Annual Transplant Nephrology Beach Trip!

Yes, I know this sounds exciting, but before we get into the details…

IF YOU DON’T WANT TO READ SOME SEMI-GROSS MEDICAL DETAILS ABOUT URINE OUTPUT, DON’T READ THIS POST

I celebrated the 5th anniversary of my kidney transplant in December of 2009.  After your first year or so post-transplant, you still get blood tests every three months or so, but you only need to go to the transplant clinic every year.   My transplant nephrologist is Dr. Horacio Adrogue, and I can’t imagine having a better doctor.  Recently he took over the transplant practice at UTMB, and is even chief of nephrology.  He’s a phenomenal academic nephrologist but also runs a great clinic and office.  I’m not sure how he does it all with a family as well.

A visit is always stressful

Even though I know my blood test results before I go there (my local PCP just emails the results to me), I’m always concerned that I’ll get some bad news, and I fear nothing more in the entire world than hearing that something is wrong with me again.  Someday it’s going to happen and I know I’ll deal with it, but the unpleasant anticipation of that day seems to fill my lungs as I approach my visit.  With this visit, because my hemoglobin is high, they did an ultrasound of my “native kidneys” (i.e. the original ones that no longer work).  During the test, the lab tech, after taking one snapshot, said “the clinic wants you to go back up and see them after these tests.”  My neurotically creative powers of deduction concluded that the lab tech had just seen something on the ultrasound that was going to require me getting some bad news from my doctor.   This, of course, was not the case, but I spent the next 20-30 minutes bracing myself to hear the words “tumor”, “cyst”, or “failure” when I should have been listening to the rational side of me.

Even the views from Dr. Adrogue’s clinic (at UTMB in Galveston, TX, where you look out at sailboats and the ocean) couldn’t prevent me from imagining the worst.

Overall

Overall, I’m great!  Things couldn’t be better from a transplant patients perspective.  My complaints are so minor it’s unbelievable.  But with my increase in training this year, I had a bunch of questions.

Protein Question

Athletes recover and build muscle by relying on protein.  The kidney is responsible for filtering and helping the body get the protein it needs.  Since I only had one working kidney, do I need to worry about eating too much protein?

Basic answer is yes, but the limits are not that low.  Typical recommended diet is 1 g of protein per kg of weight.  I’m about 74 kg, so I could eat 74 g of protein.  Yesterday, I ate at least 104 g of protein.   And that’s probably about an average day for me.   To make sure I’m not overdoing it, if I do increase my protein intake, we’ll do blood tests every two weeks to make sure I don’t have protein in my urine, because that would be a sign that the kidneys are getting overwhelmed with the protein intake.

Dehydration Question

I believe I fall into the athletic category of “super sweater”, meaning I sweat more than the average human, and need almost 2x the fluids and electrolytes during a workout.  Dehydration is BAD for kidneys, and can damage them.  The last thing I want to do is damage my only kidney, to damage the most amazing gift in the universe.   I usually go by the “if your pee is clear, you’re hydrated” rule.  Is that good enough?

This is where having Dr. Adrogue is awesome.  Apparently there are dipsticks that measure specific gravity of urine (get psyched!) and I could probably get some of these from a lab supplies store, and either during or right after a workout, judge my hydration state by peeing on the stick.  It will not tell me whether or not I’m pregnant.  Doc is checking on whether it’s possible to use ‘unspun’ urine (fresh out of the person, not spun by a laboratory test tube spinner).

The Foaming Urine Question

Boy, if this question doesn’t increase the readership of my blog, I don’t know what will.   I have always been told that if you see a lot of foam in your urine, you are losing protein.  Losing protein means your kidneys are doing their job.  I’ve always seemed to have a lot of foam when I pee, so I asked if I needed to worry about it.

Turns out foam can just come from “pouring too fast” just like the head on a beer.  So, since my blood tests don’t show any urine, this probably means that I just pee really quickly.  I’m a fast one.  Now, if the foam stays and won’t dissipate, then that’s more concerning.  But so far the last two days, I think I’m concluding that I just happen to be very speedy at the art of relieving myself.

Training Journal

  • Monday was a rest day
  • Tuesday, Swam 4,000 yards
  • Wednesday, 1 hour of core and 1 hour of lifting

For three days, that’s only 4 total hours.  I skipped spin class on Tuesday morning and didn’t run today.  I think I’m counting this week as a recovery week from the last two “build” weeks, even though I should be able to get in 14 total hours by the end of Saturday.

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