One Causes the Other and the Other Causes the One

You can be immunocompromised without being a transplant. I know because I live with someone who is. Let’s just suppose he developed chronic kidney disease [Oh, no!]. Let’s see if this would further his CKD, or if his CKD would further the being immunocompromised.

We know that CKD is the progression of the decline of your kidney function for three months or more. Let’s go to my favorite dictionary yet again, the Merriam-Webster, for a definition of immunocompromised:

“having the immune system impaired or weakened (as by drugs or illness)”

Just in case the information is needed, let’s define the immune system, too.

“the bodily system that protects the body from foreign substances, cells, and tissues by producing the immune response and that includes especially the thymus, spleen, lymph nodes, special deposits of lymphoid tissue (as in the gastrointestinal tract and bone marrow), macrophages, lymphocytes including the B cells and T cells, and antibodies”

Well that certainly seems to cover it. Time to see what CKD and being immunocompromised have to do with each other, if anything. The National Institutes of Health starts us off on this exploratory journey:

“Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response.”

You know, I’m not so sure I accepted that I’m immunocompromised before reading that. I feel more validated for still quarantining as much as possible and wearing a mask now. As usual, I want more information, so let’s find it.

PubMed offers us this information:

“Cardiovascular disease and infections are directly or indirectly associated with an altered immune response, which leads to a high incidence of morbidity and mortality, and together, they account for up to 70% of all deaths among patients with chronic kidney dysfunction. Impairment of the normal reaction of the innate and adaptive immune systems in chronic kidney disease predisposes patients to an increased risk of infections, virus-associated cancers, and a diminished vaccine response.”

This bit of information from the National Library of Medicine surprised me. Not only does CKD affect being immunocompromised, but being immunocompromised affects your CKD.

“The immune system and the kidneys are closely linked. In health the kidneys contribute to immune homeostasis, while components of the immune system mediate many acute forms of renal disease and play a central role in progression of chronic kidney disease.” 

We’re still not quite there. I want to know the mechanism of CKD causing us to be immunocompromised and vice-versa. I think I found the answer in Nature Reviews, but I’m not sure I understand it:

“The kidneys are frequently targeted by pathogenic immune responses against renal autoantigens or by local manifestations of systemic autoimmunity. Recent studies in rodent models and humans have uncovered several underlying mechanisms that can be used to explain the previously enigmatic immunopathology of many kidney diseases. These mechanisms include kidney-specific damage-associated molecular patterns that cause sterile inflammation, the crosstalk between renal dendritic cells and T cells, the development of kidney-targeting autoantibodies and molecular mimicry with microbial pathogens. Conversely, kidney failure affects general immunity, causing intestinal barrier dysfunction, systemic inflammation and immunodeficiency that contribute to the morbidity and mortality of patients with kidney disease.”

Hmm, maybe some definitions would help us understand. Let’s try that.

Pathogenic: specific causative agent (such as a bacterium or virus) of disease [Merriam-Webster Dictionary]

Autoantigens: Autoantigens are markers on cells inside your body that your immune system attacks even though they shouldn’t. Autoantigens cause autoimmune diseases. [Cleveland Clinic]

Sterile inflammation: Inflammation in the absence of pathogens and their products is referred to as sterile inflammation. [Annual Review]

Dendritic Cells: Dendritic cells are sentinels that constantly survey the kidney microenvironment for injury or infection; they recruit and regulate immune effector cells such as macrophages, T cells and neutrophils to protect the host. [Nature Reviews]

T-Cells: T cell, also called T lymphocyte, type of leukocyte (white blood cell) that is an essential part of the immune system. [Britannica]

Wow. That did work. I understand the mechanism now. Do you?

What would tip you off that you’re immunocompromised besides having CKD? Remember that CKD is not the only cause of being immunosuppressed. You probably want to keep an eye on other symptoms for those you care for. According to the Mayo Clinic:

• “Frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections
• Inflammation and infection of internal organs
• Blood disorders, such as low platelet count or anemia
• Digestive problems, such as cramping, loss of appetite, nausea and diarrhea
• Delayed growth and development
• Autoimmune disorders, such as lupus, rheumatoid arthritis or type 1 diabetes”

CKD or not, you want to deal with that lack of immunity. VeryWellHealth has some advice that almost sounds like common sense to me:

“In general, it’s the cause of the immunodeficiency that’s treated, not the immunodeficiency itself. One treatment for immunodeficiency may be a bone marrow transplant. However, that’s only an appropriate treatment for individuals whose bone marrow isn’t producing enough immune cells.

When the immunodeficiency itself isn’t treatable, there are still other options. For example, there are therapies available that can help individuals fight off certain infections. You may also be more likely to need antibiotics or antiviral medications to fight diseases that immunocompetent people can ward off without treatment.”

You know what to do. You have chronic kidney disease. You need to treat it. Adhere to the kidney diet, get enough sleep, take your high blood pressure medication, exercise, avoid drinking, stop smoking, and keep yourself hydrated. The treatment for your immune deficiency is the same as the treatment for your CKD.

Here’s hoping you all realize that you are immunocompromised by virtue of having chronic kidney disease and treat yourself accordingly.

Until next week,

Keep living your life!