forests more than a billion of the worlds poorest people live in and around forested areas and depend on the resources forests supply. Forest fruits and greens supply many of the micronutrients that keep rural communities nourished and healthy. Meat hunted in forests is a crucial source of protein for forest-dependent people (for example, many rural communities in the Congo Basin depend on bushmeat for up to 80 percent of the fats and proteins in their diets). Communities even use forests as their medicine cabinets. In short, having only scratched the surface of all the ways in which forests benefit water and food security, future food and water supplies cannot be secured without forests. But even as demand for food and water is increasing, remaining forest lands are disappearing due to land use change, climate change, insect or disease epidemics and more frequent fires affecting the vitality of ecosystems and compromising their hydrological buffering function. To preserve the essential services and safety net functions forest ecosystems provide to the livelihoods of local communities, and to preserve those forest services of which the world may not yet be aware, forests need to be kept on the global agenda at events like Rio+20. It is right to avoid considering forests as a panacea for all water-related problems, but we also cannot avoid the fact that forest management and conservation are key to water management, said Locatelli. http://blog.cifor.org/8079/the-worlds-kidneys-why-forests- matter-for-world-water-day-and-rio20/#.USaBvze9uSo
Cadmium Dietary Exposure in the European Population European Food Safety Authority 18 January 2012 Cadmium can cause kidney failure and has been statistically associated with an increased risk of cancer. Food is the dominating source of human exposure in the non-smoking population. The Joint FAO/WHO Expert Committee on Food Additives established a provisional tolerable monthly intake of 25 g/kg body weight, whereas the EFSA Panel on Contaminants in the Food Chain nominated a tolerable weekly intake of 2.5 g/kg body weight to ensure sufficient protection of all consumers. To better identify major dietary sources, cadmium levels in food on the European market were reviewed and exposure estimated using detailed individual food consumption data. High levels of cadmium were found in algal formulations, cocoa-based products, crustaceans, edible offal, fungi, oilseeds, seaweeds and water molluscs. In an attempt to calculate lifetime cadmium dietary exposure, a middle bound overall weekly average was estimated at 2.04 g/kg body weight and a potential 95 th percentile at 3.66 g/kg body weight. Individual dietary survey results varied between a weekly minimum lower bound average of 1.15 to a maximum upper bound average of 7.84 g/kg body weight and a minimum lower bound 95 th percentile of 2.01 and a maximum upper bound 95 th percentile of 12.1 g/kg body weight reflecting different dietary habits and survey methodologies. Food consumed in larger quantities had the greatest impact on dietary exposure to cadmium. This was true for the broad food categories of grains and grain products (26.9%), vegetables and vegetable products (16.0%) and starchy roots and tubers (13.2%). Looking at the food categories in more detail, potatoes (13.2%), bread and rolls (11.7%), fine bakery wares (5.1%), chocolate products (4.3%), leafy vegetables (3.9%) and water molluscs (3.2%) contributed the most to cadmium dietary exposure across age groups. Continued on page 49
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Continued from page 48 - Cadmium Dietary Exposure in the European Population The current review confirmed that children and adults at the 95 th percentile exposure could exceed health-based guidance values. Cadmium occurs naturally in the environment in its inorganic form, and anthropogenic sources have further contributed to background levels of cadmium in soil, water and living organisms. The general population is exposed to cadmium from multiple sources, including smoking, but in the non-smoking general population food is the dominant source. Cadmium is primarily toxic to the kidney, but can also cause bone demineralisation and has been statistically associated with increased risk of cancer in the lung, endometrium, bladder, and breast. A Provisional Tolerable Weekly Intake (PTWI) for cadmium of 7 g/kg body weight was established by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) in 1988. In 2010, the JECFA reviewed its previous evaluation and established a provisional tolerable monthly intake (PTMI) of 25 g/kg body weight corresponding to a weekly intake of 5.8 g/kg body weight. In 2009 and subsequently confirmed in 2011, the Panel on Contaminants in the Food Chain issued an opinion in which they recommended that the PTWI should be reduced to a tolerable weekly intake (TWI) of 2.5 g/kg body weight in order to ensure a high level of protection of all consumers, including exposed and vulnerable subgroups of the population. A number of studies have investigated cadmium levels in a range of foods. In light of the recommended lowering of the health based guidance value, it was considered important to better identify major dietary sources by reviewing cadmium levels in food on the European market and estimate cadmium exposure using detailed individual data from the EFSA Comprehensive European Food Consumption Database. In about half of the food samples available to EFSA cadmium was not detected or levels were below the limit of quantification, Individual quantified values ranged from a low of 0.001 g/kg for drinking water to a high of 61,000 g/kg for horse kidney. Tap water had the lowest average cadmium levels while algal supplements and seaweeds used as a vegetable had the highest average cadmium levels. Thirteen out of 144 food categories had a middle bound mean above 100 g/kg including algal formulations, cocoa powder, bitter and bitter-sweet chocolate, crustaceans, edible offal, fish and seafood not specified beyond FoodEx Level 1, frogs legs, cultivated fungi, wild fungi, oilseeds, seaweeds and water molluscs. By using the more detailed and refined food consumption information now available through the EFSA Comprehensive European Food Consumption Database and weighting results from the different age groups in the survey population according to the number of years they include, average middle bound lifetime cadmium dietary exposure for the European population as a whole was estimated at 2.04 g/kg body weight per week. It was highest in toddlers with an average of 4.85 g/kg body weight per week and lowest in the elderly population group at 1.56 g/kg body weight per week. Potential 95 th percentile middle bound lifetime exposure, with the assumption that the same individuals retained high exposure throughout life, was estimated at 3.66 g/kg body weight per week with a high of 8.19 g/kg body weight per week for toddlers and a low of 2.82 g/kg body weight per week for the elderly. Individual dietary survey results varied between a minimum lower bound mean of 1.15 and a maximum upper bound of 7.84 g/kg body weight per week and a minimum 95 th percentile lower bound of 2.01 and a maximum upper bound of 12.1 g/kg body weight per week reflecting different dietary habits but also likely differences in survey methodologies and the countries covered for the different age classes. Often it is not the food with the highest cadmium levels, but foods that are consumed in larger quantities that have the greatest impact on cadmium dietary exposure. This was true as the broad food categories of grains and grain products (26.9%), vegetables and vegetable products (16.0%) and starchy roots and tubers (13.2%) were identified as major contributors. Looking at the food categories in more detail, potatoes (13.2%), bread and rolls (11.7%), fine bakery wares (5.1%), chocolate products (4.3%), leafy vegetables (3.9%) and water molluscs (3.2%) contributed the most to cadmium dietary exposure across age groups. At the finest level of detail given for the food consumption information, wheat bread and rolls (6.4%), boiled potatoes (5.7%), pastries and cakes (4.0%), potatoes without preparation specified (3.1%), rice (3.0%) and carrots (2.2%) were important contributors. Both the Chemicals Branch in the Division of Technology, Industry and Economics of the United Nations Environment Programme and the EFSA Panel on Contaminants in the Food Chain have expressed concern that the margin between the average weekly intake of cadmium from food by the general population and the health-based guidance values is small. The EFSA Panel concluded that although adverse effects are unlikely to occur in an individual with current dietary Continued on page 50
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Continued from page 49- Cadmium Dietary Exposure in the European Population exposure, there is a need to reduce exposure to cadmium at the population level because of the limited safety margin. The current review confirmed that children on average and adults at the 95 th percentile dietary exposure could exceed health-based guidance values. http://www.efsa.europa.eu/en/efsajournal/pub/2551.htm
Thousands of Sugar Cane Workers die as Wealthy Nations Stall on Solutions By Sasha Chavkin & Ronnie Green Center for Public Integrity 12 December 2011
A truck full of sugar cane workers leaves the Nicaraguan plantation Ingenio San Antonio at the end of a days work. Kate Sheehy and Sasha Chavkin LA ISLA, Nicaragua Maudiel Martinez is 19 years old and has a shy smile, a tangle of curly black hair and a lean, muscular build shaped by years of work in the sugarcane fields. For most of his adolescence, he was healthy and strong and spent his days chopping tall stalks of cane with his machete. Now Martinez is suffering from a deadly disease that is devastating his community along with scores of others in Central America, where it has decimated the ranks of sugarcane workers. The same illness killed his father and his grandfather and affects all three of his older brothers. This disease eats our kidneys from inside us, Martinez said. We dont want to die, and we feel grief because we already know that were hopeless. Martinez illness stands at the heart of a lethal mystery and legacy of neglect by industry and governments, including the United States, which have resisted pleas for aggressive action to spotlight the malady and find a remedy. Wealthier nations are more focused on spurring biofuels production in the regions sugarcane industry and keeping up the heavy flow of sugar to U.S. consumers and food manufacturers than the plight of those who harvest it. Little noticed by the rest of the world, chronic kidney disease (CKD) is cutting a swath through one of the worlds poorest populations, along a stretch of Central Americas Pacific Coast that spans six countries and nearly 700 miles. Its victims are manual laborers, mostly sugarcane workers. Each year from 2005 to 2009, kidney failure killed more than 2,800 men in Central America, according to the International Consortium of Investigative Journalists analysis of the latest World Health Organization data. In El Salvador and Nicaragua alone over the last two decades, the number of men dying from kidney disease has risen fivefold. Now more men are dying from the ailment than from HIV/AIDS, diabetes and leukemia combined. In the 21st Century, nobody should die of kidney disease, said Ramon Trabanino, a physician from El Salvador who has studied the epidemic for a decade. The surge of kidney disease is overwhelming hospitals, depleting health budgets, and leaving a trail of widows and children in rural communities. In El Salvador, CKD is the second leading cause of death for men. In the province of Guanacaste, Costa Rica, the regional hospital had to start a home dialysis program because it was overwhelmed with so many CKD victims that it began running out of beds to treat patients with other ailments. So many men have died in some parts of rural Nicaragua that Maudiel Martinezs community, called The Island, now is known as the Island of the Widows La Isla de las Viudas. At first glance, the lush community bounded by vast sugarcane fields looks like many places in Latin America: children ride bicycles over dirt roads and play alongside dogs, pigs and chickens. But now there are few men in the front yards. Indoors, framed photographs of dead husbands, fathers and brothers adorn tables and countertops. No older men converge in small groups, trading gossip and news, as one often sees in communities farther inland from the Pacific coast.
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Continued from page 50 Thousands of Sugar cane Workers die as Wealthy Nations Stall on Solutions Here, women struggle to make at least a little money doing odd jobs. Some are now in the sugar-cane fields they believe claimed their husbands. My children have suffered a lot, said Paula Chevez Ruiz, a widow from La Isla whose husband Virgilio died in 2009, leaving her to support four children on her own. When she can find customers, she sells fruit and enchiladas. It is sad to want to give to your children, but not to have anything. Sometimes not even enough to buy a bag of salt. Deadly enigma and a handful of researchers In the U.S., leading causes of chronic kidney disease are diabetes and hypertension. But the ailment leading to a progressive decline in kidney function is typically a manageable condition that can be effectively controlled with treatment. Doctors understand its causes and cures. In Central America, the diseases origins are more of an enigma, and more frequently lethal. Afflicted laborers in the sugar cane fields near the Pacific generally have neither diabetes nor hypertension. Some scientists suspect that exposure to an unknown toxin, potentially on the job, may trigger onset of the disease. Researchers agree that dehydration and heat stress from strenuous labor are likely contributing factors and they may even be causing the illness. Laborers, typically paid not by the hour or day but based on the amount they harvest, often work to the point of severe dehydration or collapse, potentially harming their kidneys with each shift. CKD usually attacks small blood vessels in the kidney called the glomeruli; the Central American epidemic attacks the kidneys tubules. CKD generally affects older people with equal distribution between sexes; this epidemic overwhelmingly affects working-age men, mostly sugarcane workers but also miners and other agricultural laborers. A growing community of researchers is calling for recognition of a new illness not yet included in medical manuals: Mesoamerican nephropathy, endemic agricultural nephropathy or sugarcane nephropathy. The director of El Salvadors national CKD program has written of a Mesoamerican Regional Nephropathy that would one day be internationally recognized. It is important that the chronic kidney disease afflicting thousands of rural workers in Central America be recognized as what it is: a major epidemic with a
tremendous population impact, said Victor Penchaszadeh, a clinical epidemiologist at Columbia University and frequent consultant to the Pan American Health Organization on chronic diseases in Latin America. Dr. Ramon Vanegas, a nephrologist who assesses applications by workers to Nicaraguas Institute of Social Security for occupational illness pensions, said cases which he defines as occupational CKD follow a pattern of tubular kidney damage combined with a history of heat stroke. Usually they have been working, and they had muscle spasms, theyve gotten fever, they have collapsed, Vanegas said of the patients whose applications he approves. Then they return to work, they face the same exposures, and the cycle repeats. Then, two or three years later, the patient has [CKD]. While physicians mull labels and diagnoses, the mystery persists: Why does this particular form of CKD attack men in a particular way and in this specific region? Some studies suggest risk factors, from pesticide exposure to alcohol abuse to frequent use of anti- inflammatory drugs, may play important roles in CKDs onset. Others show that miners, stevedores and field workers in affected regions also have high CKD rates; a study in Nicaragua found a mining town to have one of the highest prevalence rates in the country. The evidence points us most strongly to a hypothesis that perhaps heat stress hard work in a hot climate without sufficient replacement of fluids might be a cause of this disease, said Daniel Brooks, lead researcher of a scientific team from Boston University that is among a handful of groups conducting early studies. During days the team observed sugar cane workers, mean temperature in the fields was 96 degrees. Their report noted that the U.S. Occupational Safety and Health Administration, which oversees safety at U.S. workplaces, calls for 45 minutes of rest for every 15 minutes of work at that heat stress level. The teams preliminary research bolsters the heat stress hypothesis; blood and urine samples taken from different types of sugarcane workers during the course of a harvest season show more evidence of kidney damage among those who did strenuous labor outside. Earlier, the team identified a number of work practices and chemicals at the company that could potentially damage the kidneys. Brooks said more research is needed before conclusions can be drawn. Continued on page 52
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Continued from page 51 Thousands of Sugar cane Workers die as Wealthy Nations Stall on Solutions Internal studies by Nicaragua Sugar, owners of one of Central Americas largest sugar plantations, provided by the company to ICIJ, show that the company has long had evidence of an epidemic tied to heat stress and dehydration. In 2001, company doctor Felix Zelaya conducted an internal study on the causes of CKD among Brooks said more research is needed before conclusions can be drawn. Internal studies by Nicaragua Sugar, owners of one of Central Americas largest sugar plantations, provided by the company to ICIJ, show that the company has long had evidence of an epidemic tied to heat stress and dehydration. In 2001, company doctor Felix Zelaya conducted an internal study on the causes of CKD among its workers. Strenuous labor with exposure to high environmental temperatures without an adequate hydration program predisposes workers to heat stress syndrome [heat stroke], which is an important factor in the development of CKD, Zelaya concluded. Nicaragua Sugar and other companies say they have acted voluntarily to protect workers by improving hydration, reducing work hours, and strengthening oversight of labor contractors. Even so, Nicaragua Sugar disputes the existence of a unique kidney ailment affecting its workers. Were convinced that we have nothing to do with kidney disease, said spokesman Ariel Granera. Our productive practices do not generate and are not causal factors for CKD. Signs of trouble In 2000, Salvadoran physician Trabanino noticed large numbers of young and middle-aged men coming into his hospital in El Salvador, all with advanced cases of chronic kidney disease. For some reason, to the rest of the world this seemed normal, he recalled. To me it seemed strange and curious. In 2002, Trabanino published one of the first studies of the disease, a profile of 205 new patients admitted to his hospital with end-stage renal disease. Two thirds of these cases lacked the usual risk factors for chronic kidney disease and had some common features. They were almost all men who lived in the low-lying zones of the country, close to the coast, near a major river, Trabanino wrote in the Pan American Journal of Public Health. A large group of these patients also described frequent occupational contact without adequate protection with insecticides and pesticides. Another study of kidney patients from northern Costa Rica again from a sweltering, low-lying region near the Pacific Coast described a similar pattern. All are young men, between the ages of 20 and 40 years, wrote Dr. Manuel Cerdas of Costa Rica in the journal Kidney International. The most interesting feature of these patients is epidemiologicall of them are long-term sugar-cane workers. Cerdas later found that victims of the epidemic shared another condition: the disease attacked a part of their kidneys called the tubules. Tubulo-interstitial disease is usually rare accounting for only 3.7 percent of cases of end-stage renal disease in the United States. Known causes include toxic exposure and dehydration. Today El Salvador promotes blood testing in hard-hit rural areas to try to catch cases in treatable stages. Trabanino, who has studied the epidemic for over a decade, said he believes screening, public education campaigns and improved worker safety could stop the ailments spread if only resources were available. Researchers in Central America, meanwhile, face an uphill battle. The few CKD studies done so far had been conducted in hospitals and affected communities, where people were already sick. Theories about the role toxic chemicals may play in causing the disease are difficult to test because scientists need access to the epidemics victims as they are falling ill. Silence on CKD; fast action on biofuel Central American sugar companies have been reluctant to open their doors to outside health researchers. Advocates believe the industry fears designation of the disease as an occupational illness. Resistance has begun to soften notably at Nicaragua Sugars Ingenio San Antonio plantation, where the Boston University team is working. But the industry typically has barred independent scientists from company property, employees or records. Aurora Aragon, an occupational health specialist at the University of Leon in Nicaragua, said that in 2004 researchers from an international NGO called SALTRA asked Nicaraguas leading sugar companies to collaborate on a study of worker safety. She said that the Ingenio San Antonio and Ingenio Monte Rosa ignored the request. In 2007, Aragon said another request for access by her colleagues was rejected by the Ingenio San Antonio. Ultimately, that was the conclusion, she said. Not one sugar company gave us permission to study the problem. Mario Amador, a spokesman for the Nicaraguan sugar industry trade group that represents plantations approached by SALTRA, said the industry has allowed Continued on page 53
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Continued from page 52 Thousands of Sugar cane Workers die as Wealthy Nations Stall on Solutions studies by doctors, medical students and health authorities, but must exercise caution in sharing information with outsiders. People with bad intentions have tried to connect CKD with work in the sugar industry, because this industry was the first to find high rates of CKD in the labor force that came to the plantations seeking work, Amador said. It is because of these constant attacks that plantations and their staff are very careful about the information they provide to any person or institution. Central American producers play a significant role in the global sugar business; in 2011 the US imported more than 330,000 metric tons of sugar from the region, representing 23% of total raw sugar imports. Beyond the kitchen table, the U.S. government has heavily promoted the sugar industry in the areas affected by the epidemic as a source of biofuel from ethanol. The U.S. funded conferences to promote biofuels in both Nicaragua and El Salvador as late as 2008, according to embassy cables released by WikiLeaks. Its ambassadors met repeatedly with the leaders of both nations sugar industries, and fretted that failure to develop ethanol production would drive these nations toward dependence on oil imports from Hugo Chavezs Venezuela. In 2007, then-Ambassador Paul Trivelli notified the U.S. State Department of Ingenio San Antonios first ethanol shipment and wrote that the company had embraced the potential to develop the industry and the positive aspects of biofuels. But he expressed concern that Nicaraguas leftist president, Daniel Ortega, might be swayed by Venezuelan President Hugo Chavezs opposition to biofuels. The following year, Trivelli wrote that the State Department had designated Nicaragua as a high-priority country for biofuels. The embassy in El Salvador, Nicaraguas northern neighbor, also forcefully promoted ethanol: ambassadors met with sugar industry leaders, shared concerns with the State Department about the political effects of oil imports from Venezuela, and sponsored a conference to promote biofuels. The World Bank, meanwhile, has provided more than $100 million in loans to promote biofuel production at two heavily affected plantations, which it approved without formal consideration of kidney disease. After workers complained, the Bank granted $1 million to sponsor the ongoing Boston University study. Before receiving the loans, the companies needed to assure the Bank that they lived up to social and environmental
standards. Appraisal teams published glowing assessments of the Ingenio San Antonio and Monte Rosas practices in September 2006 and May 2007. Neither report mentioned CKD. In October 2006, the board of the International Finance Corporation (IFC) the World Banks lender for private-sector projects approved a $55 million loan to Ingenio San Antonio. A $50 million loan to Monte Rosa was approved in June 2007. With the money, the companies expanded, sending more workers into the cane fields. Edgar Restrepo, a senior investment officer for the IFC, said his team did consider CKD when it appraised the Ingenio San Antonio, but that the content of its deliberations is privileged. IFC spokeswoman Adriana Gomez said the IFC had complied with its strict social and environmental standards in the due diligence process. A standoff in Mexico City While governments in Central America have committed few resources to combating CKD, they have begun sounding alarms. El Salvadors government has been forceful in calling for international research help. At a United Nations summit of health ministers this February in Mexico City, El Salvador Health Minister Maria Isabel Rodriguez declared that chronic kidney disease was wasting away our populations across Central America. She called on fellow health ministers to include CKD among the top chronic illnesses in the Americas, a step that could attract U.N. funding for studies. Rodriguezs proposal ran into strong opposition from the summits most powerful participant: the United States. Rodriguez said the U.S. delegation refused either to include the disease on the list of the continents most serious chronic illnesses, or to accept language suggesting that the epidemic had distinct causes related to exposure to toxic chemicals. Central American representatives said they felt so strongly they refused to sign the conferences final declaration unless CKD was included. For several tense moments, the dispute threatened to derail the consensus of the summit. Result: A single phrase mentioning chronic kidney disease in Central America. David McQueen, a United States delegate from the the U.S. opposed mentioning CKD to keep the focus on diabetes, heart disease and cancer. Declarations that are made are rarely successful unless they are very targeted, he said. Continued on page 54
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Continued from page 53 Thousands of sugar cane workers die as wealthy nations stall on solutions McQueen, who has since retired, said he wasnt aware of the dramatic spread of chronic kidney disease until it was raised at the conference. The chronic kidney thing sort of caught everybody by surprise, he said. Why is this being pushed so hard? McQueen learned at the meeting that it is a significant problem, spurring a major drain on resources for physicians and hospitals in Central America. Yet even after learning of the issue, the U.S. has taken little action. CDC spokeswoman Kathryn Harben said that at a dinner on the night of the Mexico City summit, the CDC informally offered to help Central American health ministries. It has not yet done so, she said, because those ministries have not submitted a formal request. The top U.S. health official at the summit, Dr. Howard K. Koh, assistant secretary for health at the Department of Health and Human Services, declined to be interviewed for this story. Get sick, lose your job Ingenio San Antonio and Ingenio Monte Rosa, Nicaraguas largest plantations, now regularly test workers blood to measure creatinine, a chemical that indicates kidney function. Workers with elevated creatinine levels are dismissed, a step the companies say is necessary to prevent sick workers from further risking their health in the fields. Dismissal also cuts off workers from care at company hospitals, and often from company pensions. The Ingenio San Antonio said it has reduced work hours, provided more water and hydrating solution and hired social workers to accompany contractors in the fields to ensure adequate hydration. Currently, the workday is no more than eight hours for demanding physical jobs, and the company provides eight liters of water and 2700 milliliters of hydrating solutions daily to each field worker, said spokesman Granera. In November 2009, Maudiel Martinez boarded a company bus one morning and headed for the fields. He was 17 and starting his fourth year with the Ingenio San Antonio. Harvest season was about to begin and, following routine, the company had conducted blood tests to see if workers were healthy enough for field work. the U.S. opposed mentioning CKD to keep the focus on diabetes, heart disease and cancer. Martinez was on the bus when he got the news: hed failed the creatinine test. He had the disease. I cried because of my grief, Martinez said. I was such a child at the age of 17 youre still an adolescent. The diagnosis meant that Martinez was formally prohibited from working for the company. With his family struggling financially and no alternative job in sight, Martinez assumed a fake name and Social Security number and went back to work in the same fields, for independent labor contractors who, he said, dont care that he provides a womans name and Social Security number. At least some contract workers are still going out on longer, riskier shifts. An ICIJ reporter in June 2011 noted that buses picking up Ingenio San Antonio contract workers started at 5:25 a.m. and returned at 5:31 p.m. Workers said about 10 of those hours were spent in the fields. A collapse in the fields On June 10, 2011, Martinez was assigned to cut four rows of cane. His task was to strip off the leaves, chop them into pieces, and tie them into bundles. About forty pieces make up a bundle. For this labor, he earned one cordoba per bundle less than a nickel. By 8:30 in the morning, he had cut two rows. He was starting to feel sick, but continued to cut in the sweltering heat. The sun was too strong, and I had sweated through my shirt like someone had thrown water on me, Martinez recalled. By the time he finished his rows, at about 11, Martinez was feverish and nauseous. He rested some 15 minutes, but still had to tie his pieces into bundles. Another worker came to help. Martinez said they finished about 1 p.m., and the bus came to bring the workers home about half an hour later. When it arrived, Martinez felt desperately ill. I got onto the bus and I couldnt walk anymore, he said. Since Martinez was a contract worker, he could not go to the company hospital. He took the bus toward home and on board began to vomit. The bus did not stop. The guys gave me a chance to stick my head out the bus window, he said. The road where the bus left him is separated from his home by a shallow river. His mother and brother carried him across the river to bring him to his bed. Soon after his collapse, Martinez learned that his creatinine levels were up. He had gone for days with no appetite, wanting only cold drinks to soothe the sensation of fever. If death is coming, we have to resign ourselves to wait for it, Martinez said. Resigning yourself means waiting for what the disease is going to give you. Continued on page 55
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Continued from page 54 - Thousands of sugar cane workers die as wealthy nations stall on solutions Because you look at me and I look normal now, but inside I feel like Im burning. Kidney disease deaths in Central America, 2009
In India, Verdant Terrain conceals Clues to a Fatal Kidney Disease By Sasha Chavkin 19 September 2012 UDDANAM, India A tangle of green blankets the land amid thick tropical heat. Shady groves of cashew trees strew the ground with juicy, perfume-scented fruits. Men can be seen climbing coconut palms to tap into the trunks for wine. The regions name, Uddanam, comes from a word in Sanskrit that means Beautiful Garden or Paradise. Uddanams rich terrain seems an unlikely place for the mysterious strain of illness tormenting the area. For more than a decade, a rash of chronic kidney disease has been striking down the villagers of this remote agricultural belt in the state of Andhra Pradesh, India. In some villages, the disease has impacted from 24 to 37 percent of the population, two to three times higher than elsewhere in the district, according to unpublished results from a study by Harvard Medical School. As the death toll mounts, the seemingly idyllic region has become stigmatized. In contrast to Nicaraguas Island of the Widows, which is named for the alarming rate of chronic kidney deaths among the communitys husbands, residents of Uddanam say they now have trouble getting married at all. Other people, they dont want to come for marriage, said Dr. Priya Prathibha, the state medical officer in the hard-hit village of Varaka. They are not giving any bride or bridegroom to this area, this Uddanam area. Uddanams victims have much in common with those of the unexplained epidemics in Sri Lanka and Central America. They come from farming communities and are mostly poor. Few suffer from diabetes or hypertension. The climate is sweltering, toxic pesticides are used liberally, and biopsies show the rare pattern of tubulo- interstitial kidney damage. This type of damage accounts for less than 4 percent of end-stage renal disease in the United States, and is consistent with severe dehydration and toxic poisoning. Yet in other ways Uddanam is different. The research to date suggests the disease is confined to a single belt of villages that spans less than 100 miles. Despite mens traditional role in the fields, both sexes are affected almost equally, teams from Harvard and Stony Brook University found. Farmers of several different types of crops coconuts, cashews and rice are all affected. The known impact is also smaller: from 2007 to 2012, a total of 1,520 people required treatment for kidney disease through the state health program. Even if several times as many are in the latent early stages of the disease, its geographic and humanitarian scope is more contained than in Central America or Sri Lanka. Our hypothesis is that an exposure to something in the environment, whether its in the soil or in the water or both, is responsible for this, said Dr. Ajay Singh, a nephrologist at Harvard Medical School and the co-leader of the Harvard study. The research has yet to offer definitive answers. Not a single study has been published on Uddanam CKD, nor do any official statistics measure its scale or reach. Among the scientists and the villagers, confusion and frustration reign. They come to you and they dont understand whats happening to them, Singh said of Uddanams residents. But they do understand that theyre dying from the disease and there are no resources to help them out and something needs to happen there. A Family Tragedy Hyamavathi and Prameela Bendalam have lived the tragedy that has left many Uddanam families frightened of consenting to marriages. Both were in their early twenties when they married and moved to a village in the region called Varaka. Hyamavathi was about 23 when she married her husband, a coconut and rice farmer named Venkataramana Bendalam, in 1990. Continued on page 56
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Continued from page 55 In India, Verdant Terrain conceals Clues to a Fatal Kidney Disease Prameela was about 20 when she married Venkataramanas brother Rama Rao, also a rice farmer. The marriages made the women co-sisters, and they began living together in the Bendalam family compound. For more than a decade, their husbands worked the five acres of rice paddy and coconut fields owned by the family. In 2005, their husbands began to experience difficulty urinating. Both were initially diagnosed with urinary tract infections before traveling to visit doctors in Visakhapatnam, also known as Vizag, a city more than 100 miles away. They were unwell, but we didnt know a disease had hit, Prameela said. Then we found out that they had kidney condition, when we went to Vizag. The illness left the two brothers feverish and nauseous, and eventually too sick to work. Both took medicines to relieve the diseases symptoms, but the family could not afford dialysis. Prameela said the cost of the treatment her husband did receive was more than 60,000 rupees, close to $1,100 at the current exchange rate. The family had to take out loans, and then to gradually sell off their land. Prameela and Hyamavathi took care of the two terminally ill brothers. The both of us were in a lot of pain and misery, Prameela said. In 2007, Venkataramana and Rama Rao died less than a month apart on November 25 and December 23, respectively. Prameela and Hyamavathi remain in the compound, and now work the single acre that remains of the land cultivated by their husbands. This labor provides their only income beside the thousand rupees (roughly $18) each month that Prameelas son Siva earns as a teacher in a private institute. I borrowed money thinking that he would survive, Prameela said of her husband. But he died, and now the loans have to be paid back as well. This is bad karma, full of suffering. Since their deaths, the state government of Andhra Pradesh has established new programs that assist Uddanams victims. A statewide health insurance program for the poor now covers the costs of dialysis. State-of-the-art dialysis centers have been established in several cities through a public-private initiative led by Dr. Ravi Raju Tatapudi, a leading nephrologist who served three years as Andhra Pradeshs director of medical education. But almost all of the areas nephrology and dialysis several cities through a public-private initiative led by Dr. Ravi Raju Tatapudi, a leading nephrologist who served three years as Andhra Pradeshs director of medical education. But almost all of the areas nephrology and dialysis services are in Vizag. The costs of travel and of medicines that are not covered by the insurance program are still prohibitive for many families in Uddanam. They have dialysis but they are 200 kilometers away, said Sham Sundar Puriya, the village head in Patha- Varaka, a sub-community in Varaka village. The residents cannot go to that place because of lack of money, so they are staying here and dying here. Uddanam lacks doctors. There are no full time nephrologists stationed within 100 miles of the region, and local medical officers must refer their patients to distant urban facilities. Dr. Prathibha, the medical officer who lives in Varaka, says the fear surrounding the disease has left even doctors scared to live in Uddanam. If they are not coming, she asked, who will? Frustration and Fear Since the 1990s, when Tatapudi and other nephrologists began noticing the unusual strain of CKD in Uddanam, various theories of the diseases origins have emerged.
Accordingly to unpublished results from a Harvard University study, chronic kidney disease affects 24-37% percent of the population in some villages in Uddanam, 2 to 3 times higher than other parts of the district. Anna Barry Jesler Most have centered on toxic exposure. An unpublished study by a team of researchers from Uddanam and Stony Brook University concluded that the disease is most likely to be the result of a chronic exposure to an environmental agent. Dehydration, another possible factor, has received less attention. The Uddanam area is brutally hot, and farmers spend long hours in the fields. Continued on page 57
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Continued from page 56 In India, Verdant Terrain conceals Clues to a Fatal Kidney Disease Dr. Goru Krishna Babu, a researcher who conducted door-to-door surveys in Uddanam for the Harvard study and grew up nearby in Andhra Pradesh, said the heat was so overwhelming one day, he had to stop and lie down while carrying out the surveys. One of the things I took pride in was that whatever the temperature was I could sustain myself, he said. But one of the days I literally had to lie down on the bed. So far, the efforts of the Stony Brook, Harvard and state government researchers remain tied up in delay. None have published studies that point toward specific suspects. A lab test by Stony Brook that tested local water for contamination by any of 42 toxic chemicals, including heavy metals such as arsenic and cadmium, revealed nothing out of the ordinary, said Kate Dickman, a pharmacologist with the Stony Brook team. The most visible sentiment in Uddanam is frustration: that the years of research and promises havent brought results. As the deaths continue, many residents have become fearful of living in a land so beautiful it was named after Paradise. So many people are leaving, said Siva Bendalam, Prameelas 20-year-old son who helps support his family. If the disease continues, no one will be here. http://www.publicintegrity.org/2012/09/19/10860/india- verdant-terrain-conceals-clues-fatal-kidney-disease
UNEP Report highlights Risk of Mercury Emission in Africa 13 January 2013 SUB-SAHARAN African communities face the worlds second-highest emission of mercury, a highly-toxic element used in small-scale mining and in several industrial processes, putting themselves and their environment at risk, the United Nations Environment Programme (UNEP) said in Nairobi, Kenya, on Thurs- day when it released two new studies on mercury and mercury poisoning. Mercury poisoning leads to sensory impairment, disturbed sensation and a lack of co-ordination, kidney lung and brain dysfunction and even death. Mercury can also contaminate soils and rivers, and much of human exposure to mercury is through the consumption of contaminated fish, with the UNEP studies for the first time assessing at a global level the release of mercury into rivers and lakes. Sub-Saharan Africas emissions were in the 168-154 tons/year range, 16.1% of the global average of 1,960 tons/year (range 1,010-4,070), topped only by East and Southeast Asia, with a range of 395-1,690 tons/year, or 39.7% of the total. After South Africa came South America, with an emission range of 128- 465 tons/ year (12.5% of the total), according to UNEPs Global Mercury Assessment 2013. The report noted that artisanal and small-scale gold mining emissions are, in the 2010 inventory, the major source of emissions to air, at 727 tons per year globally. Artisanal and small-scale gold mining and coal burning are the major sources of anthropogenic mercury emissions into the air, accounting for more than 35% of total anthropogenic emissions. This is more than twice the figure from this sector in 2005, however, most of the increase is attributed to some new and better information, UNEP said in a statement. Mineral Resources Minister Susan Shabangu said last year the high price of gold in recent years has seen the proliferation of illegal mining activities, especially in the Free State and Gauteng, costing South Africa an estimated R5bn a year. South Africa is party to the International Negotiating Committee on Mercury that is to hold discussions in Geneva, Switzerland, on January 13-18 in a bid to conclude a global, legally-binding treaty to minimise mercury exposure. According to UNEP anthropogenic sources are responsible for about 30% of annual emissions of mercury to air, another 10% comes from natural geological sources, and the rest (60%) is from re-emissions of previously released mercury that has built up in surface soils and oceans. It (illegal mining on the surface) is a major problem and it is extensive in the old gold mining areas, except Barberton (in Mpumalanga). The only way to eradicate it is to rehabilitate the area, said Col Hennie Flynn from the SAPS. http://www.thisissierraleone.com/unep-report-highlights-risk-of- mercury-emission-in-africa/
Mercury Introduction Mercury is a chemical (element) that occurs naturally in the environment in several forms. In the metallic or elemental form, mercury is a shiny, silver-white, odorless liquid with a metallic taste. Mercury can also combine with other elements, such as chlorine, carbon, or oxygen, to form mercury compounds. These compounds are called "organic Continued on page 58
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Continued from page 57 Mercury mercury" if they contain carbon, and inorganic mercury" if they do not. In pure form, these mercury compounds are usually white powders or crystals. All forms of mercury are considered poisonous. One organic form of mercury, methylmercury, is of particular concern because it can build up in certain fish. For this reason, rather low levels of mercury in the oceans and lakes can contaminate these fish. Mercury released into the environment stays there for a long time. Once in the environment, mercury can slowly be changed from organic to inorganic forms and vice versa by microorganisms and natural chemical processes. Methylmercury is the organic form of mercury created by these natural processes. There are many different uses for and sources of mercury. Metallic mercury is mined and is also a waste product of gold mining. Chemical factories that make chlorine use mercury and may release metallic mercury into the air. Thermometers, barometers, batteries, and tooth fillings all contain metallic mercury. Inorganic mercury compounds are commonly used in electrical equipment (for example, batteries, lamps) and skin care and medicinal products. Some inorganic mercury compounds are used in fungicides. Methylmercury is generally produced in the environment, rather than made by human activity. Fungicides and paints may contain other organic mercury compounds. Mercury compounds may be found in the air, soil, and water near hazardous waste sites. Fate & Transport Mercury is a naturally occurring metal found throughout the environment as a result of normal breakdown of the earth's crust by wind and water. The total amount of mercury in the environment caused by natural processes throughout the world is far greater than the total amount caused by human activities. However, the amount of mercury that exists in any one place through natural processes is usually very low. In contrast, the amount of mercury that may be at a particular waste site because of human activity can be very high. Air, water, and soil can contain mercury from both natural sources and human activity. The mercury in air, water, and soil is thought to be mostly inorganic mercury. This inorganic mercury can enter the air from deposits of ore that contain mercury, from the burning of fuels or garbage, and from the emissions of factories that use mercury. Inorganic mercury may also enter water or soil from rocks that contain mercury, releases of water containing mercury from factories or water treatment facilities, and the disposal of wastes. Organic compounds of mercury may be released in the soil through the use of mercury-containing fungicides. Metallic mercury is a liquid at room temperature. It can evaporate easily into the air and be carried a long distance before returning to water or soil in rain or snow. As mentioned before, some microorganisms in the water or soil can change inorganic forms of mercury to organic forms. Organic forms of mercury can enter the water and remain there for a long time, particularly if there are particles in the water to which they can attach. If mercury enters the water in any form, it is likely to settle to the bottom where it can remain a long time. Mercury also remains in soil for a long time. Mercury usually stays on the surface of the sediments or soil and does not move through the soil to underground water. Small fish and other organisms living in the water can take up the organic forms of mercury. When larger fish eat these small fish or other organisms that contain organic mercury, their bodies will store most of it. In this way, large fish living in contaminated waters can collect a relatively large amount of organic mercury. Plants may also have a greater concentration of mercury in them if they are grown in soil that contains higher than normal amounts of mercury. Exposure Pathways Because mercury occurs naturally in the environment, everyone is exposed to very low levels of mercury in air, water, and food. Sources of higher exposure to metallic mercury include breathing air containing mercury in the workplace or any place where mercury might have been spilled. Also, since amalgam dental fillings are about half metallic mercury, if you have them you can be exposed to mercury levels that are higher than the levels normally found in the environment. People with dental fillings containing mercury generally have more mercury in their breath than those who do not have these fillings. However, there is not enough evidence to prove that the mercury in amalgam fillings is causing health effects in humans. Sources of exposure to inorganic mercury include swallowing or inhaling dust that contains mercury particles in the workplace and using skin care and medicinal products with small amounts of mercury in them. You can also be exposed to inorganic mercury by drinking water that is contaminated with mercury. For most people, eating contaminated fish is the major source of organic mercury exposure. Some fish contain such high levels of mercury that eating them has been prohibited. Other foods typically contain very little mercury. A greater risk of mercury exposure may occur in fetuses exposed to mercury in their mother's blood and in nursing children who may be exposed to mercury in their mother's milk. Exposure near hazardous Continued on page 59
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Continued from page 58 Mercury waste sites is likely to occur by breathing contaminated air, having contact with contaminated soil, or drinking contaminated water. The background or natural level of mercury found in outdoor air is generally between 10 and 20 nanograms of mercury per cubic meter of air (ng/m3). Mercury levels found in surface water are generally less than 5 ng per liter of water. Levels normally found in soil range from 20 to 625 ng of mercury per gram of soil. The Food and Drug Administration (FDA) has estimated that, on average, most people are exposed to about 50 ng of mercury per kilogram of body weight per day in the food they eat. This translates to about 3.5 micrograms of mercury per day for an average weight adult. A large proportion of this mercury is likely to come from fish. Furthermore, people who eat a lot of fish are likely to have higher exposure to mercury. Exposure to mercury can occur in many jobs. Most exposures on the job occur as a result of breathing air that contains mercury. Exposure occurs in the medical, dental, and other health services, and in the chemical, metal processing, electrical equipment, automotive, building, and other industries. Families of workers may be exposed to mercury in the home if the workers have mercury dust on their clothing. Dentists and their assistants may also be exposed to mercury from skin contact with dental fillings and breathing metallic mercury vapor released from these fillings. Exposure to mercury can be determined by measuring amounts in blood and urine. Levels found in blood and urine may show whether health effects are expected. Metabolism Mercury can easily enter your body when you breathe in air containing metallic mercury. Most of the mercury that gets into your lungs as metallic mercury goes rapidly to other parts of the body. Metallic mercury that you might swallow does not enter your bloodstream very easily, and most of it leaves the body in the feces. Some metallic mercury may stay in your body, mostly in the kidney and brain. Metallic mercury can also reach the fetuses of pregnant women easily. Metallic mercury that you breathe in will leave your body in the urine, feces, and breath. Inorganic salts of mercury (mercurous or mercuric chloride, for example) that are inhaled do not enter your body as easily. However, these inorganic forms of mercury, if swallowed, enter the body more easily than metallic mercury. Inorganic mercury can also enter the bloodstream directly through the skin. However, only a small amount would pass through your skin compared
with breathing or swallowing inorganic mercury. After entering the body, inorganic compounds of mercury can also reach many tissues. Some may stay in your body, mostly in the kidneys. However, inorganic mercury cannot reach the brain as easily as metallic mercury. Inorganic mercury leaves your body in the urine or feces after several weeks or months. Organic compounds of mercury can probably enter your body easily through the lungs. Organic mercury in contaminated fish or other foods that you might eat enters your bloodstream easily and goes rapidly to other parts of your body. It can also enter the bloodstream directly through the skin, but only a small amount would pass through your skin. Organic mercury in the body is similar to metallic mercury because it can reach most tissues including the brain and fetus. Organic mercury can change to inorganic mercury in the brain and remain there for a long time. Organic mercury that you swallow or breathe leaves your body in the feces, mostly as inorganic mercury, within weeks. Health Effects Long-term exposure to either inorganic or organic mercury can permanently damage the brain, kidneys, and developing fetus. The most sensitive target of low level exposure to metallic and organic mercury following short or long term exposures appears to be the nervous system. The most sensitive target of low level exposure to inorganic mercury appears to be the kidneys. Short term exposure to high levels of mercury can have similar effects. Full recovery is more likely after short term exposures than long term exposures, once the body clears itself of the contamination. Short term exposure to high levels of metallic mercury in the air can cause skin rashes and effects on the lungs and eyes. Long term exposure to metallic mercury has been studied in workers at chlorine facilities. Some of them developed symptoms such as memory loss and shakiness. Levels of metallic mercury in air were greater than the levels normally encountered by the general population. Current levels of mercury in workplace air are lower than in the past. Because of this reduction, fewer workers have symptoms from mercury exposure. Studies in humans found there were no effects on the ability to reproduce after breathing metallic mercury for a long time. Short and long term exposure to low levels of inorganic mercury in animals can also cause kidney and brain effects. Long term exposure to higher than normal levels of inorganic mercury from eating or drinking contaminated foods or water can lead to brain and kidney damage in some people. Long term exposure to inorganic mercury has caused effects to the fetus in animals. The Continued on page 70
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African Traditional Herbal Research Clinic Volume 8, Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES Nigeria: The Rate of Kidney Disease Daily Champion 19 July 2011 Recent revelation by the National Association of Nephrology that an estimated 30 million Nigerians suffer from kidney problems is indeed worrisome and another sad story from our health sector which must be written in the interest of those who currently have these problems and those who may, if something is not urgently done, come down with this debilitating disease. Going by the figure declared by the president of the association, Dr. Chinwuba Ijeoma, at the recent 23rd general meeting and scientific conference of the International Society of Nephrology (ISN) in Benin City, Edo State, no less than 20 per cent of Nigerians have kidney problems. Indeed, and at an awareness campaign also organised by the group to mark this year's World Kidney Day, it was also revealed that every year many Nigerians die prematurely of cardiovascular diseases linked to kidney conditions. Before this time however, specifically in 1998 during their 10th Annual Scientific Conference on kidney disease, nephrologists at the University College Hospital, Ibadan, had equally raised alarm over the increase in incidences of kidney failure, stressing that teaching hospitals in the country were recording between 16 and 60 new patients seeking dialysis every month. At the moment, the number of new patients seeking dialysis every month in these institutions is said to have risen astronomically to between 200 and 300, a situation that no doubt calls for intensification of public enlightenment campaigns concerning the different kinds of chronic kidney diseases (CKD) that people suffer from, their causes and how to manage them. Among factors identified as contributing to the development of the disease in Nigeria include ingestion of fake, expired and adulterated drugs; high blood pressure; poor Western-style diet low in natural food, overuse of certain simple medications, including analgesics and uncertified herbal preparations; stress, obesity and lack of exercise. Self-medication and failure to undergo regular medical check-ups also contribute to the escalation of the disease, just as the dearth of medical equipment for diagnosis and funds for treatment lead to deterioration of simpler ailments to serious kidney diseases. But as worrisome as the rate of prevalence is, it must be noted that the situation is not peculiar to Nigeria. It is obviously a global problem. According to the United States Renal Data System (USRDS) for instance, "each year in the US, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes." Also, the World Health Report 2002 and Global Burden of Disease project reports indicate that diseases of the kidney and urinary tract account for approximately 850,000 deaths every year, representing the 12th cause of death and the 17th cause of disability. As medical experts would have it, the functions of the kidney basically include regulating the body's fluid balance by adjusting the amount of urine that is excreted daily and removing waste products that the body produces throughout the day. But while advanced nations are constantly pursuing measures to combat the scourge of CKD, the situation in Nigeria has been allowed to progress to a frightening level, even when most forms of the disease are treatable. For instance, the disease's progression can be lessened if detected and treated early, thus preventing the need for dialysis and kidney transplant. But since the nation's ailing health care system cannot provide adequate facilities for the management of the disease, it becomes imperative for the relevant authorities to embark on extensive enlightenment campaigns as a Continued on page 61
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Continued from page 60 Nigeria: The Rate of Kidney Disease measure to prevent people getting the disease that today constitutes a serious danger to Nigerians. In most hospitals, there is an acute shortage of equipment for diagnosis and because dialysis machines required to manage the disease are very few in the country, the cost is beyond what an average Nigerian patient can afford. For instance, one dialysis session is said to cost about N30, 000 and a patient requires about two sessions per week. Thus, dialysis, a procedure put in place as substitute for many of the normal duties of the kidneys, is only available for a few rich patients. Also, as very few hospitals in the country do kidney transplant, which is the last resort for patients, many Nigerian patients have had to find themselves in different hospitals abroad, particularly in India, for the transplants. Considering that many prominent persons, including former President Umaru Yar'Adua, have been lost to kidney-related ailments, no responsible government should take the matter lightly. Government at all levels must, as a matter of urgency, educate their people on the causes, symptoms and how to prevent the disease. Government must also do more by way of providing diagnostic equipment and dialysis machines for treatment of the condition to save many patients the trauma of seeking medical assistance abroad. We join other concerned Nigerians to call on the authorities to not only set up specialized kidney centres in all the states of the federation, but to also ensure that treatment is heavily subsidized to afford the growing number of Nigerian patients access to such facilities. Poverty, which has been identified as one of the factor responsible for the disease should be tackled head-on and the public health sector must be strengthened to discourage self-medication. That way, people can be sure of receiving the right medical treatment at all times. We also call for the strengthening of the National Agency for Food and Drug Administration and Control (NAFDAC), which says 40 per cent of drugs supply in the country is counterfeit, by reviewing the penalties for drug counterfeiting. Nigerians on their part must begin to show more interest in matters pertaining to their health by obtaining and heeding medical advice on the prevention of kidney ailments as well as paying more attention to what they consume.
http://allafrica.com/stories/201107200350.html
Coping With Challenges of Renal Disease By CHIBUNMA UKWU 6 January 2013 For patients with renal diseases, Life indeed is quite challenging. However, the will to live gives them the strength of fight on. It is these challenges that led to the establishment of The Kidney Care and Support Initiative, an NGO that promotes care and awareness on renal diseases. Sharing his experience on the ailment, the Chairman, Board of Trustees of the organisation, Mr. Swani B. Gandu appealed for a more compassionate approach to issues related to renal disease stressing the challenging life which the patients encounter. According to him, most Nigerians who have lost their lives to kidney diseases died not because there is no treatment but for the financial burden that has been placed on them in the course of getting the treatment. The idea to set up this organisation came to me four years ago when I lost my kidney and have to be placed on dialysis for survival. The treatment has taken me to various cities and it was during these trips that I saw the sufferings of my fellow Nigerians. Though dialysis has been improved upon in Nigeria, the prices still differ in various dialysis centers and there are people who cannot afford them. Some of these people need this dialysis three or four times in a week. Most of these people are dying, not because there is no treatment, but because of the financial burden which has been placed on them. Speaking more on the financial challenges that these people are faced with, Mrs. Comfort Gandu whose husband has suffered from disease for four years acknowledged finance as part of the major challenges of people with renal disease. In managing renal disease, finance is a major factor. For instance, patients of renal disease do not drink water rather they lick ice. This means that you have to have ice every time of the day and with the state of power supply in the country, one may have to depend on generator. That is finance. Stressing further on how capital intensive renal disease is, Mrs. Gandu disclosed the high cost of managing Continued on page 62
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Continued from page 61 Coping with Challenges of Renal Disease renal diseases which includes buying blood for transfusion as well as affording the costs of kidney dialysis. In the course of treating my husband, I have come to realise that patients with renal disease need blood transfusion always. There was a month when my husband took six pints of blood just in a month. For people that do not have the money to buy, how would they get to pay for blood? Even if there are relations who are willing to donate blood for a patient, one fact remains clear; those relations would one day get tired of donating blood, even if they dont get tired, blood is not what you give often, you do it at least once every six months thus the need for money to buy this, thus living with people with renal disease is indeed capital intensive. With the above highlights, one may wonder on what actually are the causes of kidney failure? It is an ailment that develops gradually with time. Whereas various factors contribute to it worldwide, it is established that the major causes in Nigeria are hypertension as well as drug abuse are the commonest causes. Stating the reason for the high rate of kidney diseases in Nigeria, a Nephrologist with the department of Nephrology, Jos University Teaching Hospital, Dr. Gimba Mark affirmed that hypertension, as well as drug abuse are the commonest causes of kidney diseases in Nigeria. The risk factors for kidney diseases are hypertensions, diabetes, and chronic glomerulusnephritis are usually the three commonest and diabetes is the commonest cause of kidney diseases worldwide, but hypertension and chronic [diabetes]are the most common in Nigeria. Also are lots of things that we do like use of drugs without prescriptions such as the pain killers, herbal medicines. Dr. Gimba therefore urged Nigerians to abstain from those practice that encourage renal disease which includes drug abuse. Throwing more lights on the issue, he said that it is better to avoid the ailment than to treat it. It is usually said that prevention is better than cure and that applies mostly to renal diseases. One of the chal- lenging issues about the cure is that the dialysis centers in Nigeria where kidney patients could be attended to are very few. We have about 50 dialysis center to a nation of about 200million [people, that is grossly inadequate, like where I come from in Jos, we have patients coming from Kaduna state, Taraba states to do dialysis, that is very far. Before Bauchi was opened, people were coming from Bauchi. We have people coming from Markurdi, Lokoja to Jos to do Dialysis. That is very far. We are talking of distances of four hours and more, now any problem could happen like the patient could suddenly develop a problem and if he is far from a center, he could die before getting to the hospital. So there are not enough dialysis centers. That is the reason we advocate for kidney transplantation, of course, it is going to be very difficult for individuals to fund but if there is government assistance and support, as is obtained in other countries, a patient who has kidney failure can just go for a transplant. That notwithstanding, he urged Nigerians to take their health seriously and guard against renal diseases which he said could be prevented or managed best if identified at the earliest stage. A Kidney disease is in stages. When in other stages, they could be treated but if it enters to the stage where the kidney has failed, there is nothing he can do except to do dialysis or kidney transplant because as sad as it is, even if drugs are given are given at this stage, it is just for a while as you are only treating the surface, not yet addressing the main issue. But if it was detected at an early stage, the person may not need dialysis once the patient was able to keep his Blood Pressure normal, have the level of his blood sugar controlled; chances are that he will not get to the stage 5 which is the critical stage. So these are things to do, so people who have factors for kidney diseases need to check and have those factors corrected as soon as possible but once it gets to the chronic diseases, it just goes on and on until it reaches the terminal stage. http://www.leadership.ng/nga/articles/44246/2013/01/06/copin g_challenges_renal_disease.html
UN rejects Haiti Cholera Damages Claim Global body will not pay compensation to families of those who died in 2010 epidemic blamed on UN peacekeepers. 23 February 2013 The UN has formally rejected claims for damages over a cholera epidemic in Haiti that has been widely blamed on UN peacekeepers. Continued on page 63
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Continued from page 62 - UN rejects Haiti Cholera Damages Claim About 8,000 people died in the epidemic but Martin Nesirky, UN spokesman, said on Thursday that the global body had told lawyers the damages claim was "non-receivable" under a 1946 convention laying out the UN's immunities for its actions. In November 2011, the Boston-based Institute for Justice and Democracy in Haiti filed a petition at UN headquarters in New York seeking a minimum of $100,000 for the families or next-of-kin of each person killed by cholera and at least $50,000 for each victim who suffered illness or injury from cholera. Ban Ki-moon, UN secretary-general, telephoned Haiti's President Michel Martelly "to inform him of the decision and to reiterate the commitment of the United Nations to the elimination of cholera in Haiti", Nesirky said. Certain health experts have said the cholera epidemic, which erupted in late 2010, was introduced to Haiti by Nepalese peacekeepers. The UN has never acknowledged responsibility, insisting it was impossible to pinpoint blame definitively. Lawyers for the families of some of the dead and the 635,000 people estimated to have been made sick by the cholera had predicted a damages award could cost the UN more than $1bn. "The secretary-general again expresses his profound sympathy for the terrible suffering caused by the cholera epidemic, and calls on all partners in Haiti and the international community to work together to ensure better health and a better future for the people of Haiti," Nesirky said. http://www.aljazeera.com/news/americas/2013/02/201322119 5730115406.html
Continued from page 37 - The Disease Cholera and Kidney Failure Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) the body's main energy source may occur when people become too ill to eat. Children are at greatest risk of this complication, which can cause seizures, uncon- sciousness and even death. Low potassium levels (hypokalemia). People withcholera lose large quantities of minerals, including potassium, in their stools. Very low potassium levels interfere with heart and nerve function and are life- threatening. Kidney (renal) failure. When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in your body a potentially life-threatening condition. In people with cholera, kidney failure often accompanies shock. Internet
Acute Renal Failure as a Complication of Cholera [Article in Hebrew] By Knobel B, Rudman M, Smetana S. Dept. of Medicine B and Institute of Nephrology, Wolfson Medical Center, Holon. Harefuah. 1995 Dec 15;129(12):552-5, 615. Abstract We present a 72-year-old man who had episodes of severe, acute renal failure during severe attacks of diarrhea caused by Vibrio cholerae. Patterns of acute tubular necrosis and tubulointerstitial nephritis developed following hypotension and decrease in renal blood flow, causing secondary renal ischemia. There was severe dehydration with profound hypovolemia and infection. The clinical picture included fever, weakness, arthralgia, pedal edema, mild bilateral pleural effusions, anemia, leukocytosis, azotemia with a maximum of 330 mg/dl of urea, creatine to a maximum of 9.8 mg/dl, hypoproteinemia, severe metabolic acidosis, marked increase in lactate dehydrogenase (LDH) and creatine phosphokinase (CPK), microscopic hematuria, sterile leukocyturia, normoglycemic glucosuria and phosphaturia with diminished tubular reabsorption of phosphorus. A short oliguric phase was followed by a polyuric phase lasting about 10 days, and glomerular and tubular function became normal after about 3 weeks. Treatment was by intensive infusions of fluids, electrolytes, sodium bicarbonate, salt-free albumin and antibiotics. To the best of our knowledge, this renal complication of cholera has not yet been described in Israel. PMID:8682355 http://www.ncbi.nlm.nih.gov/pubmed/8682355
Change in Causes of Kidney Infections; Research By Rebecca Rwakabukoza September 10, 2012 Continued on page 64
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Continued from 63 - Change in Causes of Kidney Infections; Research In Summary As doctors look for several ways to control kidney infections, so are the causes of the infections changing, research shows. There is an increase in Uganda of people needing kidney transplants. There are radio adverts and newspaper articles,telling the never-ending story of dialysis and a much-needed trip to New Delhi for a transplant. Dr Eyoku Simon Peter, a nephrologist (kidney doctor) at Mulago National Referral Hospital, says there is evidence of a change in the causes of kidney injury. Change in causes Acute kidney infection to the glomeruli, located in the cortex, where the first filtration in our bodies takes place, used to be the most common and when not diagnosed early and managed, sent a lot of people to theatres for kidney transplants. Acute glomerulo-nephritis is mostly caused by ischaemia, a loss of oxygen supply. Therefore, anaemic and sicklers (people with sickle cell anaemia) were at risk. Also, there were a lot of cases following operations, and accidents due to the intensive blood loss. Today, diabetes and hypertension, usually occurring together, are the most common, accounting for 47 per cent of AKI while HIV/Aids accounts for 29 per cent. The remaining 24 per cent is AKI due to damage to the glomeruli. Verdict on recovery AKI is reversible when diagnosed early. There is feasible total remission here, Dr Eyoku says. He insists that natural kidneys are the best option for a person and that no transplant is as good as the natural kidney. AKI can occur in as little time as a few hours or in a time as long as 12 weeks. It is basically damage to kidney tissue and the doctor has to, first of all, figure out if there is a lesion (visible abnormality), where it is and what it is. With answers to all these questions, AKI can be treated and its progression stopped. However, when not caught early, it is irreversible and progresses to chronic kidney disease (CKD). CKD is when damage has persisted past 12 weeks, kidney function is compromised and the lesions are irreversible. At this stage, the nephrologist tries to slow down progression to end-stage renal disease.
Food intake is controlled and an affected person cannot have foods containing potassium (bananas, tomatoes, matooke) and protein. Also, their fluid in-take is closely monitored, in such a way that each days fluid in-take should be equivalent to that of the output of the previous day plus 500mlfor instance if you take out 500ml of urine today, you should drink 1000ml of liquid tomorrow. This is to control oedema (swelling due to fluid retention in the body) since the kidneys help with water regulation. Kidney disease and HIV In a research report, HIV-related drug nephrotoxicity in Sub-Saharan Africa, published in The Internet Journal of Nephrology, Dr Robert Kalyesubula and Dr Mark Perazella look at the role of antiretroviral medications in kidney infections. Aside from the economic constraints that limit access to antiretroviral medications and also account for poor laboratory monitoring that, the report says, delays identification of toxicities, they look at use of anti- tuberculosis therapy and herbal medications. Incidence in Uganda has not been studied and documented but a review of epidemiology of AKI in South Africa showed that 17.4 per cent (122 of 700 patients) were HIV positive and mortality was noted in 20 per cent (25 of 122). Another study, by Emem et al, found an 11.5 per cent prevalence (43 of 373 patients) of CKD and attributed it to low CD4 counts in the affected patients. With HIV/Aids affected patients, the immunity levels are low and the body not as capable of dealing with infection. This, combined with the toxicities from the drugs that are routine to the HIV-positive individual, there is a higher risk of seeing AKIs which, when not detected early, lead to kidney failure. The drug cocktail for HIV-infected people often includes non-steroidal anti-inflammatory drugs (NSAIDs) and these are known to cause injury to the kidney. Acute interstitial nephritis (AIN), for instance, is usually caused by NSAIDs. Treatment However, the report by Drs Kalyesubula and Perazella stress that there is no need to treat HIV-infected patients and HIV-negative ones separately. The routine remains the same, but there is need to look at all the other issues that affect the HIV-positive patient, when trying to locate and manage a kidney injury. The rise in AKI in HIV-positive individuals that has been noted by the doctors only serves to inform the doctors and the patients to take extra caution. Dr Eyoku recommends regular check-ups, even when one feels Continued on page 65
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Continued from 64 - Change in Causes of Kidney Infections; Research healthy. For kidney injuries caused by medications or surgical procedures, the doctors and other medical personnel are to be more vigilant and consult each other, as often as needed. http://www.monitor.co.ug/Magazines/Health--- Living/Change-in-causes-of-kidney-infections--research/- /689846/1499724/-/cups05z/-/index.html
Cases of Kidney Disease in Children on the Rise By Agatha Ayebazibwe January 19, 2012 Doctors say that we can live quite well with only one kidney, and some people live a healthy life even when born with one missing. But while bones can break and muscles can waste away without causing a major risk to life, if both of your kidneys fail, as happens in end stage kidney failure, bone, muscle or brain cannot carry on. Without any kidney function, the body dies which means one ought to act immediately once they discover they have a kidney problem. Why are kidney diseases on the rise among children? For a long time, kidney diseases were associated with adults, particularly those that have HIV, smokers and the diabetic. The trend has however changed. Statistics show that the number of children suffering from kidney failures has been increasing over time. Prevalence According to Dr Violet Kayom, a resident pediatrician at Mulago Hospital, 10-15 cases of new kidney failures in children are registered every month. Over 800 children were admitted at the pediatric ward last year, 240 of these had kidney complications. 14 per cent of them died and 50 per cent had nephrotic syndrome which is the commonest cause of death in kidney disorders, Dr Kayom said. Dr Amos Odiit, an expert in kidney diseases says, When a child suffers from kidney failure, they tend to pass very little urine or none at all. This is because most kidney diseases attack the nephrons whose chief function is filtering the blood, reabsorbing what is needed and excreting the rest as urine. A normal person has two kidneys doing the same thing. When one fails, the other can still work. But when both fail, the nephrologist explains, the toxins in the blood remain and accumulate to harm the person. Data from World Health Organisation shows that for children below four years, birth defects and hereditary diseases are by far the leading causes of kidney failure. Between ages five and 14, hereditary diseases continue to be the most common causes. Also, severe malaria and pneumonia have been identified by doctors as causes of kidney failures among children except those that are borne with it. Children with chronic kidney failure are more likely not have any symptoms until about 80 per cent of their kidney function is lost. Then, they may feel tired, have nausea or vomiting, have difficulty concentrating, or experience confusion. Accumulated fluid appears as swelling around the eyes, legs, and belly, fluid congestion in the lungs, and high blood pressure. Children with renal failures are advised to have a restricted intake of sodium, which is found in table salt and salt substitutes. Many salt substitutes have potassium in them, which can cause renal failure. The deputy In charge at the paediatric ward, Mulago hospital says, sick kidneys cannot easily remove excess water, salt, or potassium, so their intake should be limited. In kids with more severe kidney failure, reducing the intake of dairy products and other protein- rich foods (such as meat, fish, or eggs) can make the filtering work of the kidneys easier, she said. However, while experts advise regulating protein and phosphorus intake, its important to remember that children do need enough protein for growth. Thus basic protein should be allowed. Treatment for kidney failure Dr Robert Kalyesubula, a nephrologist at the Renal unit, Mulago hospital says there are two forms of treatment available in Uganda. We use dialysis to give the patients life but it does not cure the disease, he says. This is a process to remove waste products and extra water from patients with chronic kidney failure. It can be done by lining the childs abdominal cavity with a filter and placing a tube containing sugar solution in the childs belly, the solution then pulls wastes and extra fluid from the blood. It can also be done using a machine that carries the childs blood through a tube to a dialyser, a canister that contains thousands of fibre that filter out the wastes and extra fluid. The cleaned blood is then returned to the child through a different tube. The high cost This procedure is costly in terms of time and money. Its done three times a week for four hours and costs between Shs350,000- Shs450,000 per visit, which most patients Continued on page 66
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Continued from page 65- Cases of Kidney Disease in Children on the Rise can not afford, Dr Robert Kalyesubula, a nephrologist says. However, the dialysis can only prolong the patients time as it doesnt guarantee cure. But without it, patients will eventually die. Aside from having very few experts in the country to deal with the disease, Mulago hospital, Panaroma Medical Centre and Case clinic are the only facilities that offer dialysis to patients with kidney failure. Most hospitals lack the necessary equipment to screen for kidney disease. Doctors detect it in its advanced stages and it becomes difficult to save the situation. Transplant option+ Dr Odiit says, The other viable option is a transplant where a healthy kidney is planted in the childs body. Kidney transplant is very expensive. In India it costs$15,000 (Shs36m), UK, 60,000 pounds (sh228m) and in South Africa, $30,000 (shs72m). This procedure largely depends on the availability of a kidney donor with similar blood group and funds. The experts advise that people who have transplants must take drugs to keep the bodys immune system from rejecting the new organ. These immune suppressive drugs can help maintain good function in the transplanted kidney for many years. However, they may have some undesirable side effects such as making a child vulnerable to infections. Stella Nkanjako, a mother to Joel, a kidney disease patient, says, she can only pray that God helps him survive the disease. She says it has crippled her rather jolly son since she can neither afford a dialysis nor a transplant. For now, medics can only manage his condition with pain killers and anti-hypertensive drugs to reduce the fluids in the body. Mulago hospital registers 40-60 new cases of kidney disease every Tuesday of the week. Renal transplants are not performed in Uganda. Most patients who can afford the transplants seek medication in India, South Africa and Nairobi of late. http://www.monitor.co.ug/Magazines/Health---Living/- /689846/1309758/-/kjo42tz/-/index.html
MERCURY IN SKIN LIGHTENING PRODUCTS Mercury is a common ingredient found in skin lightening soaps and creams. It is also found in other cosmetics, such as eye makeup cleansing products and mascara. 1-3 Skin lightening soaps and creams are commonly used in certain African and Asian nations. 1,4,5 They are also used among dark-skinned populations in Europe and North America. 2,6,7 Mercury salts inhibit the formation of melanin, resulting in a lighter skin tone. 8,9 Mercury in cosmetics exists in two forms: inorganic and organic. 3,10,11
Inorganic mercury (e.g. ammoniated mercury) is used in skin lightening soaps and creams. Organic mercury compounds (thiomersal [ethyl mercury] and phenyl mercuric salts) are used as cosmetic preservatives in eye makeup cleansing products and mascara. 1-3,12
Use, production and availability In Mali, Nigeria, Senegal, South Africa and Togo, 25%, 77%, 27%, 35% and 59% of women, respectively, are reported to use skin lightening products on a regular basis. 1
In 2004, nearly 40% of women surveyed in China (Province of Taiwan and Hong Kong Special Administrative Region), Malaysia, the Philippines and the Republic of Korea reported using skin lighteners .1
In India, 61% of the dermatological market consists of skin lightening products. 3
Skin lightening products are manufactured in many countries; for example, consumer protection agencies Skin lightening products are manufactured in many countries; for example, consumer protection agencies in the European Union 13-18
and the United States of America (USA) 19,20
have identified mercury- containing products made in China, 13,16,19,20
the Dominican Republic, 1,19
Lebanon, 13,21
Mexico, 19,22
Pakistan, 13,14
the Philippines, 13,15
Thailand, 13,17,23
and the USA. 13,18
Mercury-containing skin lightening products are available for sale over the Internet. A 2011 survey funded by the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety noted that individuals from Brazil, Kyrgyzstan, Mexico and the Russian Federation believe that mercury-containing skin lightening products are easy to obtain. 24
Some manufacturers are no longer using mercury as a preservative in mascara and eye makeup cleansing products as a result of consumer pressure. However, most jurisdictions still allow the sale of makeup products containing mercury compounds. 25
Products, packaging and ingredients Skin lightening products come in different forms,
Continued on page 67
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Continued from page 66 - MERCURY IN SKIN LIGHTENING PRODUCTS including soaps and creams; the soap is often sold as antiseptic soap. 1,2
These products are supposed to be applied to the skin to dry overnight. 2
Women use the soap to wash their hair, arms or face or their entire body. 2
It is reported that some women use these products for as long as 20 years .1
The soaps come in bar form and are sold individually in boxes. 6 The creams are generally packaged in tubes or jars. 6
The soaps contain approximately 13% mercury iodide, and the creams are composed of 110% mercury ammonium. 2 Some soap products tested contained mercury at concentrations up to 31 mg/kg, whereas cream products had mercury concentrations as high as 33 000 mg/kg. 26
Products with very high levels of mercury contamination look grey or cream coloured. 27
The amount or concentration of mercury in a product may be labelled on the packaging or in the ingredient list. Names to look for include mercury, Hg, mercuric iodide, mercurous chloride, ammoniated mercury, amide chloride of mercury, quicksilver, cinnabaris (mercury sulfide), hydrargyri oxydum rubrum (mercury oxide), mercury iodide or poison; directions to avoid contact with silver, gold, rubber, aluminum and jewellery may also indicate the presence of mercury. 1,6
However, companies selling products that contain mercury, do not always list it as an ingredient. Health effects and how to measure exposure
The main adverse effect of the inorganic mercury
contained in skin lightening soaps and creams is kidney damage. 9
Mercury in skin lightening products may also cause skin rashes, skin discoloration and scarring, as well as a reduction in the skins resistance to bacterial and fungal infections. 1,3
Other effects include anxiety, depression or psychosis and peripheral neuropathy. 1-3
The medical literature reports specific instances of individuals suffering from the aforementioned health effects following exposure to mercury through skin lightening creams and soaps. One case report describes a 34-year-old Chinese woman who developed nephrotic syndrome, a condition marked by high levels of protein in the urine. The mercury levels in her blood and urine returned to normal one month and nine months, respectively, after she stopped using the skin lightening cream. 28
One study indicated a large proportion of nephrotic syndrome among African women using ammoniated mercuric chloridecontaining skin lightening creams for periods ranging from one month to three years. Over three quarters of the women who stopped using the creams went into remission. 9,29
Mercury in soaps, creams and other cosmetic products is eventually discharged into wastewater. The mercury then enters the environment, where it becomes methylated and enters the food-chain as the highly toxic methylmercury in fish. Pregnant women who consume fish containing methylmercury transfer the mercury to their fetuses, which can later result in neurodevelopmental deficits in the children. 2
Exposure to inorganic mercury can be quantified through measurements in blood and urine. 10
Regulations Distribution of mercury-containing creams and soaps is banned in the European Union and numerous African nations. 2,24,30
A European Union Directive specifies that mercury and mercury compounds are not allowed as ingredients in cosmetics (including soaps, lotions, shampoos and skin bleaching products). However, phenyl mercuric salts for use as a preservative in eye makeup and eye makeup removal products are allowed at concentrations equal to or less than 0.007% by weight. 1
The United States Food and Drug Administration allows mercury compounds in eye area cosmetics at concentrations at or below 65 mg/kg expressed as mercury (approximately 100 mg/kg expressed as phenylmercuric acetate or nitrate). 31
All other cosmetics must contain mercury at a concentration less than 1 mg/kg. The presence of mercury must be unavoidable under good manufacturing practice. 31
Health Canadas draft guidance on heavy metal impurities in cosmetics specifies a limit of 3 mg/kg for mercury as an impurity in cosmetic products. 32-34
The Philippines is reported to have banned skin
lightening products with mercury levels exceeding the national regulatory limit of 1 mg/kg in 2011. 23
Conclusions Mercury-containing skin lightening products are hazardous to health and as a result have been banned Continued on page 68
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Continued from page 67- MERCURY IN SKIN LIGHTENING PRODUCTS in many countries. However, there are reports of such products still being available to consumers, and they are advertised on the Internet. For example, the Texas Department of State Health Services reported the availability of a mercury-containing beauty cream on 1 September 2011. 27
Public awareness needs to be raised regarding the types of products and the specific products that contain mercury and the risks associated with mercury exposure. The 2011 survey described previously states that Consumers gravitated to known mercury-free choices in countries that had government seals and/or regulation about mercury content. 24
Information on alternatives must also be provided, because skin lightening products that do not contain mercury may contain other hazardous substances. Regulatory body Limits for cosmetics other than eye area products European Union Banned 30
Many African nations Banned 2,24
United States Food and Drug Administration < 1 mg/kg 31
Health Canada 3 mg/kg 3234
Philippines Food and Drug Administration 1 mg/kg 23
Regulatory body Limits for eye area products European Union 0.007% by weight 1
United States Food and Drug Administration 65 mg/kg expressed as mercury (approximately 100 mg/kg expressed as phenylmercuric acetate or nitrate) 31
References 12. UNEP (2008). Mercury in products and wastes. Geneva, United Nations Environment Programme, Division of Technology, Industry and Economics, Chemicals Branch(http://www.unep.org/hazardoussubstances/LinkCli ck.aspx?fileticket=atOtPM- tTmU%3d&tabid=4022&language=en-US). 1. Glahder CM, Appel PWU, Asmund G (1999). Mercury in soap in Tanzania. Copenhagen, Ministry of Environment and Energy, National Environmental Research Institute (NERI Technical Report No. 306; http://www2.dmu.dk/1_viden/2_publikationer/3_fagrapport er/rapporter/fr306.pdf). 2. Ladizinski B, Mistry N, Kundu RV (2011). Widespread use of toxic skin lightening compounds: medical and psycho- social aspects. Dermatologic Clinics, 29:111123. 3. UNEP/WHO (2008). Guidance for identifying populations at risk from mercury exposure. Geneva, World Health Organization (http://www.who.int/entity/foodsafety/publications/chem/m ercury/en/). 4. Lindsey K, Balagizi I, Hirt HM (2009). Be black and beautiful. Winnenden, anamed international. New York City Department of Health and Mental Hygiene (2011). Mercury in soaps and creams. New York, NY, Department of Health and Mental Hygiene (http://www.nyc.gov/html/doh/html/epi/mercury_sc.shtml). 5. McKelvey W, Jeffery N, Clark N, Kass D, Parsons PJ (2011). Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City. Environmental Health Perspectives, 119(2):203209. 6. Engler DE (2005). Letter to the editor: Mercury bleaching creams. Journal of the American Academy of Dermatology, 52(6):11131114. Continued on page 60 7. IPCS (2003). Elemental mercury and inorganic mercury compounds: human health aspects. Geneva, World Health Organization, International Programme on Chemical Safety (Concise International Chemical Assessment Document 50; http://www.who.int/entity/ipcs/publications/cicad/en/cicad5 0.pdf). 8. ATSDR (1999). Toxicological profile for mercury. Atlanta, GA, Agency for Toxic Substances & Disease Registry (http://www.atsdr.cdc.gov/toxprofiles/TP.asp?id=115&tid =24). 9. WHO (2007). Exposure to mercury: a major public health concern. Geneva, World Health Organization (Preventing disease through healthy environments series; http://www.who.int/phe/news/Mercury-flyer.pdf). 10. Al-Saleh I, Al-Doush I (1997). Mercury content in skin- lightening creams and potential hazards to the health of Saudi women. Journal of Toxicology and Environmental Health, 51(2):123130. 11. RAPEX (2007). The Rapid Alert System for Non-Food Products, 2007 week 29, No. 22, Reference 0732/07 (http://ec.europa.eu/consumers/dyna/rapex/create_rapex.cf m?rx_id=142). 14. RAPEX (2009). The Rapid Alert System for Non-Food Continued on page 69
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Continued from page 68- MERCURY IN SKIN LIGHTENING PRODUCTS Products, 2009 week 49, No. 8, Reference 1625/09 (http://ec.europa.eu/consumers/dyna/rapex/create_rapex .cfm?rx_id=268). 15. RAPEX (2009). The Rapid Alert System for Non-Food Products, 2009 week 28, No. 3, Reference 0954/09 (http://ec.europa.eu/consumers/dyna/rapex/create_rapex .cfm?rx_id=268). 16. RAPEX (2009). The Rapid Alert System for Non-Food Products, 2009 week 28, No. 3, Reference RAPEX (2009). The Rapid Alert System for Non-Food Products, 2009 week 28, No. 3, Reference 0954/09 (http://ec.europa.eu/consumers/dyna/rapex/create_rapex .cfm?rx_id=245).
17. RAPEX (2006). The Rapid Alert System for Non-Food Products, 2006 week 31, No. 13, Reference 0491/06 (http://ec.europa.eu/consumers/dyna/rapex/create_rapex .cfm?rx_id=91). 18. USFDA (2011). Import alert: Detention without physical examination of skin whitening creams containing mercury. Silver Spring, MD, United States Department of Health and Human Services, Food and Drug Administration (Import Alert No. 53-18; http://www.accessdata.fda.gov/cms_ia/importalert_137.h tml). 17. RAPEX (2009). The Rapid Alert System for Non-Food Products, 2009 week 49, No. 8, Reference 1625/09 (http://ec.europa.eu/consumers/dyna/rapex/create_rapex .cfm?rx_id=268).
18. RAPEX (2009). The Rapid Alert System for Non-Food Products, 2009 week 28, No. 3, Reference 0954/09(http://ec.europa.eu/consumers/dyna/rapex/creat e_rapex.cfm?rx_id=268).
19. RAPEX (2009). The Rapid Alert System for Non-Food Products, 2009 week 28, No. 3, Reference 0954/09(http://ec.europa.eu/consumers/dyna/rapex/creat e_rapex.cfm?rx_id=245). 20. RAPEX (2006). The Rapid Alert System for Non-Food Products, 2006 week 31, No. 13, Reference 0491/06 (http://ec.europa.eu/consumers/dyna/rapex/create_rapex .cfm?rx_id=91). 21. USFDA (2011). Import alert: Detention without physical examination of skin whitening creams containing mercury. Silver Spring, MD, United States Department of Health and Human Services, Food and Drug Administration (Import Alert No. 53-18; http://www.accessdata.fda.gov/cms_ia/importalert_137.h tml). 22. USFDA (2011). Import alert: Detention without physical examination of unapproved new drugs promoted in the U.S. Silver Spring, MD, United States Department of Health and Human Services, Food and Drug Administration (Import Alert No. 66-41; http://www.accessdata.fda.gov/cms_ia/importalert_190.html). 23. RAPEX (2006). The Rapid Alert System for Non-Food Products, 2006 week 24, No. 16, Reference 0356/06 http://ec.europa.eu/consumers/dyna/rapex/create_rapex.cfm? rx_id=83). 24. Peregrino CP, Moreno MV, Miranda SV, Rubio AD, Leal LO (2011). Mercury levels in locally manufactured Mexican skin- lightening creams. International due-to-mercury- content/8021). 25. Anonymous (2011). FDA bans skin whitening products due to mercury content. The Manila Paper, 6 August 2011 (http://manila-paper.net/fda-bans-skin-whitening-products- Journal of Environmental Research and Public Health, 8(6):25162523. 26. Market analysis of some mercury-containing products and their mercury-free alternatives in selected regions. Gesellschaft fr Anlagenund Reaktorsicherheit (GRS) mbH, March http://www.ipen.org/ipenweb/documents/ipen%20documents/ grs253.pdf). 27. Weinberg J (2010). An NGO introduction to mercury(GRS- 253; pollution. International POPs Elimination Network (http://www.ipen.org/ipenweb/documents/book/ipen%20merc ury%20booklet_s.pdf). 28. MDH (2011). Skin-lightening products found to contain mercury. Minnesota Department of Health (http://www.health.state.mn.us/topics/skin/). 29. Texas DSHS (2011). DSHS warns of mercury poisoning linked to Mexican beauty cream. News release, 1 September 2011. Texas Department of State Health Services (http://www.dshs.state.tx.us/news/releases/20110901.shtm) 30. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, Fung KS, Chan HWH, Tong KL (2006). Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Medical Journal, 12(4):316318. 31. Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA, Cameron HM (1972). Nephrotic syndrome in adult Africans in Nairobi. British Medical Journal, 2(5806):131134. 32. IPCS (1991). Mercury-containing cream and soap. In: Inorganic mercury. Geneva, World Health Organization, International Programme on Chemical Safety (Environmental Health Criteria 118; http://www.inchem.org/documents/ehc/ehc/ehc118.htm#Sectio nNumber:3.5). 33. USFDA (2000). Cosmetics: ingredients prohibited & restricted by FDA regulations. Updated May 30, 2000. Silver Spring, MD, United States Department of Health and Human Services, Food and Drug Administration (http://www.fda.gov/Cosmetics/ProductandIngredientSafety/S electedCosmeticIngredients/ucm127406.htm). Continued on page 70
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Continued from page 69 - MERCURY IN SKIN LIGHTENING PRODUCTS 34. IPCS (1991). Mercury-containing cream and soap. In: Inorganic mercury. Geneva, World Health Organization, International Programme on Chemical Safety(Environmental Health Criteria 118; http://www.inchem.org/documents/ehc/ehc/ehc118.htm#Se ctionNumber:3.5). World Health Organization 2011 For further WHO information on mercury, please visit: http://www.who.int/ipcs/assessment/public_health/mercury/en/ index.html Financial support for this publication was provided by the German Ministry of Environment, Nature Conservation and Nuclear Safety. http://www.who.int/ipcs/assessment/public_health/mercury_fl yer.pdf
Continued from page 59- Mercury general population is generally not exposed to levels high enough to produce these effects. People who eat fish containing organic mercury or grains treated with organic mercury for a long time can have permanent damage to the brain, kidneys, and the growing fetus. The amounts of organic mercury that cause these effects are higher than the amounts to which the general population is exposed daily. Exposure to organic mercury may cause brain damage in developing fetus. Exposure to organic mercury is also dangerous for young children because their nervous systems are more sensitive to these compounds. Kidney effects occur in animals exposed to low levels of organic mercury. Low level exposure to organic mercury may also reduce the ability of animals to have babies. However, no studies are available to determine if this effect can occur in humans. There is no information to show that mercury causes cancer in humans or animals. National Toxicology Program (NTP), EPA, and the International Agency for Research on Cancer (IARC) have not classified mercury as to its human carcinogenicity. Information excerpted from: Toxicological Profile for Mercury October 1992 Draft Update, Agency for Toxic Substances and Disease Registry United States Public Health Service http://www.eco-usa.net/toxics/chemicals/mercury.shtml
Epidemiology of Acute Kidney Injury in Africa By Naicker S, Aboud O, Gharbi MB. Semin Nephrol. 2008 Jul;28(4):348-53. doi: 10.1016/j.semnephrol.2008.04.003. Source Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa. Saraldevi.Naicker@wits.ac.za Abstract Acute kidney injury (AKI) is a challenging problem in Africa because of the burden of disease (especially human immunodeficiency virus [HIV]-related AKI in sub-Saharan Africa, diarrheal disease, malaria, and nephrotoxins), late presentation of patients to health care facilities, and the lack of resources to support patients with established AKI in many countries. The pattern of AKI is vastly different from that in more developed countries. There are no reliable statistics about the incidence of AKI in Africa. Infections (malaria, HIV, diarrheal diseases, and others), nephrotoxins, and obstetric and surgical complications are the major etiologies in Africa. AKI in hospitalized antiretroviral therapy (ART)-naive HIV-1-infected patients is associated with a 6-fold higher risk of in-hospital mortality. The most common risk factors are severe immunosuppression (CD4 count, <200 cells/mm(3)) and opportunistic infection. The most common causes are acute tubular necrosis and thrombotic microangiopathy. In the post-ART era, HIV-1- infected patients with AKI still have an increased risk of in- hospital mortality and these episodes of AKI seem more frequent in the first year of ART. Subsequently, survival is comparable in those with and without HIV infection. More resources are required to prevent AKI and to provide renal support for those patients requiring dialytic therapy. PMID:18620957 http://www.ncbi.nlm.nih.gov/pubmed/18620957
Side Effects of Antiretroviral Treatment: HIV and Kidney Disease (AIDS 2010) By Abby Horstmann and Caitlin McHugh August 27, 2010 People with HIV should be screened regularly for kidney disease because even slight kidney damage can lead to an increased risk of heart problems, according to a presentation Continued on page 71
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Continued from page 70 Side Effects of Antiretroviral Treatment: HIV And Kidney Disease (AIDS 2010) at the 2010 International AIDS Conference in Vienna, Austria. Dr. Mohamed Atta, an Associate Professor of Medicine in nephrology at the Johns Hopkins School of Medicine and medical director of the Dialysis Center at DaVita Health Care in Baltimore, spoke about kidney complications and deferred versus early HIV treatment at a session on side effects of antiretroviral therapy. Kidney disease is a common problem in HIV-positive adults, with chronic kidney disease affecting an estimated 15 percent to 20 percent of people with HIV. Kidney damage can be caused either by HIV itself if left untreated, which is called HIV-associated nephropathy (HIVAN), or by antiretrovirals used to treat HIV. Both types of kidney damage are worrisome because studies have shown that even slight kidney malfunction is a significant predictor of heart complications and death due to heart disease. When investigators actually started looking at the best predictor of cardiovascular outcome, it was microalbuminuria, said Dr. Atta. Microalbuminuria is the presence of a small amount of a protein, called albumin, in the urine and is an early sign of kidney damage. Protein in the urine is often a sign of kidney malfunction. Studies have found that even the smallest indication of protein in the urine is associated with increased heart failure and mortality, regardless of HIV status. Treatment and prevention of kidney disease depends on its cause. HIV-associated nephropathy is usually a sign that HIV has progressed to the point that antiretroviral treatment is needed. It rarely shows up in people who do not have advanced HIV infections. We showedthat patients [with HIVAN] who were treated with antiretroviral therapy have better [kidney] survival versus those who were not treated with HAART [highly active antiretroviral therapy]. This is why now the guidelines recommend that HIVAN is an indication to start HAART, said Dr. Atta. However, there is some evidence that antiretroviral therapy itself can also lead to kidney damage. Crixivan (indinavir) has been associated with formation of kidney stones. Viread (tenofovir) has also been linked to kidney damage, although the reason for the damage is not yet clear.
Dr. Atta also discussed a recent European study that found an association between chronic kidney disease and use of Viread, Crixivan, Reyataz (atazanavir), or Kaletra (lopinavir/ritonavir). The potential for antiretrovirals to cause kidney damage leads to the question of whether treatment should be delayed to help spare the kidneys. In my mind, as a nephrocentric [kidney-focused] person, the deferred treatment carries the risk of heightened HIV- associated nephropathy; the early treatment is associated with heart toxicity and metabolic derangement, said Dr. Atta. In the end, he said, There is no evidence of benefit from the [kidney] standpoint of early HIV treatment unless it is necessary to treat HIVAN. However, he said, HIVAN is usually a late manifestation of HIV. Dr. Atta concluded by stating that physicians should screen all HIV patients for kidney function, whether taking antiretrovirals or not, and that high-risk patients should be monitored for kidney disease on a regular basis. http://www.aidsbeacon.com/news/2010/08/27/side-effects-of- antiretroviral-treatment-hiv-and-kidney-disease-aids-2010/
Kidney Dialysis By Dr Andrew Stein Dialysis, from the Greek word meaning to separate, is a technique that separates the good and bad things in the blood; then cleans the bad wastes from the body. This is usually the function performed by the kidney. What is dialysis? Healthy kidneys clean the blood by removing excess fluid, salt and wastes. When they fail, harmful wastes build up, blood pressure may rise, and the body may retain excess fluid. When this happens, treatment dialysis or a kidney transplant - is needed to replace the work of the failed kidneys, which is known as end-stage renal failure (ESRF). There are two main types of dialysis in ESRF: Haemodialysis Peritoneal dialysis Each provides about five per cent of the function of two normal kidneys. Haemodialysis Haemodialysis (HD) is the most common method used to Continued on page 72
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Continued from page 71 Kidney Dialysis treat ESRF and has been available since the 1960s. Despite some advances in dialysis machines in recent years, HD is still a complicated and inconvenient therapy requiring a coordinated effort from a large healthcare team, including: GP Nephrologist (kidney doctor) Dialysis nurse Dialysis technician Dietitian Social worker One important step before starting HD is a small operation to prepare a site on the body. One of the arteries in your arm is re-routed to join a vein, forming a fistula. Blood is removed from the fistula, cleaned and returned to it, allowing dialysis process to take place. Needles are inserted into a fistula (the point of access to the bloodstream) at the start of HD. You may find this one of the hardest parts, although most people report getting used to them after a few sessions. If its painful, an anesthetic cream or spray can be applied to the skin. In HD, blood is allowed to flow, a small amount at a time, through a special filter (the dialyser or artificial kidney) that removes wastes and extra fluids. The clean blood is then returned to your body via the fistula. This helps to keep the correct amount of water in the body, control blood pressure - and keep the proper balance of chemicals such as potassium, sodium and acid. Most people have HD three times a week for three to five hours, with a morning, afternoon or evening slot; depending on availability and capacity at a dialysis unit, usually in a large hospital. Some receive it at a smaller satellite unit nearer home, and a few have HD in their own homes. By learning about the treatment, and working with your healthcare team, its possible to have a full, active life. Peritoneal dialysis Peritoneal dialysis (PD) became an alternative to HD in the 1980s, with many preferring the independence it brings them. It means you dont have to have dialysis sessions at a unit, but can give treatments at home, at work or on holiday. Like HD, by learning about the treatment, and working with the medical team, its possible to have a full and active life. In PD, a soft tube called a catheter is used to fill the abdomen with a cleansing liquid called dialysis solution. The abdominal cavity is lined with a layer called the peritoneum. Waste products and extra fluid (and salt) then pass through the peritoneum from the blood into the dialysis solution. They then leave the body when the dialysis solution is drained. This used solution is then thrown away. The process of draining and filling is called an exchange and takes about 30 to 40 minutes. The period the dialysis solution is in the abdomen is called the dwell time. A typical schedule is four exchanges a day, each with a dwell time of four to eight hours. There are many forms of PD. One doesnt even require a machine and its possible to walk around with the dialysis solution in your abdomen. Talk to your specialist about whats best for your particular situation. Whatever form is chosen, an operation is needed to have the soft catheter placed in the abdomen, which will carry the dialysis solution in and out of the abdomen. Its usually inserted two weeks before dialysis proceeds, to allow scar tissue to build up that will hold it in place. http://www.bbc.co.uk/health/physical_health/conditions/in_dept h/kidneys/kidneys_dialysis.shtml
Patient killed by Rabies from Organ Transplant, CDC says By Maggie Fox March 16, 2013 Rabies killed a patient who got a kidney transplant more than a year ago, federal officials said Friday. Now they are treating three other people who got a second kidney, a heart and a liver from the same patient who apparently died either of undiagonosed rabies, or who had the virus without showing any symptoms. The donor died in Florida, and the heart, kidneys and liver from the patient were transplanted into three other people, the Centers for Disease Control and Prevention said. Doctors did not suspect rabies killed the donor and did not test for the virus, the CDC said. "Rabies was only recently confirmed as the cause of death after the current investigation began in Maryland," the CDC said. "Shortly before becoming ill, the donor had moved to Florida, but was a previous resident of North Carolina where it is believed the exposure may have occurred. How the donor may have gotten rabies is currently under investigation," the CDC said in a statement. Continued on page 75
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African Traditional Herbal Research Clinic Volume 8, Issue 2 NEWSLETTER February/March 2013 FEATURED ARTICLES Kidney Failure: Causes, Treatment and Prevention PAX HERBALS 28 July 2009 The Kidneys are two bean-shaped organs located close to the back. Although this pair of organs is relatively small, they are responsible for ensuring that the blood circulating in our body is free from harmful organisms, waste products and excess water. Your kidneys work extra hard to ensure your continued well-being. Every day, 20% of the blood pumped by the heart or approximately 200 quarts of blood passes through your kidneys for cleansing purposes. Every day, at least 2 quarts of unwanted waste materials are sifted from the blood before it is even allowed to return to general circulation. Each of these tiny organs is composed of about a million tinier units called "nephrons". Inside these nephrons, a tiny blood vessel ("glomerulus") is intertwined with a tiny urine-collecting tube (tubule). As blood passes through these nephrons, a complex interaction occurs between the glomerulus and the tubule which results in the elimination of wastes in the blood. These waste materials then enter the urinary tract and end up being excreted in the urine. Aside from sifting the unwanted materials from the blood, the kidneys also take charge of the following functions: Regulation of the composition of the blood. Maintenance of the ideal concentrations of vital substances and ions in the blood Sustaining the proper volume of water in the body Eliminating toxic wastes from the body Maintaining the acid-base concentration of the blood Normalizing blood pressure Promoting the production of red blood cells Maintaining the ideal calcium level in the body Despite the numerous tasks performed by the kidneys to ensure our safety, it is sad to note that there are a lot of people who neglect to take care of their kidneys properly. World Health Organization (WHO) statistics reveal that the death rate from intrinsic kidney and urinary tract disease was one million in the year 2002; ranking twelfth on the list of major causes of death In sub-Saharan Africa, and indeed also in Nigeria, hypertension and diabetes mellitus are among the leading causes of end- stage renal disease. By 2020, the burden of diabetes and cardiovascular disease will have increased by 130% in Africa alone. TYPES OF KIDNEY DISEASE Glomerulonephritis This refers to diseases that damage the glomeruli structures (inflammation) within the kidney responsible for the filtration in the kidneys. Diseases that are not properly treated help the body to produce antibodies and the kidneys in a bid to deal with them may get overburdened. Analgesic Nephropathy This does damage to the kidneys as a result of wrong or misuse of analgesics without proper prescription over a long time. Bleaching Creams and soaps containing heavy metal (mercury) may overburden the kidneys. Polycystic Kidney Disease An inherited kidney disease that causes large fluid filled cysts to develop in the kidney. These cysts may eventually crowd out normal kidney tissues, thus reducing its effectiveness or even or even cause its functions to cease. Other diseases may include: Sickle Cell Disease Through reduced blood flow and oxygen, which will stress kidney functioning. Drug Nephropathy Damage to the kidneys because drugs and use of medications have destroyed the kidneys. Indiscriminate use of anti-malaria drugs can damage the kidney. Continued on page 74
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Continued from page 73 Kidney Failure: Causes, Treatment and Prevention Other Causes Kidney disease also has other causes, which include collagen vascular disease such as lupus, cancer, congenital defects. CAUSES OF KIDNEY FAILURE Kidney failure may show no symptoms until it reaches an advanced stage. However, some identified causes include: Hypertension Is the leading cause of kidney failure in Nigeria. This refers to a higher than normal amount of blood pressure. It may cause no symptoms until it is advanced. This is why it is often referred to as a silent killer. Because hypertension causes no symptoms and medications are expensive and may cause unwanted side effects, many find compliance with required treatment difficult and this further compound the problem of hypertension related kidney disease. Diabetes This is the second leading course of kidney failure in Nigeria. This in general means that blood glucose levels are excessively high. Type I diabetes occurs when the body's immune system destroys the insulin producing cells in the pancreases. Type II diabetes, the body does not make enough insulin or cannot use insulin properly. Tiny amounts of proteins in urine are an early sign of kidney damage in patients with diabetes. HIV/AIDS This is fast becoming one of the major causes of kidney failure in Nigeria. HIV/AIDS will increase load on the kidneys and may lead eventually to its failure. Prevention So, what can we do to prevent this from happening? We need to start taking care of our health and to pay attention to our kidneys as well. To avoid developing kidney troubles, it is therefore necessary to maintain a healthy lifestyle. You may start by considering the following tips: A kidney transplant, which costs at least N4.5 million, provides the patient with a healthy kidney from a donor but it often requires a lot more in terms of finances. When donors (which so far in Nigeria have been living relatives, spouses or friends) is found, their
suitability for surgery is determined and they are tested to determine if their blood suitability for surgery is determined and they are tested to determine if their blood type and other issue factors match the patients. Some of these investigations are done abroad and this helps to compound the cost of the surgeries. After the surgery, transplant patients must take immunosuppressant drugs, which keep their bodies from fighting and destroying the transplanted organ and these drugs must be taken for life with a combination of other drugs, which are usually not in stock by regular pharmacists due to their high cost. When required, they are often imported specially for the patients' use. Natural Remedies Protein is restricted to decrease the protein load on the kidney and slow down the progression of kidney disease. Sodium may be restricted to improve blood pressure control and to avoid fluid accumulation. Potassium is restricted if it is not excreted effectively and levels in the blood are high. When you have too much potassium in your blood, dangerous heart rhythms may result. When you have kidney failure, the amount of urine your body produces may decrease. The amount of fluids you can drink each day is based on the amount of urine you produce in a 24-hour period. Other considerations on whether fluid must be restricted are the amount of fluid you retain, the level of sodium in your diet, whether you use diuretics, and whether you have congestive heart failure. Your diet will determine whether you survive kidney disease or not. Limit the amount of sodium [salt, common in canned food, fast-foods, processed cheese, and smoked meats. Instead, use lemon, herbs, and other spices to improve the flavor of your meals. Kidney patients should limit the amount of protein they eat. Learn about the sources of protein. Most people know that meats, fish, and dairy products contain protein. They may not know that foods such as breads, cereals, beans and vegetables also contain protein. As a general rule, avoid processed food. Keep away from milk, yogurt, or ice cream. Avoid nuts, peanut butter, seeds, lentils, peas, and beans. Avoid drinks such as beer, cola drinks, and cocoa. Since the kidney is a sensitive organ in the body, consult your health care provider for prescription of herbal remedies. Self-medication could be fatal. 1. Drink plenty of fluids. We've all heard that drinking eight to ten glasses of water each day promotes better health, but do you know why? Continued on page 75
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Continued from page 74 Kidney Failure: Causes, Treatment and Prevention Although the kidneys act as more of a filter than a reservoir, toxins can build up if there isn't enough water pressure to push them through to the urinary tract for excretion 2. Avoid caffeine. Don't get hooked on drinking multiple cups of caffeine beverages each day. Your kidneys will be forced to work harder and pump out fluid and a toxin when they become dehydrated by caffeine's purging effect and more active by its metabolism- boosting powers. If you find that you are urinating several times a day more than you used to, try cutting back on caffeine products to see if that helps. Too much caffeine isn't good for your body in many ways, and kidney stress is one of them. 3. Cut back on bumpy road rides. Long-distance truck drivers may have a higher incidence of kidney bruising or damage than people in other occupations. Until the possible link is confirmed or disproved, try to take long rides in comfortable seats, and stop for frequent breaks to get out of the vehicle and stretch your legs, which will be good for your back as well as your kidneys and other organs. 4. Eat cleansing foods. Nigeria is full of good, nourishing foods. Water melon juice helps to reduce bacteria in the urinary tract by keeping it from sticking to tissues where it can build up and cause an infection. A few glasses of this refreshing beverage each week might be enough to promote better kidney health. Some practitioners claim that white rice is a good food for cleansing the body. You may want to include this in your diet on occasion, as well. You will feel better about taking control of your health when you use tips like these to protect your kidneys. 5. Treatment The typical renal patient has a 3 to 5 hour dialysis treatment; three times per week and dialysis can only replace only about 10% to 15% of the function of healthy kidneys. In Nigeria, each session of dialysis treatment will cost an average of N25, 000.00 (twenty- five thousand naira) or N75, 000 per week or N900, 000 per year, a cost much more than the average Nigerian worker can bear. The incidence of kidney disease cuts across most ages and the prevalence is among patients aged between 20
and 50 years. This means that a significant number falls within the working population and may pose a serious threat to the future of Nigeria's economy. This means that something must be done now. All hands must be on deck to offer solutions to this problem. Kidney failure or end stage renal disease is becoming a major issue in Nigeria due to increase in its incidence. Available statistics indicate that kidney failure is increasing world -wide by approximately 7% annually and incidence in Nigeria could be as high as 10 per million population. http://paxherbals.net/herbal-remedy/
Continued from page 72 Patient killed by Rabies from Organ Transplant, CDC says The agency is not naming any of the patients involved. "In 2011, the donor became ill and was admitted to a healthcare facility in Florida and then died. At that time, the donors organs, including the kidneys, heart, and liver, were recovered and sent to recipients in Florida, Georgia, Illinois, and Maryland," the CDC said. Potential organ donors in the United States are screened and tested for viruses, bacteria and other infections. But rabies isn't one of the usual microbes that is tested for, in part because the test takes too long and in part because rabies is so rare in people. People can become infected with rabies without knowing it. It is transmitted in saliva -- which is why animal bites are dangerous -- and blood. But vaccination after a bite can prevent symptoms. Once a patient develops symptoms from rabies, it is almost always fatal. Bats are the most common cause of rabies infection, while raccoons, skunks, and foxes are the most commonly reported rabid animals. "CDCs preliminary laboratory analysis indicates that the recipient and the donor both had the same type of rabies virusa raccoon type. This type of rabies virus can infect not only raccoons, but also other wild and domestic animals. In the United States, only one other person is reported to have died from a raccoon-type rabies virus,' the CDC said. Genetic testing can reveal what strain of virus has infected someone and advanced testing that looks for genetic mutation scan show whether someone was directly infected by someone else. "The three other people who received organs from the donor have been identified and are currently being evaluated by their healthcare teams and receiving rabies anti-rabies shots (immune globulin and anti-rabies vaccination)," the CDC said. Continued on page 76
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Continued from page 75 Patient killed by Rabies from Organ Transplant "CDC is working with public health officials and healthcare facilities in five states (Fla., Ga., Ill., Md., and N.C.) to identify people who were in close contact with the initial donor or the four organ recipients and might need rabies post-exposure treatment," the agency says. Doctors perform 40,000 organ transplants annually worldwide. In 2011, a team at Northwestern Universitys school of medicine estimated that fewer than 1 percent of all organ transplants also transmitted an infection. More than 28,000 organ transplants are performed in the U.S. each year, while more than 114,000 people are waiting for organ transplants, according to the United Organ Sharing Network. In 2011, 6,669 people died waiting for organ transplants. Organ donors are routinely tested for hepatitis viruses, HIV, a virus called HTLV that can cause leukemia, the syphilis bacteria, West Nile virus and the parasite that causes Chagas disease. But other infections have been transmitted by organ, tissue and other transplants including the deadly brain disease called Creutzfeldt Jakob disease or CJD; herpes, cytomegalovirus and a variety of bacterial and fungal infections. Rabies is also known to have been transmitted both by cornea transplants and organ transplants most recently a batch of three organ recipients treated at Baylor University in Texas in 2004. Officials ended up treating hundreds of people who had been in contact with the organ donor and the recipients. But last August, Melissa Greenwald, chief of the Tissue and Reproduction Branch at the Food and Drug Administration raised concerns about the lack of a systematic protocol for testing organs and tissue used for transplant. Disease transmission through organ and tissue transplantation has been documented. Recognizing emerging infectious diseases in organ and tissue transplantation is challenging because of nonstandardization of donor evaluations and data collection, pathogen characteristics, and recipient surveillance, Greenwald and colleagues wrote in Emerging Infectious Diseases. Because organs, cells, and some tissue grafts cannot be subjected to sterilization steps, the risk of infectious disease transmission remains and thorough donor screening and testing is especially important.
Organ recipients are especially vulnerable because theyve usually been ill for a long time, and then must take drugs to suppress their immune systems so their bodies will tolerate the donated organ. http://vitals.nbcnews.com/_news/2013/03/15/17325083-patient- killed-by-rabies-from-organ-transplant-cdc-says
Political Mafias behind Human Organ Trafficking By Isa Ssenkumba 03 February 2011 When a man wants to murder a tiger he calls it sport, and when the tiger wants to murder him he calls it ferocity. So the distinction between crime and justice is no greater. And now when a man plans to murder a fellow man he calls it business. This automatically places murder among man's economic activities. Human trafficking and sacrifice has become a lucrative business. In fact international trafficking of body parts is the fastest growing business of organized crime fetching about $7 billion. Traffickers have turned Uganda into a gangster paradise. In 2007 the US placed Uganda on its watch list of countries dogged by human trafficking and we qualified to fall in 'Tier 2'. The Uganda Youth Development Link established that Ugandan children were being exchanged for guns and medicine in Kenya. Most of the victims are taken for marriage, sacrifice, cross border trade, domestic servitude, sex slaves or used to claim government benefits. A UK based charity AFRUCA - Africans Unite against Child Abuse estimated that between April and December 2009 over 200 Africans had been victims of human trafficking. These are mainly children from Nigeria, Sierra Leone, Kenya, Ghana, Zimbabwe, Uganda, Somalia and Sudan. Human body organs are highly demanded and people are ready to pay handsomely for these organs that include kidneys, lungs, hearts, liver, pancreases and many others. Victims of trafficking for purposes of organ removal are often recruited from vulnerable groups especially those who live in extreme poverty. Organized crime groups lure people abroad under false promises and jobs that never materialize and later convince them to sell their organs. Victims are required to take oaths of allegiance, secrecy Continued on page 77
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Continued from page 76- Political Mafias behind Human Organ Trafficking and confidentiality to bind them to their traffickers. This means that the trade is shrouded by a code of silence where people are fearful of speaking out allowing the practice to continue with little or no consequences for the perpetrators. In the US the federal law makes it illegal to buy and sell human body parts but private companies are actively but silently involved in the business. In Los Angeles a man accused of buying and selling human parts confessed in court having made $1.5 M through trafficking human organs in 2009. Through his donations to the University of California Medical School he managed to conspire with the school official when they realized that the scheme was profitable. People reportedly involved in this organized crime network always include brokers, surgeons, hospitals directors, doctors, ambulance drivers, mortuary workers and politicians. Medical and healthcare practitioners have received patients who go to hospitals for unrelated illnesses or accidents but the person's kidney is removed without their knowledge or consent. Organs are also removed from people who have been declared brain dead prematurely especially after a fatal accident Sometimes a person's death may be quickened in order to get the organs from the person. The kidnaps, killings and sale of people for purposes of organ removal is a silent undertaking by mafia politicians. Mysterious disappearance of citizens and arrests made during strikes or political violence are linked to this human organ trade from which politicians are the major beneficiaries. If a relative permanently disappears after a political strike he may have fallen victim of human organ trafficking. The Human Rights League in Mozambique and Child Line South Africa attach the increasing trafficking of human body organs to the cultural beliefs that human organs make the medicine more effective and it can solve any problem from poverty to health issues. Witch doctors always assign people with the duty of looking for human body parts. These parts are also used to ensure business prosperity like in the mills, constructions and other businesses. On 5th May 2010 a 12 year old boy was mutilated in Mozambique. His genitals and eyes were removed. The attackers confessed having been promised a pay of $ 266 if they brought the boy's parts that were to be transported to Malawi. Patrick Makonzi in Uganda decided to chop the head off his 12 year old nephew Eriya Kalule of Namusita village in kamuli district to receive 50,000 Uganda shillings ($ 21). People visit witch doctors who are said to communicate directly with the spirit for help. Ritual murderers believe that human sacrifice appeases these ancestral spirits. In Uganda witch crafty is a business advertised over radios, televisions and other media houses. Moreover this is occurring at the peak of unemployment. There is a need for countries to implement comprehensive anti-trafficking legislations, increase efforts to prosecute, convict and punish trafficking offenders, institute unified systems of documenting and collecting data on human trafficking cases for use by law enforcement. Labour and social welfare officials should be investigated and punish recruiters responsible for knowingly sending Ugandan into forced labour abroad. A national wide anti- trafficking public awareness campaign should be launched with particular focus on forced labour, human sacrifice and sale of human body parts. http://www.sunrise.ug/blogs/71-isa-ssenkumba/1906-political- mafias-behind-human-organ-trafficking.html
Herbal Therapies and the Patient with Kidney Disease By Mariana S. Markell The primary importance of the passage of urine for maintenance of health was recognized by early students of physiology, including Dioscorides and Pliny the Elder, 1st century scholars with broad knowledge of medicinal plants. 1,2 Dioscorides mentioned 12 plants which could be used for treatment of diseases of the kidneys in his De Materia Medica, while Pliny details 130 plants in his famous treatise Naturalis Historia. Unfortunately, we have not progressed much in our knowledge of the place for botanical therapy in renal diseases since that time. In this article, I will attempt to briefly review the main function(s) of the kidneys, and then discuss the potential hazards of using herbs in patients with compromised renal function. Finally, I will discuss potential benefits which could be derived from using herbs in this population and the data (meager that it is) which supports my contentions. Review of Kidney Function The two kidneys, which together weigh 200 to 320 grams, are truly the seat of homeostasis in the body. Kidney Continued on page 78
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Continued from page 77- Herbal Therapies and the Patient with Kidney Disease damage leads to disorders, not only of salt and water, but of blood and bone as well. 3 Kidney function can be broken clown into several parts: control of salt and water balance, filtration of solute, and maintenance of acid-base equilibrium and endocrine functions (see Table 1). Each function can be affected separately by therapies or, in the case of disease or toxic insult, all three may be affected. Salt and Water Balance The basic working unit of the kidney is the nephron, which contains a tuft of capillaries, called the glomerulus, and a system of tubules. Plasma is ultrafiltered across the glomerular surfaces at a rate of 135 to 180 L/day, which would result in death by dehydration if it were not largely reabsorbed. Initially, the ultrafiltrate enters the first part of the tubules, the proximal tubule, where 70% of the filtered water and sodium are reabsorbed. Further regulation occurs at the loop of Henle, where more sodium is reabsorbed and finally, at the collecting system, the final regulation of salt and water balance occurs. Sodium can be reabsorbed in the cortical collecting duct until almost none remains in the urine, and, under the control of antidiuretic hormone (ADH), water can be reabsorbed or allowed to remain in the ultrafiltrate, resulting in either a concentrated or dilute urine. Abnormal volume regulation is a major component of most renal diseases, resulting in fluid overload with secondary hypertension and, often, edema. Many herbs which have been used historically to treat diseases of the kidneys, including dandelion leaves and/or root (Taraxacum officinale), bearberry (Archtostaphylus uvaursi), parsley (Petroselinum crispum), and broom (Cytisus scoparius) have diuretic properties and probably function through alteration of sodium reabsorption or ADH action. Interestingly, dandelion root contains large quantities of inulin, an insoluble carbohydrate which is cleared similarly to creatinine (see below) and could act as an osmotic diuretic. Broom is known to contain scoparin, a glycoside which is believed to be responsible for its diuretic action. 4
Filtration of Solute/Maintenance of Acid-Base Balance The glomerular capillary wall serves as a barrier which determines which solutes are filtered. Filtration is determined by size-selectivity, as well as ionic charge. Solutes smaller than molecular weight of 6,000 are freely filtered, whereas those as large as albumin (or bound to albumin) are not (M.W. 70,000), unless the glomerulus becomes diseased. Filtration of highly negatively charged substances, regardless of size, is retarded by electrostatic repulsion due to the anionic charge on sialoproteins which are present in the glomerular basement membrane and epithelial foot processes. The glomerular filtration rate (GFR) determines the clearance, not only of sodium, but also of toxic waste products of metabolism including blood urea nitrogen (BUN) and creatinine which, in addition to filtration, undergoes active secretion at the proximal tubule. Control of GFR is multifactorial, depending on the hydrostatic pressure gradient within the glomerulus which drives fluid out (and which in turn depends on renal plasma flow rate), the plasma oncotic pressure, which counteracts the hydrostatic forces, as well as surface area of the glomerular capillary tuft and its permeability characteristics. If any of these factors are altered, through disease or administration of a drug or herb, the GFR will fall, eventually leading to renal insufficiency and retention of waste products. The kidney plays an important role in maintenance of acid- base balance. Ninety percent of filtered bicarbonate is reabsorbed in the proximal tubule through a complex series of steps involving active transport of hydrogen ions into the lumen of the tubule. The remainder is reabsorbed in the distal tubule and collecting duct. Anything which deranges tubular function (substances which are toxic or cause fibrosis) may cause acidosis through loss of bicarbonate in the urine. Control of potassium secretion occurs both in the distal tubule and (predominantly) in the collecting duct. Potassium secretion is mediated through the actions of the adrenal hormone aldosterone which is under the control of renin (see below) and serum potassium concentration. Damage to the collecting tubules rendering them insensitive to aldosterone, decreased aldosterone release due to adrenal disease or deficient renin release and decreased GFR all can cause hyperkalemia which can be life-threatening. For this reason, it is imperative to AVOID potassium-containing botanical products in patients with known tendency toward hyperkalemia. Conversely, overuse of diuretics can contribute to hypokalemia through increased delivery of sodium to the distal and collecting tubules. The kidney also controls levels of phosphate, calcium (both mediated in part via the actions of parathyroid hormone), magnesium, uric acid and various amino acids through complex mechanisms which are beyond the Continued on page 79
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Continued from page 78 Herbal Therapies and the Patient with Kidney Disease scope of this article, but which, when deranged, can lead to abnormal concentrations of these substances in the blood and/or urine. Endocrine Functions of the Kidney The glomerular blood flow is under auto-regulatory control via at least two substances: renin, released from the juxtaglomerular apparatus, and prostaglandins, which have important effects on moderating regional renal blood flow. Renin, which is stimulated in situations where renal blood flow is decreased (decreased renal mass, hypotension, renal artery stenosis, heart or liver failure, true volume depletion) acts on renin-substrate to produce angiotensin I, which is converted to angiotensin II via angiotensin-converting enzyme (ACE). Renal prostaglandins have many effects on kidney function, which differ depending on the prostaglandin type involved, and also serve to maintain GFR when renal blood flow is compromised by preferentially shunting blood to the renal cortex, which has the highest concentration of glomeruli. The result is that any substance, be it a pharmaceutical agent or herb, that depresses either angiotensin conversion or prostaglandin synthesis, can decrease renal function in the settings of compromised renal function or severe volume depletion. The proximal tubule plays a role in the maintenance of red cell volume and the conversion of vitamin D to its active metabolite. Specialized tubule cells secrete a hormone, erythropoietin, which stimulates the erythroid progenitor cells of the bone marrow to mature in response to anemia or hypoxia. 5 Inadequate synthesis secondary to kidney disease results in anemia, and requires replacement by the synthetic recombinant hormone. Vitamin D (cholecalciferol), following synthesis in the skin, undergoes 25- hydroxylation in the liver, followed by conversion to 1,25-cholecalciferol in the proximal convoluted tubule of the kidney. Synthesis of active vitamin D is stimulated by parathyroid hormone and hypophosphatemia and when it is insufficient, hypocalcemia can occur, predominantly because of deficient absorption from the intestine. Treatment of Kidney Diseases Diseases which affect the kidney are many and varied (see Table 2), as can be surmised by its myriad functions. Diseases of the glomerulus are either glomerulonephritides, which may be accompanied by blood in the urine, hypertension and inflammatory response within the kidney and glomerulonephroses, which are always accompanied by loss of protein into the urine, often accompanied by hypertension and edema. The former diseases usually result in a loss of kidney function which may or may not be reversible, while the latter are more variable in their effect on kidney function, but carry a great morbidity due to accompanying hypoalbuminemia. Diseases of the tubules are generally secondary to toxic insult, ischemia or interstitial inflammation (interstitial nephritis) which can follow exposure to pharmaceutical agents, most commonly antibiotics and nonsteroidal anti- inflammatory agents (NSAIDs). Diseases of the collecting system tend to be infectious or neoplastic in nature, or mechanical, such as obstruction by stone or blood clot. Because the kidney is a highly vascular organ, diseases of the blood vessels (vasculitides) can also affect the kidney, compromising blood flow. Constriction of the blood vessels leading to the glomerulus can alter kidney function, as can decreased blood flow due to volume depletion, sepsis, heart failure or other shock situations. Unfortunately, traditional allopathic medicine has little to offer once kidney disease occurs. Some glomerular diseases are treated with highly toxic immunosuppressive medications, but few respond. Most tubular diseases will either get better on their own, or the patient will develop end-stage renal disease (ESRD). Once ESRD occurs, the patient is given an option of hemodialysis, which requires attachment to a machine which passes the blood by a dialysis membrane through which dialysate flows in a counter-current direction. This requires on average, three to four hours per session, three times weekly. The patient may also undergo peritoneal dialysis, in which case a special catheter is implanted into the patient's peritoneal cavity and dialysate solution instilled and removed up to six times daily. Neither hemo- nor peritoneal dialysis restores the endocrine functions of the kidneys, which requires the patient to take medications for maintenance of calcium balance and avoidance of anemia. Finally, the patient may undergo transplantation of a cadaveric or living-donor kidney, which requires continuous immunosuppression, but restores all of the functions of the patient's native kidneys. Until the 1960s, there was no treatment for ESRD and all patients died from the buildup of toxic waste products which accumulated in the blood. Since that time dialysis and transplantation have become readily available in the United States, but very few references are available which address using herbal therapy to prevent progression of kidney disease. In many areas throughout the world today, however, including the Caribbean, South America and most of Asia, dialysis is only available for the wealthy or Continued on page 80
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Continued from page 79 Herbal Therapies and the Patient with Kidney Disease politically connected, and a strong tradition of treating renal disease with herbal medicines exists. Unfortunately for us, the treatments have been known mostly to local shamans or practitioners of traditional herbal medicine who closely guard their "prescriptions." Herbal Therapies In a recent review of the data available on "Medline" there were only seven references which appeared upon cross-search in "kidney" or "renal" and "herbs." Four of these references were negative and discussed recent outbreaks of severe interstitial fibrosis in a Belgian population following ingestion of a Chinese "slimming herb" mixture.( 6, 7, 8) The other references were published in Chinese journals and hinted at the possibility of affecting not only nephroses (see above) but also slowing the progress of established kidney disease.( 9, 10) The dearth of modern research stands in contrast to the interest expressed historically by herbologists; in the previously mentioned work by Pliny the Elder with 130 herbs and in a compendium of herbal medicines published in 1931, no fewer than 99 herbs were listed for the treatment of "kidney disorders or dropsy" (edema). Even a recent review of the NAPRALERT database revealed 28 herbs or classes or herbs with purported "antinephritic" or "antinephrotoxic" effects.( 11) In the sections which follow, I will discuss specific concerns which must be borne in mind when faced with a patient with compromised kidney function as well as potential areas of use for herbs in patients with kidney disease. At this point, I would state that, because of the complexity of the interplay of the kidney and many other body systems, unless one has been trained in nephrology, an herbalist or herbal practitioner should NOT prescribe herbs for a patient with renal insufficiency without discussion with the patient's primary physician. as potential areas of use for herbs in patients with kidney disease. At this point, I would state that, because of the complexity of the interplay of the kidney and many other body systems, unless one has been trained in nephrology, an herbalist or herbal practitioner should NOT prescribe herbs for a patient with renal insufficiency without discussion with the patient's primary physician. Potential Hazards of Using Botanicals in the Patient with Renal Disease As can be surmised from a review of peer-reviewed literature, there have been no controlled research projects focusing on the use of botanicals in the treatment of kidney disease, at least in the English literature. Part of the problem lies in the potential hazards of using botanicals in this population (Table 3), which are unique to the patient with renal impairment. Because the pharmacokinetic characteristics of many herbal products are not readily available, it is impossible to know whether the major route of elimination is through hepatic metabolism or renal excretion. In the latter situation, overdosing could occur once the patient has developed renal insufficiency, because of retention of metabolites or parent compounds. Many patients with renal disease, especially those who have received a kidney transplant, are on potent medications. Any herb (or drug for that matter) which affects the hepatic cytochrome p450 system, will alter the level of the fungal immuno-suppressants, cyclosporine or tacrolimus, with potentially disastrous results. Again, for that reason, a transplant physician should always be aware when an herb is administered to a transplant recipient, so that drug levels can be monitored and doses adjusted if needed. Herbs can have direct toxicity for kidney tissue. The aforementioned "Chinese herb nephropathy" is believed to result from progressive fibrosis of the renal interstitium believed to be secondary to aristolochic acid affecting intrarenal DNA. 7 Herbs which have not been widely used, or are used in high doses, should definitely be avoided in the renal population. In addition, renal function could be affected by changes in intrarenal autoregulatory hemodynamics (see above), similar to the effects of NSAIDS or angiotensin-converting enzyme (ACE) inhibitors, resulting in loss of kidney function. Theoretically, as some herbs may have anti-inflammatory properties mediated through alteration of prostaglandin synthesis, and even affect ACE inhibition, patients who unwittingly take large quantities of herbs with these properties might experience a decline in renal function. It should be remembered that most renal patients are taking a variety of pharmaceutical agents for blood pressure, and often for blood glucose control. Any herb which might potentiate the effects of the patient's medications, although it may be beneficial in allowing the patient to taper pharmaceutical agents, should be used with caution, and with the knowledge of the patient's primary physician. This is especially true in the case of patients with diabetes, whose insulin requirements fall as uremia (kidney failure) approaches due to the decreasing ability of the kidney to metabolize insulin. 12 Continued on page 81
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Continued from page 80 - Herbal Therapies and the Patient with Kidney Disease As mentioned previously, patients whose kidneys are failing or who are on dialysis often have a host of electrolyte abnormalities. Many of the herbs which have traditionally been used in the treatment of kidney disorders have diuretic properties, and some (e.g. dandelion leaf) are high in potassium. Ingestion of licorice (Glycyrrhiza glabra) has been associated with pseudo-hyperaldo-steronism, manifested by decreased potassium levels, sodium and water retention and hypertension. 13 It is imperative that patients taking such herbs have serum electrolytes measured at routine intervals in order to avoid potentially fatal hyper- or hypokalemia. A special concern of patients who are already on dialysis is the unpredictable effect dialysis will have on the clearance of the herb itself. Large substances (M.W. 500 to 40,000 daltons) and charged smaller substances are not cleared well by the dialysis membrane and may accumulate, but smaller substances, especially if they are water soluble, will be rapidly cleared, leading to unpredictable plasma levels. 14 Finally, patients who have received a kidney transplant must be concerned not only with alteration of essential drug metabolism but also with potential hepatotoxicity, as the fungally derived immunosuppressants, cyclosporine and tacrolimus, have hepatotoxic properties, especially when administered at high doses. 15 These patients should also be concerned with any herb which might stimulate the immune system. Although graft rejection occurs, for the most part through alloantigen recognition and activation of helper T-cells, B-cells and macrophages also play a role in antigen presentation and theoretically herbs such as Echinacea purpurea or Japanese mushrooms, such as shiitake, maitake and reishi, could be detrimental, especially in the immediate post- transplant period. Potential Benefits of Using Herbs in the Patient with Renal Disease Despite these concerns, I believe that botanical products could produce tremendous benefit in the patient with renal impairment/failure, if used judiciously, and in conjunction with a sympathetic allopathic kidney specialist. Table 4 lists areas in which herbs might be of benefit. Table 5 lists specific herbs which have been studied or have been reported to have renoprotective effects.
As the progressive nature of many renal diseases is believed to be secondary to inflammatory responses and platelet activation, 16 herbs which act as anti-inflammatory agents could have long-term beneficial effects. This is believed to be the mode of action (if the preliminary data can be reproduced) of the combination of Astragalus sp. and Rehmannia glutinosa (Men-shen-ling) which has been used to treat chronic glomerulonephritis in China. 9 Other herbs such as wintergreen contain methyl salicytate, which has anti-inflammatory properties. 4
The herbs which have been traditionally used, as listed in early herbals such as the 1931 A Modern Herbal of Mrs. Grieve, 4 or the more "modern" herbals such as the CD- ROM developed by Genusys 17 or the NAPRALERT database, 11 have unclear activity (if any). Theoretically, herbs with ACE-inhibitory effects might be used to decrease proteinuria, and other herbal preparations could be used as adjunctive therapy for diabetes, such as those used in diabetic patients without kidney disease 18 (see also Case Report 2) or hypertension and hyperlipidemia, 19
which often accompany kidney disease. Herbal therapies, including corn silk (Zea mays) and marshmallow (Althea officinalis), which are used as demulcents, and the aptly named gravel root (Eupatorium purpureum) and stone root (Collinsonia canadensis), as well as ellitory of the wall (Parietaria officinalis) which are purported to have "anti-lithic" and diuretic properties, have long been employed in the treatment of renal stones 20 These may have tremendous potential in the treatment of these disorders. Unfortunately, the efficacy of these herbs in the treatment of various stone disorders (calcium based vs. uric acid vs. struvite) has not been systematically studied, nor are the mechanisms of action known. In a rat model, Verbena officinalis, Lithospermum officianale, Taraxacum officianale, Equisetum arvense, Arctostaphylos uva-ursi and Arctium lappa were found to have mild antibacterial action and the ability to alkalinize the urine, which resulted in solvent action on uric acid stones. 21 For patients with stone disease accompanied by renal insufficiency, it would probably be wise to avoid herbal therapies because of uncertainty regarding the pharmaco- compounds which undergo renal excretion (or they wouldn't act on renal stones!). For hemodialysis patients, botanical approaches may turn out to be excellent substitute therapies in this population, which requires multiple pharmaceutical agents with frequent side effects. Adjunctive therapy for blood pressure control (both for hypo- and hypertension), improvement of uremic bruising via improvement of capillary fragility using bilberry
Continued on page 82
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Continued from page 81 Herbal Therapies and the Patient with Kidney Disease (Vaccinium myrtillus) or other herbs rich in bio- flavonoids, improvement or maintenance of energy levels with adaptogens or identification of herbs which enhance iron or calcium absorption might be fruitful areas for research. One of my colleagues reports that he has used150 mg of a standardized (0.5% essential oils) extract of valerian root (VaIeriana officinalis) to calm overly anxious patients during hemodialysis and allow them to complete the procedure without the drowsiness which occurs following benzodiazepine use. In renal transplant recipients, I have successfully used bilberry extract (see Case Report 1) for the treatment of prednisone-associated bruising. Cyclosporine-treated patients are at increased risk for gout, which is extremely resistant to treatment. As NSAIDs are typically contraindicated in this population because of the potential for decreasing renal function, we have utilized botanical products rich in linolenic acid (e.g. oil of evening primrose or flaxseed oil), without untoward effects (see Case Reports 2 and 3). Again, the "adaptogenic" potential of the ginsengs might be of use in these patients who undergo chronic corticosteroid therapy, although the potential for immune stimulation must be borne in mind, and such therapy should probably be reserved for stable patients in the late post-transplant period (see Case Report 2). An interesting and potentially beneficial herb for renal transplant recipients with hepatitis B or C is milk thistle (Silybum marianum). I have used this herb, at a dose of 420 mg (80% silymarin content) taken in three divided doses, in several patients. In one patient we observed a complete reversal of her liver dysfunction, which is very uncommon in immunosuppressed patients (Case Report 3). As this herb has proven hepatoprotective effects, 22 and the drugs cyclosporine and tacrolimus undergo extensive hepatic metabolism and have hepatotoxic properties, 15 it might be prudent to include milk thistle extract in every patient's regimen. Renal transplant recipients commonly develop urinary tract infection, and may require chronic antibiotic prophylaxis. Use of herbs which have antibacterial or demulcent activity (e.g. cranberry, corn silk) may be helpful in this regard. Finally, the drugs which we use as primary immunosuppressants, cyclosporine and tacrolimus, have nephrotoxic effects. 15 An isolate of ginkgolides from Ginkgo biloba, BN52063, has been shown in a rat model to protect against acute cyclosporine nephrotoxicity. 23 In addition, the same isolate has been reported to decrease the incidence of early delayed graft function in a human trial. 24 It is not known whether a standardized ginkgo extract would be as effective. Finally, several herbs 25, 26, 27 have been shown to be renoprotective in animal models of drug toxicity. After administration of a tubulotoxin such as cisplatinum or cyclosporine, it is believed that tubule cells die and the medulla becomes ischemic, resulting in the generation of free radicals by the remaining viable cells. 28 Herbs such as the ones mentioned above, and other with potent antioxidant properties, may be able to prevent damage by oxygen radicals in known situations where nephrotoxicity may result (e.g. administration of nephrotoxic drugs, exposure to radiocontrast agents). Summary and Conclusions Obviously, botanical medicine use in the patient with kidney disease is a potentially fruitful area for research. In reviewing the data available for this paper and in talking with many patients and colleagues, several observations become apparent. Although herbs have been used both in this country and in others for centuries for the treatment of kidney diseases, actual data regarding efficacy and safety are close to nonexistent. As Pliny the Elder astutely observed almost 2,000 years ago, "Experience, the most efficient teacher of all things especially in medicine, gradually degenerated into mere words and verbage. For it was pleasanter to sit diligently listening in lecture-rooms than to go into the fields and look for different plants at different seasons of the year." As the potential for patient benefit and the interest on the part both of patients and nephrologists alike are both tremendous, ideally, nephrologists, nurses, naturopaths, pharmacognosists, herbalists and others with an interest in both herbs and kidney patients will form a collaboration in order to answer some of the questions I have raised here and allow us to judiciously use herbs in this very complex patient population. Until that time, I will close by advising that the practitioner trained in herbal medicine should not consider administering botanicals to a patient with renal disease without collaborating with the patient's primary physician. I would also advise renal specialists to become familiar with herbs so that we can carefully begin to enlarge our clinical and research experience for the benefit of our patients. References (1) De Matteis Tortora M. Some plants described by Dioscorides for the treatment of renal diseases. Am I Nephrology 1994; 14:418-22. Continued on page 83
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Continued from page 82 Herbal Therapies and the Patient with Kidney Disease (2) Aliotta G, Pollio A. Useful plants in renal therapy according to Pliny the Elder. Am I Nephrology 1994; 14:399-411. (3) Rose B. Clinical Physiology of Acid-Base and Electrolyte Disorders. New York McGraw-Hill Company, 1984. (4) Greive M. A Modern Herbal, Vols. 1, 2. New York Dover Publications, 1971. (5) Dunn CJ, Markham A. Epoetin beta. A review of its pharmacologic properties and clinical use in the treatment of anaemia associated with chronic renal failure. Drugs 1996; 51(2):299-318. (6) Depierrieux M, Van Damme B, Vanden Houte K, Vanherweghem JL. Pathologic aspects of a newly described nephropathy related to the prolonged use of Chinese herbs. Am J Kidney Dis 1994; 24(2):172-80. (7) Schmeiser HH, Bieler CA, Wiessler M, van Ypersele de Strihou C, Cosyns JP. Detection of DNA adducts formed by aristolochic acid in renal tissue from patients with Chinese herbs nephropathy. Cancer Res 1996; 56(9):2025-8. (8) Cosyns JP, Jadoul M, Squifflet JP, De Plaen IF, Ferluga D, van Ypersele de Strihou C. Chinese herbs nephropathy: a clue to Balkan endemic nephropathy? Kidney Int 1994; 45(6):1680-88. (9) Su ZZ, He YY, Chen G. [Clinical and experimental study on effects of man-shen-ling oral liquid in the treatment of 100 cases of chronic nephritis] [Chinese]. Chiung-Kuo Chung Hsi Chieh Ho Tsa Chih 1993; 13(5):269-72, 259-260. (10) Li L, Wang H, Zhu S. [Hepatic albumin's m-RNA in nephrotic syndrome rats treated with Chinese herbs] [Chinese]. Chung-Hua Hsueh Tsa Chih [Chinese Medical Journal] 1995; 75(5):276-9. (11) NAPRALERT database. A natural products database maintained at the Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy, University of Illinois, Chicago, IL 60612. (12) DeFronzo RA, Castellino P. Metabolic and endocrine disturbances in uremia. In: Massry SG, Glassock RJ, eds. Textbook of Nephrology, 2nd ed. New York Williams and Wilkins, 1989, 1221-7. (13) Anon. Medical Letter on Drugs and Therapeutics 1979; 21 (7):30. (14) Van Stone JC, Daugirdas IT. Physiologic principles. In: Daugirdas IT, Ing TS, eds. Handbook of Dialysis. New York Little Brown Publishing, 1994, 13-35. (15) Gruber SA, Chan GLC, Canafax DM, Matas AI. Immunosuppression in renal transplantation. Clin Transplantation 1991; 5:65-85. (16) Couser WG, Johnson RJ. Mechanisms of progressive renal disease in glomerulonephritis. Am J Kidney Diseases 1994; 23(2):193-8. 17) Genusys Pharmacopoeia of Herbs, CD-ROM, publishers Genusys labs, Solebury, PA 18963, 1996. (18) Sotaniemi EA, Hapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care 1995; 18:1373-5. (19) Silagy C, Neil A. Garlic as a lipid-lowering agent: a meta- analysis. J Royal College(Physicians London 1994; 28(1):39-45. (20) Hoffman D. The Complete Illustrated Holistic Herbal. Rockport, MA: Element Books, 1996. (21) Grases F, Melero G, Costa-Bauza A, Prieto R, March JG. Urolithiasis and phytotherapy. Int Urol Nephrol 1994; 26(5):507-11. (22) Palasciano G, Portincasa P. The effect of silymarin on plasma levels of malondealdehyde in patients receiving long- term treatment with psychotropic drugs. Curr Ther Res 1994; 55:537. (23) Priotzky E, Colliez P, Guilmard C, Schaeverbeke J, Braquet P. Cyclosporine-induced nephrotoxicity: preventive effect of a PAF-acether antagonist, BN52063. Trans Proc 1988; 20(suppl 3):665-9. (24) Grino JM. BN 52021: a platelet activating factor antagonist for preventing post-transplant renal failure. Ann Intern Med 1994; 121(5):345-7. (25) Inselmann G., Blohmer A., Kottny W, Nellessen U, Hanel H, Heidemann HT. Modification of cisplatin-induced renal p- aminohippurate uptake alteration and lipid peroxidation by thiols, Ginkgo biloba extract, deferoxamine and torbafylline. Nephron 1995; 70:425-9. (26) Xuan W, Dong M, Dong M. Effects of a compound injection of Pyrola rotundifolia and Astragalus membranaceus Bge on experimental guinea pigs' gentamycin ototoxicity. Ann Otology Rhinol Laryngol 1995; 104(5):374-80. (27) Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996; 11:55-62. (28) Baliga R, Ueda N, Walker PD, Shah SV. Oxidant mechanisms in toxic acute renal failure. Am J Kidney Diseases 1997; 29(3):465-77 Table 1: Functions of the normal kidneys (summarized) Maintenance of blood pressure Filtration and reabsorption of sodium Maintenance of appropriate volume (water balance) Synthesis of active hormones and autocoids (renin, kinins, prostaglandins) Maintenance of electrolyte homeostasis Filtration, reabsorption and secretion of potassium Continued on page 84
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Continued from page 83 Herbal Therapies and the Patient with Kidney Disease Filtration and reabsorption of magnesium, chloride and other electrolytes Maintenance of acid-base balance (bicarbonate reabsorption, hydrogen ion secretion) Filtration and elimination of metabolic waste products (BUN, creatinine -- also secreted) Filtration, secretion and reabsorption of other solutes (amino acids, glucose) Maintenance of calcium and phosphorous balance Final hydroxylation (activation) of vitamin D Filtration and reabsorption of phosphate and calcium (PTH dependent) Maintenance of hematocrit/hemoglobin Synthesis of erythropoietin Table 2: General diseases of the kidneys (by no means all-inclusive) Glomerulopathies Glomerulonephritis Acute glomerulonephritis Rapidly progressive glomerulonephritis Chronic glomerulonephritis Nephrotic syndrome (nephrosis) Tubulopathies Toxic insult (drugs, poisons, radiocontrast dye) Ischemia (hypotension, blood loss, volume depletion) Allergic interstitial nephritis Vasculopathies Vasculitis (e.g., systemic lupus, polyarteritis nodosa, primary vasculitis) Hemodynamic disorders Thrombosis of the renal artery or vein Renal artery stenosis Overuse (or misuse) of NSAIDs or ACE inhibitors Hepatorenal syndrome Obstructive disorders Infection Renal stones Papillary necrosis (diabetes, pyelonephritis, sickle cell anemia) Tumors (extrinsic or intrinsic) Prostate disease Table 3: Potential hazards of using botanicals in patients with renal disease General: Unpredictable pharmacokinetics (under- or overdosing) Interactions with patient's pharmaceutical agents Negative effect on kidney function Toxicity for kidney tissue Hemodynamic alterations leading to decreased GFR Unpredictable effects on blood pressure or blood glucose Potentiation of electrolyte abnormalities (especially herbs with high potassium content or diuretic function) Dialysis patients (in addition to general concerns): Potential dialyzability of active compounds or metabolites -- under- or overdosing Renal transplant recipients (in addition to general concerns): Unpredictable effects on immune function Synergistic hepatotoxicity Table 4: Areas in which herbs might benefit patients with renal disease General: Decreased inflammatory response Decreased proteinuria Control of hypertension, hyperglycemia and/or hyperlipidemia Decreased rate of progression to end-stage renal disease Improved diuresis Management of renal stone disease Treatment of chronic urinary tract infection Continued on page 85
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Continued from page 84 Herbal Therapies and the Patient with Kidney Disease Dialysis patients: Improved blood pressure control (hypo- or hypertension) Decreased uremic bruising Increased energy Maintenance of calcium and iron balance Anti-anxiety therapy during hemodialysis treatment Renal transplant recipients: (in addition to general benefits) Decreased prednisone-induced bruising Treatment of gout Adaptogen effect in chronic steroid use Adaptogen effect in chronic steroid use Hepatoprotection during use of fungally derived immunosuppressants Treatment of hepatitis B and C Case Reports Case 1 Ms. F, a 61 year old woman with Addison's disease (adrenal insufficiency), history of a myocardial infarction, type I diabetes and a living-related kidney transplant over 15 years previously was plagued with severe bruising secondary to prolonged corticosteroid use and low dose aspirin. She had normal coagulation parameters (prothrombin and partial-thromboplastin time) and platelet count. Three weeks after starting bilberry extract (250 mg twice daily), she experienced lessening of her bruising. Now almost six months later, she has minimal bruising and has experienced no untoward effects of the bilberry. She also takes azathioprine, furosemide, losartan, amlodipine, erythropoietin, lovastatin, calcium, magnesium and zinc supplements. Case 2 Mr. F, a 40 year old man, with type I diabetes since childhood, received a cadaveric kidney with excellent renal function. Despite tapering the doses of his medications, his blood glucose control was erratic and he was frustrated and felt unwell at two years post- transplant. He was started on Asian ginseng extract (100 mg twice daily) and Gingko biloba extract (30 mg twice daily). Within one month, his blood glocuses improved, with glycosylated hemaglobin dropping from 8.6% to 7.9%. Two months later he developed worsening of hisblood glucose after "running out of the herbs." Resumption of therapy resulted again in improvement in his blood sugars and well-being. In addition to taking the ginseng on a six week on, two week off schedule, as well as the ginkgo, he takes garlic (1500 mg softgel), vitamin E (400 IU) and lecithin (1200 mg). He takes the lecithin for gout. He also takes prednisone, cyclosporine, furosemide, enalapril, cisapride, ranitidine, insulin and simvastatin. We have noted no interactions between his pharmaceutical and his botanical products. Case 3 Ms. G, a 36 year old woman, developed fulminant hepatitis C after receiving a cadaveric kidney transplant. She was given interferon but did not tolerate it and slowly recovered hepatic function, with bilirubins in the 2.5 to 3.5 mg/dl range. Her transaminases remained elevated continuously. At 11 months post- transplant, she was started on milk thistle extract standardized to 80% silymarin (175 mg twice daily). Within nine months, her transaminases normalized and her albumin increased from 2.9 to 3.4 mg/dl (despite nephrotic range proteinuria). One year following initiation of therapy with milk thistle, her bilirubins and transaminases were normal and her gastroenterologist sent her blood for a measurement of viral load and found that hepatitis C was no longer detectable in her serum. She has remained on cyclosporine and prednisone throughout the time and not required a change in her dose of cyclosporine in order to maintain adequate levels. In addition to milk thistle, she takes Ginkgo biloba extract standardized to 24% ginkgo flavone glycosides (50 mg twice daily), 1,000 mg of flaxseed oil (standardized to contain 594 mg alpha- linolenic acid, 144 mg linolenic acid, and 165 mg oleic acid) once daily for gout, which has been incapacitating and for which she also takes lecithin ( 1,000 mg), vitamin E (400 IU), and selenium (50 mcg). Pharmaceutical agents taken by the patient, in addition to immunosuppressive drugs, include erythropoietin, furosemide and clonidine. She also takes an iron preparation, magnesium and calcium supplementation and feels well at this time. Natural Product Research Consultants, Inc. http://www.encognitive.com/node/4622
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Drinking too much Water called Latest Threat to Health By The Gazette (Montreal) Canadian doctors are warning drinking too much water may cause loss of kidney function - something they discovered purely by accident. January 18, 2008 Canadian doctors are warning drinking too much water may cause loss of kidney function - something they discovered purely by accident. Researchers have been studying the health of residents of Walkerton, Ont., since the water supply was contaminated with E. coli in 2000. They identified 100 otherwise healthy adults who had a condition called proteinuria, or abnormal amounts of protein in their urine. None had any medical conditions or were on medications that would explain why. Proteinuria can cause kidney failure and is a sign of microvascular disease, where the heart's tiny arteries are damaged, causing cardiac disease and death. Of the 100 people, 56 agreed to follow-up testing and to reduce their fluid intake to fewer than eight large glasses per day for one week. The result? The cases of proteinuria were "largely reversed." "When we were in Walkerton we were surprised that almost five per cent of the population were drinking very large volumes of fluid," said Dr. William Clark, a scientist at Lawson Health Research Institute in London, Ont., and professor of medicine at the University of Western Ontario. "We went on the supposition that this must be because of the water contamination," meaning that when people moved to bottled water, they drank more. But Clark, project leader of the Walkerton Health Study, said most admitted to drinking vast amounts of water even before the contamination crisis, ostensibly for health reasons. They were drinking, on average, at least four litres per day. "That would be about 18 large glasses of fluid per day," he said. Some people were drinking six litres. One woman, a health-care worker, was drinking eight. "They didn't like it when we asked them to reduce their fluid intake, although they did do it," Clark said. "Most corrected their kidney abnormality.
Some did not correct completely, meaning they may have a permanent bit of damage." The study is published in this week's issue of the Canadian Medical Association Journal. "If you go on the Internet you'll get at least 500 hits on how healthy it is to drink as much water as humanly possible," Clark said. "Some health magazines recommend people drink a minimum of 12 to 15 glasses of fluid per day." But Clark said flushing the kidneys doesn't help kidney function. Even doctors believe the medical myth that people should drink at least eight glasses of water a day, according to an article published last month in the British Medical Journal, which traced the notion back to a 1945 recommendation from the U.S. Nutrition Council. Ignored in the original statement was that most of the fluid people need is found in food, especially fruits and vegetables, the researchers said. Clark's team has been screening the population of Walkerton to track for health syndromes associated with E. coli damage. The big, silent problem is kidney damage. The researchers measured urine protein levels from 2,253 adults who later attend ed a follow-up clinic annually between 2003 and 2005. Clark noticed many had increased protein excretion in the urine. The condition causes progressive loss of kidney function. After excluding diabetes or any other explanation for the problem, "we still ended up with 100 people who had no explanation whatsoever," he said. On average, they were excreting almost three times the normal rate. Treatment was simple, Clark said. "When they drank less water, the problem went away." "This was something we've never conceived of. It's not reported anywhere," Clark said. And he doesn't think the data is unique to Walkerton. "We're drinking lots of water, and people think it's healthy." "We would recommend until we know better that maybe eight glasses of fluid a day is fine but probably less than six is better, unless you're in a very arid climate or carrying out marathon running or massive exertion or have a particular kind of kidney damage and you lose salt." Fluid means "all fluids," including coffee, tea and juice. What's not known is "whether the proteinuria associated with excessive fluid intake in these otherwise healthy people will affect their kidney function in the long term," the researchers wrote in this week's journal article. http://www.canada.com/montrealgazette/news/story.html?id=378f 85de-27de-4046-815e-293b772666e5
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Risk of Water Wars rises with Scarcity Almost half of humanity will face water scarcity by 2030 and strategists from Israel to Central Asia prepare for strife. By Chris Arsenault 26 August 2012 The author Mark Twain once remarked that "whisky is for drinking; water is for fighting over" and a series of reports from intelligence agencies and research groups indicate the prospect of a water war is becoming increasingly likely. In March, a report from the office of the US Director of National Intelligence said the risk of conflict would grow as water demand is set to outstrip sustainable current supplies by 40 per cent by 2030. "These threats are real and they do raise serious national security concerns," Hillary Clinton, the US secretary of state, said after the report's release. Internationally, 780 million people lack access to safe drinking water, according to the United Nations. By 2030, 47 per cent of the worlds population will be living in areas of high water stress, according to the Organisation for Economic Co-operation and Development's Environmental Outlook to 2030 report. Some analysts worry that wars of the future will be fought over blue gold, as thirsty people, opportunistic politicians and powerful corporations battle for dwindling resources. Dangerous warnings Governments and military planners around the world are aware of the impending problem; with the US senate issuing reports with names like Avoiding Water Wars: Water Scarcity and Central Asias growing Importance for Stability in Afghanistan and Pakistan. With rapid population growth, and increased industrial demand, water withdrawals have tripled over the last 50 years, according to UN figures. "Water scarcity is an issue exacerbated by demographic pressures, climate change and pollution," said Ignacio Saiz, director of Centre for Economic and Social Rights, a social justice group. "The world's water supplies should guarantee every member of the population to cover their personal and domestic needs."
"Fundamentally, these are issues of poverty and inequality, man-made problems," he told Al Jazeera. Of all the water on earth, 97 per cent is salt water and the remaining three per cent is fresh, with less than one per cent of the planet's drinkable water readily accessible for direct human uses. Scarcity is defined as each person in an area having access to less than 1,000 cubic meters of water a year. The areas where water scarcity is the biggest problem are some of the same places where political conflicts are rife, leading to potentially explosive situations. Some experts believe the only documented case of a "water war" happened about 4,500 years ago, when the city-states of Lagash and Umma went to war in the Tigris-Euphrates basin. But Adel Darwish, a journalist and co-author of Water Wars: Coming Conflicts in the Middle East, says modern history has already seen at least two water wars. "I have [former Israeli prime minister] Ariel Sharon speaking on record saying the reason for going to war [against Arab armies] in 1967 was for water," Darwish told Al Jazeera. Some analysts believe Israel continues to occupy the Golan heights, seized from Syria in 1967, due to issues of water control, while others think the occupation is about maintaining high ground in case of future conflicts. Senegal and Mauritania also fought a war starting in 1989 over grazing rights on the River Senegal. And Syria and Iraq have fought minor skirmishes over the Euphrates River. Middle East hit hard UN studies project that 30 nations will be water scarce in 2025, up from 20 in 1990. Eighteen of them are in the Middle East and North Africa, including Egypt, Israel, Somalia, Libya and Yemen. Darwish bets that a battle between south and north Yemen will probably be the scene of the next water conflict, with other countries in the region following suit if the situation is not improved. Water shortages could cost the unstable country 750,000 jobs, slashing incomes in the poorest Arab country by as much as 25 per cent over the next decade, according to a report from the consulting firm McKinsey and Company produced for the Yemeni government in 2010. Commentators frequently blame Yemen's problems on tribal differences, but environmental scarcity may be underpinning secessionist struggles in the country's south and some general communal violence. Continued on page 88
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Continued from page 87 Risk of Water Wars rises with Scarcity "My experience in the first gulf war [when Iraq invaded Kuwait] is that natural resources are always at the heart of tribal conflicts," Darwish told Al Jazeera. The Nile is another potential flash point. In 1989, former Egyptian president Hosni Mubarak threatened to send demolition squads to a dam project in Ethiopia. "The Egyptian army still has jungle warfare brigades, even though they have no jungle," Darwish said. On the Nile, cooperation would benefit all countries involved, as they could jointly construct dams and lower the amount of water lost to evaporation, says Anton Earle, director of the Stockholm International Water Institute think-tank. "If you had an agreement between the parties, there would be more water in the system," he told Al Jazeera. The likelihood of outright war is low, he says, but there is still "a lot of conflict" which "prevents joint infrastructure projects from going ahead". Differing views Water scarcity, and potential conflicts arising from it, is linked to larger issues of population growth, increasing food prices and global warming. There are two general views about how these problems could unfold. The first dates back to the work of Thomas Malthus, an eighteenth century British clergyman and author who believed that: "The power of population is so superior to the power of the earth to produce subsistence for man, that premature death must in some shape or other visit the human race." In other words, more people and scant resources will invariably lead to discord and violence. Recent scholars, including Thomas Homer-Dixon, have analysed various case studies on environmental degradation to conclude that there is not a direct link between scarcity and violence. Instead, he believes inequality, social inclusion and other factors determine the nature and ferocity of strife. "Unequal power relations within states and conflicts between ethnic groups and social classes will be the greatest source of social tensions rising from deprivation," said Ignacio Saiz from the social justice group. "Water too often is treated as a commodity, as an instrument with which one population group can suppress another." Bolivia, South Africa, India, Botswana, Mexico and even parts of the US have seen vigorous water related protests, says Maude Barlow, author of 16 books and a
former senior adviser to the UN on water issues. "The fight over water privatisation in Cochobamba, Bolivia did turn into a bit of a water war and the army was called in," Barlow told Al Jazeera. "In Botswana, the government smashed bore holes as part of a terrible move to remove [indigenous bushmen] from the Kalahari desert. Mexico City has been forcibly taking water from the countryside, confiscating water sources from other areas and building fotresses around it, like it's a gold mine. In India, Coke will get contracts and then build fortresses around the water sources," taking drinking and irrigation water away from local people. "In Detroit 45,000, officially, have already had their water cut off." Human rights Strife over water, like conflicts more generally, will increasingly happen within states, rather than between them, Barlow says, with large scale agribusiness, mining and energy production taking control over resources at the expense of other users. The IPPC, the UN panel which analyses climate science, concluded that: "Water and its availability and quality will be the main pressures on and issues for, societies and the environment under climate change." Dealing with these pressures will require improved technologies, political will and new ideas about how humans view their relationship with the substance that sustains life. "People have the right to expect access to a basic life resource like water by virtue of being human, regardless of the social situation they are born into," Saiz said. "Alongside the worrying development of water scarcity, I am hopeful that we will see increasing struggles to see access to water as a right, and not a privilege." http://www.aljazeera.com/indepth/features/2011/06/201162219314 7231653.html
What is Cornsilk? Information & Medicinal Properties of Cornsilk What is Cornsilk? Corn Silk is a collection of the stigmas (fine, soft, yellowish threads or tassels) from the female flowers of Corn (maize), and they are four to eight inches long with a faintly sweetish taste. Cornsilk (Zea mays) is an herbal remedy made from stigmas, the yellowish thread-like strands found inside the husks of corn. The stigmas are found on the female flower of corn, a grain that is also known as maize and is a member of the grass family (Gramineae or Poaceae). The stigmas Continued on page 89
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Continued from page 88 What is Cornsilk? measure 4-8 in (10-20 cm) long and are collected for medicinal use before the plant is pollinated.
Cornsilk can also be removed from corn cobs for use as a remedy. If fertilized, the stigmas dry and become brown. Then yellow corn kernels develop. Corn is native to North America and now grows around the world in warm climates. Cornsilk is also known as mother's hair, Indian corn, maize jagnog, Turkish corn, yu mi xu, and stigmata maydis. Corn is a grass which can grow up to 3 meter. Corn forms thick stems with long leaves. The flowers of corn are monoecious: each corn plant forms male and female flowers. The male flowers form the tassel at the top and produce yellow pollen. The female flowers are situated in leave axils and form stigmas or corn silk (yellow soft threads). The purpose of the cornsilk is to catch the pollen. The cornsilk is normally light green but can have other colours such as yellow, yellow or light brown. Only cornsilk (styles and stigmas) is harvested for medicinal properties. Cornsilk should be harvested just before pollination occurs. Cornsilk can be used fresh or dried. The corn kernels (or corn) are a well known food. Cornsilk Medicinal Properties Cornsilk has detoxifying, relaxing and diuretic activity. Cornsilk is used to treat infections of the urinary and genital system, such as cystitis, prostatitis and urethritis. Cornsilk helps to reduce frequent urination caused by irritation of the bladder and is used to treat bed wetting problems. Cornsilk is found to reduce kidney stones. In China, cornsilk is traditionally used to treat oedema and jaundice. Studies indicate that cornsilk can reduces blood clotting time and reduce high blood pressure. Cornsilk Facts Corn originates from Central America but is cultivated in many countries as a food crop and as
fodder. In countries with colder climate the whole corn plant is used a cattle feed. Health Benefits of Cornsilk Corn Silk is an old remedy for urinary tract ailments, including bed-wetting, painful and frequent urination, stones, bloating, gravel in the bladder and chronic cystitis and prostatitis. It is also thought to help relieve edema and the painful swelling of carpal tunnel syndrome and gout. Corn Silk is an old-fashioned, gentle, but effective, diuretic without the loss of potassium. Some new research claims that Corn Silk may help to lower blood sugar levels and reduce blood-clotting time. Cornsilk also served as a remedy for heart trouble, jaundice, malaria, and obesity. Cornsilk is rich in vitamin K, making it useful in controlling bleeding during childbirth. It has also been used to treat gonorrhea. For more than a century, cornsilk has been a remedy for urinary conditions such as acute and inflamed bladders and painful urination. It was also used to treat the prostate. Some of those uses have continued into modern times; cornsilk is a contemporary remedy for all conditions of the urinary passage. Corn Silk is an old and effective diuretic that promotes the flow of urine, relieving excess water retention, and it has been used to treat acute and chronic bladder infection, cystitis, urethritis, prostatitis (and other prostate disorders) and also combat urinary stones. Unlike other diuretics, however, the high level of potassium in Corn Silk offsets potassium loss caused by the increased urination when used as directed. The herb is also believed to relieve bladder irritation caused by the accumulation of uric acid and gravel and eases the pain of burning urination. When Corn Silk is given to children (or adults) several hours prior to bedtime, it is said to diminish the occurrence of enuresis (bedwetting). Because it soothes bladder irritation, Corn Silk generally helps to reduce the occurrence of frequent urination problems. Corn Silk helps to ease edema and swelling caused by many inflammatory conditions, such as gout and carpal tunnel syndrome, and as a demulcent, it helps to soothe inflammation, especially inflamed mucous membranes. It is also used to alleviate the bloating and discomforts of premenstrual syndrome (PMS). Drinking cornsilk tea is a remedy to help children stop wetting their beds, a condition known as enuresis. It is also a remedy for urinary conditions experienced by the elderly. Cornsilk is used to treat urinary tract infections and kidney stones in adults. Cornsilk is regarded as a soothing diuretic Continued on page 90
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Continued from page 89 What is Cornsilk? and useful for irritation in the urinary system. This gives it added importance, since today, physicians are more concerned about the increased use of antibiotics to treat infections, especially in children. Eventually, overuse can lead to drug-resistant bacteria. Also, these drugs can cause complications in children. Furthermore, cornsilk is used in combination with other herbs to treat conditions such as cystitis (inflammation of the urinary bladder), urethritis (inflammation of the urethra), and parostitis (mumps). Cornsilk is said to prevent and remedy infections of the bladder and kidney. The tea is also believed to diminish prostate inflammation and the accom- panying pain when urinating. Since cornsilk is used as a kidney remedy and in the regulation of fluids, the herb is believed to be helpful in treating high blood pressure and water retention. Corn-silk is also used as a remedy for edema (the abnormal accumulation of fluids). Cornsilk is used to treat urinary conditions in countries including the United Sates, China, Haiti, Turkey, and Trinidad. Furthermore, in China, cornsilk as a component in an herbal formula is used to treat diabetes. In addition, cornsilk has some nonmedical uses. Cornsilk is an ingredient in cosmetic face powder. The herb used for centuries to treat urinary conditions acquired another modern-day use. Precautions Cornsilk is safe when taken in proper dosages. Before beginning herbal treatment, people should consult a physician, practitioner, or herbalist. If a person decides to collect fresh cornsilk, attention should be paid to whether the plants were sprayed with pesticides. Cornsilk Side Effects There are no known side effects when cornsilk is taken in designated therapeutic dosages. http://www.knowledgebase-script.com/demo/article- 889.html
URINALYSIS Definition Urinalysis is a test that evaluates a sample of your urine.
Urinalysis is used to detect and assess a wide range of disorders, including urinary tract infection, kidney disease and diabetes. Urinalysis involves examining the appearance, concen- tration and content of urine. Abnormal urinalysis results may point to a disease or illness. For example, a urinary tract infection can make urine look cloudy instead of clear. Increased levels of protein in urine can be a sign of kidney disease. Abnormal results of a urinalysis often require additional testing and further evaluation to uncover the source of the problem. Why it's done Urinalysis is a common test that's done for several reasons: To assess your overall health. Your doctor may recommend urinalysis as part of a routine medical examination, pregnancy checkup, pre-surgery preparation, or on hospital admission to screen for a variety of disorders, such as diabetes, kidney disease and liver disease. To diagnose a medical condition. Your doctor may suggest urinalysis if you're experiencing abdominal pain, back pain, frequent or painful urination, blood in your urine or other urinary problems. Urinalysis may help diagnose the cause of these symptoms. To monitor a medical condition. If you've been diagnosed with a medical condition, such as kidney disease or urinary tract disease, your doctor may recommend urinalysis on a regular basis to monitor your condition and treatment. Other tests, such as pregnancy testing and drug screening, also may require a sample of urine. These tests are separate from urinalysis. They test for substances in the urine that urinalysis typically doesn't include. For example, pregnancy testing measures the hormone human chorionic gonadotropin (HCG). Drug screening tests are tailored to detect specific drugs or their metabolic products, depending on the purpose of the testing. Results For urinalysis, your urine sample will be evaluated in three ways. Visual exam A laboratory technician will examine the urine's appearance. Urine is typically clear. Cloudiness or unusual odor may indicate a problem. Blood in the urine may make it look red or brown. A cloudy appearance may indicate an infection. Continued on page 91
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Continued from page 90 - Urinalysis Dipstick test A dipstick a thin, plastic stick with strips of chemicals on it is placed in the urine to detect abnormalities. The chemical strips change color if certain substances are present or if their levels are above normal. A dipstick test checks for the following: Acidity (pH). The pH level indicates the amount of acid in urine. Abnormal pH levels may indicate a kidney or urinary tract disorder. Concentration. A measure of concentration, or specific gravity, shows how concentrated particles are in your urine. Higher than normal concentration often is a result of dehydration, rather than another underlying medical condition. But, it may indicate a kidney disorder. Protein. Urine protein levels are normally low and aren't detected by a dipstick test. Small increases in protein usually aren't a cause for concern. Larger amounts of protein in the urine may indicate a kidney problem. Sugar. Normally the amount of sugar (glucose) in urine is too low to be detected. Any detection of sugar on this test usually calls for follow-up testing for diabetes. Ketones. As with sugar, any amount of ketones detected in your urine could be a sign of diabetes and requires follow-up testing. Bilirubin. Bilirubin is a product of red blood cell breakdown. Normally, bilirubin is carried in the blood and passes into your liver, where it's removed and becomes part of bile. Bilirubin in your urine may indicate liver damage or disease. Evidence of infection. Nitrites and leukocyte esterase are produced as a result of an infection. If either nitrites or leukocyte esterase a product of white blood cells is detected in your urine, it may be a sign of a urinary tract infection. Blood. The dipstick test can identify if red blood cells or other components of blood, such as hemoglobin or myoglobin, are present in your urine. Blood in your urine requires additional testing, as it may be a sign of kidney damage, infection, kidney or bladder stones, kidney or bladder cancer or blood disorders, among other conditions. Microscopic exam Several drops of the urine are examined with a microscope.
If any of the following are observed in above-average levels, additional testing may be necessary: White blood cells (leukocytes) may be a sign of an infection. Red blood cells (erythrocytes) may be a sign of kidney diseases, blood disorders or another underlying medical condition, such as bladder cancer. Epithelial cells cells that line your hollow organs and form your skin in your urine may be a sign of a tumor. But more often, they indicate that the urine sample was contaminated during the test, and a new sample is needed. Bacteria or yeasts may indicate an infection. Casts tube-shaped proteins may form as a result of kidney disorders. Crystals that form from chemicals in urine may be a sign of kidney stones. Urinalysis is not a test that provides a definitive diagnosis. Depending on the reason your doctor recommended this test, abnormal results may or may not require follow-up. Your doctor may need to evaluate the results along with those of other tests, or additional tests may be necessary to determine next steps. For example, if you are otherwise healthy and have no signs or symptoms of illness, results slightly above normal on a urinalysis may not be a cause for concern and follow-up may not be needed. However, if you've been diagnosed with kidney or urinary tract disease, elevated levels may indicate a need to alter your treatment plan. http://www.mayoclinic.com/health/urinalysis/MY00488
The Kidneys (Duality - Ying and Yang) Kidney disease can be avoided by eating a healthy diet and drinking clean water. In many cases, it is a preventable disease. The kidneys, as filters, play a vital role in the body. Herbs such as corn silk, cranberry, dandelion root, and burdock root, etc. help to flush toxins from urinary tract. Although we can live with one kidney, losing two means certain death. Kidney dialysis and transplants are not cures. The high rate of acute and chronic kidney disease and UTIS in communities worldwide is alarming. But whether it is because of diet or environment, we can do something to prevent and protect our kidneys from disease. Blackherbals A Marcus Garvey Pan-African Universitys Community Site of Knowledge
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Herbs of the Month Cranberry for Urinary Tract Infection (UTI) and E coli
Long before researchers started investigating, people believe that cranberries and cranberry juice have the ability to help prevent and treat urinary tract infections (UTIs). Recently, scientists found that cranberries contain the unusual nature of their proanthocyanidins (PACs) that is related to prevention of UTIs. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. Urinary tract infections are caused by microbes, including fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Most urinary tract infections (UTIs) are caused by one type of bacteria, Escherichia coli (E. coli). It is reported that E. coli is the cause of 8085% of urinary tract infections. Researchers found that the PACs in cranberry have a special structure (called A-type linkages) that blocks adhesion of bacteria, such as E. coli, to the urinary tract linings. In some studies, UTIs have been reduced by more than one-third through dietary consumption of cranberry. It is recommended to eat a handful of cranberries, or drink 2 to 3 cups of cranberry juice per day for prevention of UTI. http://www.naturalremediescenter.com/5044/cranberry-for- urinary-tract-infection-uti-and-e-coli/
CAL ENDAR OF EVENTS SPECIAL EVENT:
Afrikan Traditional Herbal Research Clinic 54 Muwafu Road, P.O. Box 29974 Ntinda, Kampala, Uganda East Africa Phone: +256 (0) 702 414 530 Email: clinic@blackherbals.com http://www.blackherbals.com http://www.facebook.com/blackherbals
Mission Statement Our aim at The African Traditional Herbal Research Clinic is to propagate and promote the awareness in Afrikan peoples at home and abroad of their health, biodiversity, history and cultural richness. We gather pertinent information on these issues and disseminate these freely to our people in Uganda, the rest of the continent, and anywhere in the Diaspora where Afrikans are located. One of the main ingredients for increasing poverty, sickness, exploitation and domination is ignorance of one's self, and the environment in which we live. Knowledge is power and the forces that control our lives don't want to lose control, so they won't stop at anything to keep certain knowledge from the people. Therefore, we are expecting a fight and opposition to our mission. However, we will endeavor to carry forward this work in grace and perfect ways. Where there is no God, there is no culture. Where there is no culture, there is no indigenous knowledge. Where there is no indigenous knowledge, there is no history. Where there is no history, there is no science or technology. The existing nature is made by our past. Let us protect and conserve our indigenous knowledge.