Urinary Tract Infections: An Introduction


A urinary tract infection (UTI) is an infection in any part of your system responsible for making and passing urine — your kidneys, ureters, bladder and urethra. In men the prostate may be involved in urinary tract infections. Most infections involve the lower urinary tract — the bladder and the urethra.

Urinary-tract-anatomy

Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys.

Symptoms

Urinary tract infections don’t always cause signs and symptoms, but when they do they may include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
  • Pelvic pain, in men when the prostate is involved.

UTIs may be overlooked or mistaken for other conditions in older adults. Sometimes especially in the elderly the beginning of a UTI can present as confusion and decreased appetite.

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Signs and symptoms
Kidneys (also called pyelonephritis) ·       Upper back and side (flank) pain

·       High fever

·       Shaking and chills

·       Nausea

·       Vomiting

Bladder (cystitis) ·       Pelvic pressure

·       Lower abdomen discomfort

·       Frequent, painful urination

·       Blood in urine

Urethra (urethritis) ·       Burning with urination

·       Discharge

When to see a doctor

Contact your doctor if you have signs and symptoms of a UTI. It may be really serious  with complications or it might be a sign of something else that needs medical attention

Causes

Urinary tract infections can be caused by bacteria, parasites, viruses or fungi. The most common infections are causes by bacteria which are typically treated with antibiotics. If you have a UTI causes by other organisms such as viruses, parasites or fungi, other special medication or anti-microbials will be necessary to treat the infection and may take a longer time to cure. You can take steps to reduce your chances of getting a UTI in the first place.

UTI’s typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. On the other hand infections of the urinary tract may occur from a blood infection that settles directly in the kidneys. In men, an infection of the prostate can start when bacteria in urine leak into your prostate. Antibiotics are used to treat the infection. If they don’t eliminate the bacteria, prostatitis (prostate infection) might recur or be difficult to treat

The most common UTIs occur mainly in women and affect the bladder and urethra.

  • Infection of the bladder (cystitis).This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.

Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.

  • Infection of the urethra (urethritis).This type of UTI can occur when intestinal bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Risk factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

  • Female anatomy.A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
  • Sexual activity.Sexually active women tend to have more UTIs than do women who aren’t sexually active. Having a new sexual partner also increases your risk.
  • Certain types of birth control.Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
  • After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

  • Urinary tract abnormalities.Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
  • Blockages in the urinary tract.Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
  • A suppressed immune system.Diabetes and other diseases that impair the immune system — the body’s defense against germs — can increase the risk of UTIs.
  • Catheter use.People who can’t urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
  • A recent urinary tract procedure.Urinary surgery or an examination of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

  • Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
  • Permanent kidney damage leading to kidney disease or even kidney failure from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
  • Increased risk in pregnant women of delivering low birth weight or premature infants.
  • Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
  • Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Prevention

You can take these steps to reduce your risk of urinary tract infections:

  • Drink plenty of liquids, especially water.Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
  • Drink cranberry juice.Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
  • Wipe from front to back.Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Empty your bladder soon after intercourse.Also, drink a full glass of water to help flush bacteria.
  • Avoid potentially irritating feminine products.Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
  • Change your birth control method.Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

Diagnosis

Tests and procedures used to diagnose urinary tract infections include:

  • Analyzing a urine sample.Your doctor may ask for a urine sample for lab analysis to look for white blood cells, red blood cells or bacteria. To avoid potential contamination of the sample, you may be instructed to first wipe your genital area with an antiseptic pad and to collect the urine midstream.
  • Growing urinary tract bacteria in a lab.Lab analysis of the urine is sometimes followed by a urine culture. This test tells your doctor what bacteria are causing your infection and which medications will be most effective.
  • Creating images of your urinary tract.If you are having frequent infections that your doctor thinks may be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Your doctor may also use a contrast dye to highlight structures in your urinary tract.
  • Using a scope to see inside your bladder and urinary tract.If you have recurrent UTIs, your doctor may perform a cystoscopy, using a long, thin tube with a lens (cystoscope) to see inside your urethra and bladder. The cystoscope is inserted in your urethra and passed through to your bladder.

Treatment

Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

Simple infection

Drugs commonly recommended for simple UTIs include:

  • Trimethoprim/sulfamethoxazole (Bactrim, Septra)
  • Fosfomycin (Monurol)
  • Nitrofurantoin (Macrodantin, Macrobid)
  • Cephalexin (Keflex)
  • Ceftriaxone

GET IN TOUCH WITH YOUR DOCTOR BEFORE STARTING ANY ANTIBIOTICS. YOU MAY NEED TESTS DONE BEFORE STARTING TREATMENT. THE DOCTOR WILL HELP YOU SELECT THE SAFE AND APPROPRIATE OPTION FOR YOUR SITUATION.

The group of antibiotic medicines known as fluoroquinolones — such as ciprofloxacin (Cipro), levofloxacin (Levaquin) and others — isn’t commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, your doctor might prescribe a fluoroquinolone medicine if no other treatment options exist.

Often, symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. Take the entire course of antibiotics as prescribed.

For an uncomplicated UTI that occurs when you’re otherwise healthy, your doctor may recommend a shorter course of treatment, such as taking an antibiotic for one to three days. But whether this short course of treatment is enough to treat your infection depends on your particular symptoms and medical history.

Your doctor may also prescribe a pain medication (analgesic) that numbs your bladder and urethra to relieve burning while urinating, but pain usually is relieved soon after starting an antibiotic.

Frequent infections

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

  • Low-dose antibiotics, initially for six months but sometimes longer
  • Self-diagnosis and treatment, if you stay in touch with your doctor
  • A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity
  • Vaginal estrogen therapy if you’re postmenopausal

 

Severe infection

For a severe UTI, you may need special tests to determine the cause of the infection and treatment with intravenous antibiotics in a hospital.

 

Advertisements

World Kidney Day 2016- Childhood Kidney Diseases.


March 10th 2016 was world kidney day with a specific focus on childhood kidney disease. 

Kidney disease affects millions of people worldwide, including many children who may be at risk at an early age. It is therefore crucial that we encourage and facilitate education, early detection and a healthy life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide.

Kidney disease can affect children in various ways, ranging from treatable disorders without long-term effects to life-threatening conditions. Acute kidney disease develops suddenly, lasts a short time, and can be serious with long-lasting effects or may go away completely once the underlying cause has been treated. Chronic kidney disease (CKD) does not go away with treatment and tends to get worse over time. CKD eventually leads to kidney failure, described as end-stage kidney disease or ESRD when treated with a kidney transplant or blood-filtering treatments called dialysis.
Children with CKD or kidney failure face many challenges, which can include

  • a negative self-image
  • relationship problems
  • behavior problems
  • learning problems
  • trouble concentrating
  • delayed language skills development
  • delayed motor skills development

Children with CKD may grow at a slower rate than their mates, and urinary incontinence—the loss of bladder control, which results in the accidental loss of urine—is common.

  
Urinary tract inside the outline of the upper half of a human body. Every day, the two kidneys filter about 120 to 150 liters of blood to produce about 1 to 2 liters of urine, composed of wastes and extra fluid.

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the back. Every day, the two kidneys filter about 120 to 150 liters of blood to produce about 1 to 2liters of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The kidneys work around the clock; a person does not control what the kidneys do. Ureters are the thin tubes of muscle—one on each side of the bladder—that carry urine from each of the kidneys to the bladder. The bladder stores urine until the person finds a time and place to urinate.

The kidney is not one large filter. Each kidney is made up of about a million filter units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called a glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which changes the fluid by sending needed minerals back to the blood and removing wastes. The final product becomes urine.

The kidneys also control the level of minerals such as sodium, phosphorus, and potassium in the body, and produce an important hormone to signal to the bone to create blood. A low level of red blood cells is called anemia and can be a result of kidney disease. 

  
Picture above of a kidney with an inset of a nephron. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called a glomerulus, and a tubule.

What are the causes of kidney disease in children?

Kidney disease in children can be caused by

  • birth defects
  • hereditary diseases
  • infection
  • nephrotic syndrome
  • systemic diseases
  • trauma
  • urine blockage or reflux

From birth to age 4, birth defects and hereditary diseases are the leading causes of kidney failure. Between ages 5 and 14, kidney failure is most commonly caused by hereditary diseases, nephrotic syndrome, and systemic diseases. Between ages 15 and 19, diseases that affect the glomeruli are the leading cause of kidney failure, and hereditary diseases become less common.

Birth Defects

A birth defect is a problem that happens while a baby is developing in the mother’s womb. Birth defects that affect the kidneys include renal agenesis, renal dysplasia, and ectopic kidney, to name a few. These defects are abnormalities of size, structure, or position of the kidneys:

  • renal agenesis—children born with only one kidney
  • renal dysplasia—children born with both kidneys, yet one does not function
  • ectopic kidney—children born with a kidney that is located below, above, or on the opposite side of its usual position
  • Some children are born without kidneys. They usually are born dead or die soon after birth

In general, children with these conditions  except being born without kidneys lead full, healthy lives. However, some children with renal agenesis or renal dysplasia are at increased risk for developing kidney disease.

Hereditary Diseases:  Hereditary kidney diseases are illnesses passed from parent to child through the genes. One example is polycystic kidney disease (PKD), characterized by many grapelike clusters of fluid-filled cysts—abnormal sacs—that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. 

 

a picture of a normal kidney to the left and a diseased polycystic kidney on the right

 
Another hereditary disease is Alport syndrome, which is caused by a mutation in a gene for a type of protein called collagen that makes up the glomeruli. The condition leads to scarring of the kidneys. Alport syndrome generally develops in early childhood and is more serious in boys than in girls. The condition can lead to hearing and vision problems in addition to kidney disease.

Infection

Hemolytic uremic syndrome and acute post-streptococcal glomerulonephritis are kidney diseases that can develop in a child after an infection.
Hemolytic uremic syndrome is a rare disease that is often caused by the Escherichia coli (E. coli) bacterium found in contaminated foods, such as meat, milk products, and juice. Hemolytic uremic syndrome develops when E. coli bacteria lodged in the digestive tract make toxins that enter the bloodstream. The toxins start to destroy red blood cells and damage the lining of the blood vessels, including the glomeruli. Most children who get an E. coli infection have vomiting, stomach cramps, and bloody diarrhea for 2 to 3 days. Children who develop hemolytic uremic syndrome become pale, tired, and irritable. Hemolytic uremic syndrome can lead to kidney failure in some children.

Post-streptococcal glomerulonephritis can occur after an episode of strep throat or a skin infection. The Streptococcus bacterium does not attack the kidneys directly; instead, the infection may stimulate the immune system to overproduce antibodies. Antibodies are proteins made by the immune system. The immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. When the extra antibodies circulate in the blood and finally deposit in the glomeruli, the kidneys can be damaged. Most cases of post-streptococcal glomerulonephritis develop 1 to 3 weeks after an untreated infection, though it may be as long as 6 weeks. Post-streptococcal glomerulonephritis lasts only a brief time and the kidneys usually recover. In a few cases, kidney damage may be permanent.

Nephrotic Syndrome

Nephrotic syndrome is a collection of symptoms that indicate kidney damage. Nephrotic syndrome includes all of the following conditions:
albuminuria—when a person’s urine contains an elevated level of albumin, a protein typically found in the blood

  • hyperlipidemia—higher-than-normal fat and cholesterol levels in the blood
  • edema—swelling, usually in the legs, feet, or ankles and less often in the hands or face
  • hypoalbuminemia—low levels of albumin in the blood

child with swollen eyes and face from nephrotic syndrome affecting the kidneys

Nephrotic syndrome in children can be caused by the following conditions:
Minimal change disease is a condition characterized by damage to the glomeruli that can be seen only with an electron microscope, which shows tiny details better than any other type of microscope. The cause of minimal change disease is unknown; some health care providers think it may occur after allergic reactions, vaccinations, and viral infections.

Focal segmental glomerulosclerosis is scarring in scattered regions of the kidney, typically limited to a small number of glomeruli.

Membranoproliferative glomerulonephritis is a group of autoimmune diseases that cause antibodies to build up on a membrane in the kidney. Autoimmune diseases cause the body’s immune system to attack the body’s own cells and organs.

Systemic Diseases

Systemic diseases, such as systemic lupus erythematosus (SLE or lupus) and diabetes, involve many organs or the whole body, including the kidneys:
Lupus nephritis is kidney inflammation caused by SLE, which is an autoimmune disease.

Diabetes leads to elevated levels of blood glucose, also called blood sugar, which scar the kidneys and increase the speed at which blood flows into the kidneys. Faster blood flow strains the glomeruli, decreasing their ability to filter blood, and raises blood pressure. Kidney disease caused by diabetes is called diabetic kidney disease. While diabetes is the number one cause of kidney failure in adults, it is an uncommon cause during childhood.

Trauma: Traumas such as burns, dehydration, bleeding, injury, or surgery can cause very low blood pressure, which decreases blood flow to the kidneys. Low blood flow can result in acute kidney failure.

Urine Blockage or Reflux: When a blockage develops between the kidneys and the urethra, urine can back up into the kidneys and cause damage. Reflux—urine flowing from the bladder up to the kidney—happens when the valve between the bladder and the ureter does not close all the way.

How is kidney disease in children diagnosed?

A health care provider diagnoses kidney disease in children by completing a physical exam, asking for a medical history, and reviewing signs and symptoms. To confirm diagnosis, the health care provider may order one or more of the following tests:

Urine Tests
Dipstick test for albumin. The presence of albumin in urine is a sign that the kidneys may be damaged. Albumin in urine can be detected with a dipstick test performed on a urine sample. The urine sample is collected in a special container in a health care provider’s office or a commercial facility and can be tested in the same location or sent to a lab for analysis. With a dipstick test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the person’s urine sample. Patches on the dipstick change color when albumin is present in urine.

Urine albumin-to-creatinine ratio. A more precise measurement, such as a urine albumin-to-creatinine ratio, may be necessary to confirm kidney disease. Unlike a dipstick test for albumin, a urine albumin-to-creatinine ratio—the ratio between the amount of albumin and the amount of creatinine in urine—is not affected by variation in urine concentration.

Blood test: Blood drawn in a health care provider’s office and sent to a lab for analysis can be tested to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate or eGFR. This is a simple test not expensive and results can be available in a few hours

Imaging studies: Imaging studies provide pictures of the kidneys. The pictures help the health care provider see the size and shape of the kidneys and identify any abnormalities. This may be an ultrasound or CT scan or special type of x-ray 

Kidney biopsy: Kidney biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. Biopsy results show the cause of the kidney disease and extent of damage to the kidneys.

How is kidney disease in children treated?

Treatment for kidney disease in children depends on the cause of the illness. A child may be referred to a pediatric nephrologist—a doctor who specializes in treating kidney diseases and kidney failure in children—for treatment.

Children with a kidney disease that is causing high blood pressure may need to take medications to lower their blood pressure. Improving blood pressure can significantly slow the progression of kidney disease. The health care provider may prescribe

angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) which help relax blood vessels, reduce blood pressure and make it easier for the heart to pump blood

diuretics, medications that increase urine output and reduce body swelling

Many children require two or more medications to control their blood pressure; other types of blood pressure medications may also be needed.

As kidney function declines, children may need treatment for anemia and growth failure. Anemia is treated with a hormone called erythropoietin, which stimulates the bone marrow to produce red blood cells. Children with growth failure may need to make dietary changes and take food supplements or growth hormone injections.

Children with kidney disease that leads to kidney failure must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation. 

Birth Defects: Children with renal agenesis or renal dysplasia should be monitored for signs of kidney damage. Treatment is not needed unless damage to the kidney occurs. 
Ectopic kidney does not need to be treated unless it causes a blockage in the urinary tract or damage to the kidney. When a blockage is present, surgery may be needed to correct the position of the kidney for better drainage of urine. If extensive kidney damage has occurred, surgery may be needed to remove the kidney. 

Hereditary Diseases: Children with PKD tend to have frequent urinary tract infections, which are treated with bacteria-fighting medications called antibiotics. PKD cannot be cured, so children with the condition receive treatment to slow the progression of kidney disease and treat the complications of PKD. 
Alport syndrome also has no cure. Children with the condition receive treatment to slow disease progression and treat complications until the kidneys fail. 

Infection: Treatment for hemolytic uremic syndrome includes maintaining normal salt and fluid levels in the body to ease symptoms and prevent further problems. A child may need a transfusion of red blood cells delivered through an intravenous (IV) tube. Some children may need dialysis for a short time to take over the work the kidneys usually do. Most children recover completely with no long-term consequences. 
Children with post-streptococcal glomerulonephritis may be treated with antibiotics to destroy any bacteria that remain in the body and with medications to control swelling and high blood pressure. They may also need dialysis for a short period of time. 

Nephrotic Syndrome: Nephrotic syndrome due to minimal change disease can often be successfully treated with corticosteroids. Corticosteroids decrease swelling and reduce the activity of the immune system. The dosage of the medication is decreased over time. Relapses are common; however, they usually respond to treatment. Corticosteroids are less effective in treating nephrotic syndrome due to focal segmental glomerulosclerosis or membranoproliferative glomerulonephritis. Children with these conditions may be given other immunosuppressive medications in addition to corticosteroids. Immunosuppressive medications prevent the body from making antibodies. 

Systemic Diseases.                              

Lupus nephritis is treated with corticosteroids and other immunosuppressive medications. A child with lupus nephritis may also be treated with blood pressure-lowering medications. In many cases, treatment is effective in completely or partially controlling lupus nephritis. 

Diabetic kidney disease usually takes many years to develop. Children with diabetes can prevent or slow the progression of diabetic kidney disease by taking medications to control high blood pressure and maintaining normal blood glucose levels. 

Trauma: The types of trauma described above can be medically treated, though dialysis may be needed for a short time until blood flow and blood pressure return to normal.

Urine Blockage and Reflux: Treatment for urine blockage depends on the cause and severity of the blockage. In some cases, the blockage goes away without treatment. For children who continue to have urine blockage, surgery may be needed to remove the obstruction and restore urine flow. After surgery, a small tube, called a stent, may be placed in the ureter or urethra to keep it open temporarily while healing occurs. 
Treatment for reflux may include prompt treatment of urinary tract infections and long-term use of antibiotics to prevent infections until reflux goes away on its own. Surgery has also been used in certain cases. 

 img_0110

Eating, Diet, and Nutrition
For children with CKD, learning about nutrition is vital because their diet can affect how well their kidneys work. Parents or guardians should always consult with their child’s health care team before making any dietary changes. Staying healthy with CKD requires paying close attention to the following elements of a diet:

Protein. Children with CKD should eat enough protein for growth while limiting high protein intake. Too much protein can put an extra burden on the kidneys and cause kidney function to decline faster. Protein needs increase when a child is on dialysis because the dialysis process removes protein from the child’s blood. The health care team recommends the amount of protein needed for the child. Foods with protein include

  • eggs
  • milk
  • cheese
  • chicken
  • fish
  • red meats
  • beans
  • yogurt
  • cottage cheese

Sodium. The amount of sodium children need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care team may recommend limiting or adding sodium and salt to the diet. Foods high in sodium include

  • canned foods
  • some frozen foods
  • most processed foods
  • some snack foods, such as chips and crackers

Potassium. Potassium levels need to stay in the normal range for children with CKD, because too little or too much potassium can cause heart and muscle problems. Children may need to stay away from some fruits and vegetables or reduce the number of servings and portion sizes to make sure they do not take in too much potassium. The health care team recommends the amount of potassium a child needs. Low-potassium fruits and vegetables include

  • apples
  • cranberries
  • strawberries
  • blueberries
  • raspberries
  • pineapple
  • cabbage
  • boiled cauliflower
  • mustard greens
  • uncooked broccoli

High-potassium fruits and vegetables include

  • oranges
  • melons
  • apricots
  • bananas
  • potatoes
  • tomatoes
  • sweet potatoes
  • cooked spinach
  • cooked broccoli

Phosphorus. Children with CKD need to control the level of phosphorus in their blood because too much phosphorus pulls calcium from the bones, making them weaker and more likely to break. Too much phosphorus also can cause itchy skin and red eyes. As CKD progresses, a child may need to take a phosphate binder with meals to lower the concentration of phosphorus in the blood. Phosphorus is found in high-protein foods. Foods with low levels of phosphorus include

  • liquid non milk creamer
  • green beans
  • popcorn
  • unprocessed meats from a butcher
  • lemon-lime soda
  • root beer
  • powdered iced tea and lemonade mixes
  • rice and corn cereals
  • egg white
  • sorbet

Fluids. Early in CKD, a child’s damaged kidneys may produce either too much or too little urine, which can lead to swelling or dehydration. As CKD progresses, children may need to limit fluid intake. The health care provider will tell the child and parents or guardians the goal for fluid intake.

  

Kidney disease, children and the responsibility we have to protect them. The two purple colored images on the back of the little baby boy below with yellow lines represent the kidneys. To learn more about kidney disease, visit us at www.kidney-solutions.com/faq 

#kidney #kidneydisease #kidneyfailure #hemodialysis #kids #children #childhoodkidneydisease #transplant #peritonealdialysis

What to Know About the Kidneys As We Get Older


Portrait of senior African American couple

Growing old is a compulsory process in life. As we age certain things weaken. The brain, our muscles, our joints age. Our kidneys get old too and their function reduces sometimes to a level that causes important problems requiring the attention of a doctor or kidney specialist.

As we get older, there are a number of changes that happen to our bodies that we can not avoid. Our memory weakens, our strength in our muscles and joints fall over time. Our energy levels reduce. The same thing happens to our kidneys too. The kidneys loose function as we age even though we might be healthy. This makes added problems such as high blood pressure, high blood sugar, heart problems, urine infections, taking medications at the wrong dose or wrong frequency problems we should avoid because they damage the kidneys even further and put our older people at high risk for kidney failure and premature death.

This post is meant to empower the older among us as well as to make family members of our older population more aware of the changes that happen in the kidney as we get older and the things that can be done to reduce additional damage to the kidney.

What happens to the kidneys as we get older?

As we age, the filtering units of the kidney called the glomeruli get scarred over and we loose some of the filtering units every year from the age of 40 or so. There is also a thickening of the blood vessels supplying the kidney leading to a reduction of blood flow to the kidney. Reducing filtering units and reduced blood flow to the kidney together lead to reductions in overall function of the kidney. In fact, approximately 2-3 our of every 10 elders over the age of 70 years old are believed to have only 60% or less of their kidney function left. In some clinical studies, it has been observed that about 1% of kidney function is lost every year we get older after the age of 40 years although it is not entirely clear if the loss of kidney function is due to age or diseases like high blood pressure, high blood sugar or other problems.

Why is it important to be aware of changes in kidney function as we age?

  • Kidney disease can progress faster if a new problem such as diabetes develops.
  • There are no proven treatments to stop or reverse age-related decreases in kidney function. Any treatment aimed at improving kidney function by causing the remaining functional kidney to work more may actually be harmful rather than beneficial to the kidney.
  • Increased risk for sudden kidney injury from even mild events such as dehydration or exposure to usual amounts of pain medication such as aspirin, naproxen, indocin, ibuprofen and other similar drugs.
  • Toxic accumulation of some medications that are cleared by the kidney may occur. Patients with disease or age-related decreases in kidney function may require medication dose adjustments. For example the dose of the drug may need to be reduced significantly or the frequency of the dosing reduced as well.
  • With the increase in number of living kidney donor transplants, we need to be aware that even healthy older people may not be appropriate candidates for kidney donation.

How are Nigerians aging, what are the most important causes of death and what has this information got to do with kidney disease?

Life expectancy refers to the average length of time people can expect to live. It provides summary information of the death rates and health of a nation, an area, or a group of people. In the last 100 years, the global average life expectancy has more than doubled but there remains marked difference between countries with the highest and lowest life expectancy (Japan 82.1 years versus Angola 38.2 years)

Overall, Nigerians rank 183rd in life expectancy among 194 countries based on 2013 WHO statistics. The life expectancy at birth for a Nigerian in 1960 was about 37 years. By 2013, this had risen appreciably to 52.5 years. Other analyses show that a 60 year old Nigerian person is expected to live till about the age of 75. This means that an increasing number of elders will have to contend with problems related to kidney disease simply by aging even if they do not have any known medical problems. The problems older people have with kidney disease may be accelerated however if they develop other medical conditions such as high blood pressure, high blood sugar or heart disease.

Pneumonia, HIV infection, stroke and heart disease are the leading causes of death in Nigeria. While kidney disease is not a top cause of death, about 20,000 people were estimated to have died from kidney disease in 2013- greater than all the people that died from Asthma and appendicitis combined.

Therefore, as Nigerians get older, more people will have kidney problems to pay attention to and these kidney problems can become a real and large cause of expense, suffering and death. In support of these statements, In many parts of the world, the fastest growing population of patients on dialysis or getting a transplant due to kidney failure are patients over the age of 65 years.

 

KidneySolutions-kidney-disease

The death rate per 100,000 deaths in Nigeria due to kidney disease is estimated at about 17.4. Nigeria ranks 58th in the world in death rates due to kidney disease. Worse than Ukraine with the lowest death rates due to kidney disease in the world by 2013 WHO data. South Africa ranks 11th in the world with a higher death rate per 100,000 due to kidney disease of 26.6

Thanks for reading this short post. Share the information you learn with others and if you have any questions feel free to ask them in the form below

 

Frequently asked questions about kidney disease


Based on popular demand, we have compiled answers to many common questions asked by patients and their families about kidney disease.

Enjoy the read. If you have a question that is not answered here, send us a message and we will be happy to provide some answers that might help you.

 

What do kidneys look like and where are they located in the body?

The kidneys in an adult are about the size of a closed hand. Most people have 2 of kidneys and a few people are born with one kidney. The kidneys are located in the belly region close to the back and each kidney is connected by a tube called the ureter to the bladder.

What is the function of the kidney?

The main purpose of the kidneys is to separate urea, mineral salts, toxins, and other waste products from the blood. In addition, the kidneys also control blood pressure, conserve water, salts, and electrolytes and produce the signals for the body to make blood. Simply put, the kidneys filter the bloodstream in order to get many toxins out of your body, and also regulate body fluids and blood content. The waste and toxins removed by the kidneys pass out of the body eventually in the urine.

What is kidney disease?

Kidney disease is also called renal disease. This is a condition where the functions of the kidney are lost. This can happen either suddenly or very slowly over time depending on the cause. Kidney disease is often irreversible and worsens over time but at times, kidney disease can be reversible or remain stable for long periods of time. Kidney disease has to be identified early or it might be too late to reverse and stop from progressing to complete loss of kidney function.

 

Myth No 1 – Kidney disease is rare. Answer- False. As many as half of people between age 30-49 could develop kidney disease in their lifetime.

Myth 2: You will know if you have kidney disease. Answer- False. By the time you have symptoms you have lost over 80% of kidney function.

Myth 3: Tests for kidney disease take a long time & are costly. Answer- No. Tests need a small sample of blood & urine and are inexpensive. The results can be available within 24 hours

Myth 4: There is nothing you can do to avoid kidney disease. Answer- false. Healthy living & regular checkups could prevent kidney disease.

Myth 5: The cause of kidney disease is unknown. Answer-False. High blood pressure, diabetes, expired drugs & traditional herbal concoctions can cause kidney disease

Myth 6: The only treatment for kidney disease is dialysis. Answer- False. Not all cases of kidney disease need dialysis.

 

What are the tests for kidney disease?

There are a number of simple tests for kidney disease. The most important tests involve tests of small amounts of blood and the urine that help the doctor know if there is a problem and how severe the problem may be. Depending on what the results of these tests are, the doctor may recommend additional tests of the kidney such as taking special pictures by x-ray, by ultrasound or even by CT scan or MRI. These pictures can tell if there is any abnormality of the kidney such as a kidney stone, a cyst or some cancer involving the kidney. Before doing any tests of the kidney or its function, talk to your doctor first. Get a yearly checkup and tests if you are-

1) A personal or family history of kidney disease, 2) Over the age of 40 years, 3) A person with a history of high blood pressure or high blood sugar

 

What are the causes of kidney disease?

The most common causes of kidney disease and kidney failure in African settings are diabetes, hypertension, toxins from herbal medicines or expired medications or infectious diseases ranging from bacteria to viruses such as HIV, Hepatitis B and Hepatitis C. Some kidney diseases may be inherited and run in families. One of the most common of these inherited kidney diseases is polycystic kidney disease. Kidney disease can also be caused by cancers of the kidney tissue. Kidney stones if large enough to cause obstruction to the flow of urine or complicated by infection can also cause kidney disease.

How do I know if I have kidney disease?

Kidney disease can sometimes progress to an advanced and concerning stage with only mild symptoms or it may develop without you developing significant symptoms. If your kidney disease progresses, you will eventually develop symptoms and signs that include tiredness, loss of appetite, difficulty thinking, difficulty  sleeping, breathing problems, muscle pain and muscle cramps, swelling of legs or eyes and dry itchy skin. You are at increased risk for kidney disease if you are black, have high blood pressure, diabetes, a family member with kidney disease or are older.

How do I prevent progression of kidney disease?

You can reduce the risk of developing kidney disease or having progressive kidney disease by:

  • Eating a healthy balanced diet
  • Getting regular exercise (at least 3 times a week)
  • Avoiding becoming  overweight
  • Having regular checkups with your doctor to check for common causes of kidney disease such as high blood pressure and high blood sugar. If you are found to have any of these problems you must religiously and properly take the medications prescribed to treat these conditions
  • Avoiding ingestion of unknown herbal medications and expired drugs
  • Quick treatment of infections
  • Avoiding excess alcohol and tobacco.

My doctor told me I have kidney failure. What does that mean?

Kidney failure occurs when there is loss of most (90% or more) kidney function. Failure can occur suddenly or slowly and may last only a short time or be permanent depending on the cause and the severity of kidney injury. If kidney failure is severe and prolonged, it is often associated with problems like severe lack of energy, leg and eye swelling, difficulty breathing, confusion, difficulty sleeping, itching and depression. At this point your doctor may prescribe dialysis treatment or recommend kidney transplantation for you to support your bodily function while he or she continues to search for and/or treat the cause of the kidney problem.

Is kidney failure or kidney disease reversible?

Kidney disease or failure MAY  be reversible depending on the cause, severity and duration. When the kidney damage has been severe and prolonged, kidney disease is not reversible and often leads to kidney failure that requires transplantation or life long dialysis to support life. Very often, your doctor needs some time and repeated testing to know if the kidney problem is reversible

What medications are needed to treat patients with kidney disease or kidney failure?

Patients with kidney disease or failure may need to be on medications for controlling their blood pressure and on medicine like iron and erythropoietin for increasing their blood levels because of low blood levels caused by kidney disease. To avoid the need for blood transfusions, your kidney doctors will prescribe erythropoietin (also called EPO) and iron to help build up your blood levels. Patients with kidney disease also develop problems with their bones that require special treatments including regular dialysis treatments if they choose dialysis over transplantation. If your kidney failure has been treated by kidney transplantation, you must take your medication carefully and continually to prevent rejection.

What are the treatment options for kidney failure?

The major treatments for kidney failure are Kidney Transplantation and Dialysis.

Kidney Transplantation is a procedure where a kidney from another person is put into you to restore your kidney function. Kidney transplantation has been successfully performed around the world for over 50 years. You will need testing and treatments to determine if you are a candidate for kidney transplantation.  If you are then considered a candidate for transplant, you will need a kidney donor. This donation can be from a person who has recently died or from a living person that does not have to be related to you. In Nigeria at the moment, donation is only possible from a living donor. The potential donor will have to be tested to ensure they are free of kidney or other disease and can withstand the surgery for donation. After successful transplant surgery, you will need to be on powerful medication to prevent rejection of the donated kidney and will need to frequently follow up with your kidney transplant doctors. To learn more about kidney transplantation in Nigeria, visit our blog post by clicking here.

If you are not a candidate for kidney transplantation or do not wish to get a transplant, Dialysis is an option for you.

What is dialysis?

Dialysis is a medical procedure that has been provided safely and successfully to patients for over 70 years. There are 2 main kinds of dialysis- hemodialysis and peritoneal dialysis. The most common type of dialysis is hemodialysis delivered through a blood vessel in your arm, neck or  but a number of patients can be managed on peritoneal dialysis. Peritoneal dialysis is delivered through a tube placed in your belly. Ask your doctor on what options are available best for you.

Hemodialysis is done at a dialysis center or at home. People can live long normal lives if they get enough dialysis. You need this kind of dialysis at least 3 times a week if your kidney failure is not reversible or you can not get a kidney transplant

Peritoneal dialysis is another form of dialysis. You perform this kind of dialysis every day which you can do at home. A special tube is placed in your belly and through this tube a special solution is placed to help draw out all the toxins in your system. You drain after some hours.

What about kidney transplantation?

Kidney transplantation is the best option for patients with end stage kidney failure. Not all patients can be safely transplanted. Kidney transplant requires a serious involvement by the patient, their family and friends. It also requires a smart kidney specialist that knows how to care for such patients. Not all kidney doctors know how to care for transplant patients. To learn more about getting a successful kidney transplant, visit our blog at https://kidneysolutions.wordpress.com/2014/01/15/transplant-101-what-you-need-to-know-as-a-transplant-patient-in-nigeria/.

How do I prepare for dialysis?

When your doctor determines that you will need dialysis, you should ask questions regarding when such treatments will start, what schedule you will be on, how long you may need to be on dialysis and what types of dialysis options are available to you. You may be on dialysis for a short time, a long time or for the rest of your life if you can not get a kidney transplant. It might take some time before your doctor knows if you will be on dialysis for a long time or not. You should inform your close family and friends if they do not know already as you will need their support to be successful on dialysis. You may also need to inform your employer so that arrangements for time off  and any financial support can be arranged. In order to be successful on dialysis you will need what is called an access. For hemodialysis, access can be in the form of a catheter placed in the neck, chest, arm, forearm or upper thigh. A safer and more reliable access is in the form of a fistula or graft. A fistula is made by a doctor during a surgical operation and is made by connecting your own vein to your own artery. A graft is a type of access also made by a doctor during a surgical operation but in this case, an artificial tubing is placed usually in your forearm or arm. For peritoneal dialysis, the access is in the form of a tubing placed in your belly through which the dialysis will be performed.

What is life like on dialysis?

When you initially start dialysis, you will feel ill, tired, with a poor appetite and depressed. You may also notice other symptoms of kidney disease or kidney failure mentioned above like tiredness, vomiting, loss of apettite, leg or eye swelling, difficulty breathing, itching of the skin and maybe chest pain. You will need to visit the doctor very often at least initially. Over time and if you get enough dialysis, you will begin to feel better and many patients can return to their life before dialysis if they get enough dialysis. Many patients that get enough dialysis and follow all other instructions from their doctor and dialysis nurse will be able to return to work and lead productive lives. Getting enough dialysis is very important and the truth is that once or twice a week dialysis is often not enough to truly return you to a high level of function. To get the best out of dialysis, the ideal number of treatments is 3 times a week. You will be prescribed some medications as mentioned above to help control your blood pressure and improve your blood levels. You will need to have frequent lab tests to determine if you are getting enough dialysis and sometimes you may need to receive a blood transfusion. Try not to miss dialysis appointments, take the medications prescribed and follow other instructions your healthcare team will advice you to follow. There will be good days and some bad days on dialysis. Anytime you are having a bad day, do not hesitate to contact your doctor or dialysis nurse and tell them how you feel so they can figure out how best to help you.

Diabetes and Kidney disease in Nigeria


The body has a complex and amazing way of controlling energy and chemical needs. One of the substances produced by the body to deal with the starch and sugars in food is insulin. Insulin is produced by an organ in the body called the pancreas whenever a starch or sugar containing food is eaten. The pancreas is located deep in the belly under the stomach and contains cells called islet cells that specifically produce insulin. The pancreas also produces other chemicals important in digesting the fat and proteins in food but the islet cells of the pancreas are responsible for insulin that in turn lowers blood sugar levels after a meal.

The pancreas is an important organ needed to digest food. It is found deep in the abdomen under the stomach.

The pancreas is an important organ needed to digest food. It is found deep in the abdomen under the stomach.

Diabetes is also called Diabetes Mellitus and is a disease that occurs when the body either does not produce enough insulin or cannot effectively use the insulin it already produces. This leads to an increase in blood sugar levels which over time leads to damage of many organs such as the heart, blood vessels, nerves, eyes and the kidney.

According to a 2014 International Diabetes Federation (IDF) report, approximately 46 out of every 1,000 adults in Nigeria between the age of 20 and 79 years have diabetes with an estimated 4 million cases many of which are undiagnosed. Several thousands are estimated to die from diabetes related conditions every year. Some women may develop diabetes during pregnancy resulting in large babies, or other problems in pregnancy. After the pregnancy, the diabetes may disappear but for some patients, it is the beginning of what will later present as full blown diabetes.

For the Nigerian score card from the International Diabetes Federation click here

For contact information of the nearest Diabetes Association of Nigeria representative near you, click here

For a clinical overview of diabetes mellitus in Nigeria, click here

Symptoms of uncontrolled diabetes   

Common symptoms of type 1 diabetes include:

Excessive thirst, frequent urination, sudden weight loss, severe tiredness and blurred vision.

People with type 2 diabetes may have the same symptoms but they may be less noticeable. Many patients have no symptoms and are only diagnosed after several years with the condition. In Nigeria over 50% of people with type 2 diabetes are are estimated to not be aware they have the condition at the time of the diagnosis.

There are two main types of diabetes:

  • Type 1 diabetes is an autoimmune disease that prevents the body from producing enough insulin. Type 1 diabetes occurs most often in children and young adults. Approximately 5 to 10 per cent of people with diabetes have type 1 diabetes.
  • Type 2 diabetes is a disease that results from the body’s inability to make effective use of the insulin produced. Genetics, obesity and lack of appropriate diet and physical activity are factors that appear to play a role in the development of type 2 diabetes. Type 2 diabetes occurs most often in adults over the age of 40 and accounts for up to 95 percent of all diabetes cases. However, as a consequence of increased obesity and inactivity among young people, type 2 diabetes is now affecting children and young adults.

Complications of diabetes. Without proper insulin production and action, sugar remains in the blood, leading to long term raised blood glucose levels. This can result in short and long-term complications, many of which, if not prevented and left untreated, can kill. All these complications have the potential to reduce the quality of life of people with diabetes and their families.

Diabetes can be a horrible disease but by paying attention you can overcome and avoid problems related to diabetes including stroke, heart attack, kidney failure, blindness, sexual problems wounds on the feed as well as amputation of the legs.

Diabetes can be a horrible disease but by paying attention to the disease, you can overcome and avoid problems related to diabetes. These problems including stroke and paralysis, heart attack, kidney failure, blindness, sexual problems, wounds on the feet that may require amputation of the foot or legsdiabetic-foot-ulcerdiabetic_gangrene

What does diabetes do to the kidneys?

With diabetes, the small and large blood vessels as well as the heart are injured. Small blood vessel damage over long periods of time eventually leads to poor function and eventually failure of the kidneys as well as other important organs such as the eyes. Because of the kidney damage from diabetes, waste products begin to accumulate in the blood and damage other body organs, the body will loose protein in the urine when there should be little to no protein in the urine and the body will retain more water and salt than it should, which can result in weight gain and ankle and eye swelling. Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

How many diabetic patients will develop kidney disease?

Three out of every 10 patients with Type 1 diabetes and 1 to 4 out of every 10 patients with Type 2 diabetes eventually will suffer from kidney failure. It usually takes 10 or more years of uncontrolled diabetes to cause kidney disease but it could occur earlier

What are the early signs of kidney disease in patients with diabetes?

The earliest sign of diabetic kidney disease is an increased excretion of protein in the urine. This is present long before the usual tests done in your doctor’s office show evidence of kidney disease, so it is important for you to have this test on a yearly basis. Weight gain and ankle swelling may occur. You will use the bathroom more at night. Your blood pressure may get too high. As a person with diabetes, you should have your blood, urine and blood pressure checked at least once a year. This will lead to better control of your disease and early treatment of high blood pressure and kidney disease. Maintaining control of your diabetes can lower your risk of developing severe kidney disease.

What are the late signs of kidney disease in patients with diabetes?

As your kidneys fail, your blood urea nitrogen (BUN) levels will rise as well as the level of creatinine in your blood. You may also experience nausea, vomiting, a loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in your legs) and anemia (a low blood count). You may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin. This does not mean your diabetes is getting better and you should not stop trying to treat your diabetes. If you develop any of these signs, call your doctor.

Prevention of diabetic kidney disease

The prevention of diabetic kidney disease starts with

  • Control your diabetes- daily checking blood sugar and hemoglobin A1c every couple of months  to see how well your blood sugar is controlled is important
  • Checking your blood sugar levels regularly will help you know how well you are doing in controlling diabetes.

    Checking your blood sugar levels regularly will help you know how well you are doing in controlling diabetes.

  • Control high blood pressure- target systolic blood pressure should be 130/80 or less
  • Get treatment for urinary tract infections
  • Correct any problems in your urinary system such as obstruction by kidney stones
  • Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications)
  • Get check ups and blood tests of your blood and urine to assess your kidney function at least once a year
  • Get enough exercise and control your weight.

Treatment of diabetes

  • Treatment of type 1 diabetes typically includes a carefully calculated diet, physical activity, blood glucose testing and daily insulin injections. Some patients may be candidates for islet cell or pancreas transplant
  • Treatment of type 2 diabetes typically includes appropriate diet, exercise, home glucose testing, oral medication/tablets and/or insulin. More recently medications that are not insulin but are injectable have become available and are useful in controlling blood glucose. Pancreas or islet cell transplant is not usually given to patients with type 2 diabetes.

Currently the only known cure for diabetes is a pancreas/islet cell transplant. For patients not receiving a transplant, taking medications along with diet and exercise is very effective in controlling blood sugar and avoiding complications.

Remember That Good Care Makes a Difference

People with diabetes should

  • have their doctor measure their A1C level at least twice a year. They should aim to keep it at less than 7 percent.
  • work with their doctor regarding insulin injections, medicines, meal planning, physical activity, and blood glucose monitoring.
  • have their blood pressure checked several times a year. If blood pressure is high, they should follow their doctor’s plan for keeping it near normal levels. They should aim to keep it at less than 130/80.
  • ask their doctor whether they might benefit from taking an ACE inhibitor or ARB.
  • ask their doctor to measure their kidney function at least once a year to learn how well their kidneys are working.
  • ask their doctor to measure the amount of protein in their urine at least once a year to check for kidney damage.
  • ask their doctor whether they should reduce the amount of protein in their diet and ask for a referral to see a registered dietitian to help with meal planning.

Polycystic kidney disease (PKD) in Nigeria- Get the facts


Kidney cysts are common and can be part of a congenital or inherited disease or simply present as a single or multiple cysts unrelated to any disease with no long-term problems. Decisions on the treatment of cystic disease of the kidney should be made with the help of a qualified and experienced doctor.

There are several genetic and inheritable kidney diseases and polycystic kidney disease (PKD) is the most common of them all. It affects several thousand Nigerians and others around the world as well. Approximately 2 to 3 of every 20 cases of kidney failure requiring dialysis or transplant is due to polycystic kidney disease. In Nigeria, while there is no strong evidence, some studies suggest the likelihood of having PKD is higher among men than women.

To read first hand, some of the literature published on polycystic kidney disease in Nigeria, click on the links at the bottom of this post.

There are 2 forms of polycystic kidney disease

1) Autosomal dominant polycystic kidney disease (ADPKD). 

This is the most common form of the disease seen in patients in Nigeria. In this form of polycystic kidney disease, there is usually a family history although new mutations in the genes can occur leading to the occurrence in a person with no prior family history.  New mutations are the cause of about 10% of cases of PKD and once a mutation occurs in a family, it there is a 50% chance of transmission to each child.

ADPKD results from a mutation in one of two genes. 85% of mutations occur in chromosome 16 (PKD1 gene) and makes a protein called polycystin-1; 15% of mutations occur in chromosome 4 (PKD2 gene) and makes a protein called polycystin-2. Remember that each cell contains pairs of chromosomes (one from either parent) and only one mutated gene of a chromosome pair is required for the disease to occur. The mutated gene can come from either parent. Every child carrying one mutated gene will have ADPKD. Every conception has a 50% chance of the child inheriting the mutated gene and having ADPKD. The disease does not present in childhood but begins to develop in the mid 20-s to 30’s. Half of the people with PKD between the age of 57 and 73 will develop end stage kidney disease. However, some patients may present much earlier or later than the age of 50 years.

2) Autosomal recessive polycystic kidney disease (ARPKD)

Autosomal recessive polycystic kidney disease (ARPKD) is a relatively rare form of PKD, affecting approximately 1 in 20,000 children. ARPKD results from a mutation in chromosome 6 (PKHD gene). This gene pair makes a protein called fibrocystin or polyductin. Both genes of the chromosome pair must carry the mutation for the disease to occur. There is no family history of the disease in affected children because each parent carries only one mutated gene. Each conception carries a 25% chance of the child inheriting both mutated genes and having ARPKD. ARPKD often causes death in the first month of life. For ARPKD children who survive the newborn period (about 70 percent), approximately one-third will need dialysis or transplantation by age 10. Previously thought to be a fatal condition, the prognosis for children with ARPKD has improved dramatically in countries where sufficient medical care and technology exists.

IPLab5PolycysticKidney2

This is a photograph of a polycystic kidney placed next to a normal kidney. This photograph demonstrates how big and abnormal these polycystic kidneys are compared to a normal kidney.

As the name suggests, PKD is a disease where there is an abnormal formation of many fluid filled sacs in the main tissue of the kidney and occasionally in other organs such as the liver. These fluid filled sacs are not cancerous but in regions where these sacs or cysts exists, the normal organ tissue there is destroyed. These fluid filled sacs increase in size and further damage nearby normal tissue causing a worsening of organ function. The enlargement and increase in number of the cysts often leads eventually to kidney failure and only very rarely does the disease lead to liver failure. Enlargement of the cysts often occurs over years but once established, the cysts are not reversible. Research is ongoing to identify treatments to reduce the rate of growth of the cysts but no successes have been made yet.

The signs and symptoms of polycystic kidney disease can range from having no symptoms in the early stages of the disease to having many signs and symptoms such as

  • High blood pressure (hypertension)
  • Frequent urinary tract infections
  • Blood in urine (hematuria)
  • Protein in urine (proteinura)
  • Urinary tract and cyst infection
  • Mitral valve prolapse- abnormal functioning of an important valve in the heart
  • Hernia
  • Back/flank pain due to enlargement or rupture of kidney or liver cysts
  • Kidney stones. There is an increased risk of kidney stones in patients with PKD.
  • Enlarged kidneys with effects on breathing and amount of food a person can eat because of the size of the kidney occupying a lot of the belly space.
  • Depression and anxiety (due to stress and emotional impact)
  • Aneurysms (bulging of the blood vessel walls) in the brain that could burst and cause stroke
  • Diverticulosis (pouches in the intestines) that could burst or get infected and cause a lot of belly pain

How do I know if I have PKD?

Unless a patient has any of the symptoms listed above, ultrasound is the only way to determine if PKD is present. People less than 20 years of age without symptoms do not need to be tested. For those above the age of 20 years with a family history of PKD with or without symptoms there are specific criteria bAsed on age and the number of cysts seen on ultrasound. For instance, a person under the age of 30 with a family history of PKD must have 2 cysts in one or both kidneys while a person over the age of 60 years with a family history of PKD needs to have 4 cysts in each kidney. Genetic testing of family members may also be useful in determining presence of PKD.

Treatment of PKD

  • Back/flank pain: testing needs to be performed to ensure that there is no kidney stone, cancer, bleeding or infection all of which can cause pain. Sometimes in the absence of stone, bleeding cancer or infection, the large size of the cysts can cause pain. Treatment of infection, removal of fluid from very large cysts to help reduce pressure and pain are options for treatment. Less frequently surgical removal of the affected kidney is required.
  • Treatment of urinary tract and cyst infection: These infections are often frequent and can be severe and may involve infection of the kidney cysts or the liver cysts. Treatment with antibiotics after testing for the kind of bacteria causing the infection sometimes for long periods of time or continuously may be necessary.
  • Treatment of kidney stones: treatment of kidney stones in patients with PKD are no different from treatment of kidney stones without PKD.
  • Treatment of hypertension: Very good control of high blood pressure is very important because high blood pressure speeds up the rate of progression to kidney failure.
  • Treatment of kidney failure: Dialysis or kidney transplantation is effective in treating cases of advanced PKD.
  • Treatment of brain aneurysms: stroke is a complication of PKD in some patients who develop aneurysms in the brain. Effective blood pressure control and in some cases surgery to clip the aneurysm is needed.

References

1) Familial polycystic kidney disease in Nigeria: a report of two cases

2)  Prevalence and pattern of cystic kidney diseases in Ilorin, Nigeria.

3) Sonographic analysis of adult polycystic kidney disease: retrospective data from South-East Nigeria.

4) Diseases causing chronic renal failure in Nigerians–a prospective study of 100 cases.

5) Expression of adult polycystic renal disease in a 17-year-old male.

6) Autosomal dominant polycystic kidney disease presenting with liver disease

Living Kidney Donation- What the donor must know.


Are you considering donating a kidney to a family member or friend?

If you are, This post is for you to help empower you to be a smart kidney donor. 

Wanting to donate a kidney to improve or even save the life of another person suffering from kidney failure is a noble and honorable thing. The donation of a live kidney is the best option for the recipient compared to donation from a deceased person as it will last longer and work better if put in properly and taken good care of. It is also certainly offers the recipient of the kidney a better and longer life compared to continued dialysis.

However, the most important thing for you to know about kidney donation as a possible donor is that donation is not safe for everybody.

Your primary responsibility is to ensure that it is safe for you to donate a kidney.

The doctors primary responsibility to you as a potential donor is to help you determine if it is safe for you to donate and nothing else.

If you do not really want to be a donor for whatever reason, you should not be forced to do so. Talk to the doctor evaluating you as a donor in private and tell the doctor your concerns. Your doctor will be able to speak confidentially on your behalf and tell the person hoping to get the kidney from you that you are not medically fit to be a kidney donor. The doctor does not need to tell them of your fears or concerns unless you ask them to do so.

First things first – who can donate a kidney?

The person intending to donate a kidney generally should be healthy, be between the ages of 20 and 65, should have 2 kidneys, should not be obesse (defined as a body mass index of >30) and have none of the following.

1) kidney disease or kidney stones

2) high blood pressure or high blood sugar

3) Large amounts of protein or blood in the urine

4) Have normal liver, heart and blood vessel function.

5) Have no ongoing infections, cancers or bleeding issues

6) Be mentally stable

Many people assume that everybody has 2 kidneys. However, it is important to know that many people live normal healthy lives being born with one kidney as long as it doesn’t get diseased. It is estimated that as many as 1 in 1000 to 1 in 1500 (100,000 to 150,000 Nigerians) were born with one kidney so do  not assume you have 2 kidneys and can donate. 

Most kidney transplants in Nigeria are either from related or unrelated living persons that are ABO blood group compatible. This means that a person with blood group O can donate to a patient with any blood group. A person with blood group AB can only donate to persons with blood group AB, while people with blood group B can only donate to patients with blood group B.  People with blood group A can donate only to patients with blood group A.  In special circumstances of donor blood group type A2, donation to patients with blood group O, B and AB is possible but decisions for such need to be very carefully made. Transplant outside these assignments while possible is associated with a higher risk of rejection of the transplant by the recipient and requires more high risk treatments to the recipient such as removal of the spleen or treatment with strong medications. Rhesus blood group is not considered a barrier to kidney transplantation

Donor Testing

As a donor, you need testing done. This is to ensure the you are of the right blood group, you have 2 kidneys, you are healthy, can stand the stress of surgery and do not have silent kidney disease or conditions that can cause kidney disease as well. Testing is also necessary to ensure that you do not transmit infections or cancers to the recipient. A psychological evaluation may also be necessary to ensure you can withstand the emotional stresses that may come during and after kidney donation.

Special testing also needs to be done to ensure you and the recipient are compatible to avoid rejection and help the surgeons know which kidney to take out of the donor and how best to take it out. Some transplant centers require that a donor be related to the recipient while other transplant centers do not insist on such a relationship.

Donor Surgery

As a donor, you should also know who will be performing the surgery and what their track record is. Not all surgeons know how to take out a kidney for the purpose of kidney donation. Taking out the kidney for the purpose of kidney donation is very different from taking the kidney out because of kidney disease. The kidney for donation has to be very carefully handled and it needs to be done quickly with minimal injury to the patient. Therefore ensure your surgeon knows what he or she is doing. Kidney donation surgery can be done in two ways.

The more recent way of taking out the kidney is a more recent and less painful way and is called keyhole or laparoscopic surgery. With this approach, 3 small holes and a 2-3 inch incision are made in your abdomen to remove the kidney. The scars are small, after a while are difficult to see and the recovery time is short. The other way is by open surgery where a long incision 8 or more inches in length is made on your side to take out the kidney. More painful with a longer recovery. Whatever method is used, make sure that the surgeon knows what he is doing. Ask about their complication rates and how many of the procedures they have done to determine their level of experience. A confident doctor should be willing to tell you what you want to know.

The decision to take out the right or the left kidney if prior testing is acceptable really depends on a number of factors that are best determined by the surgeon. However, in general, the right kidney is often selected for removal because it has a longer main artery and vein. Other considerations may make removal of the left kidney a better option.

KidneySolutions-Ikeja-Lagos-Transplant donationKidneySolutions-Ikeja-Lagos-Transplant Donation-2

Risks of kidney donation – short-term and long-term. 

The whole point of testing to ensure that the donor is healthy and finding an experienced surgeon is to ensure that the risk of harm to the donor is as low as possible.

The first living donor kidney transplant was performed over 50 years ago and since then several thousand kidney donations from living persons have been performed. A vast majority of these donors have been doing well several years after donation so the consensus now is that in properly tested and selected donors, the long term outlook is very good. There is also experience from soldiers and other victims of war who were healthy but had to have one kidney removed because of war injuries. These otherwise healthy soldiers or victims of war have also been shown to live well without problems of kidney failure decades afterwards.

However, it is important to know that even if you have 2 kidneys, if you have risk factors for kidney disease or you are not selected properly for donation, you could have problems and possibly end up on dialysis or needing a transplant yourself. 

If after you are evaluated and you are considered a good candidate and eventually donate , you need to follow a few simple rules to ensure all goes well in the long term

1) You must live a healthy life after kidney donation. This means you can not smoke, drink, add weight or engage in any other risky behaviours that could increase your risk for kidney disease.

2) You need to exercise and eat healthy continually.

3) You need to see a doctor at least once a year for the rest of your life. This is not because of a high concern for kidney disease. This is to help identify problems that might lead to kidney disease early so that progressive kidney disease can be treated and hopefully avoided.

Data from the United States shows that the risk of death within 90 days of living kidney donation is approximately 3 per 10,000 donor surgeries. This is better than the risk from laparoscopic gall bladder removal (18 per 10000 cases) or non donor nephrectomy (260 per 10,000). Other risks such as bleeding, infections, problems with wound healing etc occur at a rate of 2 to 5 per 100 cases. The incidence rates in Nigeria or other countries may be significantly different and data is not readily available on such.

The key long term concerns after donation are that of progressive and end stage kidney disease that might also require dialysis or transplant. Similarly, data from the United States and other developed countries show that the long term risk of developing kidney failure in properly selected donors who continue to maintain healthy lifestyle and habits is low.

General acceptability of kidney donation and kidney transplantation. 

Some patients and their families may have concerns that it is religiously unacceptable to get a kidney transplant. The Catholic and Anglican Church, the major Islamic bodies and Jehovah’s Witness church have approved kidney transplantation from either cadaver or living donors. In the case of Jehovah witnesses, the organ is purged/flushed of all blood and transplantation without blood transfusion while risky is possible.

Disclaimer

This post is no substitute for an actual evaluation in a medical center by a qualified and experienced professional. This post is not a recommendation to come to KidneySolutions or any other specific medical center either.

This post is only meant to educate and empower potential donors so that the experience of kidney donation is not as frightening, evaluation is properly done and potential donors have an idea of what is going on.

Questions?

If you have any questions regarding kidney donation, feel free to fill the contact form below. We will endeavour to get back to you with answers as soon as possible.