41 - Alcohol, Alcoholism and Effects on the Kidney and Kidney Disease

Abstract

This chapter reviews the diverse effects of alcohol, alcohol-mediated organ failure, and alcoholism, as they are related to the kidney and interactions in Chronic Kidney Disease (CKD) and end-stage renal disease (ESRD). Ethanol impacts the kidneys both directly and indirectly. Direct effects of alcohol include—alterations in magnesium excretion and vascular alterations that impact hypertension. Heavy alcohol ingestion may also lead to the syndrome of beer potomania in which hyponatremia develops. Indirect effects of alcohol include—hypertension that in turn has been demonstrated to hasten the development of both primary nephrosclerosis and renal dysfunction in those with under- lying chronic kidney disease. Terminal alcoholic cirrhosis with ascites, as in other forms of cirrhosis, leads to renal failure because of the hepatorenal syndrome. Additionally, alcoholic-related cirrhosis is linked to the development of IgA nephropathy. Alcoholism remains prevalent in patients with end-stage renal disease and has diverse impacts on management, from impacts on adherence to treatment regimens and diet to increasing co-morbidities, such as malnutrition and cirrhosis. CKD in alcoholic cirrhosis may be complicated by severely limited metabolism of medication, resulting in an increase in medication-related side effects.