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.

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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.

 

Reproduction and Pregnancy- What men and women with kidney disease, on dialysis or with a kidney transplant should know


Having a child is a joy but conceiving or carrying a baby to term can be a challenge if you have medical problems. A question that likely crosses the mind of many patients of reproductive age, male or female is – “will i be able to have children?”. The good news is that many of the causes of reduced reproductive capability in patients with kidney disease are known and can be treated by carefully following the instructions of knowledgeable specialists in kidney disease and reproduction.

This post will aim to address the background behind reproductive potential of patients with kidney disease and answer questions of relevance to patients with either advanced kidney disease, those undergoing dialysis treatment or those who have a kidney transplant. The information in this post is NOT a substitute for close consultation with a kidney specialist and readers are advised to seek the counsel of such experts to address their care and concerns.

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Getting pregnant can be a challenge even without having kidney disease. Sometimes, it may be safest if a woman does not get pregnant because the pregnancy may worsen the kidney disease or even lead to kidney failure requiring dialysis or transplantation or even death. Patients with a history of kidney disease in a prior pregnancy must be careful before getting pregnant again. With the right advice from doctors, it is possible to conceive and be successful with a pregnancy. Patients must however know that it will require a lot of resources to cover the costs of the more intensive care required.

Advanced kidney disease affects reproductive potential of both males and females and directly can impact the outcome of pregnancy.

In male patients with advanced kidney disease or on dialysis, problems with getting a sufficient erection, decreased sexual desire and decreased sperm count are common problems that make conception difficult. This is often due to low levels of male sex hormone called testosterone- a direct consequence of kidney disease. Getting close follow up with a doctor, getting anemia and hypertension treated properly and getting enough dialysis if necessary at least 3 times a week is key to addressing many of these problems.

Problems with erection and ejaculation however can occur in patients even without kidney disease. Diabetes (high blood sugar) is a common cause. Sometimes the medication used to treat high blood pressure may also cause problems with erection and need to be changed not stopped. Never stop your blood pressure medications because of erection problems or impotence. Talk to your doctor so the right blood pressure medication can be prescribed for you that does not have such side effects.

In female patients with advanced kidney disease there is often an absence of menses or abnormal menses, abnormal uterine bleeding and development of cysts in the ovary that disrupt the processes important for ovulation, fertilization, implantation and carrying the pregnancy to full term. It is estimated that only 1-2% of all patients with advanced kidney disease or on dialysis conceive. These chances improve significantly if you get proper care by a good kidney specialist. Only about half of those who conceive can carry their pregnancies to full term and in many cases the pregnancy is complicated by death of the baby in the womb, hypertension in the mother, premature labor and delivery, malformations in the baby and low birth weight of the baby.  For patients that are pregnant and already on dialysis, an increased dose and frequency of dialysis preferably on a daily basis is the best chance of successful outcome. It is recommended that pregnant dialysis patients undergo at least 20 hours or more of dialysis a week. The kidney specialist also needs to modify the  dialysis prescription to avoid bleeding by reducing the dose of blood thinner given during dialysis. Additional effort to control blood pressure and treat anemia is required. Nutrition is a big issue for pregnant dialysis patients and ensuring the pregnant mother gets enough vitamins including folic acid as well as protein is important. Pregnancy in a dialysis patient is a high risk pregnancy and care should be provided by both a kidney specialist and an obstetrician with experience caring for such patients.

It is important to note that for some women, kidney disease develops for the first time during pregnancy. Infections of the urinary tract need to be treated aggressively because they could lead to generalized infection and kidney failure or death. Some women develop severe  high blood pressure along with kidney and liver problems that can also be deadly.

Sexual problems for either men or women with kidney disease can be either physical or emotional. Emotional causes such as fear, anxiety and depression can seriously affect men and women equally and interfere with sexual intercourse, the ability to conceive or ability to carry a pregnancy to term. Healthy eating, exercise, talking to your partner about sexuality and health in an honest open way and following the doctors instructions are one of many ways to help deal with the emotional stress. For most patients, sexuality improves with the initiation of high quality frequent dialysis and gets even better after kidney transplant. Sometimes there may still be problems with sexual drive that persist even after transplant related to use of medications to prevent rejection or treat high blood pressure.

COMMON QUESTIONS ABOUT REPRODUCTION AND PREGNANCY IN KIDNEY DISEASE, DIALYSIS AND TRANSPLANT PATIENTS

Question: Is sexual intercourse safe for a patient with advanced kidney disease or patients on dialysis?

Answer: This is a common fear among such patients and there should be no such concern. Care should be taken to avoid damaging the dialysis access during sexual intercourse however.

Question: Is sexual intercourse safe for patients with a kidney transplant?

Answer: As long as the scar from the transplant surgery is fully healed, blood pressure is controlled and the doctor says it is safe to resume or start sexual activity, there should be no reason to worry about damage to the transplant kidney.

Question: What are the things that can affect a healthy pregnancy?

Answer: General health, age, presence or absence of high blood pressure, high blood sugar, or heart disease, presence of kidney disease.

Question: Can a woman with “mild” kidney disease have a baby?

Answer: Women with mild kidney disease with little or no protein in the urine can conceive and have a healthy pregnancy. Women with more severe kidney disease have a lower likelihood of getting pregnant and higher chance of serious complications during pregnancy which might lead to loss of the pregnancy, worsening of the kidney disease or both. If you have any degree of kidney disease and want to become pregnant, make sure you talk to a kidney specialist along with the doctor that will care for your pregnancy.

Question: Can a patient on dialysis have a baby?

Answer: It is possible but changes in the bodies of men and women on dialysis make it hard to either impregnate a woman or become impregnanted by a man. The risks to the mother and baby are quite high if a woman becomes pregnant on dialysis. If a woman becomes pregnant on dialysis, she will need close attention and very frequent dialysis to have a successful pregnancy.

Question: Can a kidney transplant patient have a baby?

Answer: Yes a woman with a kidney transplant can have a baby. However, it is usually recommended that such patients wait at least 1-2 years after the transplant with stable kidney transplant function before trying to become pregnant. There should be no protein in the urine and the dose of steroids should be at least 15 mg a day or less. Before you try to become pregnant, tell your doctor because in addition to the tests nneded to confirm it is safe to get pregnant, some of the medications used to prevent rejection of the transplant can affect the baby and need to be changed at least 6 weeks or more before any attempts to get pregnant. If the serum creatinine of a transplant patient is above a certain level, it is often recommended that the patient do not get pregnant in order to avoid the possibility of loosing the kidney transplant. Most pregnant kidney transplant patients will need to deliver by cesarean section although normal delivery has been reported. The obstetrician has to plan carefully on the surgical approach and has to consult with the nephrologist and if possible transplant surgeon to avoid damage to the transplant kidney during cesarean section surgery.

Men who have a transplant can father children. There may be some difficulty and if after trying for at least a year there is no success, you should seek the help of a fertility specialist and advice of your kidney doctor.

Question: What kind of birth control is recommended for patients with kidney disease?

Answer: Sometimes it is important to delay plans to become pregnant and birth control is needed. Women with kidney transplants or with high blood pressure should not use oral tablet or implanted hormonal contraceptives as these may increase the risk of rejection or deadly blood clots. These can also increase blood pressure and risk of events like stroke or heart attacks or heart failure. The safest options for birth control involve the use of condoms, diaphragms, sponges and the newer devices that can be placed in the uterus.

The silent actors in the drama of kidney disease- Smoking and alcohol


Chronic kidney disease (CKD) is a growing worldwide problem that is increasingly shown to be interwoven with cardiovascular disease (CVD), smoking and excessive alcohol consumption. In addition, because of the kidneys’ important and varied role in the body, impairment of their function can result in a range of disorders, from mild differences in fluid balance to acute kidney failure and death. Alcohol, one of the numerous factors that can damage and reduce kidney function, can interfere with kidney function directly, through short term excess or long term consumption, or indirectly, as a consequence of liver disease.

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Alcohol when taken in excess has many negative effects on the body. From impacts on brain function where it leads to confusion and risk for accidents and dementia, to liver disease and cancer. Alcohol can also have negative effects on kidney function.

The benefits of smoking or alcohol consumption are very difficult to identify and are at best minimal and of no real tangible benefit to its users. However, the harmful effects of these common social pleasures are well documented but not commonly known.

This post is aimed at educating readers on the harms of these silent actors to a common and growing problem of kidney disease and kidney failure. In summary, there is no safe amount of cigarette smoke to be exposed to. There are levels of alcohol intake above which health problems occur including kidney disease.

Alcohol and the kidney

Drinking alcohol can affect many parts of your body, including your kidneys. A little alcohol—one or two drinks now and then—usually has no serious effects because the body can easily and quickly get rid of the alcohol from the body. But drinking too much even if you do not have a damaged liver can harm your health and worsen or accelerate kidney disease.

For instance, alcoholics with damaged livers have been shown to have enlarged kidneys  with reduced blood flow to the kidneys. Alcohol can have effects on the kidney even in people without damaged livers by causing loss of water (remember the frequent urination?) as well as nutrients in the body such as magnesium, phosphate, calcium, sodium and potassium all of which have important functions in the body. Alcohol taken in large quantities over months to years can also impair the ability to control blood pressure through mechanisms that are yet to be fully understood and has a negative impact on the ability of the kidney to control acid balance.

How much alcohol is too much?

When experts talk about one drink, they are talking about one 350 ml bottle of beer, one glass of wine (150 ml), or one shot (45 ml) of “hard liquor.” Hard liquor includes vodka, brandy, whisky and other spirits.

Having more than three drinks in a day (or more than seven per week) for women, and more than four drinks in a day (or more than 14 per week) for men, is considered “heavy” drinking. The kidneys of heavy drinkers have to work harder. Heavy drinking on a regular basis has been found to double the risk for kidney disease and kidney failure requiring dialysis and kidney transplantation.

Binge drinking (usually more than four to five drinks within two hours) can raise a person’s blood alcohol to dangerous levels. This can cause a sudden drop in kidney function known as “acute kidney injury.” When this happens, dialysis is needed until a person’s kidney function returns to normal. Acute kidney injury usually goes away in time, but in some cases, it can lead to lasting permanent kidney damage.

Some people should not drink at all. Ask your healthcare provider if it is safe for you to drink, especially if you have a medical condition or take medicines that might be affected by using alcohol. Women, older people, and those with smaller bodies should be especially careful. Of course, pregnant women are advised not to drink alcohol.

For more information on the use of alcohol in Nigeria and the harmful effects including the impact on liver disease and road traffic accidents, read a world health organization report by clicking here.

Smoking and the kidney.

One of the many things that contribute to the poor understanding of the harmful effects of cigarette smoking is a lack of knowledge of what is contained in a cigarette. There are few effective labels or warnings about the dangers or harms of smoking.

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There are no known health benefits of cigarette smoking

Nicotine is the principal substance contained in cigarettes that not only has impact on brain function but has addiction potential. There are approximately 600 ingredients in cigarettes. When burned, they create more than 7,000 chemicals. At least 69 of these chemicals are known to cause cancer, and many are poisonous or can damage the kidney.

Many of these chemicals are also found in consumer products, but these products have warning labels. While the public is warned about the danger of the poisons in these products, there is no such warning for the toxins in tobacco smoke.

Here are a few of the chemicals in tobacco smoke, and other places they are found:

  • Acetone – found in nail polish remover
  • Acetic Acid –  an ingredient in hair dye
  • Ammonia – a common household cleaner
  • Arsenic – used in rat poison
  • Benzene – found in rubber cement
  • Butane – used in lighter fluid
  • Cadmium – active component in battery acid
  • Carbon Monoxide – released in car exhaust fumes
  • Formaldehyde – embalming fluid
  • Hexamine – found in barbecue lighter fluid
  • Lead – used in batteries
  • Naphthalene – an ingredient in moth balls
  • Methanol – a main component in rocket fuel
  • Nicotine – used as insecticide
  • Tar – material for paving roads
  • Toluene – used to manufacture paint

 

Can smoking cigarettes affect my kidneys?

Yes, for the following reasons:

  • Smoking can interfere with medicines used to treat high blood pressure. Uncontrolled or poorly controlled high blood pressure is a leading cause of kidney disease.
  • Substances released from inhaling cigarette smoke can damage blood vessels and eventually slows the blood flow to vital organs like the kidneys and can worsen already existing kidney disease.

E-cigarettes?

E-cigarettes have not been fully studied, so consumers currently don’t know:

  • the potential risks of e-cigarettes when used as intended,
  • how much nicotine or other potentially harmful chemicals are being inhaled during use, or
  • whether there are any benefits associated with using these products.

Additionally, it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.

 

What health problems are related to smoking?

According to the World Health Organization, smokers have an increased risk of developing:

  • Lung cancer
  • Bladder cancer
  • Lung disease
  • Mouth cancer
  • Heart disease
  • Pancreas cancer
  • High blood pressure
  • Cervical cancer
  • Stroke
  • Pregnancy complications
  • Kidney cancer
  • Early menopause

For more information on the impact of tobacco use on health, read the world health organization fact sheet on tobacco use by clicking here.