What are the best ways to proactively protect my kidneys?

What are the best ways to proactively protect my kidneys? So I think this is the really, really important thing about myeloma because kidney health is part of the whole package of ensuring optimal outcomes. So whenever I see a patient newly diagnosed with myeloma, I say there are three key things to long kidney health. One is hydration. Keep yourself hydrated. As we're moving into warmer weather, you can go out and exercise and go to the beach, but you have to have a bottle of water with you. The minute you start feeling thirsty, that's your body telling you you're already dehydrated. So great hydration is key. Number two is avoid NSAIDs. So drugs like Naprosyn, which is Aleve, and Ibuprofen, which is Motrin, I tell patients, avoid them. Take Tylenol. And if for some reason you have pain that's not relieved by Tylenol, ask me or your health care worker to provide you with something other than an NSAID. The third one's a little more complicated. There are certain types of contrast that I want patients to avoid, and these are iodine-based CT contrast. Not MRI contrast, but CAT scan contrast. This can put you at risk for kidney problems. So what I tell patients is, listen, if you go to see your orthopedist and they want to check out your leg with a CAT scan, tell them to call me first so we can find an alternative way of looking at it. If it's 2 o'clock in the morning and you're in an emergency room and they're thinking you're having a heart attack and they want to get a CAT scan study, let them go ahead. Are there other comorbidities that may affect kidney health? So there's a few things that we really look out for. One of them is diabetes, because diabetes can predispose certain people to kidney disease. So we really want to make sure, especially because myeloma treatment often involves steroids, that we connect people with good doctors like endocrinologists to help monitor their diabetes to make sure they don't have kidney problems from other diseases. Is there a certain diet that people with kidney disease should follow or not follow? So there are some general recommendations for patients with advanced kidney disease to prolong kidney function. And basically it's lower salt and lower protein, limiting to something like 20 to 30 grams of protein or less than 2 grams of salt. But far be it from me to deprive someone of a bacon cheeseburger every now and again. What should individuals with kidney disease know about bone strengthening or bisphosphonate therapy? So for the majority of patients who are on dialysis who need bone strengthening medicines, we tend to use Donosumab or Xjiva. The one thing that's important to note is that the risk of hypocalcemia, low calcium, increases as your kidney function decreases. So we always want to make sure for those patients that A, their calcium levels are normal before we give it, and B, that they've repleted their vitamin D to offset the risk of lowering the calcium after that dose.