Your Kidneys in TEOTWAWKI, by Dr. Bob

Kidneys are pretty important, and often an underdog in the grouping of organ systems.  Without functioning kidneys, none of us can live for more than about a week, making the kidneys pretty important from a survival standpoint.  Seems interesting that a person can literally be brain dead and survive–but without kidneys you can’t.  Kidneys often get lumped into the “random organ” category and people often think of them like their gall bladder and appendix.  Kidneys are more like lungs if you are looking for a good comparison.  You can live with one, you can’t live without two, and you really would prefer to have two that work.

There are three major issues to address when it comes to kidneys and TEOTWAWKI:  infection, stones, and failure.  Infection of the urinary system can progress to kidney infection and cause a much more serious problem called pyelonephritis.  Untreated pyelonephritis can damage the kidney directly or indirectly through severe scarring, causing kidney failure.  Kidney stones can obstruct the urinary system and can then cause both infections and kidney failure.  Stones can also cause rupture of the urinary system, which causes a much more serious infection called peritonitis; which can also be cause by pyelonephritis if the infection also breaks through the urinary confines.  Kidney failure itself does not really increase the chances of stones or infection directly.  So, all three of these issues have some connection and the big concern for preppers is preparing for the worst and trying to plan for the best.

Infection affects women many times over more than men.  This is due to the relative distance of the urethra to the outside world.  Obviously, if you think about it, men have a longer urethra and therefore more space between the bladder and the bacteria that cause bladder infections.  (Even the least fortunate men).  There are certain preventive measures that women can take to reduce this risk of bacterial invasion.  First, hygiene.  Girls need to be taught careful front to back wiping to minimize E. coli exposure.  Sexually active women need to try to urinate immediately after intercourse to “flush the system” of the bacteria typical to such activity.  Certain types of birth control methods also have a higher rate of UTI prevalence, like spermicides.  Fluids, fluids, fluids is the best possible approach to help reduce the risk of an infection.  Higher rates of UTI are known to occur with urine holding and dehydration, and although no study has actually proven that urinating more often reduces risk of UTI, it just makes common sense.

Once an infection hits, most women know to hit the fluids and hit them hard.  This often works to clear the infection without antibiotics.  After about 24 hours of flushing, most women will know which way it will play out.  If the infection needs treatment, luckily most E. coli are killed by a large group of antibiotics.  This group includes Sulfamethoxazole/TMP (Bactrim), Nitrofurantoin (Macrobid) and Ciprofloxacin (Cipro) as first-line options; and Amoxicillin, Cephalexin (Keflex), Azithromycin (Zithromax or Zpack), Doxycycline, Amoxicillin/Clavulanate (Augmentin) and Levofloxicin (Levaquin) all as second-line or alternative options.  Most of the time when men get a UTI it is in fact not a UTI but is and STD.  This is not universal, but it is a concern for any presenting male with urinary symptoms.  Sometimes a prostate infection can mimic a UTI in men, but not very often.  In fact, in the “Bible” of antibiotic recommendations, the Sanford Guide, men are not listed at all in the UTI section, but show up only in the pyelonephritis section with an asterisk for “look for obstructive uropathy or other complicating pathology”.

Stones are a real fear in the post-collapse environment.  Kidney stones cause pain and blood in the urine, but can also obstruct the system and then become a real risk to life.  There will be no lithotripsy (sound therapy) or surgery available to correct these types of large stones.  Prevention of stone formation is a must for those that have had a kidney stone in the past, or develop one at any point in the future.  The research-based knowledge bowl of UpToDate, one of my most reliable information sites medically, states that:  “…from the viewpoint of diet, increasing the intake of fluid, dietary calcium, potassium and phytate and decreasing the intake of oxalate, animal protein, sucrose, fructose, sodium, supplemental calcium and supplemental vitamin C may be beneficial”.  Some of these issues need a little more description or definition.

Increasing fluid is simple.  Water seems to be as good as anything else, and the only thing to perhaps avoid is grapefruit juice.  Contrary to popular belief; there is no reason to avoid coffee, tea, alcohol, or soda pop to reduce the most common form of kidney stone formation.  The research has not proven that high animal protein diets, oxalate-containing foods (spinach, rhubarb, nuts, legumes) sucrose, and fructose can cause stones; but avoidance of excessive consumption of any of these in the diet are recommended.  Avoiding supplementation of Vitamin C and Calcium may also help reduce the risk of stone formation.  Stone formers should not supplement their diet with either Vitamin C or Calcium unless avoiding an outright deficiency is the reason.  There is also some evidence that low-sodium diets may help reduce stone formation and that high-potassium foods like fruits and vegetables help prevent kidney stones from forming.  All these things should be taken into consideration if there is a kidney stone history in you or anyone in your prepping family.

Kidney failure is broken down into two separate categories:  acute and chronic.  There are many different subtypes of each, but the basics are fairly simple.  Acute kidney failure is defined as:  the abrupt loss of kidney function resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes.  Without a lab to check these buildups in the blood, the basic definition of acute kidney failure is that urine stops with an identifiable cause:  loss of volume, infection or inflammation, injury, toxins (including medications).  The treatment for kidney failure is fluids, plain and simple.  Helping flood the kidneys is the best hope they have for recovery, and when they do start to recover, for a faster recovery.  Whether the fluids are IV or by mouth, it doesn’t really matter, keep those beans wet and you will improve your survivability markedly when facing acute kidney failure.

Chronic renal failure (CRF) occurs in all of us if we live long enough, as kidney function decreases slowly with age.  Men have normal prostate growth which can worsen to the point of complete urinary obstruction over time.  Kidneys lose blood flow as we get more plaque build-up and our vessels age.  More microclots can form in the kidney the older we get, which affects overall function.  Basically–like lungs, hearts, brains, skin, eyes, muscles and guts–kidneys age with us too; with a decrease in overall function that can sometimes contribute to a natural death.  Obviously, there are certain conditions that contribute to increased risk of early kidney function, like diabetes, but there are risk factors for faster kidney failure that you might not be aware of:
• Greater protein levels in the urine
• Higher blood pressure
• Black race
• Lower serum HDL cholesterol (good cholesterol)
• Obesity
• Smokers
Now, the higher protein level and low HDL will not be known WTSHTF, but if you already have some kidney condition or concerns, it would be helpful to know these levels and track them to improve your kidney function while the grid is up.  When the grid does do down, obviously those with severe kidney failure that are on dialysis would not survive.  Those on the verge of dialysis would also not likely recover and likely would worsen quickly under the stresses of TEOTWAWKI.  If you end up having CRF in a post-grid world, there isn’t really going to be much you can really do about it, and there will be no way to monitor the progression either.  Fluids help kidneys recover and also stay functional.  With chronic renal failure, you don’t need to pour the fluids in aggressively or get an IV started like you do with ARF; but proper higher fluid intake does keep CRF folks ticking longer and healthier than a “hit and miss” fluid approach.

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: