Yes, it’s Friday the 13th- but I have more important things to discuss |

If you really want to deal with that superstition, you are welcome to review one of my older posts, Triskaidekaphobia…

But, now to the matter at hand.

You’ve heard me mention that kidney disease is pretty rampant in the US (and the world). The issue is that early stages don’t manifest any real symptoms. Sure, if you have diabetes and high blood pressure, it’s likely that kidney failure is in your cards. But, testing is the only way to know if one has ESRD (end stage renal disease).

Besides diabetes and high blood pressure, we’d want to check for ESRD if there is a history of kidney failure in our family or if we have heart disease. If we are already manifesting diabetes, we should also get checked annually; with the other indicators (discussed below), that’s a discussion between us and our health care practitioner.

The “gold standard” is to check one’s GFR- the glomerular filtration rate. The GFR ascertains how well our kidney’s filter junk out of our blood. (Creatinine, one of our body’s waste products, is used to determine the GFR.) Our GFR should be over 60- if it’s below 60, our kidney health is suspect; should it be below 15, our kidneys have failed and we need a transplant or dialysis to survive.

The other test used is urine albumin. (This protein is known to pass into the urine when our kidneys have failed.) The higher the albumin level in our urine, the more damaged our kidney. (Some providers use the UACR, the urine albumin to creatine ratio as the prime measurement. This value indicates how much albumin passes to our urine per day. The ratio should not exceed 30 mg/g; above that level indicates kidney disease prevails.)

But, now, Dr. Ya-chung Tian (Linkou Chang Gung Kidney Research Center, as well as the nephrology department [Taoyan, Taiwan]) has come up with a quick and dirty screening procedure for kidney failure. He presented his results at the recent virtual ASN (American Society for Nephrology) meeting held at the end of October 2020.

He based his study on the knowledge that most patients with ESRD manifest what is termed “ammonia breath”. Because the kidneys aren’t processing waste properly, the body tries to dump urea that isn’t being removed via our breath; it reacts with the saliva in our mouth to form ammonia. That condition is called ‘uremic fetor’. Tian hoped that he could correlate the ammonia in our breath with our kidney health.

Using 121 patients (62 men, average age 61) with various stages of ESRD (stages 1 through 5) and their known values of BUN (blood urea nitrogen), creatinine, and GFR results, Tian determined that breath ammonia levels correlate very well. Moreover, the results weren’t affected by gender, body weight, hemoglobin levels, albumin, or comorbidities.

Tian was able to correlate the breath ammonia readings with the patients’ GFR and ESRD biomarkers. Those patients with Stage 1 kidney disease manifested breath ammonia levels of 636 ppb+94; the levels jumped to 1020+326 ppb for Stage 2 patients; stage 3 correlated with 1943+326 ppb; stage 4 levels had surged to 4421+1042 ppb; with stage 5 breath ammonia levels reaching 12781+1807 ppb. (Yes, it’s true- there is a small overlap between Stage 1 and Stage 2 via this test.)

As such, this simple test can serve as a reliable tool for ESRD screening. If we need more definit results we can they rely on the more elaborate (and expensive) testing to discern GFR.