Lung Congestion sign of kidney disease (blood, plan, diet, require)
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Phlegm is mucus secreted by the, believe it or not, mucus cells of the bronchiolar lining. That's done at a baseline rate and increased by local irritation from dust, allegens, increased vagal tone, etc.
Pumonary congestion (congestion of the meat of the lungs, as opposed to the airways) is from fuid overload, and seen in conditons such as CHF or renal failure....It's the pulmonry equivalent of swollen legs.
Phlegm is mucus secreted by the, believe it or not, mucus cells of the bronchiolar lining. That's done at a baseline rate and increased by local irritation from dust, allegens, increased vagal tone, etc.
Pumonary congestion (congestion of the meat of the lungs, as opposed to the airways) is from fuid overload, and seen in conditons such as CHF or renal failure....It's the pulmonry equivalent of swollen legs.
Ok thanks. But interestingly I found very little about the connection between CKD and Pulmonary Congestion in searches including on pubmed. Can proteinurea cause this? Or is it primarily due to inability of kidneys to remove fluids? What is the treatement? Thanks for your reply?
When the kidneys are not functioning properly, they can't re-abosrb the filtered protein, so you get proteinuria....That also can lead to a reduced concentraton of protein in the blood, so you have reduced osmostic pressure, therefore more of a tendency for water to seep out of the circulation and into the tissue. (Nephrotic Syndrome)
Also, in CRF, you may have reduced ability for the kidneys to secrete water, leading to increased water content-- same resusult- fluid retention/edema.
Diseased kidneys can either be salt losing (interstitial nephritides) or salt retaining (all the other ones). Again, osmotic changes leading to fluid retention.
You usually don't actually see this stuff appear until you're approachng "End Stage RF."
Search "Uremic Lung."
By the time fluid retention becomes a real problem, the pt may require dialysis. Diuretics can be used to increase fluid excretion. Fluyid restrictions can be prescribed. Often by this time hi BP needs to be treated, and special attention must be given to supplementing or avoiding Na & K in the diet. Protein loss can be difficult to manage- the pt needs more protein, but the kidneys may not be able to secrete the extra urea produced (uremia)., so a protein restricted diet is prescribed.
Thanks much for the explaination, one further point...
Quote:
Originally Posted by guidoLaMoto
When the kidneys are not functioning properly, they can't re-abosrb the filtered protein, so you get proteinuria....That also can lead to a reduced concentraton of protein in the blood, so you have reduced osmostic pressure, therefore more of a tendency for water to seep out of the circulation and into the tissue. (Nephrotic Syndrome)
Also, in CRF, you may have reduced ability for the kidneys to secrete water, leading to increased water content-- same resusult- fluid retention/edema.
Diseased kidneys can either be salt losing (interstitial nephritides) or salt retaining (all the other ones). Again, osmotic changes leading to fluid retention.
You usually don't actually see this stuff appear until you're approachng "End Stage RF."
Search "Uremic Lung."
By the time fluid retention becomes a real problem, the pt may require dialysis. Diuretics can be used to increase fluid excretion. Fluyid restrictions can be prescribed. Often by this time hi BP needs to be treated, and special attention must be given to supplementing or avoiding Na & K in the diet. Protein loss can be difficult to manage- the pt needs more protein, but the kidneys may not be able to secrete the extra urea produced (uremia)., so a protein restricted diet is prescribed.
All the docs seem to be prescribing Angiotesin II Receptor Blockers (ARBs) but if your BP is below 120 do you really need those? On a search they have a lot of serious potential side effects. Chronic cough is one. Potassium overload I think is another? Supposedly these delay progression to ESRF? Patient has a cough with thick excess phlegm, being treated with guaifenisin.
Also some patients report using amino acid tablets to supplement or replace protein intake with good results on declining creatinine levels. Any comment on that?
Last edited by lilJohn5; 11-05-2021 at 05:28 PM..
Reason: add
Pts with CRF may experience stimulation of the renin/angiotensin sytem. ACE inhibitors will combat that-- about 10% of pts taking those will get that nagging cough. They can be switched to ARBs which don't cause the cough....ACEs (I'm not sure about ARBs) have been shown to delay progression of diabetic nephropathy, and treatment of HTN with any drugs will slow the deterioration in hypertensive nephropathy.
ACEs, ARBs & beta blockers can lead to retention of K, while most diuretics lead to excess loss of K. Careful attention to serum [k] is necessary.
Guaifenesin is an expecrtorant. It works by irritating the lining of the lungs to put out more, but a more dilute mucus, supposedly easier to cough out. Some pts like it. Some don't....If the pt's cough is really from fluid overload, it won't work, and if the cough is really an early symptom of bronchospasm, it'll make it worse.
AA supplements can be prescribed if the pt has digestive problems, but have no other advantage over plain meat or eggs. Once uremia (elevated BUN & creatinine) developes, attention to protein intake must be paid, but until creat gets up to the 4+/- range, restiction probably isn't necessary....An acute GI bleed can lead to a sudden rise in BUN & creat and sudden development of uremic neurlogical symptoms. A sudden change in mentation in a RF pt should suggest a GI bleed (particularly UGI bleed/bleeding ulcers).
A healthy adult requires about 60gm of complete protein per day to maintain good health (more if invovled in heavy work or exercize), for reference. Protein restriction to 40gm/d is often ordered for renal or liver failure and down to 20gm/d in extreme cases. Protein malnutrition impairs the immune system and can present problems in acute illness. You do what you gotta do when things aren't working properly.
Patient is currently limiting protein to 45-55gms/kg. Trying to consume vegetable protein as there is some research suggesting it's better, but I guess you think not? (tofu, soybeans, etc).
There is at least one pt online that claims he is delaying dialysis by using amino acids designed for that. Cursory reading on my part indicates that some amino acids are more harmful than others? Aromatic AA vs Branch chain amino acids. I have told him to avoid any supplements but there is significant research showing COQ10 is helpful in improving creatinine lab results, increasing urine output and delaying dialysis. It is a mictochondrial booster and stimulant with not reported side effects, but one wonders if it stresses the declining nephrons. He told me he may decide to check out on his own due to the hassles of going on dialysis, but he is not at that juncture yet. Protein was ok until about a month ago, no experiencing not severe but noticeable lower leg edema. BP is good under 120 under 80. Some slight morning nausea but disappears later.
Cough and lung mucus are bothersome and seem to be a stress on the heart,but no real symptoms of CHF. But some slight exercise intolerance. I have read that most CKD patients die from heart attacks, not from renal failure, not sure if that's true or not. Guaifenisin works well to reverse what can be described as a swollen feeling in the throat and a blocked feeling in the lungs and greatly facilitates the coughing up of phelgm and facilitates easy breathing. However it is recommend for use up to one week and probably has paradoxical effect after that. Only lasts 3-4 hours and extended does not seem to work well. Also can cause kidney stones if not taken with a good amount of water.
Last edited by lilJohn5; 11-06-2021 at 10:30 PM..
Reason: add
Pts with CRF may experience stimulation of the renin/angiotensin sytem. ACE inhibitors will combat that-- about 10% of pts taking those will get that nagging cough. They can be switched to ARBs which don't cause the cough....ACEs (I'm not sure about ARBs) have been shown to delay progression of diabetic nephropathy, and treatment of HTN with any drugs will slow the deterioration in hypertensive nephropathy.
ACEs, ARBs & beta blockers can lead to retention of K, while most diuretics lead to excess loss of K. Careful attention to serum [k] is necessary.
Guaifenesin is an expecrtorant. It works by irritating the lining of the lungs to put out more, but a more dilute mucus, supposedly easier to cough out. Some pts like it. Some don't....If the pt's cough is really from fluid overload, it won't work, and if the cough is really an early symptom of bronchospasm, it'll make it worse.
AA supplements can be prescribed if the pt has digestive problems, but have no other advantage over plain meat or eggs. Once uremia (elevated BUN & creatinine) developes, attention to protein intake must be paid, but until creat gets up to the 4+/- range, restiction probably isn't necessary....An acute GI bleed can lead to a sudden rise in BUN & creat and sudden development of uremic neurlogical symptoms. A sudden change in mentation in a RF pt should suggest a GI bleed (particularly UGI bleed/bleeding ulcers).
A healthy adult requires about 60gm of complete protein per day to maintain good health (more if invovled in heavy work or exercize), for reference. Protein restriction to 40gm/d is often ordered for renal or liver failure and down to 20gm/d in extreme cases. Protein malnutrition impairs the immune system and can present problems in acute illness. You do what you gotta do when things aren't working properly.
Actually both ARBs and ACEs have persistent cough as side effect, but more so with ACEs.
Also ARBS have been implicated in reducing GFR.
There is quite a lot of evidence that vegetable based proteins are less damaging than animal sources.
The other poster mentioned CoQ10. There is many studies showing it's beneficial effects. It's a natural substance produced by most organs, used in Europe to treat congestive hear failure.
Actually both ARBs and ACEs have persistent cough as side effect, but more so with ACEs.
Also ARBS have been implicated in reducing GFR.
There is quite a lot of evidence that vegetable based proteins are less damaging than animal sources.
The other poster mentioned CoQ10. There is many studies showing it's beneficial effects. It's a natural substance produced by most organs, used in Europe to treat congestive hear failure.
Cough is so rare with ARBs that I'd look for another cause of the cough vigorously before I condeded it was the med. GFR is also decreased with ACEs (BUN often rises) but that may represent a return to better renal artery blood flow rather than a deterioration in renal function.
Evidence that plant protein gives different results than animal is pretty flimsy. How does your kidney know if that alanine in your albumin came from a plant or animal?
CoQ10 is an intermediary in the syhnthsis chain of Chol...Cholesterol is to hormone & cell membrane synthesis as albumin is to muscle metabolism-- just a raw material used for transport to the active site....The fact that outcomes improve with additon of CoQ10 shows how important cholesterol is to healthy metabolism.
Hmmm? If cholesterol is so important to "healthy metabolism", then why do doctors recommend statins and such drugs for CKD patients? Patients are advise to keep their lipids down.
If you look at the patient reviews for ARBS on drugs dot com, you will see several complaints of coughing as a side effect. So I think not so rare.
Plant protein has less phosphorous than animal based protein and is less absorbed. Phosphorous in implicated in damage to the kidneys.
Last edited by lilJohn5; 11-10-2021 at 12:41 PM..
Reason: add
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Thanks much for the explaination, one further point...
