KIDNEY KNOWLEDGE SERIES - (6)

KIDNEY TRANSPLANT

Q:     I have been diagnosed with end stage renal disease. Is there any other treatment besides a kidney transplant?

A:     Dialysis and transplant are the only two treatments available for end stage renal disease (ESRD)

Q:     What is the purpose of kidney transplantation?

Kidney transplantation surgically places a healthy kidney from another person into your body. The donated kidney does enough of the work that your two failed kidneys used to do to keep you healthy and symptom free.

Q:     Who is a candidate for kidney transplantation?

A:     It is the treatment of choice for people with kidney failure who have been evaluated by the renal transplant team and found to be eligible for the procedure

Q:     What is a perfect match kidney?

A:

·        Usually, a perfect match is between identical twins, a brother or sister.

·        The chance of getting a perfect match from a living-related brother or sister is higher than from other related or non-related living donors.

Q:     Is a kidney transplant a good option?

A:     Dialysis can be done for as long as it takes to find a kidney donor but the best long-term option is a successful transplant.

Q:     Who donates kidneys for transplantation?

A:     The sources for kidney transplants include;

1.     A living donor

2.     Non-living donor ( Deceased donor ) after brain death

3.     Non-living donor ( Deceased donor ) after cardiac death

Patients who have had kidneys donated from living donors usually enjoy higher success rates than those who receive organs from non-living donors, since there is less chance for rejection.

Q:     Are there age restrictions for kidney transplant recipients?

A:

·        There are no strict age restrictions for kidney transplantation

·        However, patients over 65 years must be in relatively good health other than the kidney disease for which they are undergoing a transplant.

Q:     How will a patient know if he is eligible for a transplant?

A:     There are several considerations that determine if and when a patient is eligible for a kidney transplant.

·        Typically they will be transplanted when their function is close to 10% of normal.

·        Prospective transplant recipients undergo a medical evaluation, to determine whether they can successfully tolerate the surgery and the concomitant immunosuppression.

·        Generally, transplantation will not be considered in a patient whose underlying medical condition includes an ongoing infection, uncontrolled malignancy or an expected survival of less than five years.

Q:    How long after I am diagnosed with Kidney Failure should I have a transplant?

A:     There is no time limit to having a kidney transplant, some people stay on haemodialysis till the end of their lives. But if you are going to have a transplant, the earlier it is done, the better your quality of life.

KIDNEY KNOWLEDGE SERIES - (5)

DIALYSIS (Part 2)

Q:     When and why is dialysis given?

A:      When end-stage kidney failure occurs, treatment is necessary to replace the function of the kidneys. Dialysis is a life-saving option until a suitable organ donor is found, but it is not a cure for end-stage kidney failure.

Q:     Who can I talk to in order to learn more about dialysis treatments?

A:      There are a number of people you can talk to but the most important person is your doctor or a nephrologist (a Physician who is a Specialist in kidneys). Others are the renal care team and even other people with renal failure.

Q:     Where is the closest dialysis centre?

A:     There are a number dialysis centres across Nigeria, especially in the urban areas. Your doctor can advise you of the nearest centre and how to access it.

Q:     Can I change to a different form of treatment once I’ve started dialysis?

A:     Yes. It is quite common for people to change treatments as their health and lifestyle needs change. You may have several methods of dialysis treatment throughout your life.

Q:     Should I change my diet when I start dialysis?

A:     Yes. All forms of dialysis restrict diet to some extent.

·        Some treatment options like Haemodialysis (HD) have more restrictions than others.

·        Peritoneal dialysis (PD) lets you have more protein, fluids and potassium in your diet.

·        Your renal care team will advise you on changes to your diet plans and eating habits while on dialysis. You should also discuss these changes with a dietician if you have access to one.

Q:     What is the diet for patients on Haemodialysis?

A:      Hemodialysis and a proper diet help reduce the wastes that build up in your blood. A dietitian is usually available at dialysis centers to help you plan meals according to your doctor’s orders.

Q:     What is the diet for patients on peritoneal dialysis?

A:     A peritoneal dialysis diet is slightly different from that of a haemodialysis diet but this form of dialysis is not readily available in Nigeria presently.

Q:     Will I be able to continue my normal activities once I start dialysis?

A:      Working, driving and normal housework activities are typically not restricted on dialysis. Your level of freedom and flexibility will depend on the treatment you chose, whether it is a fixed schedule of HD, or PD.

Q:     Is it dangerous to skip dialysis?

A:     Yes, this can lead to fluid overload and accumulation of waste products in the body. It can also lead to breathing problems due to a serious condition called pulmonary edema where fluid gets accumulated in the lungs.

Q:     What is the cost of dialysis?

A:      A session of haemodialysis costs on average N25,000 (Twenty Five Thousand Naira). For it to be effective, a patient should have 3 sessions per week.

Q:     What are the possible complications of haemodialysis?

A:    

1.     Infection

2.     Poor blood flow

3.     Muscle cramps and

4.     Hypotension—a sudden drop in blood pressure

You can avoid many side effects if you follow a proper diet, limit your liquid intake, and take your medicines as directed.

Q:     What are the possible complications of peritoneal dialysis?

A:    

·        The most common problem with peritoneal dialysis is peritonitis, a serious abdominal infection. It requires antibiotic treatment by your doctor.

KIDNEY KNOWLEDGE SERIES - (4)

DIALYSIS (Part 1)

Q:     What is dialysis?

A:      Dialysis is a method of removing waste products and excess fluids from your body after your kidneys have failed. Kidney dialysis is an artificial process that performs the two main functions of the kidneys:

1.     Filtering waste from the blood; and

2.     Balancing the body’s fluid levels.

Q:     What are the types of dialysis available?

A:      There are two types of dialysis:

1.     Peritoneal dialysis (PD) and

2.     Haemodialysis (HD)

Q:     What is Haemodialysis (HD)?

A:      Haemodialysis (HD) is a machine-assisted blood filtration method which removes waste and excess fluid from your blood in a dialyser (or artificial kidney) outside your body. It usually requires a doctor to surgically insert a short term tube into the femoral vein; or long term tube (dialysis catheter) into your blood stream via a vein in your neck or chest wall. A more permanent procedure involves a surgical procedure connecting the forearm vein to the artery. This is called a fistula and it takes about six weeks for it to mature and be ready for use. These access procedures allow blood to be diverted from your body, through the dialyser and back into your blood stream.

Q:     What is peritoneal dialysis (PD)?

A:     Peritoneal dialysis (PD) uses the peritoneum, a natural membrane lining the cavity of your abdomen. The membrane has tiny holes that allow waste products and fluid to filter from your blood. The process of waste removal, as in haemodialysis, is called diffusion. The removal of excess water, osmosis, is aided by another substance within the dialysis fluid, usually glucose.

Q:     How many types of peritoneal dialysis are there?

A:      There are two types of PD:

1.     Continuous ambulatory peritoneal dialysis (CAPD)

2.     Automated peritoneal dialysis (APD).

Intermittent peritoneal dialysis can be done in emergencies and for the short-term pending insertion of more permanent Tenchkoff catheters. 

PD allows one to be relatively independent and manage your own care at home. For now, it is not widely available in Nigeria.

Q:     How does dialysis filter waste from the blood?

A:

·        During dialysis, waste and excess water pass from the blood into a liquid called dialysate for removal from the body by a process called diffusion.

·        A thin layer of natural tissue (in peritoneal dialysis) or of synthetic plastic (in haemodialysis), known as the dialysis membrane, keeps the blood separate from the dialysis fluid.

·        Blood cells are too large to pass through the dialysis membrane, though waste and water can diffuse into the dialysis fluid.

·        Wastes are then removed from the body by extracting the dialysis fluid.

Q:     How does dialysis balance the body’s fluid levels?

A:

·        In both Haemodialysis and Peritoneal dialysis, a process called ultrafiltration removes excess fluid.

·        In haemodialysis, the fluid is simply drawn from the blood by the dialysis machine. The amount of water to be removed can be varied by changing the dialyser’s settings.

·        In peritoneal dialysis a substance (most commonly glucose) is added to the blood to draw water out in a process called osmosis.

·        Peritoneal dialysis solution containing a lot of glucose will draw out more fluid than a weaker solution.

Q:     Will dialysis cure me?

A:

·        Hemodialysis and peritoneal dialysis are treatments that help replace the work your kidneys did.

·        These treatments help you feel better and live longer, but they don’t cure kidney failure.

Q:     How long can I be on dialysis?

A:      You can be on dialysis for as long as it takes to get a kidney transplant or for the rest of your life.

KIDNEY KNOWLEDGE SERIES - (3)

KIDNEY FAILURE (Part 2)

Q:     Can I die from kidney failure?

A:     In the long run, if there is no treatment with either dialysis or a transplant, kidney failure is fatal. This is due to the buildup of waste products, accumulation of fluid in the body and affectation of its other functions.

Q:     How is kidney failure treated?

A:     When the kidney failure becomes severe (usually less than 10 to 15% of the normal kidney functions), it is called end-stage-renal disease (ESRD) and treatments that replace the work of healthy kidneys must be started; this includes Dialysis and Transplantation.

Q:     What can I do to reduce damage to my kidney?

A:    

·        Keep fit with regular exercise to help blood pressure and weight control.

·        Eat healthy and maintain a good body weight – which reduces blood pressure stress of being overweight and diabetes mellitus.

·        Keep regular control of your blood sugar level

·        Monitor your blood pressure

·        Moderate alcohol consumption

·        Do not smoke

·        Do not take over-the-counter-pills on a regular basis

·        Do not use bleaching creams and/or soaps

·        Avoid herbal preparations

·        Drinking adequate quantities ( 2 to 3 Litres ) of water daily

·        See your doctor immediately you notice anything unusual

Q:     What is end-stage renal disease?

A:     Also called end-stage renal failure, it is the point at which the kidneys cannot sustain life any more.

Q:     What are the treatments for End-Stage-Renal Disease (ESRD)?

A:     When the kidneys fail completely, 2 options are available to sustain life: dialysis or transplantation.

Q:     Can kidney failure be cured?

A:      Acute renal failure is a serious condition but it may resolve in time and sometimes within days with haemodialysis. Recovery also depends on the underlying cause and the treatment given.

Chronic renal failure cannot be cured. Renal replacement therapies of dialysis can only perform 5% of the kidney’s function, while transplantation has to be sustained by a lifetime of medication.

Q:     What are the complications associated with kidney failure?

A:     When kidney function drops below 20 per cent of normal function, toxic waste and excess fluid begin to accumulate in the blood. Kidney failure may be responsible for various complications including:

·        Fluid retention in the body’s tissue causing swelling known as oedema

·        Fluid in the lungs known as “pulmonary oedema”

·        Anaemia i.e. a lowered count of red blood cells

·        Calcium shortage leading to the bones becoming weak

·        End-stage renal failure (ESRF) also known as end stage renal disease (ESRD)

Early detection and appropriate treatment may slow or stop the progression of kidney failure and its complications.

Q:     What are the risk factors of kidney failure?

A:     Those most at risk of chronic kidney failure include people who:

·        have diabetes

·        have high blood pressure

·        are obese

·        are over 50 years old

·        use traditional medication frequently

·        use bleaching creams/soaps

·        smoke cigarettes

·        have a family history of kidney disease

Q:     Does kidney failure run in families?

A:     Although it is unusual, some forms of chronic renal failure run in families. Inherited disease like polycystic kidney disease can lead to chronic renal failure.

Q:     Will kidney failure affect my sexuality and fertility?

A:     Decreased libido can occur and loss of fertility during renal failure and dialysis can be distressful to patients. It is often restored after a kidney transplant and many patients have successful pregnancies. 

KIDNEY KNOWLEDGE SERIES - (2)

KIDNEY FAILURE (Part 1)

Q:     What are the kidneys?

A:     Each person is normally born with two kidneys, located in the lower back. The kidneys are shaped like beans and are the size of the fist. Each kidney contains normally about one million little filters called nephrons.

Q:     What do the kidneys do?

A:     The kidneys have many functions. Their basic job is to clean the blood through the little filters in them by removing waste products and to regulate the body fluid. They perform this by producing urine where what is not needed in the body is eliminated. They also assist in the production of vitamin D and erythropoietin, a protein necessary to produce hemoglobin for red blood cells.

Q:     What is Kidney Failure?

A:     Kidney failure occurs when both kidneys are so damaged that they no longer can clean waste products from the blood. When only one kidney is lost, the other one is usually strong enough to do the job.

Q:     What are the types of Kidney Failure?

A:      There are 2 types of kidney failure:

1.     Acute Kidney Failure and

2.     Chronic Kidney Failure.

Q:     What is Acute Kidney Failure?

A:     Acute Kidney (Renal) Failure is a sudden decrease in kidney function. It can happen for example with severe infections, severe vomiting and diarrhea with dehydration, intoxications or allergic reactions. With treatment in the hospital, usually dialysis, there is almost always return to normal kidney function. 

Q:     What is Chronic Kidney Failure?

A:     Chronic Kidney (Renal) Failure is the gradual loss of kidney function because of kidney damage. Often people are unaware that their kidneys are not functioning properly, as they are highly adaptable organs. Even when most of a kidney is not functioning, the remaining portion will increase its activity to compensate for the loss.

Q:     What are the causes of kidney failure?

A:     The leading causes of kidney failure in Nigeria are:

1.     Hypertension (High blood pressure)

2.     Chronic Glomerulonephritis

3.     Diabetes Mellitus

Others include ;

1.     Chronic pyelonephritis

2.     Sickle cell disease

3.     Analgesic abuse

4.     Obstructive uropathy

5.     Polycystic kidney disease

6.     Congenital anomalies (In children )

7.     HIV nephropathy

8.     SLE (Systemic lupus erythematosus)

9.     Kidney stone disease

10. Herbal medication use and abuse

11. Bleaching creams containing mercury

12. For some people, the cause is unknown

Q:     How do I know I have kidney failure?

A:     The symptoms of kidney failure tend to appear gradually over a long period of time. They are therefore often easily overlooked or considered a response to the stress of daily life. This may delay diagnosis and treatment, increasing damage to the kidneys.

If you experience any of the following symptoms, discuss them promptly with your doctor:

·        Nocturia (getting up at night to pass urine)

·        Tiredness / lethargy

·        Loss of appetite & nausea

·        Increased or decreased urine volume

·        Discomfort over the bladder / lower abdomen area

·        High blood pressure.

·        Swelling in your hands, feet or face, particularly around your eyes

·        A metallic or foreign taste in your mouth

·        Shortness of breath

·        Restlessness

·        Leg cramps

Q:     How do I know there is something wrong with my kidneys?

A:     There are very few symptoms of kidney disease until the kidneys are severely affected. Usually kidney disease is picked up early, by urine tests (to detect protein) or screening blood (serum creatinine particularly).

Q:     What happens when the kidneys fail?

A:     Harmful waste products and excess fluid accumulate in the body. The individual will have a poor appetite, will get tired more easily, will look pale because of anemia (low number of red blood cells), and performance may be affected.