All You Ever Wanted To Know
Swelling over face and feet
Reduced Urine Output
Red colored urine
Frequent night time urination
Loss of appetite
Remember, these symptoms do not appear till 90% of the kidney functions are lost !! Hence absence of these symptoms does not rule out kidney disease.
If you have diseases like High Blood Pressure or Diabetes, you stand at a risk of developing kidney disease, if your Blood pressure and/or sugar values are high most of the times.
If you have had nephrotic syndrome in the past, you run the risk of the same disease coming back or causing progressive kidney damage.
Certain diseases like polycystic kidney disease run in the family. If one of your parents has this disease, you are at a high risk of developing the same disease yourself.
If you have high blood pressure, make sure your BP remains normal most of the times.
If you have diabetes, your sugar values should be in the desirable range most of the times.
Please avoid taking over the counter (OTC) drugs, especially painkillers on a long term basis.
Avoid long term use of alternative medications.
Treat Urinary Tract Infections (UTI) early and ask your doctor how you can prevent recurrent UTI.
Stop smoking. Maintain healthy eating habits. Avoid excessive weight gain. Reduce weight, if you are over weight.
There is no specific medicine to improve creatinine levels. In chronic Kidney Disease, even if the level does not increase over time, that is an achievement in itself. Measures to keep creatinine level stable include:
Strict Blood Pressure control
Strict Sugar control
Avoid use of pain-killers and other over the counter medications
Avoid alternative medications
Treat infections early
Medical disorders of the kidneys affect both the kidneys simultaneously. When creatinine level is elevated, it means that both the kidneys are affected.
Surgical disorders like obstructing kidney stones can affect only one kidney. In such cases, the second kidney will compensate and creatinine level will remain normal.
Nephrotic Syndrome is a disease of the filters ( glomerulus) of the kidney.
When the filters are damaged, they start leaking protein (albumin) in the urine. When large amounts of protein is lost in the urine, blood levels of protein fall and this results in swelling all over the body.
Commonly, the creatinine level remains normal in this disorder.
It is treated usually by steroids and sometimes immunosuppressive medications are required.
It is a procedure whereby a small needle is used to acquire small piece of the kidney. This piece is then examined under the microscope to identify the abnormalities in the kidney.
The common indications for a biopsy include:
Nephrotic Syndrome in an adult
Unexplained Renal failure
Unexplained renal failure in Transplant recipient
Keto-analogues are branched chain amino acids that do not contain Nitrogen in them.
When they enter the circulation, they derive nitrogen from the tissues. Thus, less Nitrogen is available for Urea to be formed. Less Urea means less of the toxins those are derived from Urea.
The dose is one tablet every 5 kg of body weight. E.g. A 60 kg person will need 12 tablets per day.
Its use in CKD stage III and IV is said to slow the progression of kidney disease. However, there are studies to the contrary...
Hemodialysis is a method to purify blood of the toxins which are otherwise excreted by a normal kidney. In essence, it replaces the excretory functions of kidneys.
To read more about Hemodialysis, click here.
That must be arterio-venous fistula ( AVF).
It is a connection between artery and vein. This transmits pressure of the arteries to the veins which gradually swell up. These swollen veins can then be used to place needles for hemodialysis.
To read more about AV fistula, click here.
A Perm-cath is a hemodialysis catheter that is longer than the conventional catheter and has a cuff on its stem. Its placement requires a minor surgery.
The catheter is placed in the neck veins and comes out through a 'tunnel' under the skin. This is the reason why it is also called 'tunneled' catheter.
The cuff on the catheter induces fibrosis around it so that any infection at its exit site does not travel beyond the cuff. Thus the catheter life is prolonged. Hence, the catheter is also called 'cuffed' catheter.
Commonly the Perm-cath or tunneled catheter can stay for 6 months to one year or even longer.
Not at all !!This a common misconception about hemodialysis. The only pain that one gets is the pain of needle insertion. Even that can be overcome by various applications.
Hemodialysis is not a discomfort in itself. In fact it is designed to reduce the patients discomfort !
Following are only some of the expected improvements:
Sleep is regularized
Work efficiency increases
BP control is easier.
At least three times a week, 4 hours each session.
Normal kidneys excrete waste products continuously from the body. If any artificial method to excrete these waste products are employed ( like hemodialysis), that method should also be continuous. Conceptually therefore, hemodialysis should be continuous. However, that is not practical.
The minimum kidney functions that can keep an individual healthy is a GFR of 10 mL/min.
Hence minimum amount of dialysis should be at least equivalent to ( if not more than) a GFR of 10 mL/min.
It has been calculated to find that 4 hrs dialysis, three times a week is close to a GFR of 10mL/min.
For the same reason, hemodialysis will never reduce in frequency. Three times a week is minimum, not ideal.
Dry weight is the lowest weight at which the patient has no swelling over the body and does not have episodes of low blood pressure during Hemodialysis.
This is achieved by trial and error and usually reached at over first few weeks after initiating Hemodialysis Therapy.
After a properly performed hemodialysis, one should not feel weak at all ! In fact one should feel fresh and energetic !!
If hemodialysis is less frequent, that is two times a week, the waste products build up to big levels and after the dialysis session, the levels come down drastically. This could cause some patients to feel weak and drained out.
The other possible reason could be the composition of dialysis fluid. This should be regularly checked to keep the electrolytes in proper concentrations. Wrong concentrations can cause problems like cramps and weakness.
You should not !!
A good hemodialysis centre maintains good quality of the water they use. This is done by specialized equipment.
If water quality is poor, you can get chills on dialysis. If this is happening too frequently, do ask the technician in-charge about this.
Other cause of chills on dialysis could be an infected hemodialysis catheter.
CAPD stands for Continuous Ambulatory Peritoneal Dialysis.
It is a modality of dialysis where the peritoneal cavity is utilized for the exchange of waste products and excess fluid.
To read more about CAPD, click here.
Commonly 15 to 30 min are required for each exchange. The time shortens with experience.
So, if someone is on 4 exchanges, the maximum time to be devoted to exchanges throughout the day is just 2 hrs !! This is substantially less than the time spent on each Hemodialysis session, not counting the time for commuting !
Not at all !
A small minority of patients experience pain during infusion because of slightly low pH of the PD fluid. This can be overcome by using high pH PD fluid which is costlier.
However, if the pain is new onset and severe especially associated with cloudy drains, do contact your Nephrologist immediately.
That is the whole objective behind the therapy !! The name itself says it: "Continuous AMBULATORY Peritoneal Dialysis"
You can even travel out of station, provided you have your supplies of PD bags with you.
Cycler is a machine that used to perform automated exchanges in peritoneal dialysis.
Usually used for night-time exchanges, the machine is pre-attached with requisite number of bags before retiring and the machine then safely performs exchanges at timed intervals.
It can be as frequent as one hourly cycles.
PET is Peritoneal Equilibration Test. It is a simple test performed on the bed-side that tells us the type of peritoneal membrane of the individual.
The membrane type will determine the amount of ultrafiltration and solute clearance achieved.
To understand more about PET, click here.
There are several ways.
Your monthly lab checks will tell you the creatinine level which will have stabilized to a lower level.( Remember, it will never come to normal, but should definitely come down once CAPD is started.)
Adequacy test can be performed where 24 hour PD drain fluid is collected and measured for urea and creatinine. Weekly KT/V value should be 1.7 and weekly clearance value should be 60 L/week.
Icodextrin is polymer of glucose. In PD solutions, it is used in place of dextrose (glucose) as an osmotic agent.
Icodextrin has a high molecular weight and therefore it is not absorbed in the blood. As a result, the osmotic force exerted does not reduce over time. This translates into a good ultrafiltration.
Whenever the patient gets started on dialysis, the option of Kidney Transplant remains open .
Transplantation can also be performed in advanced Chronic Kidney Disease just prior to initiating dialysis. This is called pre-emtive Kidney Transplant.
The donor has to be first degree relative of the patient i.e. parent, sibling, spouse or son/daughter.
The donor has to be blood group compatible and free of malignancy or any other disease that has the potential to involve kidneys.
The donor should be an adult. There is no absolute cut-off for the upper age-limit. Age above 70 yrs is a relative contra-indication.
However, elderly donors can be considered for donation if major illnesses like heart disease, cancer and kidney disease are ruled out.
The only risks are the ones associated with a major surgery. Removal of kidney is a routine surgery and the rates of complications are very low in this era of sophisticated surgeries.
Not at all !!
The weakness will last only a few weeks after the surgery. After that you will be like any other individual, capable of anything that a normal individual is.
Not a problem at all !!
A common misconception is that one becomes a sick person after kidney donation. This is not so.
There are people who are born with just one kidney and this sometimes gets detected late in the life and even at that stage they may have normal kidney reports !