How much water is too much?

     DEAR DR. ROACH: I am a rather healthy 35-year-old female. I drink a lot of water daily — approximately 5-6 liters, just because I feel the need to. My doctor does not seem concerned, as she says it may be normal for my body. I’ve been drinking these amounts for five to six years (I think it started during pregnancy). My family is concerned, as they say it is too much for the kidneys. I would truly appreciate your opinion. Also, I do not know whether any of this may be relevant, but I am not diabetic (but I am insulin-resistant); I do not use any medication; I am a smoker; I have gastritis; and I am slightly overweight. — A.N.
       ANSWER: Five liters a day is more than most people need. However, it is well within the ability of the normal kidneys to handle, assuming you are getting enough of the electrolytes and minerals the body requires.
       People taking diuretics, which affect the kidney’s ability to regulate salt, can develop dangerously low sodium levels with excess water intake.
       DEAR DR. ROACH: In 2010, my husband had an abdominal/pelvic CT scan (for an unrelated reason), and they found a 14-mm mass in his lower right kidney. In 2017, a repeat scan showed that the mass was much larger, and he had the kidney removed. The pathology showed a 48-by-40-mm papillary kidney cancer, type 1. We were told that removing the kidney would be curative, and no other testing (scans) have been ordered. We have not been told of specific type or staging. I had breast cancer in the past (mastectomy and radiation) so am familiar with the process. Is renal cancer different? We just feel out of the loop and that we should have more information on this cancer. He has lost a lot of weight. — K.K.
       ANSWER: Several kinds of cancers start in the kidney, but papillary kidney cell cancer is a less common type. Fortunately for you and your husband, type 1 generally are not as aggressive, and people with this kind of kidney cancer have a better prognosis than people with other types. It is completely obvious, at least in hindsight, that the 14-mm mass should not have gone so long without a follow-up.
       Around the time of diagnosis, an evaluation is undertaken to look for evidence of spread, including a CT scan of the lungs. Kidney cancer also can go to the bone, so if he had any bone pain or elevated blood tests showing bone damage (called alkaline phosphatase), most experts would recommend a bone scan as well. If there is no spread, the five-year survival in people with this type of cancer is greater than 90 percent. No chemotherapy is indicated if there is no evidence of spread. I would recommend a visit with a medical oncologist, just to make sure his workup is complete.
       The weight loss is concerning. It may indeed have been the tumor; cancers can make substances that cause people to lose weight. However, I personally wouldn’t stop looking, especially if the weight loss continues.
       DR. ROACH WRITES: A recent column on multiple myeloma noted that myeloma is uncommon in younger people. About 3.5 percent of myeloma cases occur in people under 45; however, that is still a lot of cases, and many physicians are unaware that this cancer can occur in young people. You can learn more about this cancer at myeloma.org.
       READERS: The booklet on restless leg syndrome and nighttime cramps offers more tips. Readers can obtain a copy by writing:
       Dr. Roach
       Book No. 306
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       Orlando, FL 32803
       Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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