Health maintenance

The Kidney and Pregnancy


This is a particularly important topic because of the societal pressures and premium often given to having children, frequently at the risk of the life and health of the mother. This goal of this post is not to substitute for the professional services of the doctor/obstetrician who must be seen early and often during pregnancy but to empower patients during pregnancy so that they are aware of normal changes, possible issues that may arise involving the kidney, questions to ask their doctor and general best habits and practices to maintain kidney health during pregnancy.

Previously we have shared thoughts about pregnancy in dialysis and transplant patients. In this blog posts we will share our perspective on the issues that can arise and involve the kidney during pregnancy in patients with or without any known or prior kidney disease. To start the conversation, let’s talk about normal changes in the kidney and urinary tract during pregnancy before talking about what’s abnormal

The urinary bladder is pressed on by the uterus as it enlarges with the growing baby

In a normal pregnancy there are many changes in the kidneys and urinary tract that are not a sign of a problem but just a sign that the body is changing to accommodate the needs of the mother and growing baby

  • The increased blood volume and heart output during pregnancy causes about 50% increase in blood flow to the kidney. This causes an increased elimination of waste and reduced blood levels of urea, creatinine, urate and bicarbonate.
  • Mild amounts of glucose and/or protein in the urine may occur because the increase in blood supply to the kidney may exceed the ability of the kidney to reabsorb glucose and protein.
  • Pregnancy hormones increase the retention of salt and water by the kidney. This can cause leg swelling and reduction of concentration or plasma osmolality of the blood.
  • Pregnancy hormones also cause the smooth muscle of the urinary tract to become relaxed and dilated, kidneys increase in length and ureters become longer, more curved and with an increase in residual urine volume.
  • The increase in size of the womb or uterus presses on the bladder and reduces the space for the bladder to expand and store urine. So pregnant women often urinate often. Bladder smooth muscle however also relaxes, increasing capacity and risk of urinary tract infection
    2-10% of women have bacteria in the urinary tract during pregnancy and if untreated up to 30% may develop acute pyelonephritis- an infection of the kidneys which can be serious leading to problems like premature delivery and overwhelming infection of the mother

However, there are a number of changes that can arise involving the kidneys or urinary tract during pregnancy that are not normal. These problems include:

  1. Urinary tract infections. Sometimes there may be no symptoms to mild symptoms like frequent urination to more severe symptoms like fever, pain and bloodstream infection. At every visit and if you have any symptoms like those just mentioned, talk to your doctor, get tested for possible urine infection and get treated. There are several antibiotics that can be taken safely during pregnancy
  2. Blood in the urine (Also called Hematuria). 1 to 3 out of every 10 pregnant women will have hematuria at some point in pregnancy. 75% will resolve after delivery. Most common cause is vaginal bleed or urinary tract infection. Not always linked to increased risk of preeclampsia, hypertension or premature delivery. If you see blood in your urine, see your doctor, talk about what you see and how you feel. The doctor will likely get a urine test to make sure you don’t have a urine infection. The doctor may get an ultrasound of the kidneys and bladder to see of you have a kidney stone. Ultrasound scans are safe and pregnancy does not increase risk for kidney stones but if one is found, you likely had the stone before the pregnancy.
  3. Kidney disease during pregnancy. Kidney disease may preexist and be known, preexist and be discovered during pregnancy, or be new onset in pregnancy. Ability to sustain pregnancy depends on kidney function and blood pressure levels rather than the cause of kidney disease. Kidney function may decrease irreversibly during pregnancy and after delivery. Increased urinary protein excretion has worse outcome. Diabetes (high blood sugar), lupus, cystic kidney disease are all conditions that can worsen kidney function during pregnancy. Talk to your doctor about these so that a treatment plan can be developed to ensure you and your baby are safe.
  4. Hypertension in pregnancy. The kidney is an important organ in controlling blood pressure so it make sense that issues impacting the kidney can cause abnormal blood pressure in pregnancy. Hypertension affects 1 to 3 out of every 10 pregnancies. For hypertensive patients in pregnancy, most cases become hypertensive during pregnancy and this may continue after delivery. If you develop hypertension in pregnancy, you must be extremely careful, see your doctor and get the hypertension treated. There are several medications that can be used to treat high blood pressure in pregnancy safely. Hypertension can become a very serious condition called preeclampsia which can not only destroy the kidneys but lead to pregnancy loss, liver and even brain damage.

 

Questions

1. If I have kidney disease but I am not yet on dialysis, can I get pregnant? Yes it is possible. How easily you get pregnant depends on how severe your kidney disease is and the cause of your kidney disease. If you are a dialysis patient it is not impossible to get pregnant but it is a challenge and will require the skill of a kidney specialist that knows what to do working with your obstetrician

2. If I have kidney disease will it get worse if I try to get pregnant? It might get worse. You need to tell your doctor before you get pregnant if you already have kidney disease so the doctor can determine your risk of progressive or advanced kidney disease due to pregnancy. For some patients, the risk is too high and they may end up with kidney failure requiring dialysis or transplant after delivery. You may be advised not to become pregnant if your kidney disease is severe.

3. The doctor told me about doing a biopsy during the pregnancy to better understand why my kidney is having trouble. Should I do it? That decision is yours but ask to your doctor to describe the risks and benefits of the biopsy. If the benefit does not exceed the risk, you can decide to not do the biopsy or do it after the delivery.

Exercise for patients on dialysis


This post is meant to help you the dialysis patient live strong and well and overcome challenges you may be facing

Why is exercise important to me?
No matter how old you are, exercise can make you stronger, more flexible. If you stay fit, you will be more able to do things, like go food shopping or visit friends. Think of your body as a rechargeable battery. It helps control blood pressure, too. If you are diabetic, exercise can lower blood sugar. It aids circulation and helps you sleep. Exercise can also help keep your bones healthy. Exercise can fight depression and help you feel more positive about your life.


How should I start to exercise?
First, tell your doctor that you want to exercise. He or she can make sure you do not have any special problems that would be made worse by a workout.  After checking with your doctor, write down a goal you would like to reach. Goals might be walking around the street without stopping, bike riding with your family, shopping at the mall with a friend, or going dancing. Make an exercise plan that will work for you. Write down how often you will exercise, what time of day, and for how long. Start with small blocks of time, like 10 minutes every other day. Increase it by a minute or two each week.


How will I know exercise is helping?
It can take a few weeks or a few months—to feel better with exercise. Keep track of when you exercised, what you did, and how it felt. You will be able to see your progress. This can keep you from getting discouraged. Once you reach your goal, set a new one. Exercise should become a long-term habit.


Can people in wheelchairs exercise?
Yes. There are many stretching and strengthening exercises that can be done in a chair.

Travel Advice for kidney disease, dialysis and transplant patients


Are you a patient with kidney disease or a kidney transplant or a patient on dialysis thinking about travelling? Are you a business person wishing to travel for a meeting or are you interested in attending the wedding of a family member, or being with family for a ceremony like a graduation or simply want to get a break and go on a holiday?

 

Whether you are traveling within the country or traveling internationally, patients with kidney disease, on dialysis or with a kidney transplant can travel if they are stable.  There are a few things you need to consider and plan for to remain safe, maintain your self-esteem and enjoy your life.

 

Advice No 1: Plan ahead and talk to your doctor early about your plans

Give yourself time to decide on your travel plans. Talk to your family and friends and doctor early. They will share ideas with you and if there are any special consideration your doctor can inform you in time and help make arrangements that may involve another doctor or center at your travel destination. If you are planning on travelling to multiple destinations, a plan for every destination is necessary so even more time is needed.

 

Advice No 2: Find and communicate with a doctor or center that can care for you at your destination.

Your doctor can help you find a dialysis center or kidney disease or transplant doctor that can care for you. Family and friends at your destination may be able to make a good recommendation for you and a search online for your options can help

The receiving doctor or center will need some basic information about your medical condition.

If you have kidney disease or have a kidney transplant, being armed with an updated report from your home doctor that outlines your medical issues and lists your recent medications and lab tests will be important.

If you are on dialysis, a medical report, your dialysis prescription, your medication lists and recent lab tests will be required. Depending on your doctors other information may be required. Put your doctors in touch with each other.

 

Advice No 3: Try and get some information for yourself on the quality of care offered by the doctor or center

The experience of the doctor in caring for patients with kidney disease or with a kidney transplant will be useful if you have any of these conditions.

If you are a dialysis patient, find out if the center you are going to be working with at your destination has experience with your kind of dialysis ie hemodialysis or peritoneal dialysis. Also ask

  • What is the cost of dialysis and is your insurance accepted at the destination center?
  • Does the unit reuse dialysis filters or blood lines?
  • How far is the unit from where you will be staying at your destination?
  • Can they provide a convenient treatment time and treat you for the duration you need?
  • What kind and size of dialyzer filters are used at the center?
  • Can you get all the medications or supplies you usually use at your home center?
  • If you fall ill and need to be hospitalized, where do you go? You may or may not need to investigate the hospital offered.

 

Advice No 4: If you are waiting to get a transplant, just let your doctors know.

They may have to make alternative plans that you should be aware of. You can then make a decision if you should travel or not.

 

Advice No 5: Diabetics need extra plans to be made.

If you are also diabetic, make plans to have adequate supply of insulin, medications and readily available sources of sugar if needed

10 habits to keep your kidneys healthy


Kidney disease and kidney failure requiring dialysis or transplant can be a bad experience in many ways.

Here are 10 good habits you can adopt to keep your kidneys healthy. These habits will likely protect many other aspects of your health like your heart, brain, blood vessels and other organs

  1. Eat healthy foods. Food rich in fibers, plant protein and vegetables and low in starch, animal protein are generally considered healthy food
  2. Control your weight. Some use sophisticated measures such as body mass index to determine if someone is overweight. However a simple measure for adults is waist circumference. For adult males a waist circumference below 40 inches and in females below 35 inches is a rough way to determine if you are overweight.
  3. Exercise. Yes, we know you work hard every day and are tired so that should count as exercise, right? The answer to that is NO. The kind of exercise we are talking about is aerobic exercise that works out the heart and muscles continuously for at least 30 minutes every day. Exercise has several benefits for blood pressure, blood sugar, mood and energy levels.   
  4. Avoid tobacco products and consume alcohol very lightly if at all. Tobacco has absolutely no healthy benefit and is known to cause over 50 diseases. Alcohol in small quantities may offer some benefits but in large quantities causes several diseases including kidney damage as well.
  5. Get enough sleep. Lack of sleep increases stress levels and increased stress levels have effects on blood pressure, the heart and the kidneys. Try to get at least 8 hours of uninterrupted sleep every day.
  6. Drink lots of water but don’t take too much. At least 3-4 liters a day will keep you hydrated and flush your kidneys. Taking much more than that can actually get you in trouble. Remember, too much of anything is bad.
  7. Keep your intake of salt low. Remember that salt may already be added to food while it is being cooked and many foods and snacks contain salt. At least try not to add salt at prepared food and ask the food preparer to keep the salt content low.
  8. Make sure your blood pressure is controlled. High blood pressure is one of the major causes of kidney disease in the entire world. Get your blood pressure checked at least once a year. If you are placed on blood pressure medication, do not stop it without the advice of your doctor.
  9. Be very careful about taking supplements and herbal medications. If you eat a healthy diet and exercise, a multivitamin tablet everyday should suffice. Anything else can only increase your risk of a medical problem. Traditional or even western herbal medication and supplements have a track record of causing kidney failure. Beware.
  10. Get a medical check up at least once a year. Sometimes, even if we do all the right things, it might not be enough and detecting problems early with the kidney can save us lots of money and discomfort. Get a checkup once a year. Tests for kidney disease are simple and cheap and involve taking small samples of blood and urine and testing them for kidney function.