Drinking alcohol with kidney disease
Some people with insulin-treated diabetes may benefit from a pancreas transplant if they have complications like kidney disease or severely low blood sugar levels. Alcohol use disorder (AUD) affects millions of people worldwide, causing extensive morbidity and mortality with limited pharmacological treatments. Here we show that a liver-gut axis, rather than liver alone, synergistically drives systemic AcH clearance and voluntary alcohol drinking. Mechanistically, we find that after ethanol intake, a substantial proportion of AcH generated in the liver is excreted via the bile into the gastrointestinal tract where AcH is further metabolized by gut ALDH2. Modulating bile flow significantly affects serum AcH level and drinking behaviour. Thus, combined targeting of liver and gut ALDH2, and manipulation of bile flow and secretion are potential therapeutic strategies to treat AUD.
Kidney Structure and Function
Ethanol itself markedly induces the expression of the microsomal ethanol oxidation system (CYP2E1), producing reactive oxygen species as a byproduct. Increased gastrointestinal permeability and endotoxin load may lead to alcoholic steatohepatitis resulting in excessive immunoglobulin A (IgA) load (due to increased intestinal production and decreased hepatic IgA clearance). Renal microcirculatory alterations in advanced liver cirrhosis leads to hepatorenal syndrome. Alcohol-induced skeletal muscle damage how alcohol affects the kidneys leads to excessive amounts of circulating myoglobin, causing renal tubular injury as a result of increased oxidative stress. In fact, IgA glomerulonephritis—acute inflammation of the kidney caused by an IgA immune response—is one of the most common types of primary glomerulonephritis worldwide (D’Amico 1987). This IgA-related kidney disease leads to clinical symptoms of renal injury and eventually progresses into renal failure (Amore et al. 1994; Bene et al. 1988; Pouria and Feehally 1999).
- Similar alterations have been found in body fluid volumes among chronic alcoholic patients.
- Calabrese and Rizza (1999) found that ethanol induced a significant increase in the levels of fatty acid ethyl esters.
- Patients were followed until the end of 2013 or earlier if they developed CKD, died, or lost follow up.
Complications
In many patients with liver cirrhosis, the kidneys’ ability to create dilute urine is compromised, leading to a state of abnormally low sodium concentration (i.e., hyponatremia). In hyponatremic patients, the amount of fluid retained by the kidneys is disproportionately greater than the amount of sodium retained. In other words, the kidneys’ ability to excrete excess fluid by way of dilute urine is impaired, and too much fluid is reabsorbed. Hyponatremia probably is the single most common electrolyte disturbance encountered in the management of patients with cirrhosis of the liver (Vaamonde 1996). This abnormality may reflect the severity of liver disease, but the available data do not allow correlation of kidney impairment with the degree of clinical signs of liver disease, such as ascites or jaundice.
Considerations When Drinking Alcohol with Chronic Kidney Disease
People with chronic kidney disease should not drink alcohol at all, and they can speak to a doctor for help with quitting if they are finding it challenging. Alcohol can produce urine flow within 20 minutes of consumption; as a result of urinary fluid losses, the concentration of electrolytes in blood serum increases. These changes can be profound in chronic alcoholic patients, who may demonstrate clinical evidence of dehydration. One of the main functions of the kidneys is to regulate both the volume and the composition of body fluid, including electrically charged particles (i.e., ions), such as sodium, potassium, and chloride ions (i.e., electrolytes). However, alcohol’s ability to increase urine volume (i.e., its diuretic effect) alters the body’s fluid level (i.e., hydration state) and produces disturbances in electrolyte concentrations. These effects vary depending on factors such as the amount and duration of drinking, the presence of other diseases, and the drinker’s nutritional status (see table, p. 90).
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Alcohol also affects the ability to regulate fluid and electrolytes in the body. When alcohol dehydrates (dries out) the body, the drying effect can affect the normal function of cells and organs, including the kidneys. A high alcohol intake may also increase the risk of other problems that can hurt the kidneys, such as a urinary tract infection, high blood pressure, and long-term kidney damage. Despite the clinical importance of alcohol’s effects on the kidney, however, relatively few recent studies have been conducted to characterize them or elucidate their pathophysiology. It is hoped that future investigations will focus on this important subject area. Chronic alcohol consumption may cause both fluid and solutes to accumulate, thereby increasing the overall volume of body fluids.
Under these conditions, the urine formed is dilute and electrolyte concentration in the blood simultaneously rises. Although increased serum electrolyte concentration normally activates secretion of ADH so that fluid balance can be restored, a rising blood alcohol level disrupts this regulatory response by suppressing ADH secretion into the blood. The few studies focusing on alcohol’s direct effects on perfusion in human kidneys suggest that regulatory https://ecosoberhouse.com/article/how-to-naturally-reduce-alcohol-cravings/ mechanisms retain control over this component of kidney function despite alcohol consumption. Even at high blood alcohol levels, only minor fluctuations were found in the rates of plasma flow and filtration through the kidneys (Rubini et al. 1955). Similarly, clinicians long have noted significant kidney enlargement (i.e., nephromegaly) in direct proportion to liver enlargement among chronic alcoholic2 patients afflicted with liver cirrhosis.
Sales of ready-to-drink beverages, such as hard seltzers, alcoholic teas, and canned cocktails or wines, have boomed in the last several years. The American Public Health Association says binge drinking is more common among men, 18-to-34-year-olds, and people with household incomes of $75,000 or more. As scientific information emerges, experts are becoming increasingly concerned about Americans’ drinking patterns, and how best to talk to the public about its potential risks. It’s always wise to check with your doctor or dietitian before incorporating alcohol into your diet and it is recommended that you combine your alcohol with food. Finally, if you want to drink alcohol, please discuss this with your pharmacist as some medications do interact with alcohol.
