Dialysis

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.

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. 

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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

 

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.

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.

Upcoming Blog Post in March 2014- Viral Infections in Kidney Disease & Dialysis Patients- Truths, Myths and What Can And Needs to be Done


Hepatitis B, Hepatitis C and HIV

An increasing number of apparently healthy people as well as people with kidney disease on dialysis are getting infected with one or more of the Hepatitis B, Hepatitis C or HIV viruses in Nigeria. These are growing problems that need better public knowledge especially among dialysis patients and their family and friends.
Stay tuned and revisit our blog in March 2014 to read on the truths, myths and important issues in dealing with these infections in Nigeria especially as a dialysis patient.