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Tuesday, December 16, 2008

FAQ for Kidney Patients

Q. Can I develop kidney disease?
A. Persons who are diabetic, have long-standing or severe hypertension, or have diseases involving the immune system like systemic lupus erythematosus are at risk of developing kidney disease. In addition there are some kidney diseases that run in the family. Therefore presence of family members with kidney diseases may also be an indicator of future renal disease.

Q. How do I know if I have a kidney disease?
A. The symptoms of kidney diseases depend on the nature of the disease. The most common symptoms are swelling of the feet or the face (especially on waking up), a decrease in the amount of urine passed or passage of blood or increased frothiness of urine. If the renal disease is advanced then decrease in appetite and repeated vomiting occur. It is also a good idea to find out if you have a renal disease you are under the age of 40 and have to consistently get up 2-3 times to pass urine in the night. Some patients develop aches and pains in their bones. An increase in BP could also be a manifestation of a kidney disease.

Q. What test should I undergo to find out if I have a renal disease?
A. You should undergo a thorough evaluation by your physician. Among other things, your blood pressure will be checked. Your urine should be looked at for protein as well as for pus cells or blood cells. Your blood urea and creatinine levels should also be checked.

Q. Are both of my kidneys affected?
A. Most diseases affect both the kidneys simultaneously and to the same extent. There are some diseases like stones, cancer and hypertension due to narrowing of the blood supply to kidneys where only one kidney might be affected or the two kidneys may not be involved to the same degree.

Q. I have a kidney disease. What should I do?
A. The treatment of kidney diseases depends on the nature of the kidney disease. The best method to go about it is to consult your nearest Nephrologist. As a broad principle, control of your BP and blood sugar (if high) will be important. Also, many renal diseases are chronic which means they cannot be completely cured but can be controlled with the help of medications. This means regular visits to a nephrologist. Also, many over-the-counter medicines especially commonly available pain remedies can adversely affect kidney function and you should not take any new medicine without consulting and revealing the nature of your illness to a doctor.

Q. How do I find out if there is a Nephrologist in my area?
A. The best method is to contact your physician who can guide you to a nephrologist. The other option is to get in touch with us and we shall inform you.

Q. What happens if my kidneys fail?
A. Mild kidney failure can be managed with medicines. But many kidney diseases will progress to severe kidney failure that will require kidney replacement therapy – either dialysis or kidney transplantation. In general, a person requires renal replacement therapy once the serum creatinine value is consistently above 8 mg/dl, or if symptoms of severe renal failure (loss of appetite, nausea, vomiting, loss of weight, extreme weakness, change in level of consciousness, drastic reduction in urine volume, breathlessness due to accumulation of fluid in the lungs or elevation of potassium levels in blood) appear.

Q. What is dialysis?
A. Toxic wastes and fluid generated constantly in the body as a result of the metabolic processes are normally excreted by the kidneys. Patients with kidney failure are unable to excrete them and hence they accumulate in the bloodstream and adversely affect the functioning of several organ systems. Dialysis is a process by which the blood is cleared of these substances. There are two forms of dialysis – hemodialysis and peritoneal dialysis.

Q. Can dialysis restore the function of my kidneys?
A. Dialysis acts to substitute the excretory function of the kidneys. By itself, it does not have any effect on the function of the kidneys. In some situations the kidney function can recover either spontaneously or with help of drugs, and patients require dialysis only for a short period of time. This is called acute kidney failure. The recovery may be complete or partial depending upon the type and severity of damage. In contrast to this, the kidney function does not recover in patients with chronic kidney failure and dialysis is required indefinitely or until kidney transplant is done.

Q. What does the dialysis not do?
A. Kidneys have other functions apart from the excretion of wastes and water, such as production of a hormone called erythropoietin that regulates production of red blood cells. These cells contain hemoglobin. Patients with kidney failure cannot form these cells and therefore develop a low hemoglobin. Kidneys also help in formation of active form of Vitamin D which is important in maintaining normal architecture of our bones. Dialysis cannot replace these functions and therefore other medications are required to correct these abnormalities. These problems are corrected after kidney transplantation.

Q. I have kidney failure. What kind of diet should I take?
A. Kidney failure patients are commonly advised to restrict dietary protein intake because unlimited protein consumption can worsen kidney function in patients with kidney disease. A minimum protein intake is necessary for body functions and it is important that the protein intake not be stopped completely. It is a myth that total elimination of proteins from the diet is good for these patients. In fact patients whose blood protein levels are low are likely to fare worse than those with normal levels. An average daily protein intake of 35-40 gms (depending upon the eight of the person) is essential. Patients on dialysis lose a lot of proteins, and the intake needs to be increased to approximately 60-80 gms/day once a patient is on dialysis.

The following food items contain approximately 10 gms of protein and should be taken in various combinations to meet the requirement. Cooking different types of pulses (DAL) in combination is better than anyone alone.

* A cup (~50 gms) of pulses (DAL)
* 250-300 ml of milk
* 350 gms of curd
* 60 gms of paneer (cottage cheese)
* 2 eggs (white portion only)
* chicken 40 gms
* fish 50 gms

In addition, a normal intake of calories is essential to ensure optimal utilization of proteins and therefore cereals like rice, bread etc and vegetables should be taken in normal amount.

Food items to be avoided: Green leafy vegetables (e.g. spinach), potassium rich foods (mangoes, lime, lemon, cheekoo, nuts and other dry fruits, watermelon, tomatoes, amla, jaggery, chocolate, coconut water, coffee).

Fruits that can be taken: cucumber, pineapple, apple, ripe papaya, guava, pear.

Patients who are hypertensive need to restrict their salt intake to around 4-5 gm/day. A general rule is not to add any extra salt to food items and to avoid pickles. Patients with a low urine output need to restrict intake of both salt and water.

Q. I have undergone a kidney transplant. How long do I need to take immunosuppressive medications?
A. Our immune system has been designed to protect our bodies against foreign objects such as infectious organisms by killing them. This system perceives the organ transplanted from another individual (like kidney) as a foreign object and tries to kill (reject) it. A well-matched organ such as from a close relative (e.g. parents, children and siblings) is perceived as "less foreign" than the one from a poorly matched (unrelated) donor and has less chances of getting rejected. The immunosuppressive medications (e.g. cyclosporine, azathioprine, mycophenolate and prednisolone) depress your immune system and thus serve to prevent it from rejecting the new kidney. So these drugs need to be taken for the rest of your life. The dosage, however, may need to be modified from time to time. These medicines are not required only if you have received a kidney from an identical twin. Because of financial reasons, some patients find it unable to continue taking all the drugs (especially cyclosporine) forever. In such cases, your nephrologist may allow you to slowly reduce the dose or even stop this drug altogether if he/she feels it to be safe. It is important that the drug is not stopped suddenly. We recommend that it be withdrawn at least over a 12-week period. The risk of rejection increases after withdrawal and therefore close supervision is necessary during and after withdrawal.

Q. What precautions should I take after transplant?
A. Since the immune system is our main protection against infections, patients taking immunosuppressive medications are under threat of developing severe life threatening infections. The risk is especially high in the first 6 months after transplant and in those who require treatment for rejection episodes. The nature of these infections depends upon the dose and duration of these drugs and the infectious organisms prevalent in the environment around you. After transplant, you will be prescribed certain medications that can prevent development of some of these infections. Leading a clean lifestyle is absolutely crucial. You should drink boiled/filtered water, eat clean cooked food, avoid crowded and polluted places and should be in constant touch with your nephrologist. You should also be compliant with the medicines prescribed for you. A good control of your blood pressure is also important.

Q. I wish to come to PGI Nephrology Department. How do I go about it?
A. The Nephrology department runs Renal Clinics thrice a week; on Mondays, Wednesdays and Saturdays (9 AM to 1 PM). A separate clinic is held for Renal Transplant patients on Thursdays at 2 PM. You have to first come to Medical OPD and will be referred to the Renal Clinic by the Medical OPD doctors.

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