Vitamin B1 + Early Stage Kidney Disease

[kay_rae]

Kay_rae, we can certainly see why your serum albumin is low at 3.8 (optimal 4 -5), as your high albumin/creatinine ratio shows a lot of albumin being excreted through urine,

However, I'm of the opinion that your true serum albumin may be lower than 3.8, as the basis for that metric is on the assumption of normal blood volume. If normal blood volume is 5 liters, and one has low blood volume of say 4 liters, the serum albumin may actually be 3.8 (4/5) =2.8. That is the reason I wanted to get serum CBC data from you, as we can look at the RBC, Hgb, and Hct values to determine if you have low blood volume.

Low serum albumin is likely to lead to low blood volume, because albumin attracts sodium in a complex, and this keeps sodium retained in blood. More sodium increases the osmolarity of plasma, and this attracts more water into plasma, thus increasing the volume of blood.

The CBC also gives an idea, thru the wbc and its differential count of the different kinds of white blood cells (neutrophils, lymphocytes, monocytes, eosinophils, basophils) - of the degree of low-level infection in your internal system (excluding the gut). This also has a bearing on your kidney health, as you may be focused on your diabetic condition as a cause.

Your serum creatinine at 1.11 is just above optimal (0.8-1,1), and so you don't seem to be deep into chronic kidney disease, and as you said, you're in stage 1. However, is the ACR (albumin creatinine ratio ) of 1066 correct? What is the value of your urine albumin, and your urine creatinine? Just to be sure that's not a typo.

As far as your eGFR goes, were all the eGFR computed using the same formula. Were those values taken by the same lab? There are many eGFR formulas, and they're not consistently used. I've maintained my serum creatinine at 1.1 since 2002 (I have CKD 1 and working on it as well) yet my eGFR keeps going down over the years, simply because eGFR formula use both age and serum creatinine to estimate eGFR. Personally, I think the formulas are hokey. I'd rather use the 24hr urine collection method to determine the creatinine clearance than rely on eGFR estimates that are used merely for convenience than anything else.

Just like albumin, creatinine values are also dependent on blood volume. If your blood volume is low, creatinine also is going to appear higher. If suddenly your blood volume should turn from being 80% of normal to normal, your creatinine would go down by 20%. So we have to keep this in mind as we can't be too mechanistic and numbers driven. If you see your creatinine or eGFR fluctuate, it may just be your blood volume fluctuating. We just have to see things in the right perspective. I'm pretty sure most of our doctors act like technicians and there's no use arguing with them as they just don't get it.

As far as thiamine goes, I believe that thiamine helps with kidney disease because thiamine is able to convert lactate back to glucose via the Cori cycle. In kidney disease, a lot of times blood flow is restricted in the capillaries that feed the kidney's nephrons and tubules. Because oxygen supply is limited, lactate is produced because of anaerobic glyolysis. So thiamine can be helpful, but it's not really going to cure your kidney. It is just like a maintenance drug.

Do you have high blood pressure? Are you taking Losartan to lower blood pressure? Again, just my opinion, but I don't think it's true blood pressure lowering medication protects the kidneys. If the kidneys's capillaries aren't able to deliver oxygen and nutrients to the kidney with normal blood pressure, the body will know to increase the blood pressure to keep the kidneys nourished and protected, as it knows higher blood pressure will enable blood to feed the organ and keep the nephrons alive. I've had high blood pressure for 18 years. During this time, my serum creatinine has stayed the same at 1.1 My kidney has not deteriorated. I only have CKD 1 barely, and only a small amount of albumin gets excreted by urine and it's classified as microalbuminuria. My blood pressure is very high and reaches 200/140. Yet I don't have any sign of poor health. I don't have any headache ever, and I'm not even high risk for COVID. I haven't had a fever nor flu for the past 20 years (yet I'm not hypothyroid), and I don't have any allergies. The last allergic rhinitis I had was 3 years ago.

I think that taking blood pressure medication only causes the kidney to fail, only because the nephrons are going to die from lacking blood supply, simply because normal blood pressure isn't getting the job of nourishing the nephrons done. If you're excreting a lot of albumin, could it be because you're interfering with the body, on advice of your doctor? Think back to when you started taking bp medication, and if you have a good record system, you can trace back to see if your kidneys were better then.

I have more to say but I hope I gave you enough food for thought.

Lastly, could you tell me what Tirosint is and why you are taking that?

This is so much good information to dive in to, thank you! I've requested from my doctor to do a CBC panel as well as get the CA/P test done - so hoping she adds those to my August labs. I'll hopefully have more details to share at that time about those results.

Most of my eGFR tests have been done through the same lab company, but it's good to know the formula can be different. My doctor even said eGFR can fluctuate and that the more important number to watch is Creatinine.

And apologies, I think I shared the wrong values for ACR. Here are the complete urine panel from Feb 2020. My ratio has always been elevated (between 700-1200 since Feb 2016), which is what triggered my doctor to start me on the Lisinopril/Losartan medications.

And I will certainly keep in mind that these numbers may be off based on other factors. Hoping some more blood tests can help narrow down where I'm actually at.

Tirosint is medication for hypothyroidism. It has helped bring my numbers (TSH, T4 & T3) back into range over the last few years.

Thank you again for sharing all of this. Certainly lots to think about, look into, and base decisions on. Like I mentioned in my earlier reply, I definitely think I'll be stopping that Losartan as the correlation between that start of that medication and the steep decline of eGFR is a little too concerning.

 

[S-VV]

Do not stop the losartan.
Your albumin to creatinine is high. This means that your glomeruli are filtrating blood protein.

This protein is nephrotoxic and will further damage the nephron. In order to compensate for the loss of functional nephrons, the kidney will attempt to increase the glomerular filtration rate.

This, however, is maladaptive, as even more blood protein will be filtered and the nephrons will become sclerotic quicker.

Over the short term losartan will decrease the eGFR, however, since it reduces filtered protein, over the long term it is protective.

 

[yerrag]

Do not stop the losartan.
Your albumin to creatinine is high. This means that your glomeruli are filtrating blood protein.

This protein is nephrotoxic and will further damage the nephron. In order to compensate for the loss of functional nephrons, the kidney will attempt to increase the glomerular filtration rate.

This, however, is maladaptive, as even more blood protein will be filtered and the nephrons will become sclerotic quicker.

Over the short term losartan will decrease the eGFR, however, since it reduces filtered protein, over the long term it is protective.

I've never used these ARBs, though I have thought about it since Ray Peat seems to like them so much, as protection from COVID- by increasing ACE2 enzymes.

So help me understand how Losartan protects the kidneys. How does Losartan reduce albumin from being excreted thru the urine, if that is what you mean by it "reducing filtered protein?"

Kay_Rae had 4 years of using ARBs, yet albumin excretion has stayed pretty much the same range. Is this considered short term? How long should she keep taking it?

It is entirely possible her eGFR would continue to worsen whether she took Losartan or not. But Losartan has not helped reduce albumin excretion in urine, and it has neither arrested the decline in the eGFR.

Also, the primary usage for Losartan is for reducing high blood pressure. But Kay_Rae didn't have high blood pressure, so she is being prescribed Losartan for another reason - to protect her kidneys. How does Losartan protect her, specifically as it pertains to her kidneys? I am asking because I don't know this drug well enough, and would appreciate your help here.

Kay_Rae, please weigh things first. Maybe if you could ask your doctor why he thinks Losartan is protective.

August is around the corner, and we'll have your CBC results. But if you have an older CBC, we can still use that.

Meanwhile, do you have history of serum albumin and creatinine from 2016 to now?

 

[S-VV]

@yerrag
I have annotated and underlined a small pdf for you that explains how to treat albumin in urine.

 

[S-VV]

The basic idea is that when there is protein in the urine, something is wrong with the glomeruli, and they don’t stop protein from filtering (going) into the urine.

This filtered protein damages the nephron, and the kidney responds by increasing the GFR. However, this will lead to more filtered protein, more kidney damage, and a maladaptive vicious cycle.

To stop this cycle, ACE inhibitors and ARB are used. They reduce the GFR and increase blood creatinine, BUT they stop the filtration of protein. Since less protein is filtered, less damage will be done to the kidney and the longer functionality can be maintained.

The initial loss of GRF is a feature, not a bug, because the reduction of GRF reduces filtrated protein and gives the kidney a chance to heal.

If you do not stop the filtered protein in the urine (proteinuria), the kidneys will enter a vicious cycle, and destroy themselves.

 

[S-VV]

It is counterintuitive, but an initial loss of GRF means that the ARB are working. The important measure is albumin in urine. This is what kills the kidney.

 

[yerrag]

But 4 years of eGFR reduction and continued loss of albumin in urine with no reduction of loss - seems to not agree with that approach though.

 

[yerrag]

@yerrag
I have annotated and underlined a small pdf for you that explains how to treat albumin in urine.

Thanks.

It certainly says the points you raised. It also considers the role of hypovolemia in raising creatinine levels.

But it does not consider other causes other than glomerular lesions that would make albumin pass through the nephron. Such as albumin becoming oxidized when it is used to counter oxidative stresses, changing the charge of albumin, making it more easily pass through the glomerular membrane. It also fails to consider that albumin can lose its agglomeration with other protein structures, due to bacterial enzymes for example, making albumin more easily pass through the filter.

It may not be a kidney issue but an albumin degradation issue, and the increase in creatinine may simply reflect lower albumin causing hypovolemia.

It is also not spelt out clearly how ARBs protect the kidneys except that it brings about vasodilation, which in this case isn't necessary as subject does not have high blood pressure issues.

And I do not agree with their idea that biopsies are needed to help diagnose a patient with proteinuria issues save for diabetic patients. The review seems to me a subtle attempt to bring more business to the medical industry. The lack of diagnostic acumen merely invites more problems for the patient with the need to cut them up as the starting point, bringing more harm to patients at the get go.

 

[kay_rae]

Do not stop the losartan.
Your albumin to creatinine is high. This means that your glomeruli are filtrating blood protein.

This protein is nephrotoxic and will further damage the nephron. In order to compensate for the loss of functional nephrons, the kidney will attempt to increase the glomerular filtration rate.

This, however, is maladaptive, as even more blood protein will be filtered and the nephrons will become sclerotic quicker.

Over the short term losartan will decrease the eGFR, however, since it reduces filtered protein, over the long term it is protective.

Thanks S-VV. Definitely more things to consider before making any decisions. I'm trying to find more records pre-2016 just to see what numbers were like prior. I do not like that it initially harms and then is suppose to protect the kidneys, and certainly wish this is something doctors would talk to you about when going on a medication. I am feeling a little desperate to improve my kidney function and am nervous about harming them any further. Do we have any better concept of what short-term vs. long-term means in this case? It has been over 4 years of this medication and I haven't seen improvement anywhere. I'm also taking into consideration that I didn't do any changes (diet, supplement, lifestyle) prior to 8 months ago that would additionally support my kidneys, other than gaining much better diabetes control. Am I likely to see even more decrease in eGFR from it? Does the dose jump from 5, 10 and then 25 play a major role in either how much it harmed eGFR to how much it is doing to protect the kidneys? Do I consider stopping or adjusting this medication since my urine microalbumin has no decreased at all since starting, or is that simply a matter of continuing the medication while simultaneously doing other things to reduce the microalbumin.

I'm thinking my plan for now should be to finish out the Vitamin B1 for another 2-3 months to see if that has any impact. Then consider some of the other methods people have shared with me on here.

August is around the corner, and we'll have your CBC results. But if you have an older CBC, we can still use that.

And thanks Verrag. It looks like I do have some CBC measures from Feb 2017, but no other records. At least we'll have something to compare to in August.

Meanwhile, do you have history of serum albumin and creatinine from 2016 to now?

• Feb 2016: Albumin - 3.6 | Creatinine - 0.83
• Apr 2016: Albumin - 3.8 | Creatinine - 0.88
  
• Feb 2017: Albumin - 4.1 | Creatinine - 1.04
  
• Nov 2017: Albumin - 3.8 | Creatinine - 1.02
  
• Aug 2019: Albumin - 3.7 | Creatinine - 1.16
  
• Dec 2019: Albumin - 3.8 | Creatinine - 1.3
  
• Feb 2020: Albumin - 3.7 | Creatinine - 1.07
  
• Jun 2020: Albumin - 3.8 | Creatinine - 1.11

 

[S-VV]

@yerrag ARB work by preferentially dilating the efferent glomerular arteriole, lowering the intraglomerular pressure and slowing the filtration of protein and the damage to the nephron.

It is true that albuminuria can be caused by oxidized albumin, but the pathogenic mechanism remains the same. Damage to the nephron and maladaptive increases in GFR that lead to a vicious cycle. This cycle can be slowed with ARB or ACE inhibitors.

 

[S-VV]

@kay_rae yeah, chronic illness is difficult to manage, and no one really knows how any of this works. We are all guessing with the best data available.

One thing I would to is airthight blood glucose control. High blood glucose is very nephrotoxic, and it is a low hanging fruit to improve kidney health.

I assume that the EMF device you talked about earlier was an insulin pump. I would absolutely use it, in combination with continuos glucose monitoring. Yes, the EMF may have some negative effects, but good glucose control, in my opinion is far more important.

 

[S-VV]

Also, bully your doctor if necessary to get regular 24 hour urine protein test. This will directly indicate how the kidney is doing

 

[S-VV]

Do we have any better concept of what short-term vs. long-term means in this case? It has been over 4 years of this medication and I haven't seen improvement anywhere. I'm also taking into consideration that I didn't do any changes (diet, supplement, lifestyle) prior to 8 months ago that would additionally support my kidneys, other than gaining much better diabetes control. Am I likely to see even more decrease in eGFR from it? Does the dose jump from 5, 10 and then 25 play a major role in either how much it harmed eGFR to how much it is doing to protect the kidneys? Do I consider stopping or adjusting this medication since my urine microalbumin has no decreased at all since starting, or is that simply a matter of continuing the medication while simultaneously doing other things to reduce the microalbumin

Those are all very good questions, and it shows that you are an informed patient. Knowing is half the battle.

Are for short term vs long term, your proteinuria has not increases over 4 years, which is very good news. In that timespan some people loose their kidneys completely.

You could consider stopping the losartan, but then it would be important to very regularly measure 24h urine protein. If it stays stable, then your in luck and your body seems to be able to halt the degenerative process.

But if the proteinuria shows a trend towards increasing, then you know that the losartan was helping.

The stopping + regular measuring could be a very interesting therapeutic probe and would help to target treatment.

 

[S-VV]

And I do not agree with their idea that biopsies are needed to help diagnose a patient with proteinuria issues save for diabetic patients. The review seems to me a subtle attempt to bring more business to the medical industry. The lack of diagnostic acumen merely invites more problems for the patient with the need to cut them up as the starting point, bringing more harm to patients at the get go.

Biopsies can be very useful for getting to the root cause. There are over ten types of glomerulonephritis, and the only way to know for certain is to biopsy.
Some glomerulonephritis have good treatment options.

 

[lvysaur]

Over the short term losartan will decrease the eGFR, however, since it reduces filtered protein, over the long term it is protective.

Do you think this has anything to do with the US-black/white differences in kidney failure? Apparently blacks have a higher rate of end stage renal disease, but a lower rate of chronic renal disease.

It's also well known that black people (and men, relative to women) have higher eGFRs

 

[kay_rae]

Also, bully your doctor if necessary to get regular 24 hour urine protein test. This will directly indicate how the kidney is doing

We have one scheduled for the Aug labs - so will know that as well. My doctor recommended that right away.

Those are all very good questions, and it shows that you are an informed patient. Knowing is half the battle.

Are for short term vs long term, your proteinuria has not increases over 4 years, which is very good news. In that timespan some people loose their kidneys completely.

You could consider stopping the losartan, but then it would be important to very regularly measure 24h urine protein. If it stays stable, then your in luck and your body seems to be able to halt the degenerative process.

But if the proteinuria shows a trend towards increasing, then you know that the losartan was helping.

The stopping + regular measuring could be a very interesting therapeutic probe and would help to target treatment.

I'll definitely keep this option on the list of things to try. When I have my next actual appointment with my doctor I'll have a deeper conversation with her about Losartan and the possible pros/cons. See if she will prescribe a regular monthly 24 hr urine test if I do decide to drop the Losartan.

@kay_rae yeah, chronic illness is difficult to manage, and no one really knows how any of this works. We are all guessing with the best data available.

One thing I would to is airthight blood glucose control. High blood glucose is very nephrotoxic, and it is a low hanging fruit to improve kidney health.

I assume that the EMF device you talked about earlier was an insulin pump. I would absolutely use it, in combination with continuos glucose monitoring. Yes, the EMF may have some negative effects, but good glucose control, in my opinion is far more important.

I have been very happy with my control over the last 5 years - especially the last 8 months. Best control of my life and never have gotten anywhere near this control. I know how important this is in all aspects of health. The insulin pump and CGM I am using right now is called DIY Looping with a Dexcom G5 & OmniPod (as well as bluetooth from my phone and RileyLink.) This has been a game-changer for me and has reduced EMF significantly from the Medtronic 670g system I was using the last 3 years or so, and given me better control. If there are ways to reduce EMF while still maintaining or improving my current control I definitely want to do that, but also knowing I can't sacrifice my diabetes control. Just really hoping the damage that has been done prior due to poor diabetes control can be halted or even reversed.

Thank for you this information. Just knowing more is helping me feel more at ease and have more confidence that not all hope is lost. Appreciate all the ideas and feedback everyone on this post is providing. Definitely not at a lack of options.

 

[S-VV]

@kay_rae wow, that really impressive! I just had a look at the docs, and for a newbie building an iOS app is no easy task, as well as configuring everything.

 

[S-VV]

Do you think this has anything to do with the US-black/white differences in kidney failure? Apparently blacks have a higher rate of end stage renal disease, but a lower rate of chronic renal disease.

It's also well known that black people (and men, relative to women) have higher eGFRs

Yeah, that seems about right. A high eGFR will mean that the kidneys take longer to degenerate. But once there is proteinuria, the high eGRF will precipitate a kidney failure.

It really is a balancing act.

 

[kay_rae]

Any opinions on Biophotonic treatments? My chiropractor also recommended occasional sauna, yoga, and/or hot yoga to increase blood frow throughout the body, but especially to the kidneys. I had my first sunglightened infrared sauna treatment today for 30 minutes and the owner suggested trying biophotonic treatment as well. Just doing some research, but not too familiar with it overall.

 

[kay_rae]

@kay_rae wow, that really impressive! I just had a look at the docs, and for a newbie building an iOS app is no easy task, as well as configuring everything.

Thanks S-VV. I have to give lots of credit to a friend who helped me out. She had already done it before and was able to walk me through. It's a long process, but totally worth it. The sense of control it gave me to adjust anything and everything I needed really helped hold myself accountable to my numbers. I can't say game-changer enough.