Anaemia

What happens when you suffer from anaemia?

Anaemia is a condition in which the quantity of heamoglobin in the body goes down. Heamoglobin, as we know, is a protein that is very essential to the body. It supplies oxygen to different parts of the body and it does many other functions. If it is low, each and every part of the body gets affected. The first implication would come because there is not sufficient oxygen being transported to different areas. All parts of the body would start feeling weak.

What diet should be prescribed for an anaemic person?

I must clarify that anaemia by itself is not a disease. Anaemia is a manifestation of a particular disease. The real treatment would be to treat the cause. Say, if diet is responsible for anaemia, then taking a good diet could make a difference. There is usually a deficiency of iron or another vitamin. It could be vitamin B12, it could be folic acid or it could be pyridoxine. Deficiency of these things in the diet can lead to anaemia. In case there is iron deficiency, then one has to ensure that whatever food item one takes should contain enough of iron and it should be made available to the body; that means it should get absorbed also.

Should one take supplements or natural forms of iron?

There is no doubt that the natural forms are the best ways of supplementing. But having said it, there are certain problems. Vitamin B12 is not found in vegetarian diet. It is largely a vitamin found in non-vegetarian diet. I would not want any vegetarian to change to a non-vegetarian for the sake of vitamin B12. It is much cheaper, it is more effective and it is more social to supplement with the tablets of B12.

So, basically, if you are not getting it from your daily intake of food, then you have to supplement it with pills. What are the tests to diagnose anaemia?

Anaemia is the reduction of the haemoglobin level in the body. Normally this varies with the age and gender of the individual. According to the WHO criteria, an adult male having the haemoglobin of less than 13, an adult non-pregnant female having a haemoglobin of less than 12 and a pregnant lady having a haemoglobin of less than 11 is diagnosed as anaemic. A simple test is a complete blood count, which gives us a value of haemoglobin and certain other rates and indexes that help us to diagnose a patient as anaemic.

What are the levels of haemoglobin in children?

The values in children tend to vary from the time of birth till about the age of 12 years, though the gender differences do not come till puberty. The value for a newborn is round 13. They vary from the age of six months to one year, two years to six years and again 12 years. So, these are the criteria, which decide whether the child is anaemic or not.

How does a newborn supplement iron? Does it come entirely from the mother’s milk?

When a child is born his haemoglobin is more than the adult’s hemoglobin. Milk that he consumes is deficient in iron, just remember milk is deficient in iron, and that goes on for the whole first year of his life. That is the time by end of first year his haemoglobin drops down to as low as 11, that is normal for them. What we have to remember is that during this time he should be given iron supplementation.

Are only women affected by anaemia?

Not at all, this is a wrong notion that women are the only ones to get affected. However, women have a regular monthly blood loss. In addition to that, married women also might have blood loss during pregnancy or might even have to give away some of their iron and essential elements to the child. This is the reason why women tend to have more prevalence of anaemia as compared to men.

Is there a reserve of iron in the body?

If body needs about 100 mg of iron on a day-to-day basis, 99% of it is recycled and one milligram is taken from the diet. Now, that one milligram is sufficient to manage the requirement of 100 mg because the rest is recycled. Since it is such an essential element in the human body, nature has created a separate reserve for it. So even if somebody does not take iron for a month it should not affect him because he can fall back upon that reserve. By the time anaemia develops, these reserves would have been used up altogether.

Is it true that vegetarians are more likely to be anaemic than non-vegetarians?

The risk of a vegetarian getting into an anaemic state occurs only because of B12 deficiency. We have a large population in our country that is vegetarian. In our clinical practice, we see that most of them do not become deficient in this essential vitamin. So, a healthy person is not likely to get anaemic but there are chances that a vegetarian might get deficient in B12, which may or may not lead to anaemia.

How is thalassaemia related to anaemia?

Thalassaemia is a hereditary disorder, which presents itself as anaemia. It is a very frequent problem in India because we have a large gene pool of beta thalassaemics in India. And it presents itself, in a fashion, in a laboratory very similar to iron deficient anaemia, but there are simple tests which are available which help us distinguish between a thalassaemic and an iron deficient individual. A simple estimation of haemoglobin A2 levels and a fetal hemoglobin level estimation with the examination of the complete blood count should by and large be able to give the diagnosis.

What is bone marrow biopsy and does it help in determining anaemia?

A bone marrow biopsy is an investigative technique in which a small needle is inserted into the bone and a piece of the marrow tissue is taken out. As far as the diagnosis of anaemia is concerned, this is rarely restored to, even though staining of the bone marrow iron is supposed to be the most definitive test for iron deficiency. If a patient’s bone marrow does not stain positive for iron it means the patient is completely depleted of iron. But being an invasive technique and with the presence of so many more simple techniques available to us, we do not resort to it. However, it is an important investigation as part of the diagnosis of a patient who is having unexplained anaemia in which he would like to rule out the secondary causes of anaemia, like cancers, like leukaemia or myelodysplastic syndromes in an elderly individual.

Are chemotherapy patients more likely to be anaemic?

Certain groups of anticancer drugs, which act against the folate metabolism can cause anaemia.

By and large all anticancer drugs would have some affect on the bone marrow. Bone marrow is a factory for the production of haemoglobin. Whenever there is anaemia, it is important to check the factory, whether it is working or not. All anticancer drugs can have an affect on this bone marrow.

Is there any way to prevent anaemia?

Yes, and I think that is the best strategy. We have preventive strategies for both kind of anaemias - the hereditary type of anaemia and those that are acquired. I will take the acquired one first because they are more common. Acquired, they are from the deficiency of iron or one of the vitamins such as — B12 or deficiency of protein. It is very easy for anybody to take a healthy diet, a nutritious diet and a balanced diet. Highly processed foods destroy folic acid resulting in anaemia. One should avoid taking tea; one can take some lemon or vitamin C that helps absorb iron. When it comes to the hereditary causes, like thalassaemia: one can prevent it; in fact, some of the countries are going to eradicate thalassaemia by genetic conunselling, which is a preventive and curative measure.

Polycystic kidney disease

What is polycystic kidney disease? Polycystic kidney disease (PKD) is a genetic disorder characterised by the growth of numerous cysts in the kidneys. The cysts are filled with fluid. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure. What are the causes? Polycystic kidney disease (PKD) is an inherited disorder (with autosomal dominant inheritance). If one parent carries the gene, 50% of the children will develop the disorder. The exact mechanism that triggers cyst formation is unknown. Cysts in the kidneys may be associated with aneurysms of the blood vessels in the brain. They may be associated with diverticula of the colon, and with cysts in the liver, pancreas, and testes. As many as 50% of people with polycystic kidney disease also have cysts in the liver. What are the types? Autosomal dominant PKD (ADPKD) is the most common, inherited form. Symptoms usually develop between the ages of 30 and 40, but they can begin earlier, even in childhood. About 90 percent of all PKD cases are autosomal dominant PKD. Autosomal recessive PKD is a rare, inherited form. Symptoms of autosomal recessive PKD begin in the earliest months of life, even in the womb. Acquired cystic kidney disease (ACKD) develops in association with long-term kidney problems, especially in patients who have kidney failure and who have been on dialysis for a long time. Therefore, it tends to occur in later years of life. It is not an inherited form of PKD. What are the symptoms? In early stages of the disease, the cysts enlarge the kidney and interfere with kidney function, resulting in chronic high blood pressure, anaemia, and kidney infections. The cysts may cause the kidneys to increase production of erythropoietin (the hormone that stimulates production of red blood cells) resulting in increased number of red blood cells, rather than the expected anaemia. Hypertension caused by polycystic kidneys may be difficult to control. The disease is slowly progressive, eventually resulting in end-stage kidney failure. It is also associated with liver disease, including infection of liver cysts. The presenting symptoms include: blood in the urine flank pain on one or both sides excessive urination at night abdominal pain or tenderness Additional symptoms that may be associated with this disease: nail abnormalities painful menstruation joint pain drowsiness high blood pressure How is it diagnosed? Examination may show high blood pressure, kidneys or abdominal masses which are felt during examination, abdominal tenderness over the liver (right upper quadrant), and enlarged liver. A urinalysis is nonspecific, but it may show urine protein or blood in the urine. A CBC (complete blood count) may show decreased or increased RBCs Polycystic kidney disease, and associated cysts on the liver or other organs, may show on: abdominal ultrasound abdominal CT scan abdominal MRI scan In a family with several affected members, genetic linkage tests can be performed to determine with fair reliability whether a person at risk carries the gene for ADPKD. What is the treatment? Currently, no treatment can prevent the cysts from forming or enlarging. Treatment aims at reducing the symptoms and prevention of complications. -Medicine and surgery to reduce pain -Antibiotics to resolve infections -Dialysis and transplantation to replace functions of failed kidneys Hypertension may be difficult to control, but control of it is the most important aspect of treatment. Treatment may include antihypertensive and/or diuretic medications, low salt diet, or other treatments. A urinary infection should be treated promptly with appropriate antibiotics. If there are symptoms of anaemia, it may be treated with iron and other supplements, erythropoietin administration, or blood transfusion. Surgical or radiologic drainage of cysts may be indicated because of pain, bleeding, infection, or obstruction. There are usually too many cysts to make cyst removal a feasible alternative. Surgical removal of one or both kidneys may be required. Treatment of end-stage kidney disease includes kidney or kidney transplantation. What is the prognosis? Polycystic kidney disease progresses slowly but persistently. Medical treatment may provide relief of symptoms for many years. Eventual end-stage kidney failure is common. The absence of systemic disease or autoimmune disease makes people with polycystic kidney disease good candidates for kidney transplantation.

World kidney Day

Kidney Disease is common, harmful & treatable

World Kidney Day

When?

· The second Thursday in March every year

· Thursday 12 March 2009 this year

Why?

· To raise awareness of the
importance of healthy kidneys

Who?

· People with kidney disease

· Relatives and friends of people
with kidney disease

· People at risk of kidney disease

· Healthcare professionals

· Researchers

· Health policy makers &
healthcare commissioners

· Governments

Where?

· Everywhere!

Our Kidneys are amazing!

Download a concise guide to help you keep your kidneys healthy

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Are your Kidneys Healthy?
To check your Risk click here

Kidney disease is often ‘silent’, causing few symptoms, especially in the early stages. If left unchecked the disease can progress or lead to kidney failure. It can severely impact on quality of life and ultimately can cost lives. Very often it comes along with other health threatening conditions, such as cardiovascular disease and diabetes.

If kidney disease is detected early, appropriate treatment can delay or even stop chronic kidney disease. It is easy to detect early signs of kidney problems by using simple tests performed by your GP.

Download copies of the Healthy Kidneys Flyer
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World Kidney Day on 12 March 2009

AMAZING KIDNEYS ARE YOURS HEALTHY?

World Kidney Day (WKD) is a global health awareness campaign focusing on the importance of our kidneys and reducing the frequency and impact of kidney disease and its associated health problems worldwide. The campaign is celebrated every year on the second Thursday of March in more than 100 countries on 6 continents.

World Kidney Day will be held on 12 March 2009.

"Keep the pressure down"

The 2009 campaign highlights the importance of high blood pressure as one of the key symptoms and causes of Chronic Kidney Disease (CKD).

Every year millions die prematurely of kidney failure or heart attacks and strokes linked to chronic kidney disease (CKD). WKD encourages everyone to learn more about their amazing kidneys and to raise awareness of the fact that that kidney disease is common, harmful and treatable

Take the test and see if you are at risk

Tick the box next to the questions, if your answer to them is yes.

Do you have high blood pressure?
Do you suffer from diabetes?
Are you overweight?
Do you smoke?


Do you have a family history of kidney disease?
Do you suffer from other kidney diseases?

Via: http://www.worldkidneyday.org/

Blood urea

Why is the test done? The blood urea test is used mainly to test the renal (kidney) function. In kidney diseases, there is an increase in the blood urea level due to reduced excretion by the kidneys. What is urea? In protein metabolism, urea is formed in the liver as the end product. Protein is broken down to amino acids during digestion. Amino acids contain nitrogen that is split off as the ammonium ion (NH4). The ammonium ion combines with other small molecules to produce urea. The urea is passed into the blood and excreted by the kidneys in the urine. Blood urea levels go up in most kidney diseases as urea excretion is affected. It may also be high in patients with liver disease or dehydration. A large number of drugs increase blood urea level by competing with it for excretion by the kidneys. How is the test done? Blood is drawn from a vein by venepuncture, usually from the inside of the elbow. No special preparation is required for the test. What are the normal values? 7 to 20 mg/dl What are the abnormal results? More-than-normal values could be due to: Kidney diseases like glomerulonephritis, pyelonephritis, and acute tubular necrosis Renal (kidney) failure Too much protein breakdown like in starvation Very high protein intake Congestive heart failure Heart Attack Bleeding in the gut Decrease in the blood volume like in burns, dehydration or shock Obstruction in the urinary tract due to a tumour, stones, or prostatic hypertrophy Drugs used in gout, infections, epilepsy, blood pressure, pain relief, etc may raise blood urea. These include allopurinol, aminoglycosides, cephalosporins, chloral hydrate, furosemide, indomethacin, methotrexate, methyldopa, drugs toxic for the kidneys (like high doses of aspirin, amphotericin B, carbamazepine, colistin, penicillamine, polymyxin B, probenecid, vancomycin), propranolol, rifampin, spironolactone, tetracyclines, thiazide diuretics, and triamterene Lower-than-normal levels may be due to: Low protein diet, malnutrition or too much fluid intake Liver failure Drugs to treat some infections like chloramphenicol and streptomycin

Pregnancy and kidney dialysis

Women with kidney disease who are on dialysis may wonder how dialysis will affect their chances of getting pregnant and delivering a healthy baby. Studies show that only 1 to 7 percent of women of childbearing age on dialysis can get pregnant. Over 90 percent of women of childbearing age on dialysis cannot get pregnant because having kidney disease can decrease the ability to produce healthy eggs that can be fertilized. Also, some women on dialysis may not menstruate or if they do, they have irregular periods. This is caused by irregular hormone levels in the body.

While it is rare, women on dialysis have become pregnant. Of these pregnancies, about 20 percent will end in miscarriage. A full-term pregnancy lasts about 40 weeks; however, about 80 percent of dialysis pregnancies will only go about 32 weeks, resulting in a premature birth.

Is pregnancy recommended for women on dialysis?

Pregnancy is generally not recommended for dialysis patients because it is considered a high-risk pregnancy. Healthy kidneys work all day everyday, yet in-center hemodialysis is only about 12 hours per week and replaces only a portion of kidney function. The body of someone on dialysis has a higher level of waste products than a body with good kidney function. Having extra wastes in the body makes it harder for the baby to develop as it should.

During pregnancy, healthy kidneys must work overtime to keep the blood clean because the baby releases wastes into the mother’s blood stream, and she also has an increased amount of blood in her body. So, for women on dialysis whose kidneys don’t work, pregnancy is even harder on the body, and more frequent dialysis is recommended to keep the blood as clean as possible.

How can a woman on dialysis improve her chances of having a baby?

If a woman on dialysis wishes to have a baby or discovers she is pregnant, she should talk to her doctor about her individual condition. Her doctor will be able to explain the risks involved and be able to provide guidance to increase the chances of keeping the woman healthy and to help her carry her baby to term.

The chances of a woman with kidney disease becoming pregnant are higher if she has just recently started dialysis and still has a fair amount of residual kidney function or if she has had a transplant because she is more likely to be in better health and have a regular menstrual cycle.

A woman’s fertility will usually return to normal after a successful kidney transplant. Typically, she will have more regular periods and better general health compared to a woman on dialysis. It is easier for a woman with a transplant to get pregnant and have a child than a woman on dialysis. Statistics show that 20 percent of female kidney transplant patients attempting to get pregnant conceive compared to 1 to 7 percent of women on dialysis.

After receiving a transplant, it is important to wait until the transplant surgery scar has begun to heal before resuming sexual activity. Once the doctor says it is alright, there is no reason to worry about damaging the transplanted kidney.

However, pregnancy is not recommended for at least one year after a kidney transplant, even with stable kidney function. (Some sources recommend waiting as long as two to five years.) Women who have minimal protein in their urine, normal blood pressure and no evidence of kidney rejection are the best candidates for pregnancy.

In some cases, pregnancy is not recommended at all because of risk to the mother's life or possible loss of the transplant. A female transplant patient who is considering pregnancy should discuss any possible risks with her doctor.

Some women with chronic kidney disease or who are on dialysis have found that receiving erythropoietin (EPO) to treat anemia has improved their overall health, which can result in a greater chance of pregnancy. An improvement in overall health can lead to more energy for sexual activity, which can increase a woman’s chances of pregnancy.

When a dialysis patient becomes pregnant, she requires extra care and attention. She must work closely with her health care team, which includes her doctor, an obstetrician who specializes in high-risk pregnancy, a nephrologist (kidney doctor), a dialysis nurse, a pediatrician specializing in premature births and a renal dietitian. The baby’s progress should be continually monitored with ultrasounds to identify and treat problems early.

Many kidney disease patients have high blood pressure, which tends to get worse in pregnancy and often leads to miscarriage or premature delivery. The mother’s blood pressure must be monitored closely, because it could rise during pregnancy and cause problems for her and her baby. The expectant mother should take additional vitamins, eat a diet higher in protein and avoid alcohol and tobacco.

How often should a pregnant dialysis patient do dialysis treatments?

A pregnant woman on dialysis should increase the frequency of her dialysis treatments from three times to five or six times per week, depending on what her doctor suggests. More frequent dialysis is gentler on the mother’s body and less traumatic for the baby because more frequent dialysis more closely resembles the function of healthy kidneys. Blood pressure control is also better with more frequent dialysis.

More frequent dialysis allows the expectant mother to enjoy a varied and healthier diet. A healthy nutrient-dense diet during pregnancy is extremely important. Requirements are increased for protein and most vitamins and minerals, particularly folate and iron. The additional 300 calories a day needed during the second and third trimester is fairly easy for most women to meet. Pregnant women should work with their renal dietitian to evaluate their nutritional needs and come up with a diet plan.

If a woman is on in-center hemodialysis, it is recommended that she work with her health care team to increase the frequency of her dialysis treatments. She may want to consider switching to short daily home hemodialysis (HHD) or in-center nocturnal hemodialysis while she is pregnant so that she can do dialysis treatments more frequently. If she is currently doing home hemodialysis, it is recommended that she increase the frequency of her treatments so that her blood is getting cleaned almost daily. Pregnant women on dialysis are advised to have frequent ultrasounds to monitor the baby’s development and identify and treat any problems early and aggressively.

Peritoneal dialysis (PD) is also an option for pregnant women on dialysis, although some women may experience discomfort due to the growing baby and the dialysis fluid inside their abdomen. A PD catheter is not harmful to the baby and can be placed at any time during pregnancy. If a pregnant woman chooses PD, her doctor may decide to supplement her PD treatments with hemodialysis treatments as she gets closer to her due date to ensure that her blood is being cleaned as thoroughly as possible.

What kind of birth control is recommended for kidney patients?

Dialysis patients who have periods or those who could become pregnant should use birth control to guard against pregnancy. Doctors can recommend the type of birth control that should be used. Women who have high blood pressure should talk with their doctor before using a birth control pill, as some can raise blood pressure.

Women who want to have children are advised to consider using contraception while on dialysis and plan to have children after a kidney transplant. Some dialysis patients feel that they would be better able to care for a child after a kidney transplant, rather than when they are on dialysis because they will typically have more energy, feel better and have more free time because they do not have to go to dialysis treatments several times a week.

Transplant patients are advised not to use an intrauterine device (IUD), which is a small, plastic, T-shaped device that is inserted into the uterus to prevent pregnancy. Transplant patients are more likely to get an infection from an IUD because the anti-rejection drugs they must take lower the body’s ability to fight infection. Diaphragms, sponges and condoms are other forms of birth control that may be considered.

What emotional issues might couples go through if one of them is a dialysis patient and they can’t have a child?

A woman on dialysis may experience feelings of loss because she is unable to have a baby. She may feel incomplete or unfulfilled in her role as a woman, which may lead to feeling negative about herself and her sexuality. As a way of coping, she should talk openly about her feelings and needs with her partner and/or a health care professional.

With today’s cutting edge advances in fertility procedures, dialysis patients have more options than ever before. If a female patient is still ovulating, her eggs can be frozen and then fertilized with the sperm of her husband, partner or donor at a later date, and a surrogate can carry the pregnancy to term. Although some men experience a small decline in fertility while on dialysis, others experience reduced testosterone levels, reduced volume of seminal fluid, reduced sperm count or infertility. So, by the same token, a male dialysis patient can freeze his sperm for use at a later date. Dialysis patients can also experience parenthood by adopting or becoming a foster parent.

Low Potassium Diets for People with Kidney Disease

Having to go on a low potassium diet definitely has its challenges. That is because potassium is a mineral that is found in many of the foods that we eat. In fact, many of the foods that were recommended when you were diagnosed with diabetes, like fruits and vegetables, nuts, lean meats, milk and whole grains are high in potassium. Now, you are being told to limit these foods. Why?

First, let’s explain how potassium works. All of the different minerals in our bodies have different functions that they perform to keep your body running smoothly. Potassium helps maintain normal blood pressure and also helps muscles, including the heart muscle, to contract properly. It is the job of your kidneys to keep the right balance of potassium in your body. When your kidneys are not functioning properly, potassium can build up in your blood, and this can lead to dangerous side effects, such as confusion, irregular heartbeat and even a heart attack. If your kidneys are not functioning properly, your doctor may recommend that you limit potassium in your diet to keep your potassium levels in your blood in a safe range.

This article offers some general guidelines for a low potassium diet, and describes a sample meal plan. It is highly recommended that you see a dietitian who specializes in kidney disease, to help you with more specific meal planning.

General Tips:

• Eat refined grains the majority of the time, because they contain less potassium than whole grains. Bran and bran products are high in potassium.
  
  
• Use refined grains as the base of your diet, because they tend to be lower in potassium than many of the other food categories. Try to have at least 6 to 10 servings a day, spread out over 3 meals plus snacks. Of the 6 to 10 grain servings, up to 2 can be whole grains.
  
  
• Make sure to get enough fat in your diet to keep your calories consistent. Olive oil, butter and margarine tend to be low in potassium. Choose olive oil most of the time in cooking, since it is a healthy fat and contains no potassium.
  
  
• Incorporate 2 – 3 ounces of medium-fat cheese (less than 5 grams of fat per ounce) into your diet daily as it a good source of protein and lower in potassium than most meats and fish.
  
  
• Egg whites are a low potassium food and are a good source of protein.
  
  
• Some foods are so high in potassium that they are best avoided most of the time:
  
  
• Fruits you should avoid include apricots, avocados, bananas, cantaloupe, grapefruit, honeydew melon, kiwi, orange juice, oranges, nectarines, papaya, plantains, prune juice, prunes, raisins, tangelos, watermelon.
  
  
• Vegetables you should avoid include artichokes, butter beans, beets, brussel sprouts, collards and other dark green leafy vegetables, mushrooms, potatoes, rutabagas, sweet potatoes, tomatoes, winter squash, yams, and zucchini.
  
  
• Milk should be limited to one 8-ounce serving per day. This would include buttermilk, yogurt and ice cream.
  
  
• Meats and fish should be limited to three 4-ounce servings or the size of a small deck of cards, up to 2 times a day.
  
  
• Beans and legumes should be avoided or used in very small quantities, infrequently.
  
  
• Nuts are high in potassium, but if you limit them to 1 ounce per day or less, they offer a healthy source of fat and are a good source of protein.
  
  
• Other foods to limit are bran, chocolate, molasses and sardines.
  
  
• You can remove some of the potassium from your favorite high-potassium vegetables using a soaking process called ‘leaching’. Though you will still need to limit how often you eat them, this soaking will allow you to eat these vegetables occasionally.
  
  To leach vegetables, peel and slice them into small pieces. Rinse under warm running water and then soak them in a large amount of warm water (10 times the amount of vegetables) for several hours. Drain and rinse the vegetables under warm running water and then cook them in about 5 times the amount of water as the amount of vegetables.
  
  
• There are still many fruits and vegetables that you can eat. It is recommended to limit to 4 servings of fruit or vegetables a day. The serving size is ½ cup or 1 small fruit.
  
  
• Avoid salt substitutes because they usually contain potassium.
  
  
• Use only salt and seasoning mixes that do not contain potassium.
  
  
• Limit most dried fruits and juices because they are more concentrated. If you really want to drink juice, choose a lower potassium fruit juice such as cranberry juice, peach or pear nectars, and limit to 4 oz. once a day.
  
  
• For other beverages, water is best, but you can also drink one or two 8-ounce sugar-free lemonade or diet sodas, which tend to be low in potassium. Limit coffee to one cup per day.

As you can see, a low potassium diet may be tricky to follow because so many foods contain potassium. I bet you are thinking, so what can I eat? And that is a good question. I recommend working with a renal dietitian to help you get the right balance of foods in your diet.

In the meantime, here is a sample meal plan for a low potassium, low sodium diet. A diet is considered low potassium when it totals between 1500 - 2400 mg of potassium per day. The samples below fall between approximately 1800 – 2200 mg of potassium, depending on which serving size and food items you choose.


* I used the nutrition counting guide listed as a reference at the bottom of this article to determine the potassium content of this meal plan.

Breakfast
1 cup coffee or tea
1 – 1½ cup cornflakes with up to 1 cup of milk or soymilk
½ cup blueberries
OR –
1 cup of coffee or tea
1 – 1½ cups of cream of wheat
½ cup strawberries and 1 Tbsp chopped nuts
OR -
1 cup of coffee or tea
1 English muffin or equivalent bread product
1 - 2 eggs
1 slice ham
½ cup applesauce

Snack
1 slice of bread with 1 Tbsp peanut butter

Lunch
1 sandwich on white, oatmeal or wheat bread with 2 oz. of turkey, chicken or roast beef, 1 slice of cheese, mustard and mayo, a few slices of cucumbers.
1 small apple or peach
2 vanilla wafers or 10 pretzels
Sugar free lemonade or water

Snack
4-5 crackers and 1 - 2 oz. of low fat cheese

Dinner
3- 4 oz. of chicken, beef or fish
1 cup of green beans or
1 cup of white rice or pasta
1 slice of rye bread

Snack
3 - 4 cups popcorn

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.

Kidney Transplant - Q. & Ans.

The following will help answer questions you may have about kidney transplants.

1. What is a kidney transplant?

A kidney transplant is an operation performed by a transplant surgeon in which a healthy kidney from another person is placed into your body. Normally the non-working kidneys remain. However, in rare cases, they are removed to control infection or high blood pressure. A kidney transplant is the treatment option which is most like normal kidney function. The new kidney performs the functions of your own non-working kidneys. Because the time spent waiting for a transplant may be lengthy, dialysis is usually required while you are waiting for your transplant. Additionally, transplanted kidneys may not work immediately and a short period of dialysis may be required after the operation.

2. Where does a donor kidney come from?

A donor kidney may come from any of these sources: Living related donors: A member of your family can donate one of their kidneys if your tissue and their tissue match. Family members who are related by birth are the most likely to have matching tissue. Living unrelated donors: Sometimes people who are not related by birth are willing to donate a kidney. Usually people who are not related will not have tissue that matches yours, but it is possible. Cadaver organs: A cadaver donor is a person who has recently died (usually accidentally.) These people have indicated that they would like to donate their organs when they die. In most instances, donors must be adults, age 18 or older.

3. Do I have the right to refuse a transplant if a kidney becomes available?

Yes. If for any reason you are uncertain about accepting a kidney for transplant, you may decline the offer without jeopardizing your ability to receive another offer. You should discuss your concerns with your doctor.

4. How do we find a kidney that "matches" mine?

The best match for a kidney transplant is an identical twin because identical twins have perfectly matching kidneys. Brothers and sisters (by birth), or your mother or father, may also have a kidney that is compatible. The relative who wishes to donate must talk with the doctor about additional tests, the surgery, and possible risks. Tests include a complete medical evaluation, blood and urine tests, an EKG (electrocardiogram) and x-rays. To determine a good, healthy match, the following steps are done: The donor's blood is tested to rule out hepatitis or AIDS The blood type and tissue type are tested to see if they match (Tissue typing is done on a sample of blood and does not require taking any tissue from your skin or body.

5. What does the kidney donor have to go through? Is it dangerous?

The person who wishes to donate must talk with their doctor. The suitability of the donor depends on: 1) the donor wanting to donate a kidney, 2) normal kidneys in the donor, and 3) the kidney match being good (based on the test results) and his or her medical evaluation. The hospital stay for the donor is usually 5-7 days. Like any major operation, there is some pain afterwards. The donor should plan for 1-2 weeks at home and 1-2 months with no heavy lifting or labor. Many people worry donating a kidney will leave the donor in a dangerous situation. The living donor of the kidney is left with one healthy functioning kidney, which should be more than enough for the rest of the donor's life. His or her activities are not usually limited.

6. How many people have successful kidney transplants?

As of 1997, there were over 76,000 people living in the U.S. with a functioning kidney transplant. That same year, there were over 8,000 kidney transplants performed in the U.S. About a third of the patients with renal failure are eligible for a transplant.

7. How will the kidney transplant affect my lifestyle?

The transplanted kidney works 24 hours a day, doing the work of normal kidneys. This often gives the person who has the new kidney more energy than he or she had while on dialysis. Also, a working kidney keeps you healthier overall. Once you have had a kidney transplant, you can resume a fairly normal lifestyle. The kidney will react to chemical and fluid changes in the body immediately. Multiple medications will be required on a strict schedule for the rest of your life.

8. Can I travel?

Transplant patients are free to travel as long as they follow treatment guidelines. Patients should always make sure they have enough medication with them, and should always make sure to take their doctor's phone number with them.

9. Are there any diet restrictions?

Medications to prevent rejection make soMedications to prevent rejection make some patients very hungry. Since it is easy to gain weight after a transplant, you may need to watch calories closely. Some patients find it difficult to manage this weight gain, which can affect a patient's body image, or the way they feel about themselves. In addition, if you have high blood pressure, you may also need to limit the amount of sodium (salt) you eat. Protein and phosphorus are not limited as they are when you are on dialysis. A dietitian or a member of your health care team will be able to help you with any special diet recommended by your doctor. They will help you and your family select the right foods

10. Can people tell that I've had a kidney transplant?

Other than the scar that remains after a kidney transplant, there is little evidence to indicate that the surgery ever took place. However, the medications that your doctor prescribes to keep you from rejecting your transplant may result in some changes in your physical appearance. Some of these may include: Weight gain Increased sweating Acne Muscle weakness Puffiness of the face and abdomen Gum problems Hand tremors An increase in the amount of hair Not all patients suffer from all of these side effects.

11. Will I be able to keep working and/or go to school?

Once you have received a kidney transplant and have recovered completely from the surgery, you may return to work or school outside the home as long as your health remains stable.

12. What should I know about exercise?

There are some activities you may be asked to avoid after a kidney transplant. You should discuss this with your doctor. You will be urged to pace yourself and do as much as you feel able to do. Keep busy with activities at work, at home, with family and friends, or within the community. This will help you both physically and emotionally.

13. Are kidney transplants expensive? How can I afford one?

Costs associated with a transplant can add up quickly. Few patients are able to pay all the costs from one single source. Most likely, you will have to rely on several sources. These might include: private insurance, Medicare, the Veterans Administration (VA), and prescription drugs assistance programs. There are also costs associated with a transplant after surgery, including the cost of the anti-rejection drugs, which must be taken for as long as you have your transplanted kidney. Ask your transplant financial team, your insurance provider, and your employee benefits officer for the latest information or help.

14. My doctor said there are medications to take after the transplant. What do they do?

As a transplant patient, you will need to take immunosuppressive medications to stop your body from rejecting the donor kidney. These medications protect the kidney from attack by your immune system. These oral medications must be taken daily for as long as you have the transplanted kidney. Immunosuppressive medications lower your ability to fight off illness. To stay healthy, you should stay away from people who have contagious conditions such as colds, flu, or chicken pox. After you go home from the hospital, it is important that you take the correct dose of medicine, and that you visit your doctor on a regular basis. Your doctor will then be able to routinely check your kidney function and adjust your medicine as needed. Using immunosuppressive medications has been associated with mild to severe side effects. Some of the side effects are temporary, and some are related to the dose and can be prevented by adjusting the dose. It is important to note that not everyone has all of these side effects. Some of the most common side effects include: Weight gain Increased sweating Elevated blood pressure Acne Muscle weakness Puffiness of the face and abdomen Gum problems Upset stomach Hand tremors Mood swings

15. What happens if my body rejects the kidney transplant?

Rejection is the major problem with kidney transplants. This means your body is trying to get rid of something that doesn't belong there. The body's immune system, which normally protects us from illness by recognizing and attacking foreign bodies such as bacteria and viruses, can also recognize a transplanted kidney as something foreign. When this happens, it tries to attack it the same way as it would with a virus. Rejection stops the transplanted kidney from working. Rejection episodes are relatively common in at least half the people in the first 3 months. Treatment for rejection includes increasing the dose of your current medications and possibly taking steroids. Of the rejection episodes, 90 to 95% occurring in the first 3 months can be reversed. However, 10 to 15% of all transplants are still lost to rejection in the first year. If the transplanted kidney is rejected totally by the body, a patient will need to return to dialysis and await another transplant. It is up to you to take your medication every day for as long as you have your new kidney. You should take it at the same time every day. The success of the kidney transplant is directly related to taking this medication. The first 3 months after receiving a transplant are the most unstable. It is during this time that the patient is most likely to experience rejection. Clinic visits are usually scheduled once a week for the first 3 months. If all goes well during this period, you will have to see your doctor less often after this time.

16. What do I do to take care of my kidney transplant?

To keep a transplanted kidney healthy, you need to take care of it. Following treatment guidelines are key to keeping healthy. You will need to: Take your immunosuppressive medicine as directed by your doctor, for as long as you have the transplanted kidney Visit your doctor as scheduled Follow your doctor's guidelines Control your diet Keep active Watch for and report any problems Once you have your transplanted kidney, you will continue to visit your doctor on a regular basis. Clinic visits are more frequent for the first 3 months. Your doctor will check your kidney function and adjust your immunosuppressive medications. It is up to you to take your medication for as long as you have the transplant. It is too easy to forget the transplant exists and to forget to take your medication. Medications to prevent rejection make some patients very hungry. Since it is easy to gain weight after a transplant, you may need to watch calories more closely than on dialysis.

17. How do I know if I'm a candidate for transplant?

You must not be a substance abuser. You should be free from cancer and free from infection. You should be close to your ideal body weight. Remember that you must actively involve yourself in the process if you want to be placed on the waiting list for a transplant.

18. Is the transplant surgery dangerous for the recipient?

Same risk as any major surgery