Question for Tim Fogarty about Renal Failure

[nicorulez]

Guys, don't freak out just yet.  Go to a family doc or internist.  Have them do a complete blood count.  If there is something amiss, they will work it up.  There could be numerous causes of elevated BP's and Dzullboy since you are so large, you have to be aware that you need to use a big cuff.  Normal cuffs won't work on a guy with 19-20 inch arms, thus you will get a falsely elevated BP.  To the other reader, if you Creatinine is high, you need to follow up ASAP.  It may be something very treatable.  Don't procrastinate and delay.  I am not only a physician; I have been a patient also.  I had cancer in my twenties (over ten years ago and all is now fine), but I too was in denial.  Finally got everything checked out and then treated.  I am fine now.  Remember, docs are there to correct the problem to the best of their ability.  They trained for many years for that ability so you might as well take advantage of them.  Peace.

[timfogarty]

To the other reader, if you Creatinine is high, you need to follow up ASAP.  It may be something very treatable.  Don't procrastinate and delay. 

this is a bodybuilding board.  bodybuilders tend to take massive amounts of creatine.  everyone's creatinine levels will show up as high

[nicorulez]

If you are taking creatine supplements, it is the fuel for muscle cells and you will have a slightly high creatinine.  However, it should ot be severely compromised.  I would consider Ronnie Coleman to have an abnormal Creatinine if his level were greater than 1.4 to 1.5 mg/dl.  The bodies filtration system is very effective, but if you gobs of muscle it can be higher.  The truest measure of glomerular filtration rate is a inulin test or possibly a iothalamate study.  However, these are very expensive and not used much except in clinical trials.  What would be more concerning is if you are spilling abnormal amounts of protein in your urine.  Thus, to be safe, I would get checked out with lab work and a urinalysis.  If you are a big guy (> 220 pounds), you may have a normally elevated creatinine of 1.2-1.3 or so.  However, if your creatinine is closer to 2.0 mg/dl you have compromised renal function plain and simple.  I understand that this is bodybuilding site Tim, however, to assume your creatinine is high simply because you are using a supplement is fallacious and foolish.  You may be missing a treatable disease and to blow it off is unwise.  I bet you if TP or other bodybuilders with renal failure would have been more fastiduous, they may have saved themselves a world of hurt.

[nicorulez]

Here is a very understandable article about the dangers of Cr and possible masking of renal failure.  It is a good read, and may make users of the substance a little more weary.  If you are using creatine monohydrate, I recommend drinking a lot water. 

http://www.vanderbilt.edu/AnS/psychology/health_psychology/WrestlingandCreatine.htm

[timfogarty]

I'll have to find out the actual numbers, but I know of many guys who have their doctors be all concerned about sky high creatinine levels, and had to explain to them that they were taking creatine, and why.  btw, the average guy at the gym is much more likely to be taking 5-20 g of creatine a day than a pro bodybuilder.

[The Master]

Here is a very understandable article about the dangers of Cr and possible masking of renal failure.  It is a good read, and may make users of the substance a little more weary.  If you are using creatine monohydrate, I recommend drinking a lot water. 

http://www.vanderbilt.edu/AnS/psychology/health_psychology/WrestlingandCreatine.htm

Do you think that drinking close to or above a gallon of water a day over a long periods of time can have negative effects on the kidneys? (If you work out and eat a BB diet)

[nicorulez]

The problem with drinking so much water is that you can actually get something called psychogenic polydipsia.  That is usally associated with drinking 10-12 liters of water daily, so I think if you drink 3-4 liters it would not be too dangerous.  I think drinking around 2500 cc of water daily (little more than a 1/2 gallon) should protect your kidneys.  I hear what you are saying Tim, but it would be really easy to check the guys GFR.  You could do a 24 hour urine for creatinine clearance and get an idea of his renal function.  If it is severely compromised (less than 60 cc/min), I would check a renal ultrasound and quantify the degree of proteinuria (to see if it is abnormal...< 150mg protein daily is usual).  If they are normal and he has no medical issue, I would have him stop the creatinine supplement and re-check in 6 weeks.  If his creatinine has not normalized or come down, something is likely amiss.  Regardless, after researching creatinine monohydrate in my fellowship, I am very wary of it.

[Campeon Del Mundo]

Nordic, funny you should ask this is as I am a renal specialist.  This is my job for a living; I also take care of dialysis patients on a daily basis.  Mr. Fogarty is correct for the most part.  If you want to get technical, normal BP by JNC VII (national conference on BP management and guidelines....link below) basically states that normal BP is 140/90 or better.  However, to be techical, A BP of 120-139/80-89 is considered pre-hypertensive.  In fact, in patients over 50 years of age, SBP (the higher number) is actually more dangerous as it conveys increased risk for stroke or MI (heart attack). 

To answer your question, the reason that Advil and its variants such as Naproxen, Fenoprofren, etc are so bad if abused daily is that they have two effects on the kidney.  First, they cause a depletion of vasodilator prostaglandins which are important to maintain perfusion in the kidneys.  Thus, if you abuse these at length, they can cause a hemodynamic shift with a relative hypoperfusion of the kidneys (i.e. blood doesn't get to the kidneys).  Long term this is bad.  They also raise BP as they increase Na uptake in the kidney and once again deplete prostaglandins, which are vasodilators.  Moreover, sometimes, daily abuse can actually cause an inflammatory reaction in the kidneys called Acute Interstitial Nephritis.  This is often manifested by large amounts of protein being dumped out of your body thru the urine (bad...called nephrotic syndrome if you want to look it up).  It can also lead to acute renal failure....usually reversible if the NSAIDs are stopped.  Chronically, NSAIDs like Advil cause scarring of the kidney and decrease renal function.  Thus, you get a syndrome called Chronic Interstitial Nephritis and it is ballgame for the beans.  Typically, these people have irreversible kidney damage and often progress to renal failure requiring dialysis.  I suspect Mr. Prince had acute renal failure from a hemodynamic mediated effect as he was probably also taking diuretics (bad combo).  Well, hope that helps.  I tried to make it as non-technical as i could, but it is a very complicated process. Peace.


http://www.nhlbi.nih.gov/guidelines/hypertension/

"basically states that normal BP is 140/90 or better.  However, to be techical, A BP of 120-139/80-89 is considered pre-hypertensive"

   how can that be considered pre-hypertensive?? 120/80    I dont get it...anything lower than that is low bp...

[timfogarty]

how can that be considered pre-hypertensive?? 120/80    I dont get it...anything lower than that is low bp...

cutting and pasting again:

Millions of people whose blood pressure was previously considered borderline high (130–139/85–89 mm Hg) or normal (120/80) now fall into the "prehypertension" range, based on new, more aggressive high blood pressure guidelines from the Seventh Report of the Joint National Committee  on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NIH Publication No. 03–5233, 2003)

[Bodies]

Ummmm......what does it mean if you start pissing blood?  Just curious.  Thanx.

[suckmymuscle]

a web search shows people have been worried that Ibuprofen may cause kidney damage since 1997, yet the nih.gov site doesn't list kidney damage as a possible side effect.

any drug can be abused.  I'm sure weeks and months of heavy use could cause problems.  If you're concerned about Advil, don't use it or only use it occasionally.   If you're using an analgesic many times a day for weeks at a time, you need to fix the underlying problem.

  The difference, of course, mister "expert", is that Ibuprofen is only used when you have an inflamation/headache, which only happens seldomly. And that you use it for a few days and then quit. AASS, conversely, are taken by pros continuously, for years on end, thus cummulatively causing far more damage to the internal organs than ibupofren. Higher toxicity/few days<lower toxicity/years= worse on end. Case closed.

SUCKMYMUSCLE

[brianX]

Ummmm......what does it mean if you start pissing blood?  Just curious.  Thanx.

I've heard of guys pissing blood after a heavy workout. I would definitely get it checked if it doesn't stop.

[nicorulez]

Sucky, you are correct for the most part.  However, there are individuals with chronic pain (i.e. reportedly Tom Prince) who took Ibuprofren at huge doses daily for months, if not years.  Some patients I have have taken Alleve (Naproxen) at 500 - 1000 mg twice daily for years (usually woman with chronic pain).  However, I read an article on TP that stated he was in such constant pain that he abused Ibuprofren daily (max daily dose is 800mg three times daily and I wonder if he was taking the max dose or beyond) for months.  Along with all the other drugs he was taking, I am sure the Advil definitely contributed to his kidney failure.  Advil is much more toxic to your kidneys than anabolics.

[ether]

Ummmm......what does it mean if you start pissing blood?  Just curious.  Thanx.

It means u're fucked, and that is my professional medical opinion.

[nicorulez]

Ehhhrrr guys, I didn't catch that post about "pissing blood."  I concur with Ether and he is a surgeon.  It usually is not a good thing to have gross hematuria.  It could mean something is really bad with the pipes (urethram bladder, ureters), the kidneys (renal cell cancer, IGA nephropathy, thin basement membrane (benign), Alport's disease, etc) or even the prostrate.  I would recommend getting your arse to a doc ASAP.

[ether]

Ehhhrrr guys, I didn't catch that post about "pissing blood."  I concur with Ether and he is a surgeon.  It usually is not a good thing to have gross hematuria.  It could mean something is really bad with the pipes (urethram bladder, ureters), the kidneys (renal cell cancer, IGA nephropathy, thin basement membrane (benign), Alport's disease, etc) or even the prostrate.  I would recommend getting your arse to a doc ASAP.

Yep....either that or wait it out...i'm sure it will go away on its' own